CHADD members and others affected by ADHD are continually looking for ways to minimize the negative impact of ADHD symptoms on their own lives or the lives of their children. They are often bombarded by advertisements for assessment services, “treatments,” or other “interventions” that make claims that may or may not be supported by evidence-based research or clinical practice.
While CHADD does not endorse or promote particular assessments or treatment interventions, CHADD always looks to science in evaluating ADHD interventions. CHADD is committed to helping those making decisions for themselves or others evaluate important questions: Does this assessment tool do what it claims to do? Will this intervention make my/my child’s life easier, and help manage my/my child’s ADHD? Does it work?
CHADD encourages its members and others reviewing CHADD's publications to make these decisions in consultation with trained medical/mental health professionals who know the full medical/mental health history of the individual with ADHD and who have particular expertise and experience in diagnosing and treating ADHD.
There continue to be a number of emerging services, products, or interventions that are broadly called “alternative or complementary.” To assist CHADD members and the general public in making decisions, CHADD’s Professional Advisory Board (PAB) has developed a “Levels of Evidence” scale. CHADD’s Professional Advisory board will use this scale to provide a frame of reference for assessing whether, and to what extent, a specific service, program, product or intervention is deemed to be evidence-based for the assessment or treatment of ADHD symptoms.
The PAB will evaluate specific services, programs, products or interventions, as opposed to general approaches that include a number of specific assessments or interventions. A review of the broader literature will be included for consideration as background, and will be essential in order for a program to be considered as Level 2 (“Promising”) or 1 (“Evidence-based”).
To be clear, an intervention may be effective for an individual without having specific scientific evidence, and new interventions have not have had the opportunity to be researched thoroughly. At the same time, an intervention with solid research may not be effective for a specific individual. But we look to research to give us an independent evaluation of the effectiveness. Use this information and consult with your treating doctor to decide what will work best for you or for your family member.
It is important to note that in the following, the effectiveness of the intervention is considered with respect to whether or not it reduces symptoms of ADHD and/or functional impairment associated with ADHD.
CHADD’s 4-point Levels of Evidence Scale
Level 4: Non-evidence-based assessments and interventions1 are approaches without peer-reviewed, published evidence, or with inadequate evidence in peer-reviewed, published research. These clinical methods may use basic general principles that are evidence-based and may even have a positive effect on the symptoms of ADHD. However, the way they utilize such principles has yet to be systematically evaluated and tested. If the description of the assessment/intervention is not adequately specified, it will be assigned to Level 4. Additionally, if well-designed clinical trials have been conducted and the preponderance of the data indicate negative findings for the efficacy of the treatment, Level 4 should be assigned. In order to further explain the lack of evidence, Level 4 rankings will be subdivided as follows:
4.a: No peer-reviewed, published evidence
4.b: Some negative evidence not balanced by positive evidence
4.c: Substantial negative evidence
Confidence that the intervention will produce desired clinical outcomes is low, though they may have a positive effect in particular situations. While an assessment or treatment with this label may be effective, we cannot know that it is. Additionally, if well-designed clinical trials have been conducted and the preponderance of the data indicate negative findings for the efficacy of the treatment, Level 4 should be assigned.