ADHD in Children K-12: Advantages Between Pharamcological Therapy Versus Non-
Pharmacological Therapy
Abstract
Background: ThDiagnosis of ADHD in children K-12 is at
an all time high in the United States. Diagnosis and
treatment vary depending on variable economic factors.
This paper aims to review current recommendations and
diagnosis criteria set by the DSM-5 and determine the most
successful treatment
Methods:  Articles were collected from publicly available
scholarly databases to evaluate pharmacological treatment,
as well as various non-pharmacological treatments
including but not limited to biofeedback and therapy.
Articles chosen included Journal of Clinical Child &
Adolescent Psychology, School Psychology Quarterly,  and
the International Journal of Special Education.
Results: Objective findings were that combination therapy
had the best overall results in terms of reported improved
mood and performance in school. However, most ADHD
treatments continue to lack combination therapy.
Clinical Question
What is the best treatment option for children
under 18 years old with ADHD,
pharmacological or non-pharmacological
thearapy?
Methodology
Academic Information collection regarding widespread
treatment used among young adults & adolescents who are
diagnosed with ADHD. Data collecting methods included
the Westminster Library data service; Griffin search,
CINAHL, and Academic premier, respectively.The Griffin
Search database contains materials that Westminster’s
library has access to, which gives access to academic
journals without needing to purchase a subscription. Access
of information at low to no cost is preferred. With the use of
keywords and process of elimination, accurate and relevant
articles were found on the research topic. Keywords
included but were not limited to: “ADHD”, “Attention
deficit disorder”,”Adolescence”, “teenager”, “young
adult”,”Medication”, “Pharmacologic”. Articles chosen are
all within the last 10 years. Due to the fact that this project
is a systematic review in essence, project specificity was
determined by research gathered.
. https://pediatrics.aappublications.org/content/144/4/e20192528
Ian Shenk, WCSN
Tiffanie N. Tran, WCSN
Mariah Cardon, WCSN
Westminster College of Nursing
Introduction
ADHD is the most common neurodevelopmental disorder diagnosed in childhood. Multiple studies have analyzed different
ADHD treatment methods amongst youth. This problem is relevant to parents, medical professionals, and any caregivers for
children due to its high prevalence in the population. In 2016, it was estimated that 6.1 million children ages 2-17 have
received an ADHD diagnosis in their lifetime (Danielson et al., 2018). Questions have arisen: what is the best method of
treatment for ADHD in youth? It is important for current and future medical professionals to understand the treatment options
available for ADHD in order to educate and provide information for concerned family members. Additionally, diagnosis
affects an increasing proportion of adolescents each year. Incorrect recognition, diagnosis, and treatment would have quickly
escalating, systemic effects on society as a whole.  Finally, for the future of ADHD management, it is essential for healthcare
providers to know the possible treatment available to recommend to ADHD patients and their family as well as educate on
the effectiveness of the treatment. This study aims to understand the treatment plans available, pharmacological versus non-
pharmacological management, and determine the most effective treatment based on current research evidence in children
under the age of 18.
Literature Review
Through the reviews of articles the following was found:
• In a single site, randomized, double-masked inpatient trial by Brown and
colleagues that the length of opioid treatment with methadone was
significantly shorter than that with morphine, 14 days compared to 21 days,
respectively. A limitation of the study is the small sample size at a single
site, which makes it difficult to generalize the findings. [2]
• In a multisite, randomized, double-blinded trial of NAS, Davis, and
colleagues found that treatment of NAS with methadone was modestly
Nursing Implications better than treatment with morphine. The study concluded that methadone
was associated with a 14% reduction on the mean number of hospitalization
Medical professionals should be aware of ADHD due to its high days,16% reduction in the length of treatment and required secondary
prevalence and its impact on patients and their families. Because of
medications to control symptoms less frequently than those treated with
its high prevalence, it is likely that a nurse will encounter a patient
morphine[3].
with ADHD diagnosis and should assess if their treatment regimen is
effective. Treatment for ADHD needs to be evaluated over time and • Tolia and colleagues' results reached similar conclusions to the first two
should involve pharmacological and non-pharmacological studies. The primary focus of the study was the relationship between the
interventions to reach optimal dosing and maximum benefit. Once the
length of stay and pharmacotherapy used. Methadone treatment was
treatment regimen has been evaluated to be effective, it should
associated with a 22% shorter median length of stay, a 19% shorter median
continue throughout childhood and as needed into adulthood as
NICU stay, and less likely to require two medications.[10]
approximately half of ADHD cases persist past adolescence (Ricci et
al., 2017). The nurse can assist parents or guardians to advocate for • The retrospective study conducted by Young and colleagues found that oral
their child to receive developmentally appropriate education and morphine sulfate had a reduced length in the NICU and hospital stay, length
accommodations for their needs from the public school system (Ricci of treatment, and total cost of treatment for NAS. It found that the neonates
et al., 2017). The nurse can also educate patients and families about
treat with morphine average hospital stay was 12.08 days versus 44.23
ADHD and help assess whether management should be reevaluated
by a provider. average days with methadone treatment. The length of treatment was also
found to be shorter in the morphine-treated neonates 7.46 days versus 38.08
days. Two limitations of this study recognized were the small sample size,
and the methadone-treated group did not have a standard protocol. [11] 
• The final study reviewed was a retrospective, cross-sectional study to
determine the median initial dosing for methadone and morphine and the
influence it has on symptom control based on the Finnegan score in
neonates with NAS. There was no difference between the two when it came
to dose adjustment times and time to symptom relief. The only difference
the study found was the frequency of dosing, and those receiving
methadone required less frequent dosing. [7]
Conclusion
Based on the data found combined therapy provided the
best treatment outcomes for kids with ADHD. Integrating
behavioral therapy with drug therapy resulted in equally
beneficial results and lower medication doses for
adolescents compared to drug therapy alone for ADHD.
For young children, it is recommended to start with
behavioral therapy because many psychostimulant
medications are not labeled as approved for use under the
age of 6. However for adolescence, the CDC states there is
not yet enough information to recommend soley behavioral
therapy because not enough research has proven that it is
more effective in treating ADHD symptoms as
pharmacological interventions alone. In conclusion, the
best way to optimize treatment is by integrating behavioral
therapy and low dose psychostimulants to start. Further
research is needed to analyze the possibility to wean the
child off of psychostimulants after.
Limitations
This systematic review was conducted with information free to the public. No
financial support was used in the access of materials or research. This can be seen
as an advantage in that the information is public domain. Any research requiring
subscription or payment was not reviewed which limited the pool of information
available. In addition, this research was conducted at a bachelorette level. Further
evaluation as new research evolves is highly recommended. The material and
conclusions presented here are meant to serve as a beginning summary to the
diagnosis and treatment of ADHD.
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https://doi-org.ezproxy.westminstercollege.edu/10.1542/peds.2019-1682