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Acupuncture for ADHD: A Promising Alternative or Placebo? A Look at Recent Research
Attention Deficit Hyperactivity Disorder (ADHD) is a common condition affecting children and adolescents worldwide, characterized by symptoms such as hyperactivity, impulsivity, and inattention. While traditional treatments like medication and behavioral therapy are often used, some individuals are turning to complementary and alternative therapies (CAM) for help. One such option gaining attention is acupuncture. But does it really work for ADHD?
A recent comprehensive study aimed to evaluate the effectiveness of acupuncture in treating ADHD symptoms. Here’s a breakdown of the findings, with a focus on the age groups included in the research and what these findings could mean for ADHD treatment options.
What the Study Explored
The study in question conducted a systematic review and meta-analysis (SR/MA) of acupuncture trials for ADHD, comparing its effects to traditional treatments such as pharmacotherapy and behavioral therapy. The researchers focused on acupuncture’s impact on core ADHD symptoms like hyperactivity, impulsivity, inattention, and conduct problems, while also exploring how acupuncture might help with other issues, such as learning difficulties and psychosomatic symptoms.
One key feature of this study was the inclusion of a broad age range of participants, specifically children and adolescents. These two groups are the most commonly diagnosed with ADHD, and their responses to treatments can vary significantly. Understanding how acupuncture works for these age groups is critical for evaluating its effectiveness as an ADHD treatment.
Here’s what the study found across the different age groups:
- Children: Acupuncture appeared to be particularly effective in reducing hyperactivity and impulsivity in younger children with ADHD. These symptoms, often more prominent in younger populations, responded well to acupuncture when used alongside other treatments like medication.
- Adolescents: For adolescents, acupuncture seemed to improve both hyperactivity and inattention, two symptoms that can often become more challenging as children grow older. This age group also benefited from acupuncture’s ability to reduce side effects from ADHD medications, such as irritability or sleep disturbances.
- Combined Effects for Both Groups: When acupuncture was used in combination with pharmacotherapy, it also helped reduce side effects such as sleep problems and appetite loss in both children and adolescents. This could make it an attractive adjunctive treatment for those already on medication but experiencing undesirable effects.
- Inattention and Conduct Problems: For both children and adolescents, acupuncture used in conjunction with either medication or behavioral therapy showed notable improvements in inattention and conduct problems—two of the most difficult symptoms of ADHD to manage.
- Learning Difficulties and Psychosomatic Symptoms: Interestingly, the combination of acupuncture and medication provided significant improvements in learning difficulties, which are particularly relevant for children with ADHD. Meanwhile, acupuncture paired with behavioral therapy had a positive impact on psychosomatic symptoms, such as anxiety or stress, that often co-occur with ADHD.
Despite these promising results, the study also highlighted several limitations:
- Study Quality Issues: The quality of the studies reviewed was often low, with many trials lacking the rigorous controls needed for high confidence in their results. For example, only a small number of trials used objective ADHD diagnostic tools, which could lead to biases in assessing acupuncture’s effectiveness.
- Need for More Research: There is a lack of large-scale, high-quality randomized controlled trials (RCTs) comparing acupuncture with placebo treatments, which makes it hard to determine whether acupuncture’s effects are truly therapeutic or simply a placebo.
Conclusion: Is Acupuncture a Good Option for ADHD?
In short, and as is so often the way of evidence-based medicine, we still can’t say with absolute certainty one way or the other. These studies may show promise in improving hyperactivity, impulsivity, inattention, and conduct problems– in both children and adolescents. However, the evidence is not yet strong enough to recommend it as a primary treatment. While it may serve as a helpful complement to standard therapies, especially for those struggling with medication side effects or access to behavioral therapy, more research is needed to establish its effectiveness.
Is Pharmacotherapy Effective for ADHD Adults with Autism Spectrum Disorder?
How effective is pharmacotherapy of ADHD in adults with Autism Spectrum Disorder?
The team of researchers found that pharmacological treatment of adults with diagnoses of ADHD and ASD seem to be just as successful as the pharmacological treatment of adults with only ADHD.
Autism spectrum disorder (ASD) is frequently comorbid with ADHD. Among adults with ADHD, as many as half are reported to also have ASD.
A Dutch team set out to answer two questions:
- Do adults with ADHD and comorbid ASD experience less effectiveness of pharmacological treatment for ADHD than adults with only ADHD?
