Complementary and Integrative Treatments for Attention-Deficit/Hyperactivity Disorder in Youth

The complex nature and holistic perspectives that characterize and bring value to many CIM interventions for ADHD also present inherent challenges for controlled sci-entific study. Heterogeneity of method, inadequate blinding, and risk of bias are com-mon. So despite the existence of multiple studies reported in the literature for some of the approaches described above, their limitations can make it difficult to come to definitive conclusions about efficacy. Exceptions include omega-3 supplementation, restriction of artificial food additives and physical activity, the evidence for which have progressed to the point that these CIM interventions can be considered evi-dence-based. So where does that leave the thoughtful medical professional when evaluating CIM interventions which are not yet considered evidence-based? When the existing evi-dence base is not sufficient to clarify the benefits for a proposed treatment, the SECS versus RUDE criteria can be a useful framework to determine if an intervention is reasonable to recommend. SECS stands for 'safe, easy, cheap and sensible', whereas RUDE denotes those treatments which are "risky, unrealistic, difficult or expensive." A treatment that is safe, sensible and affordable might reasonably lower the threshold for recommendation even if the evidence base is limited. However, if any single element of the RUDE criteria is met, a treatment should not be considered advisable without convincing efficacy evidence. Utilizing the evidence-based classification for efficacy above along with the SECS versus RUDE criteria for those interventions that cannot yet be considered evidence-based, several modalities are worth highlighting. Increasing consumption of foods rich in omega-3 PUFAs and decreasing consumption of foods containing artificial food coloring are reasonable dietary interventions. Of mind-body activities, meditation and yoga can similarly be recommended. Patients and their families should also be encouraged to practice sleep hygiene and seek out opportunities for regular physical activity. For those patients with co-morbid emotional dysregulation, broad-spectrum micronutrients could also be considered. Although none of these should be considered replacements for first-line psychopharmacologic and psychosocial strategies to manage inattention and hyperactivity, all offer a reasonable expectation of adjunctive benefit with minimal associated risk while conferring additional health benefits.