Contrary to popular thinking, medications for child attention deficit disorder (ADHD) are not always the best first-line treatment. Instead, parents should seek out behavioral treatments according to new research presented this past weekend at the annual convention of the American Psychological Association.
That’s because while medications address ADHD symptoms such as restlessness and fidgeting in a classroom, they don’t address the impairments caused by ADHD. Those include a lack of successful interactions with peers, deficits in reading and math skills, and difficult relations with parents and family members.
Behavioral interventions are not just one-to-one general psychotherapy. They are targeted, specific techniques targeted at the problematic behaviors commonly associated with attention deficit disorder — impulsivity, inattentiveness and hyperactivity. There are over 175 studies showing the effectiveness of these techniques.
But perhaps most controversial is the recommendation to also include parent training in child ADHD treatment. Why should parents also need help if the ADHD is a problem with their child? William Pelham, the lead researcher presenting at the APA convention, suggests these reasons:
Parents of ADHD children have significant stress, psychopathology, and poor parenting skills
ADHD children contribute greatly to parental stress and disturbed parent-child relationships
Parenting styles characteristic of ADHD parents predict long term negative outcomes
Parenting mediates most negative outcomes and needs to be the main focus of intervention
So what are some behavioral interventions parents can try out in the home? Pelham suggests the following:
- Rules for the home
- Ignore mild inappropriate behaviors and praise appropriate behaviors (choose your battles)
- Appropriate commands:
- Obtain the child’s attention: say the child’s name
- Use command not question language
- Be specific
- Command is brief and appropriate to the child’s developmental level
- State consequences and follow through
- Daily charts (e.g., School, Home Daily Report Cards)
- Premack contingencies (e.g., watch TV or phone time contingent upon homework completion)
- Time out from positive reinforcement/work chores
- Point/token system with both reward and cost components
- Level system
- Homework hour
- Contracting/negotiating with adolescents
While these techniques might seem common-sensical or obvious, many parents don’t know how to give their child a proper time-out or have ever considered using a point or token system to reward positive behavior (which has been proven time and time again in the research to be very effective in modifying child behavior).
In combination with psychotherapeutic behavioral interventions, you can treat many children (if not most) with these techniques and keep medication to a minimum. Some children can even be treated for ADHD without any medication whatsoever.
Michael Phelps, the USA Olympic-gold swimmer, was diagnosed with ADHD as a child. After taking medications, he chose to discontinue them and worked on his symptoms on his own.
Read the full article: Therapy as First-line Treatment for ADHD
View the ADHD slideshow (PDF) from lead researcher William Pelham
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15 Comments to
“Non-Drug Alternatives for ADHD Proven Effective”
It’s about time someone did something to help the parents. In the 13 years I dealt with kids with ADHD I wished that we could do something with parents. Often their personal tool box was empty and they were not being trained to reinforce the benefits the child was experiencing in vision therapy. And, speaking of vision therapy, the College of Optometrists in Vision Development (http://covd.org/) offers an incredible amount of non-drug help for both children and adults who suffer with this problem.
We’re doing 90% of what Pelham suggests – the only one that doesn’t work is homework hour. If the meds aren’t on board, the day is shot to hell.
I think that the reasons stated: poor parenting, psychopathology in the parents & stress are an oversimplification & misleading evidence for the cause of ADHD. While I agree that behavioral strategies need to be implemented, those mentioned are appropriate for all children. With children, any behavioral intervention should include the parents. It should also be mentioned that parenting these children may be more difficult as there is usually other disorders associated with ADHD, such as Oppositional Defiance Disorder or Depression/anxiety to name two of many.
You know I have used psychotherapy for most of my adult life over 20 years intermittently, it has proved to be a very successful method for me. I have also attend Al-Anon in the past and this program has done the most for me in dealing with life and people and its free. I have taken meds for a bit but now am not and the meds didn’t do as much for me as the therapy did. I would strongly reccomend this to anyone, but I wish that more life coaches were available to persons with ADD or ADHD in supporting us in our home to create more organized lives. My counselor doesn’t come into my home. Thanks.
BJ
I have a friend whose son shows abnormal behavior patterns like ADD. He is rude, spits on people, pinches and kicks them as well. How does one convince the parent that it is not acceptable? Which parent really wants to acknowledge the fact that they are also partly to blame?
ADHD coaching is an excellent way helping high school and college students to stay on track. Many adults with ADHD also use it. It can be done by phone, 1/2 hour per week with daily email support to keep on track with personal goals.
The Edge Foundation (www.edgefoundation.org) is a non-profit that trains coaches on the special concerns of adolescents and young adults. They have coaches ready to help you.
It’s not cheap ($75/session) but it can be less costly than the long term impact of failing at school!
Hope people will check it out!
I don’t think ADHD is caused by parents with poor parenting skills. I thik parents become this way because of having to deal with ADHD. I think I’m a good mom, but dealing with this day in and day out can make even Nanny 911 lose her wits at times.
This could be taken as a somewhat transparent attempt to preserve therapists’ market share with respect to ADHD clients.
Several problems:
ADHD is the most genetically-driven Psychiatric Disorder that we know of. Many families with an ADHD child or teen will also include at least one parent with similar clusters of social, focus and problem-solving/Executive Function problems (R. Barkley, 2006). The supposition that most Disorganized Parents of ADHD offspring will be able to consistently execute and track complex and structured home programs is questionable. We should have learned some lessons from previous struggles by parents afflicted with cognitive inefficiencies who have attempted in vain to successfully run Token Economies in their homes.
