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[00:00:00] Hello everyone. Welcome to The Testing Psychologist podcast, the podcast where we talk all about the business and practice of psychological and neuropsychological assessment. I’m your host, Dr. Jeremy Sharp, licensed psychologist, group practice owner, and private practice coach.

This podcast is brought to you by PAR.

To determine if someone is feigning psychiatric illness, trust the Miller Forensic Assessment of Symptoms Test or M-FAST. This 25-item screening interview helps you assess for malingering. Learn more at parinc.com\mfast.

Hey everyone, welcome back to the final episode in the ADHD series. If you haven’t tuned into the previous ADHD series episodes, I would encourage you to do that. I put together a series of 8 to 10 episodes covering different topics in the ADHD [00:01:00] world, mostly summarizing The World Federation consensus statement on ADHD which is linked in the show notes. 

Today, I’m going to wrap it up by discussing non-medication treatment options.

If your practice is anything like mine, you get a ton of questions from parents and others who want alternatives to medication. I’ll go over some of the most well-supported options in addition to options that aren’t as well-supported. Spoiler. Most options are not as well supported as I thought or would have liked, but we will get to that.

In the meantime, if you’re a practice owner and you would like some coaching and accountability, I’d invite you to check out The Testing Psychologist Masterminds. There’s a beginner group, an intermediate group, and an advanced group. Cohorts are continually enrolling and might be a good fit for you. So you can go to [00:02:00] thetestingpsychologist.com/consulting and schedule a pre-group call.

All right, let’s talk about non-medication treatments for ADHD.

Okay, everybody. Just digging right into it. These ADHD series episodes are meant to be relatively brief, but informative summaries of the current state of the research mostly contained in The World Federation Consensus Statement. So, let’s talk about what works for ADHD; non-medication interventions that work for ADHD.

So not a lot of surprise here. Straight-Up, CBT for [00:03:00] kids tends to show moderate improvements in ADHD symptoms and conduct problems as reported by parents but not by independent raters like non-parents. So that’s interesting, right off the bat.

Parents, I would imagine, have an investment in the symptoms being reduced. Parents are often the ones who are undergoing some of the behavior training. So maybe there’s an investment there to rate the symptoms as lower, but in all the meta-analyses that are out there, there are quite a few, Straight-Up CBT and behavioral training for parents has shown moderate improvements in ADHD symptoms and conduct problems.

Now, CBT for Adults is all over the map. It has shown some [00:04:00] effect in all of the meta-analyses that I saw, but those effects range from small to moderate or even large effects on self-reported ADHD symptoms. I think all in all, we could say, okay, CBT is relatively effective for adults.

I was really curious about this next one. Meditation-based programs for kids have grown in popularity in recent years. I included them in this list of treatments that work, but it is a little bit of a toss-up. Some studies say, yes, meditation-based programs do have moderate effects, but when you remove those with just waiting list controls, the effects do diminish almost to the point [00:05:00] of disappearing in all of those meta-analyses. So it depends on the threshold for the quality of study that you include here.

A waiting list control is, I would say better than no control, but not as effective or as solid as an active control or something like that. It depends on how you want to look at it. If you’re more inclusive with studies, then they do say, okay, yes, there are moderate effects from meditation-based programs for kids. I would like to hope that that’s the case, but clearly, we need to dig into that a little bit more.

Let’s see. The next intervention is “organizational skills intervention.” This is a bit like executive [00:06:00] functioning coaching. Programs that incorporate those strategies did have moderate effects on parent-reported inattentive symptoms, which is what organizational skills typically target. So there is some evidence there.

Let’s move to more supplement-based or dietary interventions. I’ve talked about this a little bit on the ADHD and diet episode. So you can go back and check that out for more detail. But there are small to medium effects for Omega 3 fatty acid supplements for the most part, though one meta-analysis did find no effects. On the whole, though, there were several, I think there were 3 or 4, maybe even more meta-analyses that did support small to medium effects for Omega 3 supplementation in [00:07:00] reducing ADHD symptoms.

Restricting food dyes did have a “tiny impact”. That was interesting language for the research world. I would call that small, but this particular phrasing said it was tiny. In Joel Nigg’s book: Getting Ahead of ADHD, this was, I think from maybe 2017, he does talk about how things like Omega 3 supplementation and restricting food dyes are going to move the needle a bit, but if we’re talking about a 1 to 100 scale and medication is going to make a, say 50% to 60% point impact, then removing food dyes and omega 3 supplementation might be more along the lines of a 5% to 10% point impact.

Let’s take a break to hear from our featured partner.

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All right, let’s get back to the podcast.

Lastly, talking about exercise, I did another episode on exercise and ADHD, but summarizing quickly here, there’s one meta-analysis that showed moderate effects for exercise. This was interesting. I couldn’t get to the bottom of this, but it said that in this meta-analysis, the effects were discounted after accounting for publication bias, and I couldn’t find more information about [00:09:00] that. If anyone knows what that’s about, let me know. But that mental analysis did show moderate effects of exercise in reducing ADHD symptoms.

Another meta-analysis that was not discounted due to publication bias found no effect of exercise on ADHD symptoms, but there was a positive effect in reducing symptoms of anxiety and depression in kids with ADHD. The research there I think is…That’s tangled. Separating symptoms of anxiety and depression in kids with ADHD. That gets at the overlapping nature of anxiety, depression, and ADHD.

