Behavior Treatments First for Kids with ADHD?

Findings from a new study could change the way treatment is handled for children with ADHD. According to an article in The New York Times, two research papers published in the Journal of Clinical Child and Adolescent Psychology support using behavior techniques first, followed by medication for those who need it.

The study looking at the sequence of treatments for ADHD, “found that stimulants were most effective as a supplemental, second-line treatment for those who needed it—and often at doses that were lower than normally prescribed.”

Study Method

The study randomly assigned 146 children, ages 5 to 12 years old, to one of two groups: those receiving low-dose generic Ritalin, or those receiving no medication, but whose parents were trained in behavior modification techniques (e.g., rewards and consequences).

After two months, the yearlong study took an innovative turn. If a child had not improved, he or she was randomly assigned one of two courses: a more intense version of the same treatment, or an added supplement, like adding a daily dose of medication to the behavior modification. About two-thirds of the children who began with the behavior therapy needed a booster, and about 45 percent of those who started on medication did.

But the behavior-first group had an average of four fewer rules violations an hour at school than the medication-first group.

In a second paper comparing the cost of both approaches, behavior-first treatment was found to cost about $700 less annually.

These findings, if replicated, could change how children with ADHD are treated in the future. Yet the change in sequence from medication-first to medication as a second-line treatment raises other concerns: “I think this is a very important study, and the take-home is that low-cost behavioral treatment is very effective,” said Mark Stein, a professor of psychiatry and pediatrics at the University of Washington, “but the irony is that that option is seldom available to parents.”

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