Early behavior therapy better than medication in treating children with ADHD

February 19, 2016 by Ayleen Barbel Fattal
William E. Pelham helped lead a new study about treatment options for children with ADHD. Above, Pelham at the FIU Center for Children and Families Summer Treatment Program.

In the United States, medication is the first line of treatment for 90 percent of children with attention deficit hyperactivity disorder (ADHD). However, Florida International University (FIU) researchers have determined behavioral therapy—when used first—is more effective in treating children with ADHD than medication. It is also more cost-effective.

Their findings were recently published in two separate articles in the Journal of Clinical Child & Adolescent Psychology.

One study led by William E. Pelham Jr., a pioneer in the field of ADHD research and treatment, and director of FIU's Center for Children and Families, looked at the sequence of treatments—implementing behavior first compared to medication.

Results showed stimulants were most effective as a supplemental, second-line treatment option for those who needed it and at lower doses than typically prescribed. The year-long study enrolled 146 children ages 5 to 12 who had an ADHD diagnosis. Half were randomly assigned to receive a low dose of generic Ritalin. The other half received no medication, but parents attended training sessions to learn behavior-modification techniques based on a system of rewards and consequences. If after two months, a child had not improved, he or she was randomly assigned a more intense version of the same treatment or an added supplement, like incorporating a daily dose of medication to the behavior modification. The study is the first of its kind in the field to alter the types of treatment midcourse and evaluate the effects.

"We showed that the sequence in which you give treatments makes a big difference in outcomes," Pelham said. "The children who started with behavioral modification were doing significantly better than those who began with medication by the end, no matter what treatment combination they ended up with."

The second study addresses the cost-effectiveness of behavioral interventions as first-line treatment for ADHD. Led by FIU health economics expert Tim F. Page and co-authored by Pelham, this study compared the costs of the different treatment sequences, evaluating the cost of medication as well as the time invested by parents and doctors. Results showed the cost of a behavior-first approach was approximately $700 less annually than a medication-first approach.

"Prior work had found that medication was cheaper than behavioral therapy," Page said. "However, these studies were done before the introduction of extended release—and very expensive—medications. Our study shows that with the cost of the new medications, it is no longer the case that is cheaper than behavioral treatment."

If replicated in larger studies, the effectiveness of this behavior-first approach could revolutionize the standard practice of medicating first the more than 4 million and adolescents diagnosed with ADHD in the United States.

"Our estimate is that health care costs for ADHD could be reduced by more than $4.5 billion annually in the country if doctors followed the behavioral -first approach," Pelham said.

Pelham also serves as chairman of the FIU Department of Psychology. Page is associate professor in the Department of Health Policy and Management. The studies were funded by the Institute of Education Sciences and in part by grants from the National Institute of Mental Health, the National Institute of Alcohol Abuse and Alcoholism, and the National Institute on Drug Abuse.

Explore further: New program empowers teens to make choices about ADHD meds

Related Stories

New program empowers teens to make choices about ADHD meds

June 18, 2015
FIU's Center for Children and Families (CCF) is offering a new program to help teens with ADHD make healthy, informed decisions about treatment.

Combination of treatments could lead to lower and safer doses of medication in children with ADHD

April 8, 2014
Balancing a low dose of behavior therapy with a low dose of medication may be the key to helping children with Attention Deficit Hyperactivity Disorder (ADHD), according to a new study by researchers at FIU's Center for Children ...

Children in foster care three times more likely to have ADHD diagnosis

October 23, 2015
Researchers already knew that attention-deficit/hyperactivity disorder (ADHD) was the most common behavioral health diagnosis among children enrolled in Medicaid. A new study to be presented at the American Academy of Pediatrics ...

Three-quarters of children with ADHD take meds

April 4, 2015
(HealthDay)—Most children with special health care needs (CSHCN) with current attention-deficit/hyperactivity disorder (ADHD) receive medication treatment or behavioral therapy, according to a study published online March ...

For some children with ADHD, music has similar positive effects to medication

November 5, 2012
(Medical Xpress)—The findings are part of a study on the effects of distractors on children with ADHD. A team of researchers, led by FIU Center for Children and Families Director William E. Pelham Jr., set out to examine ...

Summer Treatment Program helps children with ADHD benefit from sports, research shows

March 28, 2014
A summer program at FIU is proving that children with Attention Deficit Hyperactivity Disorder (ADHD) can excel in team sports and benefit from the experience.

Recommended for you

ADHD medication tied to lower risk for alcohol, drug abuse in teens and adults

July 13, 2017
The use of medication to treat attention deficient hyperactivity disorder is linked to significantly lower risk for substance use problems in adolescents and adults with ADHD, according to a study led by researchers at Indiana ...

Video game promotes better attention skills in some children with sensory processing dysfunction

April 6, 2017
A video game under development as a medical device boosts attention in some children with sensory processing dysfunction, or SPD, a condition that can make the sound of a vacuum, or contact with a clothing tag intolerable ...

Children with ADHD often live in chaotic households

March 9, 2017
Researchers often observe inadequate parenting, a negative emotional climate and household chaos in families of children with ADHD. A research group at Goethe University Frankfurt and the universities of Bremen, Heidelberg, ...

ADHD a 'brain disorder', not just bad behaviour: study

February 16, 2017
People with ADHD have slightly smaller brains than those without the condition, according to a study released Thursday which insisted it is a physical disorder and not just bad behaviour.

Could the 'Mediterranean' diet help prevent ADHD?

January 30, 2017
(HealthDay)—Kids who follow a Mediterranean diet—high in fruits, vegetables and "good" fats—may be less likely to have attention deficit hyperactivity disorder (ADHD), a small study suggests.

Data scientists find causal relation in characteristics of ADHD

December 2, 2016
Hyperactivity seems to be the result of not being able to focus one's attention rather than the other way around. This was proposed in an article in PLOS ONE, written by researchers at Radboud university medical center and ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.