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Section 4

Non-Pharmacological Interventions

Clinical practice gaps, uncertainties and need for guidance

There is a need to evaluate the effectiveness of non-pharmacological treatment options to guide Australian clinicians and people with ADHD when choosing appropriate evidence-based intervention options.

For each of the interventions discussed in this section, the nature of the intervention and outcomes that the intervention aims to address are described. The outcomes examined for each intervention focus on ADHD symptoms and other symptom measures (see Table 14 below), consistent with the NICE guideline. However, it should be noted that many non-pharmacological interventions have value beyond improving ADHD symptoms. They can improve other important areas of functioning such as quality of life, self-esteem, social, adaptive and family functioning. These outcomes were rarely examined in the included trials.

A note about terminology: Use of the term ‘should offer’ in the recommendations in this chapter reflects the principle that clinicians should discuss these interventions and present the intervention as an option for individuals or parents/carers/families to consider. It is acknowledged that not all people or parents/carers/families will decide to proceed with the offered interventions, but it is important for individuals or parents/carers/families to be aware of these options to make informed treatment choices. Avenues for future research related to non-pharmacological treatment of ADHD is noted in Chapter 8.

4.1 Lifestyle Changes

Lifestyle changes involve modifying aspects of daily life to improve health and wellbeing. Lifestyle changes have the potential to improve day-to-day functioning for people with ADHD.

4.2 Cognitive-behavioural intervention approaches

The term ‘cognitive-behavioural interventions’ is used to refer to a broad range of approaches that use cognitive and/or behavioural interventions to minimise the day-to-day impact on functioning from ADHD symptoms.

4.3 Cognitive Training

Cognitive training for ADHD in this guideline refers largely to the use of computerised training programs to improve aspects of cognition such as attention and memory.

4.4 Neurofeedback

Neurofeedback applies principles of operant conditioning to teach self-modification of cortical electrical activity. There are several different types of neurofeedback and various treatment regimes.

4.5 Organisation/School-Based Interventions

Organisational/school-based interventions are usually programs run at school or before/after school care programs.

4.6 ADHD Coaching

ADHD coaching involves a collaborative, client-centred, client-driven process to support the person’s empowerment, education about ADHD and skills coaching to build on the person’s strengths.

4.7 Peer Support Workers

There has recently been a resurgence in the use of peer support workers in mental health settings generally, and there are an increasing number of studies supporting their role.

4.8 Adherence to Non-Pharmacological Interventions

Helping people with ADHD (or their parents) to adhere to evidence-based non-pharmacological treatments will likely maximise the benefit of the intervention in terms of symptom reduction and improved functioning.

Table 14. Outcomes reported in evidence reviews


Description or definition

ADHD symptomsIncludes inattentive, hyperactive-impulsive and total ADHD symptoms (combined inattention and hyperactive-impulsive).

Raters include the person with ADHD, a parent, teacher, clinician or other informants.

Quality of lifeIncludes parent, teacher or self-reported measures, for example, health-related quality of life (HRQoL)
Other symptoms or characteristics(Applies to children and adolescents)

Includes any non-ADHD symptoms or characteristics (e.g. symptoms of other conditions, or characteristics such as a parent report of executive functioning)

FunctionFunctional measures such as adaptive behaviour
Clinical global impressionClinician rating of whether the intervention resulted in improvement
Adverse eventsReduction in total adverse events or serious adverse events
Emotional dysregulationSelf-reported or reported by a parent, teacher or clinician
Academic outcomesApplies to children and adolescents

Includes literacy, numeracy and combined academic measures

Self-harmSelf-reported or reported by a parent, teacher or clinician