With young ADHD clients it is not usually an issue of teaching children and teens what to do, but rather an issue of having consistent home and school environments that can cue them on when they should emit adaptive target responses. There also needs to be enough supports to ensure that clients emit enough repetitions of new adaptivie responses in order to ensure that they have been truly mastered their new skills. It can also be hard to predict when such children will “get it” and thus be able to provide relatively adaptive response patterns on their own. Sometimes they might not “get it” for a while, and may need to be managed by continuous and externally-imposed environmental structuring.
In general, people with ADHD know what to do, but cannot retrieve and execute what they know – when they actually need to execute what they know. In other words, people with ADHD know what to do, but have problems with doing what they know.
For many young clients, especially those with a challenged parent(s), the appropriately titrated Medication portion of a treatment plan might reduce the extent of their needs for consistent adult responding in their home settings.
Given a real shortage of adequately trained and supported teachers, a well-done medication element for a given child might also be helpful at school, as it often is.
In summary, there needs to be individualized treatment plans for clients, that must require careful and complete diagnostic protocols, carefully-titrated Medication elements when called for, and Behavioral/ Cognitive-Behavioral interventions for most clients. Sometimes, the overall treatment plan might also benefit from having Coaching-like elements that can provide relatively frequent support contacts for especially challenged family units and/or members.
It’s important not to overlook the impact that teachers can have on children. They spend several hours with them every day. Even if parents are adequately doing their job managing challenging symptoms at home, if the school has inadequately trained staff implementing mostly negative feedback to the child and ignoring good behaviors (because they feel they’ve already given the child too much attention) then it’s an uphill battle. The APA would do well not to leave the impact of teachers on children out of the equation.
I understand this is a discussion between psychologists but I would like to introduce my two-cents comment on neurobiology. ADHD, in my humble opinion, is no different from Parkinson Disease (PD) or Diabetes Mellitus (DM) in regard to its etiology.
Following this idea, you can use your best set of therapies or to point a gun at the head of a person with PD in an attempt to stop him or her from shaking (or a diabetic to normalize the blood sugar)and your efforts will surely fail.
The found “improvement” of symptoms reported by the author can be understood in the context of the exaggerated prevalence of ADHD. I refer the reader to my commentary The Crisis of Overdiagnosed ADHD in Children” published by http://www.psychiatrictimes.com in July of 2007. In a few words, my clinical experience shows that 8 out of 10 patients diagnosed as ADHD have something else.
Manuel Mota-Castillo, M.D.
Assistant Clinical Professor
St. Matthews University Medical School
Orange City, Florida
(As of June of 2007 I have no ties with any pharmaceutical company)
This is an interesting blog. Numerous studies have correlated the consumption of wheat and dairy with ADHD. Often the children are sensitive to gluten and casein (the protein -antigenic- components) and are reacting adversely to common foods, not ADHD.
Now the challenging part of finding affordable, hypo-allergenic replacements for those foods…
There is a lot of information out there (case studies, research studies) that demonstrate the effectiveness of chiropractic care for ADHD. Rather than just addressing symptoms, chiropractic attempts to eliminate the cause of ADHD – which is usually nerve interference caused by spinal misalignments in the upper cervical spine. Chiropractic adjustments restore nervous system integrity by correcting misalignments, allowing the body to heal on its own, without dangerous drugs with risky side effects.
Just Google “Chiropractic and ADHD” for more information. Let’s stop treating our children with drugs that may have short and long-range effects. This is a nation of “a pill for everything” and all they do is alleviate symptoms in the short-term, they don’t correct causes for a long-term cure.
I disagree when it says parents with children of ADHD have bad parenting skills. My son was just diagnosed this past month and many things mentioned above we do 8 out of the 10. I absolutely agree with parents taking psychotherapeutic behavioral interventions. I have not yet taken mine but, will start a 8 week class once a week. I am really exicited to learn techniques and new ways of how to deal and help my son cope with the problems he is having. I think it is very important that parents be invovled rigth now, I am at the point of trying alternatives rather then just giving him medication. I will post back to update and give input to how it helped me and my son. Thanks!
My daughter has Adhd . My wife is very Pro med.(concerta).I dont like it.I am very weary of meds. unless it is absolutely needed.I would much rather try a non-drug alternative.The concerta worked at first, but now not so much. My wife wants to ask Doc. to up the dosage. I disagree, I just want her off it and dont want a catatonic kid. It makes it an uphill battle when Doc,wife ,teachers,drug companies try to sell you on it. Of Course the teachers at school recommend the drug,it makes the child more docile and easy to deal with ,but what about the long term effects.Im not a doc.and not very highly educated. I am just concerned about my daughters long term health.I am her only advocate. Her mom has her convinced she can not achieve with out this drug. I also know these drug companies push the doctors to prescribe and sell these drugs. Its all about the money.They have a drug for everything now and there is always some side effect.
Patrick and group…
My son has just been diagnosed with ADHD and I too am worried about giving him drugs. He has a heart condition that will probably mean he can’t take the medication anyway, so I am now looking for alternative non-drug treatments. Have you (or has anyone on this board) had any success with that??
Patrick, keep being your daughter’s voice. Don’t give up trying to find other solutions. You are not alone!
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Last reviewed: By John M. Grohol, Psy.D. on 19 Aug 2008
