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Running head: TRADITIONAL AND NON-TRADITIONAL ADHD TREATMENTS ADHD Treatments: A review between traditional drug treatments and alternative treatments Raman Nazari, Michael Cvetich, Stephanie Valenzuela University of California, Merced Author Note: Raman Nazari is a double major candidate in Molecular Immunology and Psychology at the University of California Merced. He is planning on earning an MPH and pursuing medical school after to become a neurosurgeon. His email address is [email protected]. Michael Cvetich is a psychology candidate with a history and philosophy minor at the University of California Merced. He will be continuing his education to get his M.A. and teaching credentials in order to pursue a career as a teacher. His email address is: [email protected]. Stephanie Valenzuela is a psychology candidate with sociology minor at the University of California Merced. She is planning on pursuing graduate school to earn her PhD to become a child psychologist. Her email address is [email protected] 1 TRADITIONAL AND NON-TRADITIONAL ADHD TREATMENTS 2 Abstract Recent surveys have demonstrated that the general public is concerned with the increased amount of ADHD diagnosis and the prescriptions of psycho-stimulant medications. We compare the different types of ADHD drug treatments to alternative treatments of ADHD for children up to the age of 18 to determine whether drug treatments alone or a combination of both have the greatest positive effects. All subjects must have met either the DSM-III or DSM-IV criteria for ADHD to be considered for the treatment options. Although several of the alternative treatments for ADHD reviewed in this article show promise as a potentially effective treatment for ADHD, we do not believe that the overall amount of evidence shown through clinical trials is sufficient to be solely used as a therapy treatment for ADHD. Some therapeutic treatments such as dietary interventions, Interactive Metronome Training, EEG neurofeedback, yoga, massage, and homeopathy, offer no serious side effects and can be recommended as an alternative treatment to the standard ADHD treatment regimens. We believe that that the best treatment for ADHD in children is a mixed combination of drug treatments and alternative treatments. Keywords: ADHD drug treatments, ADHD alternative treatments, ADHD dietary treatments, ADHD yoga, EEG neurofeedback, Interactive Metronome Training, ADHD Massage, ADHD homeopathy TRADITIONAL AND NON-TRADITIONAL ADHD TREATMENTS 3 Introduction Several studies have reported that children with attention-deficit/hyperactivity disorder (ADHD) have conflicts in social interactions. ADHD is characterized by Diagnostic and Statistical Manual (DSM-IV) as having short attention span, poor concentration, hyperactivity, mood shifts, forgetfulness, and distractibility. It is believed that ADHD affects the frontal lobe of the human brain but there has yet to be scientific evidence to prove this claim. Despite the fact that ADHD is a complex subject, there are ways to help control ADHD symptoms. Traditional treatment for ADHD is through drug therapy, however, there are a number of key problems that have risen in the past few years. An increasing amount of side effects, stigmas of medication, and false diagnosis have been brought to the attention of physicians by parents of children who have been diagnosed with ADHD. Due to the increase of complaints reported, patients have turned to other alternative treatments for their disorder. In this article, we review the mechanisms of action and efficacy for traditional drug treatments and the rising alternative treatments for ADHD. Instead of briefly reflecting on a range of alternative treatments, we have chosen to focus more on the controversies, such as dietary inventions, Interactive Metronome Training, chiropractic medicine, EEG neurofeedback, yoga, massage, and homeopathic remedies. We located articles for this review through computerized searches of the United States National Library of Medicine using combinations of the following words: ADHD drug treatments, ADHD dietary interventions, ADHD yoga, ADHD Interactive Metronome Training, ADHD Neurofeedback, ADHD massage, ADHD homeopathic remedies, and ADHD chiropractic medicine. The articles chosen for this review consisted of human participants between the ages of three to eighteen. We have identified 18 articles