Too Little Behavioral Therapy for Kids with ADHD
At the end of May, a JAMA report noted that the U.S. Centers for Disease Control and Prevention’s 2009-2010 National Survey of Children with Special Health Care Needs shows that about 43 percent of U.S. children and teens received only ADHD medications for attention deficit hyperactivity disorder (ADHD).
That compares to about 13 percent of those treated solely with behavioral therapy — the best, first-line treatment recommended by every professional treatment guideline and the American Academy of Pediatrics. About 31 percent of children in the survey received both behavioral therapy and medication (the second recommended treatment option).
So the least recommended treatment for children and teens with ADHD is the most commonly used. What’s going on here?
It gets even scarier when you look at how especially young children — under 6 years old — are being prescribed ADHD medications. Nearly 25 percent of children at these ages with ADHD were receiving medication — a practice few experts endorse. Another 21 percent received medication along with behavioral therapy — also generally not recommended at these young ages.
One of the problems comes from the way the mainstream media talks about ADHD treatment.
For instance, in this Washington Post article, “Still more questions than answers about how to treat ADHD”, author Arlene Karidis focuses on medication treatment for ADHD:
Some practitioners and researchers say drugs are by far the most effective treatment. Others argue that long-term drug use addresses symptoms only and does not provide important tools to help people manage their inattentiveness. They say it’s more helpful to focus on behavioral interventions, nutrition, exercise and special accommodations at school.
Nowhere in this article does the author mention that behavioral therapy (either combined with medication for older children, or alone for younger ones) is the primary recommended treatment for ADHD. Who says so? Well, beyond the research, we have the American Academic of Pediatrics, the National Institute for Health and Care Excellence (NICE), the American Academy of Family Physicians, among others.
Instead, the author promotes a biased treatment guide developed by two psychiatric professional associations. You know, the same professionals whose primary treatment method is to prescribe medications.
There remain significant flaws in the ADHD research literature, especially when it comes to long-term side effects (there are few, if any, longitudinal studies that examine ADHD medications in young children beyond a year or two).
Even in the meta-analysis cited in the article, the study notes that a significant portion of people on medications — 40 percent! — still have “significant symptomatology, requiring additional clinical attention.” Translation: ADHD medications won’t work for a great many people without behavioral or other psychotherapy interventions.
Instead, behavioral therapy interventions — which are science-based with hundreds of studies conducted over the past 3 decades — are lumped with a bunch of other “alternative” options, most of which have far less research evidence. Vitamins, hormone therapy, iron levels, and dietary restrictions share the same breath with behavioral interventions, making it seem like they are all similar research-backed approaches (they are not).
Medication Has a Place, But More Emphasis Needs to Be Given to Behavioral Therapy
There is little argument that medication has a place in the treatment of ADHD for many people, becoming a life-altering benefit. But we have a serious lapse in professional (and parental judgment) when it comes to prescribing these medications to very young children (6 years old or younger). ADHD medications should almost never be prescribed to a child under 6 years old.
A child’s developing brain is undergoing rapid, important changes. Introducing medications into these brains without understanding their long-term impact on the brain seems reckless — especially when other, safer approaches are available.
It is up to psychiatrists, pediatricians, psychologists and family physicians to help parents understand the research and benefits of behavioral therapy interventions. I think CDC Principal Deputy Director Ileana Arias said it best when she said,
“We do not know what the long-term effects of psychotropic medication are on the developing brains and bodies of little kids. Because behavioral therapy is the safest ADHD treatment for children under the age of 6, it should be used first, before ADHD medication for those children.”
News From the Centers for Disease Control and Prevention. (2015). Too Little Behavioral Therapy for Kids With ADHD. JAMA. 2015;313(20):2016. doi:10.1001/jama.2015.4969.
Schwartz, S. & Correll, C.U. (2013). Efficacy and Safety of Atomoxetine in Children and Adolescents With Attention-Deficit/Hyperactivity Disorder: Results From a Comprehensive Meta-Analysis and Metaregression. Journal of the American Academy of Child & Adolescent Psychiatry. DOI: http://dx.doi.org/10.1016/j.jaac.2013.11.005
Grohol, J. (2018). Too Little Behavioral Therapy for Kids with ADHD. Psych Central. Retrieved on June 2, 2020, from https://psychcentral.com/blog/too-little-behavioral-therapy-for-kids-with-adhd/