Abstract 

This literature review studied the effects and results of using pharmaceutical versus 

non-pharmaceutical treatments for ADHD. Background research was done on the types of 

treatments available. Among the pharmaceutical treatments, stimulants containing Amphetamine 

such as Adderall, Dexedrine, and Ritalin (methylphenidate) are very common for treating 

ADHD. Treatments such as Ritalin focus on increasing the amount of neurotransmitters in the 

brain in order to increase the activity of the brain circuits to control unfocused thought processes. 

Sedative drugs such as Benzodiazepines are central nervous system (CNS) depressants which 

help to slow down activity in the CNS. Non-pharmaceutical treatments observed included 

behavioral therapy, neurofeedback, dietary restriction, biofeedback, natural supplements, and 

intense exercise. Based on the background research, it was hypothesized that if a literature 

review studies the effectiveness of pharmaceutical and non-pharmaceutical treatments for 

ADHD, then using non-pharmaceutical treatments in conjunction with low doses of 

pharmaceutical treatments would be most effective. The evidence that led to this prediction came 

from numerous studies that found combination treatment to be highly effective. A total of 16 

studies were collected and analyzed to assess the overall effectiveness of various treatment 

options in addressing ADHD symptoms. Treatment side-effects as well as specific areas of 

improvement were also analyzed. It was seen that 8 out of 10 pharmaceutical treatments were 

effective compared to 8 out of 9 non-pharmaceutical treatments. Chi-squared tests were 

performed and it was seen that there was not much of a difference in the effectiveness of ADHD 

treatments when comparing pharmaceutical to non-pharmaceutical approaches Two more 

chi-squared tests were undertaken to determine whether statistically significant differences in 
effectiveness exist between pharmaceutical treatments compared to combination treatments and 

similarly between non-pharmaceutical treatments compared to combination. However, in both 

cases, the null hypothesis was accepted based on p-values greater than .05.Consequently, the 

hypothesis that a combination treatment would be most effective for treating ADHD was not 

supported. The results of this study show that one specific treatment for ADHD is not much 

better than the others, and,while all three treatments proved to be somewhat effective, further 

research needs to be done to find more highly effective treatments. The fact that pharmaceutical, 

non-pharmaceutical, and combination therapies did not show significantly different outcomes 

points to a positive result for patients, who may feel empowered by having legitimate choices 

about how to treat their ADHD symptoms. 

 Introduction 

Which is a more beneficial ADHD treatment, a pharmaceutical treatment, a 

non-pharmaceutical treatment, or a combination of the two? 

Attention Deficit Hyperactivity Disorder (ADHD) is a disorder caused by the imbalance 

of chemical neurotransmitters in a person’s brain. Many sufferers of ADHD tend to act on 

impulse and not think about the consequences. Symptoms of ADHD include forgetfulness, 

hyperactivity, disorganization, not completing tasks, , lack of focus, and possessing irregular 

sleeping habits. (Evans, 2001). Sleep and ADHD are very much interconnected. Additionally, 

certain medications used in the treatment of anxiety and attention deficit disorders have side 

effects which disrupt a person’s sleep and can cause sleep apnea. (Owens, 2009). At least 25% of 

people diagnosed with ADHD are at an increased risk for sleep-related breathing issues. Studies 

have found that 50% of children with ADHD have breathing issues during their sleep (Cherwin, 

Sleep Foundation). 

The symptoms of ADHD can lead to poor social skills, poor academic performance, 

isolation, and dependence on others to help with basic functioning (Cherwin, Sleep Foundation). 

Depression, stress, and anxiety are also linked to diagnosis with ADHD, either as a potential 

cause or a side-effect of the disorder. Because ADHD is connected to feelings of anxiety and 

restless sleep, it is important to consider the possible treatments for anxiety and sleep as possible 

treatments for ADHD (​Bhandari, 2016). 