that focused on the moderators in the context of this review. TRADITIONAL AND NON-TRADITIONAL ADHD TREATMENTS 4 Traditional ADHD Treatments Recent surveys have demonstrated that the general public is concerned with the increased amount of ADHD diagnosis and the prescription of psycho-stimulant medications. There have been several studies that have reported substantial rates of alternative medicine as being an effective treatment for ADHD. Despite the fact that evidence suggests conventional ADHD drug treatments as being the common method of treatment, parents of children prefer alternative natural treatments in which they have control over. The average individual typically considers drug treatments more effective because of the possibility to curb the negative effects of ADHD better than any other sort of treatment. Recent drug treatments which have evolved over the years from prior drug formulas have become much more effective in targeting specific issues in patients, rather than just neutralizing the effects. Newer medications are meant to target specific negative manifestations of ADHD and negate them without affecting the other aspects of a person’s psyche. However, the numbers of side effects with drug treatments seem to outweigh the benefits. The evolution and scientific support of the non-drug treatments have been a more recent event. Yoga, dietary interventions, EEG neurofeedback, homeopathy, and therapy have only recently become substantially backed treatments. However, when compared to drug treatments, there outcomes seem to be promising, but little supporting evidence is available. Researchers have been trying to conduct clinical trials in hopes of bettering the lives of children by choosing this method opposed to medication. We compare the different types of ADHD treatments, drug treatments, and alternative treatments for children up to the age of 18 to determine which has the greatest positive effect towards their disorder. All subjects must have met either the DSM-III or DSM-IV criteria for ADHD to be considered for the treatment options. TRADITIONAL AND NON-TRADITIONAL ADHD TREATMENTS 5 Drug Treatments Methylphenidate (MPH) has been the favored drug of choice in treating patients with ADHD, but a new drug, Fluoxetine, can now be considered as an alternative treatment for ADHD patients. Nevertheless, a newer drug, Atomoxetine, has shown to reduce ADHD symptoms and is a safe and tolerable drug for patients to take. Even though there are no differences found among groups as a whole on a family and parenting stress level basis, parents that are highly involved in their children’s lives while being treated were able to make better family and social interactions However, there is a need for better educating parents about the effectiveness and side effects of the different treatments. Methylphenidate Perhaps the most common prescription drug treatment is Methylphenidate (MPH), whose trade name is Ritalin. Despite not completely understanding the mode of action, MPH is a central nervous system stimulant that is used in children who have ADHD. Existing studies demonstrate that short-term treatment of methylphenidate (MPH) improves the rapid movement of core and associated ADHD symptoms. In a recent study, researchers have attempted to show the behavioral, temporal, and situational effects of MPH over a four month period to explore the effectiveness of core and associated symptoms of MPH treatments in children who have ADHD (Schachar, Tannock, Cunningham, and Corkum, 1997). Specifically, Schachar and colleagues found that treatment with MPH showed improved symptoms of ADHD in children both in the morning and in the afternoon at school, but not at home. However, treatment with MPH had more side effects than the placebo, which indicated that both parents and teachers should be educated about the extent of behavioral, temporal, and situational effects of MPH treatment. When different dosage amounts of Methylphenidate were given at 0.15mg/kg and 0.50mg/kg on TRADITIONAL AND NON-TRADITIONAL ADHD TREATMENTS 6 27 preschool children who had ADHD, the off task and noncompliant behavior decreased, while the rates of compliance significantly increased (Barkley, 1988). Another common treatment for ADHD in children is the once daily OROS Methylphenidate formulation (Wells, Epstein, Hinshaw, Conners, Klaric, Abikoff, et al., 2000). Wells and colleagues have demonstrated the