Alternative treatments in attention deficit hyperactivity disorder

Abstract

Attention-deficit/hyperactivity disorder (ADHD) is characterised by clinically impairing levels of inattention and hyperactivity/impulsivity along with cognitive deficits and problems with emotional lability (EL). Stimulant medication, although the first line treatment, can be problematic due to for example, adverse effects and partial response. Patients often explore alternative treatments.

In children, a small to moderate effect of Omega-3 polyunsaturated fatty acid supplementation (n-3 PUFA) in reducing ADHD symptoms has been found. However effects on cognition and EL are unclear. Part one, consists of two meta-analyses examining the effects of n-3 PUFA supplementation on cognition and EL. In children with ADHD or with a related neurodevelopmental disorder, there was suggestive evidence for effects on EL with little evidence for effects on cognition. In the general population there was little evidence for effects on cognition. A randomised-controlled trial (RCT) of n-3 PUFA supplementation has not yet been conducted in adults with ADHD.

Part two, was an RCT of n-3 PUFA supplementation in 81 adults with ADHD. Baseline case/control comparisons showed the ADHD cases to have impaired cognitive performance and high levels of EL, with no difference in n-3 PUFA levels. Supplementation with n-3 PUFA in the ADHD cases indicated no beneficial effect in the intent-to-treat analysis but some indication of an effect in the per-protocol analysis.

Self-medication with cannabis appears common in ADHD. Part three was an RCT of the cannabinoid medication, Sativex in 30 adults with ADHD. Results indicated a beneficial effect on ADHD symptoms and potentially cognitive performance and EL.

The cannabinoid medication, Sativex, could be a promising avenue for further research as an alternative treatment for adults with ADHD. Although evidence for n-3 PUFA supplementation is weaker, it could have a small to moderate effect in adults with ADHD, further research is warranted.

Date of Award	2016
Original language	English
Awarding Institution	King's College London
Supervisor	Charlotte Tye (Supervisor) & Philip Asherson (Supervisor)