ADHD is often treated with a pharmaceutical, usually a stimulant medication. Stimulant 

drugs are able to excite functions in the Central Nervous System (CNS), and thus promote 

alertness and an elevated mood (Evans, 2001). Used extremely commonly in ADHD treatment 
protocols, these drugs seem to benefit 70% of ADHD patients who use them. Amphetamine is 

one of the most commonly used active ingredients in ADHD medication. Amphetamine can be 

found in medications such as Adderall, Dexedrine, and Methylphenidate. These stimulant 

medications trigger an increase in the amount of the neurotransmitters dopamine and 

norepinephrinein brain. As a result, more neurotransmitters increase the activity of brain circuits 

which is able to alleviate the unfocused brain activity commonly seen in ADHD sufferers. 

However, this medication does come with strong side effects for many users, including insomnia, 

low appetite, and feelings of anxiety. These stimulant treatments have short-term effects on 

people, which usually only last a few hours (Palombi, 2009). Not all stimulant medications prove 

to be helpful. In some patients, non-stimulant medications appear to work better with fewer 

side-effects. Non-stimulant medications such as atomoxetine, clonidine, or guanfacine may be 

better alternatives in such cases. (WebMd, Healthwise). 

Along with ADHD medications that treat symptoms of the disorder, other medications 

which address the underlying causes of ADHD may also be useful in curing ADHD altogether. 

The leading symptoms of ADHD,trouble focusing, short attention span, hyperactivity, and poor 

organizational skills, all are also leading factors in cases of stress and anxiety (Evans, 2001). 

Stress and anxiety in ADHD patients can lead to a variety of secondary health problems, 

including Tourette’s syndrome, anxiety attacks, fibromyalgia, and chronic pain (​Bhandari, 2016). 

In some cases, taking medication for stress and anxiety has proven beneficial in mitigating 

ADHD symptoms. Anxiety medications, which include sedatives (CNS depressants), 

Benzodiazepines, and Bupropriond, affects an area of the brain that also contributes to ADHD 

symptoms (Mills, 2008). 

 Along with Pharmaceutical treatments, non-pharmaceutical treatments are also possible 

treatment options for ADHD sufferers. Behavior therapy is a very common treatment option 

which is quite often used alongside the use of pharmaceutical treatments. Behavior therapy is 

when children with ADHD learn various methods of attention-regulation, including 

problem-solving, communication, and self-advocacy skills (WebMd, Healthwise). This kind of 

treatment is also seen as helping root causes to ADHD such as anxiety and stress. Behavior 

treatment for students can also entail learning note-taking, social, and problem solving skills 

(Evans, 2001). Just as stress and anxiety pharmaceutical treatments may be helpful in treating 

ADHD, so too are the non-pharmaceutical treatments.  

Cognitive behavioral therapy, Psychodynamic therapy, meditation, a healthy diet, 

Hypnotherapy, Biofeedback and sound therapy are all non-pharmaceutical options for 

anxiety-driven ADHD sufferers. Cognitive Behavioral Therapy (CBT) is a self-instructed 

training which helps to develop a more reflective approach to thinking and behaving. It is a 

goal-oriented approach to everyday situations and problem-solving (such as in school). Other 

behavioral therapies include parent-led behavioral therapy and classroom-based behavioral 

therapy. Parent-led behavioral therapy informs parents of ADHD sufferers of how they can help 

their children through therapeutic and behavior management skills. Classroom-based behavioral 

therapy combines behavior modification and cognitive behavioral techniques. It is specifically 

geared towards informing teachers about how to help students with ADHD. Neurofeedback 

involves computer-based exercises which give feedback on the progress one has made 

augmenting their attention levels. As a patient is doing the exercises, an electroencephalogram 

monitors the efficiency of their brain behavior (Mills, 2008). 

 A few studies have looked closely at the effects of pharmaceutical, non-pharmaceutical, 

and combination therapies for ADHD. In one experiment, ADHD teens completed a behavioral 

therapy treatment program alongside taking low doses of stimulant medications. The study 

subjects were 40 boys and 5 girls in a summer program at the University of Pittsburgh. Along 

with receiving a behavioral treatment plan, children also received either 10, 20, or 30 mg of a 

stimulant or placebo medication. Results showed that around two-thirds of teens, those taking a 

low dose of stimulants, improved abundantly in their academics. Only one sixth of students, 

those taking a 20 mg dose (higher dose of Ritalin), showed improvement. The study concluded 

that the combination of both stimulants and behavioral treatment led to the greatest 

improvements in the student subjects. (Evans, 2001). Another experiment compared the 

effectiveness of seven non-pharmaceutical treatments, including behavior modification, 

Neurofeedback therapy, school-based programs, and parental training. Out of all the 

non-pharmaceutical treatments, behavior modification and neurofeedback proved to be the most 

effective at treating ADHD (Evans, 2013). 

