It was a reasonable challenge from a parent of a newly diagnosed ADHD patient. “I do not want my son to take medications. I assume you offer other treatment options?” I reviewed our clinic offerings, including CBT groups. But based on my clinical experience, this 24-year-old newly diagnosed student needed a medication intervention as well. The situation was further complicated by my patient’s profound desire to respect his mother’s wishes while at the same time, wanting to take medications. He attended several group sessions but over time he drifted away. I was dogged by the sense that I could have better met his needs had I been able to offer other biologically oriented treatments.
In “Non-Drug Treatments for ADHD: New Options for Kids, Adults and Clinicians” I found a sound, scientifically-based approach to the implementation of alternative treatments. Psychiatrists and clinical faculty, Dr. Brown, psychopharmacologist, and Dr. Gerbarg, clinician, present the information in balanced ways, never disrespectful of traditional psychopharmacologic approaches. The book is structured to discuss a range of treatments, including herbs, diet, vitamins, mind-body practices, and neurofeedback and to review the evidence base for these treatments. Wherever possible, the authors use evidence from randomized clinical trials. They also discuss the challenges of mounting research studies without the financial support available from pharmaceutical companies.
This book is written for lay people and their doctors. A patient might offer it to their treating physician as resource material when requesting alternative treatments. It is written in a colloquial style, but the authors do not shy away from covering important scientific topics like neurotransmitters, receptors and genetics. I will use the accessible chapter, “Why Sweat the Science? Just a Tasting of Science Soup”, to teach even patients without ADHD about neurotransmitters. I like the authors’ focus on more recently postulated areas of ADHD dysfunction - Hypoarousal/Impulse Control, Reward Deficiency and Emotional Dysregulation - as areas for treatment targets. Throughout, they remain committed to the science of ADHD and its treatments. The importance of emerging research, such as how genetic variability may explain response differences to specific preparations, is emphasized throughout.
Each section includes a resource list with recommended books, resources and websites for further research. Many chapters include practical suggestions on indications for various remedies, recommended trusted brands and doses. When the evidence is scanty, a section like “How can I use this information now?” provides preliminary advice. Readers are encouraged to use the resources provided to stay up to date with new developments.
The section on yoga is full of practical suggestions for use with children and about tailoring programs for individuals with specific needs. They present a school-based yoga program for young children, which would no doubt be helpful for many, and refreshingly, review the research to support its use. The section on neurostimulation offers some of the foundational science underlying these techniques. While it is important to know about this area as a promising future treatment, Brown and Gerbarg extrapolate optimistically from the small studies. They do so with full disclosure however.
Overall, this book is approachable and user-friendly, a valuable resource for patients and their families. It is an excellent starting point for the clinician seeking reliable information about alternative treatments. But I will need to know more before I am comfortable offering these approaches to my patients as part of a range of treatment options (I certainly know where to look for this information given the extensive resources provided by Brown and Gerbarg.). It would be good to have a comprehensive clinician-focused book which might be a companion to “Non-Drug Treatments for ADHD: New Options for Kids, Adults and Clinicians”.
Equipped with strategies from this book, I am prepared to have a more comprehensive discussion with my 24-year-old patient who has drifted away from the clinic. I’ll send him home with the book. I will also need another copy as an office reference, as I imagine I’ll be referring to back to it frequently.