Either way, exercise is helpful possibly for kids with ADHD alone, and definitely for kids [00:10:00] with anxiety and depression nested within the ADHD.

Let’s move to things that don’t work or at least don’t have the research support at this point.

Surprisingly, social skills training with kids is not very effective, at least according to teachers. The meta-analysis that I found in The World Federation consensus statement said that social skills training with kids was not super effective when you look at teacher rating of ADHD symptoms and social skills in kids.

The next one, I don’t think will surprise anyone, and at the same time, probably will make me some enemies on the podcast and elsewhere, but neurofeedback has very mixed results. When you look at everything in total, it’s of all [00:11:00] over the board. One meta-analysis did find small positive effects on inattentive symptoms, but nothing for hyperactivity and impulsivity. Another meta-analysis found the opposite of that. Small effects on hyperactivity, and impulsivity, nothing for inattentive symptoms. And yet another meta-analysis on neurofeedback found no effects for any ADHD symptoms.

I’m not going to wade into the argument about whether neurofeedback is helpful or not, just going to reflect on the research here that would say that if anything, it does have small effects on ADHD symptoms and there are likely other interventions that are better uses of time, money, and energy.

Computer programs, I think Cogmed, things like that, not super [00:12:00] helpful. It’s a little tricky though, because they typically do show improvements in these independent cognitive constructs, like verbal working memory, but those improvements do not tend to generalize to the real world. I feel like that’s been the outcome of these studies for years now. I keep waiting for something to say that Cogmed or other computer brain training programs are going to be more helpful, but that’s not where we’re at. So still stuck in this place of people tend to do well on the measures of skills within the program or even on independent cognitive measures, but it does not generalize to the real world in terms of symptom reduction.

So that’s where we’re at. There are [00:13:00] of course, any number of other auxiliary treatments for ADHD. I’m going to dive into all of those because these are the major ones with a lot of research behind them. So we’ll leave it at this.

You might be thinking to yourself, this is sad. There’s not a whole lot out there that is super effective for ADHD aside from medication. And I think there’s some truth to that. That is a takeaway from all of this is that as much as we want non-medication options, medication is the treatment option that has the best support at this point. Next in line is Straight Up behavior therapy or behavioral training for parents and teachers.

The good news is there are some exciting options on the horizon. Two that came up that were admittedly new to me, I’m sure there are plenty of you out there who are familiar with these, but new to me, [00:14:00] one was trigeminal nerve stimulation or TNS. This is a treatment where there’s a stimulation of this trigeminal nerve, it’s up near your forehead. There’ve been a couple of pretty good studies with controlled trials with positive results. Look out for that one on the horizon.

The other one is game treatment. Y’all may have seen some of this where there are two computer games or programs that are being used to treat ADHD. And the same thing here, two good studies are out there that have shown positive results with a control group. That’s encouraging. I would love to see more treatments for ADHD because like I said, plenty of people are looking for non-medication options to treat [00:15:00] ADHD.

I’m going to wrap up the ADHD series with that. Like I said, this is just a big summary of mostly The World Federation Article. It is linked in the show notes. There’s lots of good info in there that I did not cover. I would encourage you to take a read-through. It’s pretty easy to look at. You can certainly dive deep into all of the citations in that study or in that statement. There’s a lot, of course, to explore. So if you want to go deeper with ADHD, that’s a great place to start.

ADHD is such a common presenting concern. It will be coming up on the podcast in the future. So this is, of course, not the last you have heard from ADHD.

Thanks for tuning in. Thanks for going through the ADHD series with me. If you have [00:16:00] other topics related to ADHD that you would like me to tackle either with a guest expert or on my own, feel free to let me know.

All right. That’s it for now.

All right, y’all. Thank you so much for tuning into this episode. Always grateful to have you here. I hope that you take away some information that you can implement in your practice and in your life. Any resources that we mentioned during the episode will be listed in the show notes. So make sure to check those out.

If you like what you hear on the podcast, I would be so grateful if you left a review on iTunes, Spotify, or wherever you listen to your podcasts.

If you’re a practice owner or aspiring practice owner, I’d invite you to check out The Testing Psychologist Mastermind Groups. I have mastermind groups at every stage of practice development: Beginner, Intermediate, and Advanced. We have homework. We have accountability. We have support. We have resources.[00:17:00] These groups are amazing. We do a lot of work and a lot of connecting. If that sounds interesting to you, you can check out the details at thetestingpsychologist.com/consulting. You can sign up for a pre-group phone call and we will chat and figure out if a group could be a good fit for you. Thanks so much.

The information contained in this podcast and on The Testing Psychologist website is intended for informational and educational purposes only. Nothing in this podcast or on the website is intended to be a substitute for professional, psychological, psychiatric, or medical advice, diagnosis, or treatment.

Please note that no [00:18:00] doctor-patient relationship is formed here, and similarly, no supervisory or consultative relationship is formed between the host or guests of this podcast and listeners of this podcast. If you need the qualified advice of any mental health practitioner or medical provider, please seek one in your area. Similarly, if you need supervision on clinical matters, please find a supervisor with expertise that fits your needs.

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