- Do adults with ADHD and comorbid ASD experience different or more severe side effects of pharmacological treatment for ADHD than adults with only ADHD, as measured in side-effect scores, blood pressure, heart rate, and weight?
This was a retrospective study, using well-documented medical records, of the effects of drug treatment with methylphenidate (MPH), dexamphetamine (DEX), atomoxetine (ATX), bupropion, or modafinil.
The researchers compared 60 adults with comorbid ASD and ADHD to 226 adults with only ADHD. ADHD symptoms were scored using the Conner's ADHD Rating Scale: Self Report-Short Version (CAARS: S-S). Side effects of ADHD medication were measured using either a 13-item or 20-item checklist with 4-point scales for item response. Researchers also tracked changes in body weight, blood pressure, and heart rate.
Following treatment, ADHD symptoms among the comorbid group declined by a quarter, and among the ADHD-only group by almost a third. There was no significant difference between men and women. Controlling for age, gender, and ADHD subtype, a comorbid diagnosis of ASD also did not significantly affect ADHD symptom reduction.
Turning to side effects, in the ADHD+ASD group, there were significant increases in decreased appetite and weight loss, and decreases in agitation, anxiety, and sadness/unhappiness. In the ADHD-only group, there were significant increases in decreased appetite, weight loss, and dry mouth, and decreases in sleeping disorder, nervousness, agitation, anxiety, and sadness/unhappiness. Yet there were no significant differences between the two groups. Side effects increased and decreased similarly in both. Likewise, there were no significant differences between the groups in changes in heart rate and blood pressure. The only significant difference in medication dosage was for bupropion, which was higher in the ADHD+ASD group, though without any sign of difference in side effects.
The authors concluded that this retrospective study showed pharmacological treatment of adults with diagnoses of ADHD and ASD to be just as successful as the pharmacological treatment of adults with only ADHD, but cautioned that a randomized controlled trial should be conducted to evaluate the effectiveness and possible side effects of pharmacological treatment for ADHD in patients with ASD more reliably.
ADHD May Be Underdiagnosed Based on Sociodemographics
ADHD is underdiagnosed, to varying degrees, among adults of different ethnicities, ages, and education levels in the U.S.
ADHD is underdiagnosed and most cases of ADHD in adults are not being diagnosed by clinicians.
A cohort study looked at over five million adults and over 850,000 children between the ages of five and eleven who received care at Kaiser Permanente Northern California during the ten-year period from the beginning of 2007 through the end of 2016. At any given time, KPNC serves roughly four million persons. It is representative of the population of the region, except for the highest and lowest income strata.
ADHD Diagnosis Rates:
- Adults: Diagnosis rates rose from 0.43% in 2007 to 0.96% in 2016.
- Children: Diagnosis rates went up from 2.96% to 3.74%, nearly four times higher than in adults.
Diagnosis Rates by Ethnicity:
- Non-Hispanic whites had the highest adult diagnosis rates, increasing from 0.67% to 1.42%.
- American Indian/Alaska Native (AIAN): Rates grew from 0.56% to 1.14%.
- Black and Hispanic adults had similar rates: Black adults increased from 0.22% to 0.69%, and Hispanic adults rose from 0.25% to 0.65%.
- Asian adults had the lowest rates (0.11% to 0.35%), followed by Native Hawaiian/Pacific Islanders (0.11% to 0.39%).
ADHD Diagnosis and Age:
The likelihood of being diagnosed with ADHD dropped sharply with age.
(When compared to 18-24-year-olds):
- 25-34-year-olds were 16% less likely.
- 35-44-year-olds were 33% less likely.
- 45-54-year-olds were less than half as likely.
- 55-64-year-olds were less than a quarter as likely.
- Adults over 65 were about 5% as likely.
This matches findings from other studies showing that ADHD diagnoses become less common with age.
Other Factors:
- Adults with higher education levels were twice as likely to be diagnosed as those with less education.
- Household income had little effect on diagnosis rates.
- Women were slightly less likely to be diagnosed than men.
ADHD and Comorbidity:
Adults with ADHD were more likely to have other mental health conditions:
- Eating disorders: 5 times more likely.
- Bipolar disorder or depression: Over 4 times more likely.
- Anxiety: More than twice as likely.
- Substance abuse: Slightly more likely.
