Practitioner Review: Non-pharmacological
treatments for ADHD: A lifespan approach
Susan Young and J. Myanthi Amarasinghe
Institute of Psychiatry, King’s College London, UK
Background: Attention-deficit/hyperactivity disorder (ADHD) is a chronic and pervasive developmental
disorder that is not restricted to the childhood years. Methods: This paper reviews non-pharmacological
interventions that are available at present for preschoolers, school-age children, adolescents and
adults. Results: The most appropriate intervention for preschoolers is parent training. For school-age
children with moderate impairments there is some evidence to suggest that group parent training
programmes and classroom behavioural interventions may suffice as a first-line treatment. For schoolage
children with severe impairments, interventions are more appropriate when combined with stimulant
medication (i.e., integrated treatment packages are likely to be more successful than ‘standalone’
treatments). Multimodal interventions seem to be best suited for middle school/adolescent children,
which most likely reflects that these interventions usually integrate home and school treatment strategies
and often include an element of social skills training. Stimulant medication is generally the first
line of treatment for adults but CBT has also been found to be effective at addressing the complex needs
of this population. Conclusion: Current research has largely ignored that ADHD is a developmental
disorder that spans the preschool to adult years. Most studies focus on young school-age children and
outside of this age group there is a dearth of controlled trials that provide conclusive evidence. As
children mature the mode and agent of intervention will shift to reflect the developmental needs and
circumstances of the individual. Keywords: ADHD, preschool children, school-age children, adolescents,
adults, behavioural parent training, classroom interventions, cognitive behaviour therapy, social
skills training.
Attention-deficit/hyperactivity disorder (ADHD) is a
chronic and pervasive developmental disorder that is
not restricted to the childhood years. It is also one of
the most studied childhood disorders of our time.
A meta-analysis and several recent reviews have
been published on this topic: Fabiano et al. (2009),
Chronis, Jones, and Raggi (2006), Daly, Creed,
Xanthopoulos, and Brown (2007), and Safren et al.
(2005). This review extends these reviews by focusing
on the progressive and changing needs of a person
with ADHD at different stages in their lives. The
review adopts a developmental psychopathological
framework in order to highlight the treatment
options that are most suitable for the different age
groups presenting with ADHD symptoms based on
research and clinical evidence available to date.
Although not a systematic review, a number of literature
searches using Pubmed, Psychinfo, Web of
Science and OVID search engines were conducted.
Primary search terms used were: ADHD + preschool
children, children, adolescents, adults, reviews,
non-pharmacological interventions, Randomised
Controlled Trials (RCTs). Following this, individual
searches were conducted for each of the treatments
discussed in this review for the appropriate age
ranges (e.g., parent training + preschool children,
children, and adolescents). The authors aimed to
report findings from RCTs but in a majority of cases
these were lacking. Therefore, articles that reported
non-controlled trials were included and it is made
clear when these are cited.
In the United Kingdom, the National Institute for
Health and Clinical Excellence (NICE) published
ADHD Clinical Guidelines in early 2009. These firmly
endorsed the use of non-pharmacological treatments
by stating that drug treatments for children, young
peopleandadults withADHDshould always form part
of a comprehensive treatment plan that includes
psychological, behavioural and educational advice
and interventions. The developmental psychopathology
framework proposes that, in childhood, prior to
confirming a diagnosis of ADHD, the clinician should
assess and compare the child’s behaviour to
developmental norms and ensure that the child’s
impairments and functioning are assessed across
multiple domains (Holmbeck, Greenley, & Franks,
2003). Following this, the child can then be assigned
to a treatment that takes into account both his/her
level of cognitive development and developmental
needs, and is based on normative functioning for the
child’s age. Children exist in multiple contexts, the
two most important being home and school. Therefore,
ideally, treatments should be implemented both
at homeand at school (Pelham, Wheeler, and Chronis,
1998), and take into account differing risk and/or
protective factors that exist in either environment
(Mash, 1998). In keeping with this framework, a
young cognitively immature child will not benefit from
didactic sessions but respond better to parent train-
Conflict of interest statement: No conflicts declared. ing interventions supplemented with behavioural
Journal of Child Psychology and Psychiatry 51:2 (2010), pp 116–133 doi:10.1111/j.1469-7610.2009.02191.x
2009 The Authors
Journal compilation 2009 Association for Child and Adolescent Mental Health.
Published by Blackwell Publishing, 9600 Garsington Road, Oxford OX4 2DQ, UK and 350 Main Street, Malden, MA 02148, USA
