Estimated reading time: 6 minutes
Exploring and understanding the various ADHD treatment options can feel overwhelming. As you've probably experienced, there are strong opinions everywhere, with mixed messages online and plenty of statistics - all of which can be quite difficult to interpret.
As a child psychologist, I've diagnosed and successfully treated ADHD for more than 30 years. My goal in this article is to make the research more understandable so you can make thoughtful, confident decisions for your child.
Let’s dive in.
“Significant Difference” and It's Impact on ADHD Treatment
When scientists study ADHD treatments, they usually compare two groups: one group which receives the treatment and the other which does not. Next they ask a simple question: Is the difference between these two groups real, or could it just be random chance? If the difference is unlikely due to chance, it’s called a “statistically significant difference.” In other words, this means the treatment likely had a real, or legitimate effect. However, that’s only part of the story. The next question matters just as much.
How Big Is the Improvement?
Once we know an ADHD treatment is successful, we want to know how much it helps. Is the improvement small, moderate, or life-changing? This is where a term called “effect size” comes into play. Simply put, effect size indicates, or measures the average strength of a treatment’s impact.
Here's a simple way to think about it:
- 0.0 – No better than placebo
- 0.2 – Small effect
- 0.5 – Moderate effect
- 0.8 – Large effect
- 1.0 and above – Very strong impact
ADHD Medications: What the Evidence Shows
Stimulant medications are among the most researched ADHD treatments in child mental health. Notably, in blind clinical trials, stimulant medications typically show large effect sizes, often around 0.95.
Some examples from research studies include:
- Lisdexamfetamine (Vyvanse) – around 1.28
- Methylphenidate (Ritalin, Concerta) – around 0.77
- Mydayis – roughly 0.67 to 1.1 depending on dose
- Alpha agonists (Clonidine, Guanfacine) – around 1.3 in some studies
Importantly, when doses are carefully adjusted to the individual child, outcomes can be even stronger. By comparison, non-stimulant medications show moderate effects:
- Strattera – about 0.44 to 0.68
- Bupropion – about 0.34
Of course, these figures can't predict the results for a specific child, but they can serve as a helpful reference.
The Power of Exercise
Exercise has also been proven to help children with ADHD. For instance, research shows moderate improvements in attention, hyperactivity, impulsivity, anxiety, executive function, and even social skills. Overall, effect sizes for aerobic exercise in children and teens range from 0.56 to 0.84, depending on which symptom is being measured.
The key takeaway is that exercise tends to have a positive, but temporary effect. As a result, it can improve regulation and focus for a few hours afterward. This is why timing physical activity before school, or prior to homework can be especially beneficial.
Dietary Changes
Regarding dietary interventions, removing artificial food dyes and implementing certain dietary restrictions show small overall effects, around 0.21. While some children clearly benefit, on average the impact is modest compared to medication.
Interventions with Poor Results
Computerized brain training programs may improve performance on a specific skill being practiced. Unfortunately, however, these improvements rarely extend to academic or daily performance. Similarly, neurofeedback appears to be more effective for treating anxiety than core ADHD symptoms.
Depression Treatment: Medication and Therapy
Antidepressant medications are clearly helpful for moderate and severe depression. The benefit over placebo increases as depression severity increases. Conversely, in mild depression, the difference tends to be smaller. Overall, medication effect sizes for depression typically range from about 0.18 to 0.44 depending on the specific medication. In contrast, psychotherapy ranges more widely, from approximately 0.22 to 0.80. Additionally, a strong therapeutic relationship as well as the skill and experience of the clinician can also make a meaningful difference.
Comparing Medical Treatment Effect Sizes?
To better understand the efficacy of ADHD treatments, it can help to step back and look at the broader medical world. For example, many common medical treatments fall within similar ranges:
- Metformin for diabetes – about 0.87
- Migraine medication – about 0.83
- Blood pressure medications – about 0.65
- Statins for cholesterol – about 0.15
- Aspirin for vascular disease prevention – about 0.12
When viewed in context, medications used to treat ADHD compare favorably to many widely accepted medical treatments.
Statistics Are About Groups, Not Individuals
This next statement is extremely important. Statistics describe averages across large groups. They do not predict how your specific child will respond.
A medication with a modest effect size may produce dramatic improvement for one child, while a treatment with a large average effect may not work well for another. Research groups people together. In real life, we treat individuals. Symptom patterns, temperament, co-occurring conditions, and family dynamics all matter. Furthermore, keep in mind, even a small percentage of people who respond well to a treatment mean that many lives are greatly improved.
What This Means for Parents
So, when considering treatment options, it’s helpful to ask the following questions:
- Is a given ADHD treatment effective? Does it work at all?
- If so, how strongly does it tend to work?
Effect size helps us answer the second question. Moreover, it allows us to move beyond marketing claims and anecdotal stories. At the same time, your child is not a statistic. Consequently, careful assessment, ongoing monitoring, collaboration, and individualized decision-making are just as important as research data.
Key Takeaways
- Understanding ADHD treatment options can be overwhelming due to mixed messages and statistics.
- Effect size measures the strength of a treatment's impact, indicating whether an improvement is small or significant.
- Stimulant medications show large effect sizes, making them highly effective for ADHD, while non-stimulant options provide moderate benefits.
- Exercise positively impacts ADHD symptoms, typically offering temporary relief.
- Statistics indicate averages across groups; individual responses to treatments can vary widely, making personalized assessment crucial.
If you have questions about treatment options for your child, or if you'd like to schedule an appointment, please feel free to email me at: DrCarosso@aol.com. I'm always happy to help guide families through these important decisions.
