In Commanding Attention I report on how much any given intervention might help improve ADHD or Inattentive ADHD symptoms. Researchers refer to the amount of help any treatment provides as the ‘effect size’ for that treatment. A reported effect size can be biased because of a number of reasons but one of the biggest problems with ADHD non-drug treatment effect sizes has to do with ‘blinding’ the person that will report on the effect of the treatment.
Blinded studies for drug interventions are the norm but true ‘blind’ studies of the non-drug treatments are fewer and far between. The reason is that blinding these studies can be difficult or impossible. If you want to ‘blind’ a parent or a teacher in order to get a non-biased assessment of whether they think a child has improved following a treatment, the parent and teacher must not know that the child was treated. This is easy to do with treatments that are pills. You give one group a sugar pill and another group the ‘active’ pill. How do you do this with diet, Neurofeedback, cognitive training, or behavioral interventions? If you put my kid on a diet, I am going to know it and depending on how horrible the diet is, his teachers will know all about it too. “Blinding” is hard but, luckily, not impossible.
In a study, soon to be published in the American Journal of Psychiatry, researchers looked at the effect size for a variety of non-drug treatments to determine how accurate these calculated values were. What they found was that for the 54 published, randomized controlled trials that involved individuals diagnosed with ADHD and that included an ADHD outcome, there were several interventions that had positive effects.
The interventions with positive effects included behavioral interventions, Neurofeedback, cognitive training, Omega-3 fatty acids and restricted elimination diets but the researchers found a problem with these studies. Only a few were blinded. In the blinded studies, studies where the person evaluating improvement was not aware of who had been treated, only fatty acid supplementation and the elimination of food dyes, in sensitive individuals, produced significant reductions in ADHD symptoms.
The authors reported that the number of blinded studies looking at non-drug interventions is lacking and that the psychiatric research community needs to do a better job of assessing non-drug ADHD interventions in good clinical trials. Edmund J. S. Sonuga-Barke, PhD, professor in psychology and developmental psychopathology and director, Developmental Brain-Behaviour Laboratory at the University of Southampton, United Kingdom, the lead author of the study said in a statement that “Properly powered, randomized controlled trials with blinded, ecologically valid outcome measures are urgently needed, especially in the psychological treatment domain” and that “Future trials should focus across a broader range of child-, parent-, family-related functional outcomes.” Good advice for sure!!
There is a way that we can ‘blind’ the results of non-drug ADHD treatments. We can use quantitative measuring tools such as fMRI or the computerized ADHD measurement device to determine if the treatment was effective. Both of these two diagnostic tools take the human out of the assessment equation. Imaging and computerized tools have only recently come into vogue as measurement tools and they are not used or available universally. As these new non-human types of diagnostic measurement tools are used more in research studies, the issue of bias because of “un-blinded” results should diminish and advice and information regarding what non-drug treatments best improve ADHD symptoms will become less vague.