Key Findings:
- Rising ADHD Diagnosis Rates: The increase in diagnoses may be due to better recognition of ADHD by doctors and greater public awareness during the study period.
- Differences by Ethnicity: The differences in diagnosis rates by ethnicity could be related to access to healthcare, cultural attitudes toward mental health, or even attempts to obtain ADHD medications for non-medical reasons, which may be more common among white patients.
Conclusion:
The authors speculate that rising rates of diagnosis “could reflect increasing recognition of ADHD in adults by physicians and other clinicians as well as growing public awareness of ADHD during the decade under study.” Turning to the notable differences by ethnicity, they note, “Racial/ethnic differences could also reflect differential rates of treatment-seeking or access to care. … Racial/ethnic background is known to play an important role in opinions on mental health services, health care utilization, and physician preferences. In addition, rates of diagnosis- seeking to obtain stimulant medication for non-medical use may be more common among white vs nonwhite patients.” They conclude, “greater consideration must be placed on cultural influences on health care seeking and delivery, along with an increased understanding of the various social, psychological, and biological differences among races/ethnicities as well as culturally sensitive approaches to identify and treat ADHD in the total population.”
The study highlights that many cases of adult ADHD go undiagnosed. Research shows about 3% of adults worldwide have ADHD, but this study found that less than 1% are diagnosed by doctors. This points to the need for better training for clinicians to recognize, diagnose, and treat ADHD in adults. It also emphasizes the importance of understanding cultural factors that affect how people seek and receive care.
Daytime Sleepiness, Cognitive Function, and Adult ADHD
What's the relationship between daytime sleepiness and cognitive functioning in adults with ADHD?
Sleep disorders are one of the most commonly self-reported comorbidities of adults with ADHD, affecting 50 to 70 percent of them. A team of British researchers set out to see whether this association could be further confirmed with objective sleep measures, using cognitive function tests and electroencephalography (EEG).
Measured as theta/beta ratio, EEG slowing is a widely used indicator in ADHD research. While it occurs normally in non-ADHD adults at the conclusion of a day, during the day it signals excessive sleepiness, whether from obstructive sleep apnea or neurodegenerative and neurodevelopmental disorders. Coffee reverses EEG slowing, as do ADHD stimulant medications.
Study participants were either on stable treatment with ADHD medication (stimulant or non-stimulant medication) or on no medication. Participants had to refrain from taking any stimulant medications for at least 48 hours prior to taking the tests. Persons with IQ below 80 or with recurrent depression or undergoing a depressive episode were excluded.
The team administered a cognitive function test, The Sustained Attention to Response Task (SART). Observers rated on-task sleepiness using videos from the cognitive testing sessions. They wired participants for EEG monitoring.
Observer-rated sleepiness was found to be moderately higher in the ADHD group than in controls. Although sleep quality was slightly lower in the sleepy group than in the ADHD group, and symptom severity slightly greater in the ADHD group than the sleepy group, neither difference was statistically significant, indicating extensive overlap.
Omission errors in the SART were strongly correlated with sleepiness level, and the strength of this correlation was independent of ADHD symptom severity. EEG slowing in all regions of the brain was more than 50 percent higher in the ADHD group than in the control group and was highest in the frontal cortex.
Treating the sleepy group as a third group, EEG slowing was highest for the ADHD group, followed closely by the sleepy group, and more distantly by the neurotypical group. The gaps between the ADHD and sleepy groups on the one hand, and the neurotypical group on the other, were both large and statistically significant, whereas the gap between the ADHD and sleepy groups was not. EEG slowing was both a significant predictor of ADHD and of ADHD symptom severity.
The authors concluded, These findings indicate that the cognitive performance deficits routinely attributed to ADHD are largely due to on-task sleepiness and not exclusively due to ADHD symptom severity. we would like to propose a simple working hypothesis that daytime sleepiness plays a major role in cognitive functioning of adults with ADHD. As adults with ADHD are more severely sleep deprived compared to neurotypical control subjects and are more vulnerable to sleep deprivation, in various neurocognitive tasks they should manifest larger sleepiness-related reductions in cognitive performance. One clear testable prediction of the working hypothesis would be that carefully controlling for sleepiness, time of day, and/or individual circadian rhythms would result in a substantial reduction in the neurocognitive deficits in replications of classic ADHD studies.
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