effects of the fairly new OROS formulation in children for over a period of 24 months. The effectiveness of the daily OROS Methylphenidate formulation was monitored on a monthly basis for 24 months by parents and school teachers using values dictated by the IOWA rating scale. Results from their experiment showed that children showed a high tolerance from the OROS MPH treatment. Despite the sleep irregularities and tics occurring in patients, it was found that children responded positively to the treatment in short term periods and that a once daily dose allows high effectiveness for ADHD. Overall, there is good scientific evidence through clinical trials that demonstrates that Methylphenidate is an effective treatment for ADHD in children. However, more recent studies with larger sample sizes are needed to address the different side effects that occur in children who take Methylphenidate as a form of drug treatment (Jensen, Kettle, Roper, Sloan, Dulcan, Hoven, et al., 1999). Fluoxetine One of the more popular prescription drug treatments is Fluoxetine, also known as Prozac. Fluoxetine is an antidepressant and works as a selective serotonin reuptake inhibitor (SSRI), but is not FDA approved for treatment in ADHD. Even though prior studies have demonstrated that Methylphenidate (MPH) and Dextroamphetamine are and have been the favored drugs of choice in treating patients with ADHD, researchers have shown that not all patients respond positively to these stimulants (Barrickman, Kuperman, Noyes, Schumacher, and Verda, 1991). Fluoxetine, a fairly new treatment for ADHD, has been designed to be an available option as a treatment due to the high prevalence rates of ADHD. Patients who took Fluoxetine as TRADITIONAL AND NON-TRADITIONAL ADHD TREATMENTS 7 a prescription showed a positive impact towards their disorder compared to those who took antidepressants and stimulants in which there was no response. Barrickman et al. found that over half of their patients wished to continue their medication, despite the high cost. Barrickman and colleagues believe that Fluoxetine may be the new alternative drug treatment for ADHD patients. Although there is promise in the future with Fluoxetine, there remain a high number of adverse side effects such as nausea, insomnia, somnolence, anorexia, anxiety, nervousness, asthenia, and tremor. In addition, there is a shortage of preliminary and clinical trials that show Fluoxetine as having consistent positive results towards patients with ADHD. Atomoxetine A non-stimulant pharmacotherapy, Atomoxetine is studied as a potential ADHD treatment in children. Since Atomoxetine can act as a blockade for norepinephrine receptors, Faries and colleagues have attempted to investigate the efficacy, safety, and tolerance at different doses (Michelson, Faries, Wernicke, Kelsey, Kendrick, Sallee, and Spencer, 2001). Results showed that more than half had mixed subtypes of symptoms and each of the symptoms severity ranged from moderate to severe in most children. However, doses at 1.2mg/kg/day and 1.8mg/kg/day showed superior outcomes in ADHD symptoms. The dose at 0.5mg/kg/day showed intermediate efficacy between the placebo and the two higher dosages. It was also found that both family and social interactions improved symptoms significantly with continuous treatment. Children who took the Atomoxetine had reduced ADHD symptoms and treatment with Atomoxetine was safe and tolerable for all subjects who participated. When treatment of Atomoxetine alone was compared to a combined Atomoxetine/Fluoxetine treatment in a study containing 127 subjects, it was found through preliminary evidence that Atomoxetine therapy alone appears to be just as an effective treatment than Atomoxetine/Fluoxetine (SemrudClikeman, Pliszka, and Liotti, 2008). Both anxiety and depressive symptoms improved, but the TRADITIONAL AND NON-TRADITIONAL ADHD TREATMENTS 8 combined group treatments had an increase in blood pressure and pulse. Overall, Atomoxetine is a safe and well-tolerated drug treatment that should be considered as a method of therapy for children with ADHD (Kratochvil, Newcorn, Arnold, Duesenberg, Ernslie, Quintana, et al., 2005). Alternative Treatment Methods Even though prescription medications and standard behavioral treatments have been shown to be an effective method of treatment for ADHD, there has been an increase in the demand for alternative treatment methods for ADHD. The most