There are more treatment options available for ADHD than ever before. Which ones are people using, and are they finding them effective? We wanted to find out the answers, so we asked you, our readers, in an exclusive ADDitude survey. What we discovered from the more than 4,000 responses challenges our assumptions about how people are actually treating their ADHD in 2017.
ADHD is a complex and nuanced condition, with symptoms varying widely from distractibility to excessive activity and many points in between. The average treatment plan, it seems, is correspondingly complex.
A recent survey of more than 4,000 ADDitude readers shows us that adults and parents treating ADHD typically try multiple treatment options and continue to tinker with the overall plan years, or decades, after being diagnosed. No single medication, therapy, or dietary and supplement regimen works for all individuals with ADHD. What’s more, the treatments that our readers told us work best aren’t always the ones recommended by their doctors or used by the most people.
Getting to the right treatment plan is complicated and affected by economics, geography, and access to information. Survey respondents also suggest that ADHD treatment plans may be shaped by factors like insurance coverage, lifestyle changes, budgets, and side effects.
“Everyone with ADHD is different — reacts to different treatment modalities differently, reacts differently to drugs,” one mother wrote in the survey. “For some, it’s straightforward. For others — like us — it is frustrating, at best.”
The trial and error of treatment feels like “a full-time job,” our readers said. ADHD medications, many of which are controlled substances, often require multiple doctor’s visits, frequent refills, and expensive copays — “and that’s with insurance,” one parent wrote. Non-medication options, like coaching or neurofeedback, are not available outside of many metropolitan areas — and if they are, they’re often not covered by insurance, leading respondents to “not try things because we couldn’t afford to.”
Patients also reported having to research comprehensive treatment plans on their own, and this is not easy. For the most part, respondents received little expert information about treatment options beyond medication, which was recommended by 92 percent of our respondents’ medical professionals.
For example, the American Academy of Pediatrics (AAP) recommends behavior therapy paired with medication for all children with ADHD over the age of six. Yet fewer than one-third of the ADDitude caregivers surveyed said their doctors prescribed behavior therapy. According to the survey, 59 percent of children with ADHD are not receiving this recommended form of treatment.
Similarly, exercise was rated as “extremely” or “very” effective by roughly half of the respondents who use this treatment. Yet only 13 percent of these respondents said a doctor had recommended exercise to reduce symptoms, and only 37 percent of all respondents said physical activity was part of their treatment plan.
In the end, despite combining medication and lifestyle changes, researching and self-funding treatments not covered by insurance, and continually revisiting their treatment plans, overall satisfaction rates were low. Indeed, only 30 percent of caregivers called their child’s treatment plan “extremely” or “very” effective. Likewise, just 44 percent of adults surveyed were satisfied with their ADHD treatment. Here, we will analyze the survey data for reasons why this is true, and look for a better way forward.
Percent of Survey Respondents Currently Using Each Therapy
|Vitamins, Minerals, or Supplements||36%||41%|
|Cognitive Behavioral Therapy (CBT)||—||19%|
|Behavioral Therapy/Parent-Training Classes||10%||—|
|Neurofeedback with a Clinician||5%||3%|
|Home-Based Brain Training||3%||2%|
Percent of Survey Respondents Who Rated Each Therapy Extremely or Very Effective
|Vitamins, Minerals, or Supplements||12%||15%|
|Cognitive Behavioral Therapy (CBT)||—||41%|
|Behavioral Therapy/Parent-Training Classes||33%||—|
|Neurofeedback with a Clinician||30%||42%|
|Home-Based Brain Training||22%||14%|
In August 2017, we sent the “My ADHD Treatment Plan” survey to a group of ADDitude newsletter subscribers. Among the 4,425 respondents, 2,495 were parents reporting on a child, and 1,563 were adults focused on their own treatment. Boys comprised 74 percent of the children, while 75 percent of the adults reporting on their treatment plans were women. Subjects ranged in age from four to older than 65; most children were diagnosed between the ages of five and eight, while 44 percent of adults were diagnosed after the age of 40.
The survey (and a follow-up) documented readers’ history with and attitudes toward 10 ADHD treatments: medication, vitamins and supplements, neurofeedback, home-based brain training, coaching or counseling, cognitive behavioral therapy, parent training, exercise, diet and nutrition plans, and mindful meditation.
Find complete information about the survey and the resulting data HERE.
