Is homeopathic treatment as an effective intervention for children with a diagnosis of Attention Deficit Hyperactivity Disorder (ADHD)?

How to demonstrate Homeopathic effectiveness is an ongoing question. Pragmatic trials have high external validity, representing homeopathic treatment as it is practised in real life, and may provide a solution. Two studies provide examples.

A consecutive case series investigated whether homeopathic treatment is effective for children with ADHD. Twenty children received adjunctive homeopathic treatment and were compared with ten children not receiving homeopathic treatment at baseline and after 24 weeks, on DSMIV characteristics (Conner's Parent Rating Scale - CPRS) and a self-selected-item scale (Measure Your Own Medical Outcome Profile - MYMOP).

An analysis of variance (ANOVA) found a significant interaction between time and the treatment received. A long term analysis of treated children after one year found that they continued to improve, with half the participants registering improvement in their DSMIV scores of over 10 points. Different methodologies were explored to ascertain optimum treatment protocols, and CEASE methodology proved especially effective for these children. It was found that remedies often needed repeating to retain effectiveness. This suggested obstacles to cure. CEASE proved effective at removing obstacles after which constitutional remedies needed repeating less often, and their effectiveness was enhanced. Despite the small sample size, this study suggests that homeopathic treatment is an effective intervention for children with ADHD. However limitations such as lack of randomisation, blinding and unequal sample sizes mean results have limited generalisability.

A Pragmatic Randomised Controlled Clinical Trial is being designed to enhance and develop the findings of the above Case Series and provide more powerful and robust evidence. The aim of the trial is to evaluate the comparative clinical and cost effectiveness of adjunctive treatment provided by homeopaths for children with a diagnosis of ADHD, in comparison to standard care alone.

Key elements of the design include the retention of the totality of homeopathic treatment; a control group receiving standard care; equal sample sizes of adequate power; random distribution of groups; groups representative of the ADHD population; homeopathic treatment undertaken by several homeopaths in several locations; evaluation of clinical and cost effectiveness using appropriate outcome measurements reflecting the requirements of stakeholders; and allowance of sufficient trial time to detect results. These studies into homeopathic effectiveness for ADHD are the first pragmatic studies comparing the totality of the homeopathic intervention with usual care. They build on the work of Frei (2005) and Lamont (1997) who demonstrated the effectiveness of Homeopathic remedies for children with ADHD; Jacobs (2005) who demonstrated the effectiveness of remedies and the clinical intervention. A systematic review recommended studies of 'homeopathy as it is practised by homeopaths ie pragmatic trials.