Based on this literature review, it is hypothesized that a comparison between the 

effectiveness of pharmaceutical and non-pharmaceutical treatments for ADHD will reveal that 

non-pharmaceutical treatments taken together with low doses of pharmaceutical treatments will 

produce the greatest benefits for patients. Pharmaceutical treatments have proven to be helpful to 

70% of ADHD sufferers(WebMD, Healthwise); however, symptoms such as fatigue and 

insomnia could also lead to more serious side effects, including anxiety and depression. Also, 

many pharmaceutical treatments, specifically stimulants, are not very long-lasting, treat only 

symptoms rather than underlying causes, and do not actually cure ADHD (Palombi, 2009). 
Non-pharmaceutical treatments, such as Cognitive Behavioral Therapy and other forms of 

therapy focus on ridding stress and anxiety, which in some cases represent the root causes of 

ADHD (Mills, 2008). Because specific pharmaceutical treatments oriented towards anxiety and 

stress are similarly short-acting, they possess some of the same limitations as the stimulant 

treatments in terms of treating symptoms rather than root causes.  

In this study, the procedure will include reading research articles and evaluating existing 

published data on the effectiveness of ADHD treatments. Evidence of the effectiveness of 

pharmaceutical treatments will be compared to evidence of the effectiveness of 

non-pharmaceutical treatments. Evidence of the effectiveness of combination therapies will also 

be collected and evaluated. Side effects, including rates of depression and anxiety, will also be 

studied comparatively across the three treatment types: pharmaceutical therapies, 

non-pharmaceutical therapies, and combination therapies. By comparing the effectiveness and 

relative side-effects of the various treatment types, it will be possible conclude which treatment 

option is most beneficial to the overall wellbeing of patients with ADHD.   

 
 Experimental Design 

Material List 

● 10 or more primary sources (data tables, graphs) with published data as to the 

effectiveness of the three types of ADHD treatments:  

○ Pharmaceutical treatments 

○ Non-pharmaceutical treatments 

○ Combination treatments  

● Pencil 

● Laptop (for sources, statistical tests, and data analysis) 

● Science journal 

Procedure 

1. At least 20 sources of experiments must be collected, reviewed and summarized for 

treatments of ADHD including pharmaceutical, non-pharmaceutical, or using both. 

Summary includes treatments used, on what group of patients, long term/short term 

results and effectiveness, and as well as side effects. 

2. Raw table should be made of these results of the outcomes of pharmaceutical and 

non-pharmaceutical treatments. 

3. Chi squared tests will be done in order to see if there is a significant difference between 

the effectiveness of pharmaceutical and non-pharmaceutical treatments. 

4. Results of tests will be recorded and displayed through formal tables 

5. The specific types of treatments used in studies for pharmaceutical and 

non-pharmaceutical treatments will be displayed in a pie chart.  

6. Also, the negative side effects of the treatments will also be displayed through a pie chart 

 
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 Discussion and Conclusions 

In this investigation, the hypothesis​ ​if a literature review studies the effectiveness of 

pharmaceutical and non-pharmaceutical treatments for ADHD sufferers, then using 

non-pharmaceutical treatments in conjunction with low doses of pharmaceutical treatments 

would be most effective, was not supported in a statistically significant manner. The p-value 

comparing the effectiveness of non-pharmaceutical and pharmaceutical treatments was not 

significant at p < 0.05 and therefore the null hypothesis was not rejected. When the null 

hypothesis is not rejected it indicates that there is not a significant difference in the positive and 

negative effects of both pharmaceutical and non-pharmaceutical treatments. Despite the fact that 

2 pharmaceutical treatments were seen as not very effective compared to 1 non-pharmaceutical 

treatment that was seen as not very effective (Table 1), the chi-squared test does not show a 

statistically significant difference between pharmaceutical and non-pharmaceutical treatments.  

