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A new report from the Centers for Disease Control and Prevention looks at the best way to treat young children with attention-deficit/hyperactivity disorder, also known as ADHD. The new studies provide strong evidence that not only is behavior therapy effective and it works without the side effects of medication —it's the better first step.
ADHD is a biological disorder that causes hyperactivity, impulsivity and attention problems in children. Currently, there are two million children who are diagnosed with the disorder before the age of six and the vast majority of them are treated with medication.
The findings are from a recent landmark study by psychologist Dr. William E. Pelham, director for the Center of the Children and Families at Florida International University.
Pelham and his team studied children with ADHD who were treated first with medication then with behavioral therapy. He compared them with children with ADHD who started first with behavioral therapy, then were treated with ADHD drugs, if needed.
The results, published as two studies in the Journal of Clinical Child and Adolescent Psychology, found that treating children first with behavior therapy may take time and effort but it works better, lasts longer and is even more cost-effective than treating with ADHD medicine first — even when drugs are added later.
We asked Pelham for five things every parent needs to know about ADHD.
1. Parents need training, too
Dr. Pelham recommends that once a diagnosis of ADHD is made, parents should find a therapist who not only can help the child but also give them learn helpful parenting strategies and tools to treat the disorder in real life settings.
“Talk therapy by itself is useless,” Pelham states. Parents need to get out of the office and implement simple strategies that don’t involve yelling or screaming if the child is acting inappropriately. For example, tactics like “time-out” work when a child is acting out – and praise works as a reward when the child is acting well-behaved, parents should reward and praise the behavior.
2. Schools are key
Schools also play an integral role in behavioral therapy.
Teachers can use the same sorts of strategies as parents to help diagnosed children, such as using “time-out” for any rule-breaking behaviors in school as well as reinforcing positive actions.
In Pelham’s study, teachers sent a “daily report card” that documented the child’s behavior for the day, and parents collaborated by rewarding good school performances at home.
3. Play better to live better
Teaching the child skills to get along better with other children, making friends, learning how to participate in sports activities are fundamental and essential skills that are part of behavioral therapy. The added benefit is they come without the side effects of ADHD medications.
4. Know the goal
“The goal of treatment is not to reduce the symptoms of ADHD, but to improve the problems in daily life functioning that brought the child to the parents, teachers, and professionals in the first place, “Dr. Pelham states. In his study, he and his researchers found that medication may help children pay attention, but it doesn’t help with every day activities and responding to daily life challenges at home or at school. In addition, behavioral therapy teaches life-long skills to parents, teachers, and children.
5. The first step is not ADHD meds
“Medication should be used at best as an adjunct to behavioral therapy. Providing medication as a first line treatment undermines the parent’s motivation and willingness to engage in behavioral treatment” Pelham says.
Children with ADHD may still need medication, but often, this is a lesser amount that would have been required, which likely means fewer side effects.