widespread treatment methods include dietary inventions, Interactive Metronome Training, chiropractic medicine, EEG neurofeedback, yoga, massage, and homeopathic remedies. However, despite the wide variety of options, more rigorous studies are needed to determine whether alternative treatments alone can be solely used as a treatment option for ADHD. Dietary Interventions One of the most painstaking and enduring controversies has been the dietary intervention in children with ADHD. It is unclear whether or not a child’s diet can improve behavior, hyperactivity, and inattention. Researchers believe that children are sensitive to certain foods they consume, and by reducing the exposure to these types of foods will improve behavioral symptoms. The most widely known dietary intervention is the Feingold Diet. This diet is based on the theory that states that children are most sensitive to artificial sugars, added coloring, flavors, and preservatives. Even though there have been only a handful of clinical studies, there has yet to be a single study that supports this theory (Rojas and Chan, 2005). TRADITIONAL AND NON-TRADITIONAL ADHD TREATMENTS 9 Another dietary intervention is to avoid all sugars. There has been a belief for years that sugar causes hyperactivity, however, there has been no clinical trials indicating that there is an association between sugar and hyperactivity. On the other hand, children who are born with genetic abnormalities have shortages of vitamins and minerals. Furthermore, another theory for dietary intervention is through means of supplementation, but there has been no controlled studies supporting this claim. In contrast, there have been a few studies that show children with ADHD may have shortages in iron and trace mineral deficiencies, which leads to behavioral problems. Overall, maintaining a healthy diet on a daily routine is always a safe option, but adhering to a strict healthy diet is quite challenging, especially for children who are not well disciplined (Rojas et al., 2005). Interactive Metronome Training One of the fairly new training programs that emerged in the early 1990s is the Interactive Metronome. This program helps individuals improve their ability to selectively pay attention for extended periods of time without interruption by internal or external distractions. The training involves basic limb motion exercises that are used as systematic outward catalysts to help improve mental processes. In the past, therapists improved motor planning and sequencing capacities in educational or therapeutic settings. In a recent study, 53 of 58 variables affecting ADHD were found favorable in Interactive Metronome and significant increases in factors such as attention, motor control, language processing, reading, and parental reports were observed (Shaffer, Jacokes, Cassily, Greenspan, Tuchman, and Stemmer, 2001). There are a limited number of preliminary trials that have tested for improvements in ADHD symptoms with the Interactive Metronome training. We believe that this program has potential in the future as a treatment for ADHD, but until further controlled studies with larger sample sizes are conducted, the true effects remain unsolved. TRADITIONAL AND NON-TRADITIONAL ADHD TREATMENTS 10 EEG Neurofeedback A fairly new ground breaking technique, EEG Neurofeedback or Neurotherapy, challenges the brain to function better as a whole. This powerful therapeutic method trains the brain to perform at its maximum potential by performing brain exercises. Through neurofeedback training, individuals with ADHD can lower their slow activity in their EEG and increase their deficient fast activity in the EEG. In a recent study consisting of 23 subjects who went through rigorous neurofeedback training, both subjective and objective controlled conditions were seen in positive effect (Lubar, Swartwood, Swartwood, and O’Donnell, 1995). Findings corroborate and support prior research that indicates neurofeedback can be used as an appropriate and efficacious treatment for ADHD, but we believe there has yet to be an ample amount of well controlled scientific studies that demonstrate whether to accept or reject the effectiveness of EEG neurofeedback for treatment of ADHD (Fuchs, Birbaumer, Lutzenberger, Gruzelier, and Kaiser, 2003). Yoga Yoga is one of several alternative treatments that help children to concentrate and focus. Yoga is a Hindu discipline that is targeted