Exercise. Behavior training classes. ADHD coaching and counseling. These are the treatments rated most effective by caregivers and adults with ADHD, according to our survey. All three — plus meditation, neurofeedback, and CBT — ranked higher than did medication for efficacy. Yet, despite the middling effectiveness rating for medication — and the occasional glowing review — our respondents used it far more than any other treatment. Why? Convenience factored heavily — particularly when considering the time commitment associated with therapy or lifestyle changes. But medication’s main advantage may be the tangible, immediate changes it can bring — and for those struggling with symptoms on a daily basis, any concrete improvement can feel like a lifesaver.
That said, finding the most effective medication with the fewest side effects was not usually a quick or easy process. Most survey respondents tried a number of medications before finding one that worked — 2.7 medications, on average, for caregivers; 3.5 for adults. You must be “patient and willing to go through trial and error,” wrote an adult who tried Ritalin, Adderall, and Evekeo before settling on Vyvanse. “Once you find it, it will do so much in improving symptoms.”
Another group of survey respondents (16 percent of caregivers; 18 percent of adults) reported that they had used medication in the past but had stopped taking it altogether. This decision was usually because of persistent side effects. Among the most common were:
Parents too often face criticism for “jumping on the medication bandwagon.” In reality, only 14 percent of caregivers said they viewed medication as the “first-line” treatment for their child’s ADHD symptoms; an equal number said medication was their “last resort” — and an additional 20 percent said they tried other treatment options before deciding to pursue medication.
“It’s not that I don’t think the other treatments will work at all,” one parent wrote. “It’s that we think medication will have quicker results, work better, and [work] more consistently.” Medication has “worked wonders” for her daughter for 14 years, she wrote.
Adults were generally far less reluctant to try medication, and more likely to view it in a more positive light. About a third of adults saw medication as their “first-line” treatment; less than 5 percent said it was their last resort. Only 9 percent said they tried something else before trying medication, and 51 percent see medication as life-changing. “I don’t know how I survived without it all of these years,” wrote one person. “It’s like someone switched on a light.”
Those who turned quickly to medication frequently cited its “ease” and immediacy — a doctor’s prescription was easily filled and any effects (positive or negative) were usually noticeable right away. “I wanted to get my son’s symptoms under control quickly,” said one caregiver. “Medication seemed like a good first-line attack for that.”
Others said they were at their wits’ ends. “Getting [my daughter] to do anything was a struggle,” wrote one parent. “I took her to a psychologist who suggested medication. I was 100 percent on board — I would say I was desperate to find something to work.”
Other parents said they changed their minds about medication because other treatments failed to ameliorate symptoms. One caregiver, who reported trying vitamins, behavior therapy, and neurofeedback before settling on medication, said: “I don’t want to give him medicine to make him feel ‘normal’ — but he cannot function without it.” Some parents never feel at ease with their decision. “It terrifies me,” one parent wrote. “I only give it to him during school — no weekends or summer.”
“Before meds, our bad days outnumbered our good,” one parent wrote. “On meds, our good days outnumber the bad.”
|Average # Meds Tried||2.7||3.5|
|We thought of medication as a “first-line” treatment||14%||34%|
|We thought of medication as a “last resort”||14%||5%|
|Medication has been a life-changer||45%||51%|
|Medication has some positives and some negatives||44%||45%|
|Medication is just part of a treatment plan||41%||21%|
Vitamins, minerals, and supplements were the most popular non-medication treatment among our survey respondents, 47 percent of whom said they had tried at least one. Of that group, fish oil was the top choice (used by 77 percent), followed by magnesium and vitamin B6. Yet only 17 percent of people said their doctors had recommended supplements.
Despite their relative popularity, vitamins ranked as the least effective treatment for children and the second least effective for adults. More than a third of caregivers and adults called them “not very” or “not at all” effective. When it came to fish oil, in particular, adults complained of having to take “huge” doses to see any benefits, and parents struggled to get kids to swallow large capsules or to get beyond the “fishy” taste. Many parents stopped this treatment, in part, because they could not find a formulation that worked and/or they could not tell whether it was helping. “The fish oil did help my son,” one parent wrote, but, “he got tired of the taste of both of the kinds we tried and didn’t want to take them anymore.”
