Challenging status quo: Why shouldn’t behavioral therapy, instead of medication, be first-line treatment for ADHD?

— Par­tic­i­pants at a social skills train­ing camp. Source: Flori­da Inter­na­tion­al University

Behav­ioral Ther­a­py First for ADHD Treat­ment? (Web­MD):

“Behav­ioral ther­a­py should be used before med­ica­tion in treat­ing chil­dren with atten­tion-deficit hyper­ac­tiv­i­ty dis­or­der (ADHD), accord­ing to new research.

One paper found that chil­dren’s ADHD prob­lems improve faster when their first ther­a­py is behav­ioral — such as being taught basic social skills — rather than medication…Another paper said using behav­ioral ther­a­py first is less expen­sive over time.

Med­ica­tions were most effec­tive when used as sup­ple­men­tal, sec­ond-line treat­ment for chil­dren with ADHD who required the drugs. In many cas­es, the drugs were effec­tive at dos­es low­er than nor­mal­ly pre­scribed, accord­ing to the find­ings in the Jour­nal of Child & Ado­les­cent Psychology.”

Study: Treat­ment Sequenc­ing for Child­hood ADHD: A Mul­ti­ple-Ran­dom­iza­tion Study of Adap­tive Med­ica­tion and Behav­ioral Inter­ven­tions (Jour­nal of Clin­i­cal Child & Ado­les­cent Psychology)

• From the abstract: Behav­ioral and phar­ma­co­log­i­cal treat­ments for chil­dren with atten­tion deficit/hyperactivity dis­or­der (ADHD) were eval­u­at­ed to address whether end­point out­comes are bet­ter depend­ing on which treat­ment is ini­ti­at­ed first and, in case of insuf­fi­cient response to ini­tial treat­ment, whether increas­ing dose of ini­tial treat­ment or adding the oth­er treat­ment modal­i­ty is superior…The group begin­ning with behav­ioral treat­ment dis­played sig­nif­i­cant­ly low­er rates of observed class­room rule vio­la­tions (the pri­ma­ry out­come) at study end­point and tend­ed to have few­er out-of-class dis­ci­pli­nary events…Parents who began treat­ment with behav­ioral par­ent train­ing had sub­stan­tial­ly bet­ter atten­dance than those assigned to receive train­ing fol­low­ing med­ica­tion. Begin­ning treat­ment with behav­ioral inter­ven­tion pro­duced bet­ter out­comes over­all than begin­ning treat­ment with medication.

To learn more:

• To improve aca­d­e­m­ic out­comes, chil­dren with ADHD need both med­ica­tion and non-med­ica­tion treatments
• Why cog­ni­tive behav­ioral ther­a­py (CBT) should be first-line treat­ment for chron­ic insomnia
• Should Cog­ni­tive Behav­iour­al Ther­a­py (not anti­de­pres­sant drugs) be the first-line treat­ment for depression?