Despite the statistically similarity of the different treatment options, it is worth noting the 

side effects from certain pharmaceutical treatments listed in the raw data table, including high tic 

severity, insomnia, and headaches. Even though the chi-squared test shows that overall 

throughout all 16 experiments analyzed, statistically both pharmaceutical and 

non-pharmaceutical treatments showed equal effectiveness in treating ADHD, the side effects of 

pharmaceutical treatments must be considered in discerning what is holistically in the best 

interest of the ADHD patient.With nearly equal effectiveness, such results allow sufferers of 

ADHD to choose between taking a prescribed medication such as methylphenidate and 

Dextroamphetamine, or an alternative treatment such as cognitive behavioral treatment or 

behavioral management treatment (figure 6 and 7). These options are especially helpful if the 

side effects have a negative effect on the patient’s overall health.  

Along with testing the comparative effectiveness of pharmaceutical and 

non-pharmaceutical treatments, the comparative of effectiveness of non-pharmaceutical and 

combination treatments was also tested. Between the two categories of testing, both 

non-pharmaceutical and combination treatments treated children with ADHD while one study 

from each category focused on ADHD in adults. There were 5 very effective non-pharmaceutical 

treatments and 4 very effective pharmaceutical treatments;however, the p-value of the test was 

not significant (based on the p < 0.05 standard) and therefore the null hypothesis was not 

rejected able 2). Similarly, the null hypothesis was again not rejected when comparing the 

effectiveness of pharmaceutical and combination treatments (Table 3). These results show 

that,contrary to widely held beliefs by medical experts that the best treatment for ADHD is a 

combination of pharmaceutical and non-pharmaceutical treatments, the statistics of these studies 

suggest otherwise (Mills, 2008). 

The results of a combination treatment not having superior effectiveness for ADHD 

patients was quite shocking, because it was seen that both pharmaceutical and 

non-pharmaceutical treatments are created to more effectively prevent ADHD behavior. For 

example, a study was conducted in which a combination of intensive behavioral treatment 

(non-pharmaceutical) and medication management (pharmaceutical) was used on children 

diagnosed with ADHD between the ages of 7 and 14. The study found that this combination 

treatment was extremely effective in improving the areas of social skills, family relations, and 

reading (Strain, 2006). Such results are expected because moderate dosages of pharmaceutical 
treatments such as methylphenidate are best known for providing individuals with enough 

dopamine and norepinephrine in their system (Healthwise, 2015). Also, intensive behavioral 

treatment focuses on educating children to outgrow their ADHD symptoms by specifically 

helping them to overcome anxiety and mood disorders which often result from ADHD (Miller, 

2015). 

The results of the chi-squared tests show that pharmaceutical as well as 

non-pharmaceutical treatment enthusiasts and innovators must re-evaluate the actual positive 

effectiveness of their treatments. While it has been analyzed through the raw data table and 

shown through Tables 1, 2, and 3 that most pharmaceutical, non-pharmaceutical, and 

combination treatments are highly effective in treating ADHD symptoms such as behavior, 

emotion, family relations, auditory and visual response and attention (table and figure 4), not one 

single type of treatment is seen as significantly more helpful than the other treatments. Even 

though many treatments are successful, most treatments have not been fully studied for possible 

long-term negative physical or emotional effects, especially in developing children. Despite the 

success of possible pharmaceutical and non-pharmaceutical treatments, scientists must be able to 

innovate a highly effective treatment which is able to tackle ADHD without the slow 

effectiveness, harsh side effects, and short-term usefulness that many current treatments offer. 

This study brings to awareness that treatments of ADHD must be much further studied and 

improved. ADHD changes the course of a child’s life and can become very dangerous when it is 

carried out through adulthood; it can make finishing tasks extremely difficult and can lead to 

other severe disorders such as ODD, anxiety, depression, and dyslexia (Healthwise, 2015). It is 
very important that a treatment or even a cure is found which proves to be the most effective for 

all age groups suffering from ADHD. 