High-quality fish oil, like other supplements, can be expensive, respondents said. “I didn’t see much bang for the buck with this treatment — and it was a lot of bucks,” wrote one man in his 30s. The high costs made him abandon the treatment quickly — an experience echoed by others.
|Vitamins, Minerals or Supplements||36%||41%|
|Decreasing/eliminating artificial colors/dyes||70%||53%|
|Decreasing/eliminating artificial flavors||51%||48%|
|Not covered by insurance/high cost||29%||28%|
|Hard to find professionals||24%||25%|
|Wasn’t aware of other treatments||11%||22%|
|Medication alone works well enough||10%||20%|
Exercise ranked as the most effective ADHD treatment among both caregivers and adults — 49 percent and 56 percent of whom gave it high marks, respectively. That is not a surprise. Research shows that exercise elevates dopamine and norepinephrine levels in the brain, thus boosting focus, self-control, and mood. Despite the solid science and high satisfaction levels, however, our survey shows that only 37 percent of children and adults with ADHD are managing their symptoms with daily exercise.
The respondents who exercise said they do so to benefit their general health, not just their ADHD symptoms. But its mood-boosting and sleep-inducing effects, in particular, were popular. “Exercise allows me to drain my brain,” said one adult. “When I leave the gym, my brain is happy, content, and not going in all different directions.” Parents, too, notice behavior improvements associated with exercise. One mother reported, “I can tell by his behavior when my son does not get enough active outdoor time.”
The AAP recommends behavior therapy as the first-line treatment for children younger than six, and using it in conjunction with medication for older children — and 41 percent of our survey respondents had completed a parent-training course. Those who did liked that it gave them more “tools” as parents and, due to the group setting of many programs, the realization that they were not alone.
Still, why did less than half of the caregivers we surveyed use this AAP-recommended treatment? One-third reported difficulty finding a practitioner in their area; another 34 percent were deterred by inadequate insurance coverage or a high out-of-pocket cost. Only 9 percent said that they didn’t seek behavior therapy because they felt it wasn’t needed.
“It’s hard to find the proper counselor,” one parent wrote. “Many don’t take insurance, and the time commitment to bring him made therapy very inconvenient.” One parent wrote of a 90-minute car trip to take her child to a therapist each week; another wrote that insurance covered only five sessions — and paying for more out of pocket was unaffordable.
In addition, effectiveness “entirely depends on the program and the support given to parents,” wrote the mother of a teen. That thought was held by others: Behavioral therapy was primarily positive (33 percent rated it “extremely/very” effective) — when it was available — but an ADHD-specific program is critical to success.
Our survey results indicate that ADHD treatment is neither streamlined nor satisfying for most families and individuals. Most of our respondents conducted their own treatment research, cast wide nets, and combined multiple strategies — and, even then, felt satisfied less than half the time. Many described the process as “a moving target” or “a work in progress” — even if their journey began years or decades earlier.
While some respondents did report satisfaction with their treatment plan, many reported that the process can seem arbitrary, complicated, and overwhelming — in large part because treatment almost never comprises just one modality. Though caregivers and adults face no shortage of options, each has its own upsides and drawbacks.
More than a quarter of respondents have used dietary changes to address ADHD symptoms (with higher rates in those who had never tried medication). Decreasing or eliminating sugar was the most popular choice, followed by eliminating artificial dyes and increasing protein.
Many caregivers reported struggling to make dietary changes stick. “We tried working with a nutritionist, but our child simply wouldn’t follow the diet,” wrote one parent. “She tends to eat carbs and sweets, and wouldn’t realize how often she strayed from the diet.”
Mindfulness is used by 35 percent of adults with ADHD, but just 13 percent of children. The satisfaction rate among adults who use meditation is high, with 42 percent rating it as highly effective. Many cited mood boosts, improved executive functioning, and decreased anxiety as benefits of this therapy.
“Meditation is a critical part to starting the day!” wrote one adult. “Taking a few moments to ground yourself before your ADHD brain races off works wonders.”
Twenty-six percent of caregivers and 21 percent of adults reported experience with ADHD coaching or counseling. For adults, this was the second most effective treatment; more than 48 percent rated it as “extremely” or “very” effective. Caregivers also viewed it generally positively, with more than a third rating it highly.
However, “Finding the right personality is key,” said one parent. “And my daughter doesn’t always want to follow the coach’s advice.”
Very few respondents use neurofeedback and home-based brain training (5 percent or less in both populations), with slightly higher rates in parents and adults who had never medicated.
Neurofeedback was rated well by 30 percent of parents and 42 percent of adults — meaning that, while it was barely used, it ranked higher in effectiveness than several more popular treatments. Still, among parents and adults as a whole, home-based brain training wasn’t well reviewed: just 22 percent of parents and 14 percent of adults rated it highly, and one called it “just a glorified video game.”