Practitioner review: Non-pharmacological treatments for ADHD: a lifespan approach.

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 school-age 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.