The results of the chi-squared tests also provide positive outcomes. The fact that 

pharmaceutical, non-pharmaceutical, and combination treatments for ADHD all show very 

similar effectiveness allows for patients to decide what treatment they would like to depend on. 

This study demolishes the belief that an alternative method to medication is much safer and 

healthier for an individual than a pharmaceutical treatment. While such a stereotype may be 

reliable for other disorders or diseases, it is proved to not be the case for ADHD. While both 

pharmaceutical and non-pharmaceutical treatments have very successful effects on individuals, 

individuals may not need to be pressured to take prescribed medications, or use an alternative 

method. This could become very helpful to sufferers of ADHD who may not be able to afford 

expensive pharmaceutical treatments. Also, if an individual may experience side effects by 

substances in specific pharmaceutical treatments, they will always have the opportunity to use an 

equally effective non-pharmaceutical treatment. Having choices can feel empowering to parents 

of young children and patients of all ages. 

There were experimental errors observed in this literature review.​ Experimental errors 

included that the project did not focus on finding studies experimenting with one specific 

demographic group,since there were groups of young children, adolescents,and adults. 

Comparing studies of such varied groups of people could explain the varying effects of 

pharmaceutical and non-pharmaceutical treatments on individuals and calls into question the 

validity of statistical comparisons. Also, certain subjects tested also suffered from other illnesses 

such as tourette’s syndrome, which could also affect the outcomes of using pharmaceutical and 
non-pharmaceutical treatments(​Castellanos, 1997).​ Lastly,not enough studies were collected for 

each type of medication. The results would be more accurate if specific types of pharmaceutical 

treatments were assessed separately. 

As a result of the literature review, it was seen that both pharmaceutical and 

non-pharmaceutical treatments as well as a combination treatment provide equally effective 

results for ADHD sufferers. In the future, in order to find a specific treatment that would be far 

more effective, studies using antidepressants and anxiety medications for ADHD sufferers 

should be analyzed and compared to the medications specific for ADHD. Medications specific to 

depression and anxiety may prove to help far better with ADHD because depression and anxiety 

are thought of as possible side effects and, in some cases, causes of ADHD (Bhandari, 2016). 

Also, for further research, it would be interesting to focus on a certain brand of pharmaceutical 

treatment, or a certain method of non-pharmaceutical treatment, and to conclude whether certain 

treatments have varying effects on different age groups of ADHD sufferers. ADHD is a very 

prominent disorder especially among adolescents. The disorder can strongly affect the way in 

which children learn and grow. Permanent ADHD can also affect individuals for a lifetime. New 

technology such as Crossinology Brain Integration Technique allows doctors to locate areas of 

blockage in the brain for individuals with ADHD and doctors are able to correct the path of 

neurosignals in the brain as an alternative medicine approach (Beach, 2014). It would be 

interesting for the future to research the results and long-lasting effects of such treatment plans in 

comparison to established pharmaceutical and non-pharmaceutical treatments. Being able to 

evaluate and research the most effective pharmaceutical and/or non-pharmaceutical treatment for 

ADHD, people with the disorder will be able to receive the best knowledge as to what treatment 
would most improve the condition of their health. By effective, it is meant that the treatment is, 

for the most part, permanent with no harmful side effects and that the treatment actually tackles 

the symptoms of ADHD with enough strength to not have the treatment be of slow and gradual 

improvement.  

In conclusion, the results of this experiment indicate that the hypothesis, ​if a literature 

review studies the effectiveness of pharmaceutical and non-pharmaceutical treatments for ADHD 

sufferers, then using non-pharmaceutical treatments in conjunction with low doses of 

pharmaceutical treatments would be most effective, was not supported in a statistically 

significant manner. After chi-squared tests were performed, it was seen that the null hypothesis 

was not rejected for the comparison of pharmaceutical treatments and non-pharmaceutical 

treatments, nor was it rejected for pharmaceutical and non-pharmaceutical treatments compared 

individually to a combination treatment. Further research is needed and the results of this 

investigation indicate that there is great potential for improved outcomes for people living with 

ADHD as new treatments options are developed and studied.