towards training the human conscious to a state of perfect spiritual insight and tranquility. With its origination approximately 3,000 years ago, the purpose of this scientific system is to allow individuals reach their highest potential and experience enduring periods of happiness. Due to its success at many different levels, yoga has been reported to have great success as an affective therapy treatment for chronic diseases and conditions that do not respond well to conventional treatment methods. For instance, children with ADHD and other concentration disabilities that practice yoga often report a greater ability to focus, balance, and compose their daily lives. The largest beneficial effects are due to the deep TRADITIONAL AND NON-TRADITIONAL ADHD TREATMENTS 11 breathing patterns practiced. Since the rate and depth of breathing has an effect on the autonomic nervous system and heart rate, regular practice helps children with ADHD learn to control their responses and actions in social settings. The benefits of yoga as an alternative treatment are that it has similar effectiveness to medication and more effectiveness than behavioral therapy. In addition, there are no side effects associated with yoga except for improvements in higher selfesteem, school performance, and behavior. To our knowledge, there has been only one Yoga controlled study trial published that shows the effects on ADHD (Jensen and Kenny, 2004). This study had 14 boys randomly chosen who were diagnosed with ADHD and placed into two treatment groups, to either one hour yoga treatments (n = 6) or cooperative activities (n = 8). The yoga sessions included respiratory, relaxation, postural, and concentration training. Despite both groups showing improvement in the Conner subscales, the yoga subjects showed significant improvement in parent rated Oppositional, ADHD index, and Global Index Restless/Impulsive subscale scores. Even though there is a severe shortage in rigorous studies available that demonstrates yoga’s efficiency, these results reveal that Yoga may have a role as an alternative treatment method to ADHD (Kenny, 2002). Massage Massage therapy is also an alternative treatment for children with ADHD. By manual manipulation to the soft tissue in the body, an individual is relaxed both physically and mentally by promoting increased blood flow and relief of muscular tension. Despite the fact that there is no set specific ADHD massage technique, certain methods have been reported to have a great effect than others. The four most effective massage methods are the Swedish massage, Cranial sacral therapy, Myofascial therapy, and Watsu. The Swedish massage allows slow stroking movements that have a sedating effect, leading to the activation of the parasympathetic nervous system, while the Cranial sacral therapy method allows for the removal of any restrictions in the TRADITIONAL AND NON-TRADITIONAL ADHD TREATMENTS 12 cranium or sacrum that contribute to ADHD. The benefit of the myofascial therapy is that slowly unwinds the muscles focusing on the fascia as one large connected system to activate the parasympathetic system. Watsu is a deep relaxing style of bodywork performed in a water warm pool. In a recent study, children who received massage therapy for two weeks reported themselves as being happier, less fidgety, and more on task behavior (Field, Quintino, Hernandez-Rief, and Koslovsky, 1998). Positive changes were also noted by adolescent psychiatric patients who reported significantly less depression and anxiety following massage therapy (Field, Morrow, Valdeon, Larson, Kuhn, and Schanberg, 1992). Even though these two studies have revealed promising outcomes, these results are still considered preliminary due to the small sample sizes and lack of generalization and comparison to traditional ADHD treatments. Homeopathy A German physician, Samuel Hahnemann, found homeopathy over 200 years ago in the late 1700s. Homeopathic medicine is an alternative medical treatment that treats the symptoms of a disease with small doses of natural substances. These substances come from Mother Nature and have no reported side effects. By the early 1900s, homeopathy was practiced by one out of every six medical practitioners in the United States and widely practiced in South America, India, and Europe. When an adolescent child with ADHD seeks homeopathic treatment, not only will attention and behavior improve, but also