[Photo: robert_rex_jackson, Flickr]
The Question: While more than two-thirds of youth diagnosed with attention-deficit hyperactivity use prescription medication to control their symptoms, it’s not uncommon for both parents and children to want a non-drug alternative. The guidelines recommend evidence-based behavior therapy as the primary treatment for pre-school age children; older students are advised to try ADHD medication alone or in combination with behavior therapy. Despite these clear recommendations, clinicians and parents may not know that alternative treatments exist, or how to access them.
The Alternatives: Three types of non-medication interventions have been demonstrated as effective for ADHD.
- Parental training is designed to help caretakers improve their own communication and discipline practices. The goal is to better manage a child’s behavior by encouraging positive behavior and deterring what might be seen as classic ADHD conduct. Four parent training programs have been shown to reduce disruptive behavior: Triple P; Incredible Years; Parent-Child Interaction Therapy; and, the New Forest Parenting Program.
- A mental health professional typically delivers psychosocial therapy, counseling a patient and his or her family on a regular basis about how to manage ADHD symptoms. These therapists, however, may not know the latest evidence-based techniques for working with children who have ADHD.
- Behavioral therapy focuses on teaching children important skills, such as organizing, socializing, and problem solving. Showing parents and teachers how to help manage behavior and symptoms is an essential aspect of behavioral therapy as well. Some of this training may take place in the classroom, depending on the school’s resources, but it can also occur at sites where therapists have been specifically trained in evidence-based ADHD interventions. Two such examples are the Summer Treatment Program at Florida International University’s Center for Children and Families and the Challenging Horizons Program at the Center for Intervention Research in Schools at Ohio University.
These treatment types can overlap. For instance, some therapists use behavioral modification while behavioral therapy programs often have a parent-training component. For more information about the types of treatment and their costs, see this brochure (PDF) produced by the Agency for Healthcare Research and Quality.
A Note on Trauma: None of the behavioral
treatments for ADHD are designed specifically for traumatized children; however, training for parents can help strengthen their relationship with a child and reduce harmful discipline and communication practices.
Related Story: How childhood trauma could be mistaken for ADHD
The Research: In 2011, the AHRQ published a comprehensive review of both prescription and non-drug ADHD treatments in different age groups. For pre-school youth, several studies showed that Triple P, Incredible Years, Parent-Child Interaction Therapy, and the New Forest Parenting Program reduced disruptive behavior, enhanced parenting skills, and in some cases, improved ADHD symptoms. The review included a single study that compared medication and parent training and found similar effectiveness, but it was too limited to draw any conclusions.
In 5- to 12-year-old patients, studies have shown that combining psychosocial and behavioral therapy for children with medication – even very low doses – is as effective as medication by itself, and superior to non-drug treatments on their own. Measuring improvement across treatment types has been difficult because key studies have evaluated different outcomes; some focus on symptom severity while others look at daily functioning.
In a Clinical Psychology Review paper published in April, several researchers analyzed 15 years of studies on pharmacological and psychosocial treatments and found that medication and behavioral therapy produce a “similar range of therapeutic effects” in adolescents with ADHD. This view, the authors pointed out, contradicts guidelines from the American Academy of Pediatrics (PDF) and American Academy of Child and Adolescent Psychiatry (PDF), which describe prescription medication as the preferred treatment.
The federal Substance Abuse and Mental Health Services Agency (SAMHSA) includes both the Summer Treatment Program and Challenging Horizons Program in its registry of evidence-based practices. The eight-week summer program, which is offered at other sites around the country, targets behaviors like impulsivity and concentration, and teaches campers positive academic and interpersonal skills. Instructors also prepare parents for reinforcing these traits long after their children leave camp. The Challenging Horizons Program is a middle and high school-based intervention that targets areas of impairment and focuses on strengthening numerous skills, including studying, goal setting and group cooperation. Parents are involved in treatment through group training sessions and weekly reports. While studies of the STP and CHP found positive results for adolescents, the effects may wane once the intervention is no longer practiced on a daily or regular basis.