Use of complementary and alternative medicine in children with ADHD: Results from the 2012 and 2017 National Health Interview Survey

doi:10.1016/j.ctim.2020.102352

Complementary Therapies in Medicine

Volume 49, March 2020, 102352

https://doi.org/10.1016/j.ctim.2020.102352 Get rights and content

Highlights

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Nearly all children experiencing ADHD have comorbid psychiatric disorders, and they are more likely to use CAM than those without comorbidities.
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The most frequently used CAM modality for ADHD was meditation, which has substantially increased in usage - more than four-fold - from 2012 to 2017.
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Parents' reasons for the use of CAM among their children with ADHD included their unique function in reducing ADHD symptoms and their lack of unwanted side-effects.
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Among children with ADHD, CAM use is generally not correlated with conventional medical care use, except for a significant inverse relationship between CAM use and use of prescription medication for more than three months.
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It is imperative to improve effective communication between health care providers and ADHD patients to better understand and respect patients values and preferences and improve overall health care.

Abstract

Objective

To examine the prevalence, patterns, and factors associated with CAM use among children with ADHD.

Method

We used data from the 2012 and 2017 National Health Interview Survey. Descriptive statistics, Wald F chi-square test, and multivariable logistic regression were performed.

Results

Approximately 8.4 % of U.S. children had ADHD in 2017. Children with ADHD had greater CAM use than those without (p < 0.05). Meditation (10.8 %), yoga (9.6 %), and deep breathing (7.3 %) were the most commonly used mind-body CAM modalities in ADHD children in 2017, with their use increased 468 %, 433 %, and 192 %, respectively, since 2012. Nearly all children experiencing ADHD (91.9 %) have comorbid psychiatric disorders, and they are more likely to use CAM than those without comorbidities (p < .0001). Less than one-third of the respondents disclosed children’s CAM use to their medical doctors. Among children with ADHD, CAM use is generally not correlated with conventional medical care use, except for a significant inverse relationship between CAM use and use of prescription medication for more than three months.

Conclusion

The use of mind-body CAM modalities has substantially increased among children with ADHD, compared to those without ADHD, from 2012 to 2017. Parents' reasons for the use of CAM among their children with ADHD included their unique function in reducing ADHD symptoms and their lack of unwanted side-effects. It is imperative to improve effective communication between health care providers and ADHD patients and their parents, in order to understand patients’ values and preferences for using CAM therapies as a natural holistic therapy for ADHD.

Introduction

Attention-deficit/hyperactivity disorder (ADHD) is a widespread neuropsychiatric disorder among children and adolescents in the United States (U.S.), comprising about 50 % of child psychiatric diagnoses.¹ According to the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5), ADHD is characterized by “a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development”.² ADHD is often comorbid with other psychiatric disorders such as depression, executive disorder, poor attention, learning disabilities, and disruptive behavioral disorders,³^,⁴ which are associated with lower academic attainment, impaired social functioning, increased substance use, and lower quality of life.⁵^,⁶

Conventional treatments for childhood ADHD typically consist of behavioral accommodations and stimulant medication (primarily methylphenidate).¹^,⁷ Children treated with stimulants, however, often show adverse side effects, such as depressed growth, insomnia, loss of appetite, abdominal pain, and nervousness,⁷^,⁸ and not all children respond favorably.⁹ Thus, many parents have turned to a variety of complementary and alternative medicine (CAM) therapies to help with their children’s ADHD, especially when they are concerned about the long-term effects from pharmacologic treatments or have difficulty accessing behavioral therapies.¹⁰

Indeed, many clinical studies indicate that a range of CAM therapies, such as herbs, dietary therapies, neurofeedback, and mind-body exercises, are utilized for children with ADHD.⁷^,¹¹^,¹² Epidemiological studies also suggest that CAM use is becoming increasingly widespread and acceptable for use among children with ADHD.¹³ For example, Carmonaa suggested that more than half of children with ADHD were using CAM therapies.¹⁴ Black et al. also indicated that ADHD was one of the most common health issues that used CAM approaches in both 2007 and 2012.¹⁵ However, most of those studies provided only brief information about CAM use among children with ADHD, and the data is relatively outdated, therefore, the results may not reflect the current characteristics of CAM use among this pediatric population.

To address this knowledge gap in the literature on CAM use for ADHD, this study aimed to 1) describe the prevalence of CAM use (as surveyed by the National Health Interview Survey (NHIS)), 2) identify the most frequently used CAM therapies, 3) examine the patterns of and reasons for using CAM, and 4) explore the associated factors with CAM use among children with ADHD, by using the data from the 2012 and 2017 NHIS.