any physical problems such as headaches, allergies, and asthma. Even though there are numerous case reports on the use of homeopathy in ADHD treatments, there are only three clinical trials in existence (Lamont, 1997; Strauss, 2000; Frei and Thurneysen, 2001). All of these cases reported improvements in behavior on both standard and nonstandard rating scales. Despite these three clinical trials, group sizes in each study were relatively small and the result analysis did not take into account the potential effect of medication TRADITIONAL AND NON-TRADITIONAL ADHD TREATMENTS 13 status. To our knowledge, we believe there is an insignificant amount of circumstantial evidence to support the use of homeopathy solely as an alternative treatment method for ADHD. Even though homeopathic substances are deemed to be safe, such liquid remedies, which contain alcohol, are not suitable for children (Rojas et al., 2005). Conclusion The information gathered in our paper was conducted to compare a variety of ADHD drug treatments to alternative treatments for all children younger than 18. Each subject must have met the criteria for DSM-III or DSM-IV level for ADHD for the treatments that were available. A combination of both drug and alternative treatments was found best in treating ADHD. Drug treatments for children were not a problem in the past but parents preferred their children to use any other type of non-medicated treatment for their children. This was due to side effects that arose from drug utilization over extended periods of time. Through the use of alternative treatments such as yoga, diet, homeopathy and therapy, there is hope that ADHD symptoms will be diminished and under control, but there are still numerous clinical trials needed for experimentation in order to successful demonstrate that these alternative treatments help a number of children with ADHD. When investigating the drug treatments that were being used by ADHD patients, we compiled the most popular and effective drug treatments. Some of the effective drugs found were Methylphenidate (MPH) or Ritalin and Fluoxetine, better known as Prozac. Not all patients have gained positive effects from the different drug treatments. This was the reason for the outreach of alternative therapy. It is speculated that diet, interactive metronome training, yoga, massage and Homeopathy are useful alternative therapies to treat ADHD symptoms. Although sugar has not been tested in relation to excessive hyper disorder, dietary interventions are mainly to avoid all sugar intake. Yoga, massage and homeopathy are not therapeutic therapies for the mental disorder, but more of a way to help the patients and their TRADITIONAL AND NON-TRADITIONAL ADHD TREATMENTS 14 families cope with the disorder. Overall, we believe that medical drug treatments have better results, but alternative therapies are much safer. Although several of the alternative treatments for ADHD reviewed in this article show promise as a potentially effective treatment for ADHD, we do not believe that the overall amount of evidence shown through clinical trials is sufficient to be solely used as a treatment therapy for ADHD. Some therapeutic treatments such as yoga, massage, and homeopathy, offer no serious side effects and can be recommended as an alternative treatment to the standard ADHD treatment regimens. We believe that that the best treatment for ADHD in children is a mixed combination of drug treatments and alternative treatments. TRADITIONAL AND NON-TRADITIONAL ADHD TREATMENTS 15 References Barkley, R.A. (1988). The effects of methylphenidate on the interactions of preschool ADHD children with their mothers. Journal of American Academy of Child & Adolescent Psychiatry, 27(3), 336-341. Barrickman, L., Kuperman, S., Noyes, R., Schumacher, E., & Verda, M. (1991). Treatment of ADHD with Fluoxetine: A preliminary trial. Journal of the American Academy of Child & Adolescent Psychiatry, 30(5), 762-767. Field, T., Morrow, C., Valdeon, C., Larson, S., Kuhn, C. & Schanberg, S. (1992). Massage therapy reduces anxiety in child and adolescent psychiatric patients. Journal of the American Academy of Child and Adolescent Psychiatry, 31(1), 125-131. Field, T.M., Quintino O., Hernandez-Reif, M., & Koslovsky, G. (1998). Adolescents with attention deficit hyperactivity disorder benefit from massage therapy. Journal of Adolescence, 33(1), 103–108. Frei, H., & Thurneysen, A. (2001). Treatment for hyperactive children: Homeopathy and methylphenidate compared in a family setting. British Homeopathic Journal, 90(4),183–188. Fuchs, T., Birbaumer, N., Lutzenberger, W., Gruzelier, J.H., and Kaiser, J. (2003). Neurofeedback treatment for attention deficit hyperactive disorder in children: A comparison with Methylphenidate. Journal of Applied Psychophysiology and Biofeedback, 28(1), 1-12. Jensen, P.S., & Kenny, D.T. (2004). The effects of yoga on the attention and behavior of boys with attention-deficit/hyperactivity disorder. Journal of Attention Disorders, 7(4), 205-216. TRADITIONAL AND NON-TRADITIONAL ADHD TREATMENTS 16 Jensen, P.S., Kettle, L., Roper, M.T., Sloan, M.T., Dulcan, M.K., Hoven, C., Bird, H.R., Bauermeister, J.J., & Payne, J.D. (1999). Are stimulants overprescribed? Treatment of ADHD in four U.S. communities. Journal of the American Academy of Child & Adolescent Psychiatry, 38(7), 797-804. Kenny, M. (2002). Integrated movement therapy: Yoga-based therapy as a viable and effective intervention for autism spectrum and related disorders. International Journal of Yoga Therapy, 12(1), 71-79. Kratochvil, C.J., Newcorn, J.H., Arnold, L.E., Duesenberg, D., Emslie, G.J., Quintana, H., Sarkis, E.H., Wagner, K.D., Gao, H., Michelson, D., & Biederman, J. (2005). Atomoxetine alone or combined with Fluoxetine for treating ADHD with co-morbid depressive or anxiety symptoms. Journal of the American Academy of Child & Adolescent Psychiatry, 44(9), 915924. Lamont, J. (1997). Homeopathic treatment of attention deficit disorder. British Homeopathic Journal, 86(4), 196–200. Lubar, J.F., Swartwood, M.O., Swartwood, J.N., & O’Donnell, P.H. (1995). Evaluation of the effectiveness of EEG neurofeedback training for ADHD in a clinical setting as measured by changes in T.O.V.A. scores, behavioral ratings, and WISC-R performance. Journal of Applied Psychophysiology and Biofeedback, 28(1), 83-99. Michelson, D., Faries, Wernicke, J., D., Kelsey, D., Kendrick, K., Sallee, R., and Spencer, T. (2001). Atomoxetine in the treatment of children and adolescents with attention-deficit hyperactivity disorder. Journal of American Academy of Pediatrics, 108(5), 83-91. TRADITIONAL AND NON-TRADITIONAL ADHD TREATMENTS 17 Rojas, N.L., & Chan, E. (2005). Old and new controversies in the alternative treatment of attention deficit hyperactive disorder. Journal of Mental Retardation and Developmental Disabilities, 11(2), 116-130. Schachar, R.J., Tannock, R., Cunningham, C., & Corkum, P.V. (1997). Behavioral, situational, and temporal effects of treatment of ADHD with Methylphenidate. Journal of the American Academy of Child & Adolescent Psychiatry, 36(6), 754-763. Semrud-Clikeman, M., Pliszka, S., & Liotti, M. (2008). Executive functioning in children with ADHD: Combined type with and without a stimulant medication history. Journal of Neuropsychology, 22(3), 329-340. Shaffer, R.J., Jacokes, L.E., Cassily, J.F., Greenspan, S.I., Tuchman, R.F., & Stemmer, P.J. (2001). Effect of interactive metronome training on children with ADHD. American Journal of Occupational Therapy, 55(1), 155-162. Strauss, L. (2000). The efficacy of a homeopathic preparation in the management of attention deficit hyperactivity disorder. Journal of Biomedical Therapy, 18(2),197–201. Wells, K.C., Epstein, J.N., Hinshaw, S.P., Conners, C.K., Klaric, J., Abikoff, H.B., Abramowitz, A., Arnold, L.E., Elliott, G., Greenhill, L.L., Hechtman, L., Hoza, B., Jensen, P.S., March, J.S., Pelham, W., Pfiffner, L., Severe, J., Swanson, J.M., Vitiello, B., and Wigal, T. (2000). Parenting and family stress treatment outcomes in attention deficit hyperactivity disorder (ADHD): An empirical analysis in the MTA study. Journal of Abnormal Child Psychology, 28(6), 543-553. TRADITIONAL AND NON-TRADITIONAL ADHD TREATMENTS 18 Contributions Raman- I put together the entire paper and edited each section after each group member gave me their portions. I helped find articles and identify the key information needed to pull out for review. I put together the reference sheet and did the bulk of the body and abstract. Michael – I put together the introduction and edited the entire paper as well. I helped find articles and helped pull out key information needed for review. Stephanie – I put together part of the body paragraph and the conclusion. I also helped edit the entire paper. I helped find articles and helped pull out key information needed for review.