Section snippets

Data sources

We examined data from the 2012 and 2017 NHIS sponsored by the Centers for Disease Control and Prevention. Because the two sets of data were not identical in the questions asked and some questions were asked in 2012 only, we used the data from 2012 NHIS to describe patterns of and reasons for CAM use in children and the data from the 2017 NHIS to describe the prevalence and associated factors of CAM use in children. NHIS employs an area probability sampling design that allows the representative

Prevalence of CAM use among children with ADHD

For purposes of this study, children were deﬁned as those aged 4–17 years in the U.S. Among all parents interviewed, 8.4 % (an estimation of 4.9 million) stated that their sample child had ADHD in 2017. Compared with children without ADHD, the prevalence of ADHD was significantly higher among older children (12–17 years old vs. younger children 4–11, p < .0001), boys (vs. girls, p < .0001), children whose family income was less than $34,999 (vs. > $75,000, p < .0001), children whose parents had

Discussion

The dramatic increase in prescription medications used to treat ADHD symptoms in many Western countries has led to remarkable controversies and public debate around the clinical and social management of ADHD.¹⁹^,²⁰ The continuing controversy over the safety, efficacy, and appropriateness of these medications in the lay press has led to serious parental concerns.²¹ These concerns are a likely reason for parents increasingly turning to CAM therapies for help with their children’s ADHD.⁵^,⁷

Based on

Limitations

This study has limitations. First, our study focused on children with ADHD, however, the response was from the parents rather than the children themselves. Therefore, there may be a response bias in terms of the actual use of CAM therapies among children. Second, the 2017 NHIS did not include all types of modalities¹⁷ that have been identified as having been used for children with ADHD. Thus, a direct comparison of the CAM use between 2012 and 2017 is impossible.⁷ Despite these limitations, our

Conclusions

Approximately five million children were reported to have ADHD, and almost one million of them used one or more CAM therapies in 2017 in the U.S. The prevalence of CAM use is significantly higher among children with ADHD than those without. The most frequently used CAM modality for ADHD was meditation, which has substantially increased in usage - more than four-fold - from 2012 to 2017. This rapid increase in popularity may be due to mounting evidence of meditation's usefulness for increasing

Financial disclosure

No financial disclosures are reported by the authors of this paper

Contributor’s Statement

Dr. Wang conceptualized and designed the study, carried out the initial analyses, and drafted the initial manuscript. Dr. Li conceptualized the study, helped with data analysis, and reviewed and revised the manuscript. Dr. Gaylord contributed to the writing of the initial manuscript and critically reviewed the manuscript for important intellectual content. Dr. Seo contributed to the interpretation of data, and reviewed and revised the manuscript. All authors approved the final manuscript as

Declaration of Competing Interest

Authors have no conflict of interest to report.

Acknowledgments

The authors wish to acknowledge the statistical analysis support from the Howard W. Odum Institute for Research in Social Science at the University of North Carolina at Chapel Hill.

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View full text

Use of complementary and alternative medicine in children with ADHD: Results from the 2012 and 2017 National Health Interview Survey

Highlights

Abstract

Objective

Method

Results

Conclusion

Introduction

Section snippets

Data sources

Prevalence of CAM use among children with ADHD

Discussion

Limitations

Conclusions

Financial disclosure

Contributor’s Statement

Declaration of Competing Interest

Acknowledgments

J Health Econ

Acad Pediatr

BMC Complement Altern Med

Am J Prev Med

Clin Psychol Rev

Child Adolesc Psychiatr Clin N Am

Cogn Brain Res.

Psychiatry Res

Complement Ther Med

Prevalence of parent-reported ADHD diagnosis and associated treatment among US children and adolescents, 2016

J Clin Child Adolesc Psychol

Diagnostic and statistical manual of mental disorders (DSM-5®)

Comorbidity prevalence and treatment outcome in children and adolescents with ADHD

Eur Child Adolesc Psychiatry

Attention-deficit/hyperactivity disorder

Dtsch Arztebl Int

Attention‐deficit hyperactivity disorder (ADHD): An updated review of the essential facts

Child Care Health Dev

Educational and health outcomes of children treated for Attention-Deficit/Hyperactivity disorder

JAMA Pediatr

The pharmacological and non-pharmacological treatment of attention deficit hyperactivity disorder in children and adolescents: A systematic review with network meta-analyses of randomised trials

PLoS One

Methylphenidate for children and adolescents with attention deficit hyperactivity disorder (ADHD)

Cochrane Libr