For ADHD, Better to Teach Skills Than Prescribe Pills?

[Daniel E.]

For ADHD, It's Better to Teach Skills Than Prescribe Pills, Meta-Analysis Shows
University of Buffalo
April 7, 2009

An analysis of ADHD studies conducted by Gregory Fabiano has shown that behavioral treatment works as well as drugs for children with the condition.

BUFFALO, N.Y. -- Behavior treatment works as well as drugs for children with ADHD and bypasses the risk of medication's side effects, a meta-analysis of 174 studies on ADHD treatment conducted at the University at Buffalo, has shown.

The results, published in the March issue of Clinical Psychology Review, found that teaching parents and teachers how to respond when children do things the right way -- as well as when they display harmful or aggressive behavior -- is effective, and in some cases more effective, than medication for ADHD.

"This review shows that behavioral treatments work, and in general work well," said Gregory A. Fabiano, Ph.D., assistant professor in the Department of Counseling, School and Educational Psychology in UB's Graduate School of Education, and first author on the paper.

"For the past couple of decades, there has been considerable professional controversy about the role and adequacy of behavior modification treatments in the care of children with ADHD. The next step is to figure out how to make them work for individual families over the long run, because we now know that ADHD is a lifelong condition."

Through use of behavior modification, children could bypass the risk of side effects from ADHD drugs and achieve the same or better results as drug treatments, Fabiano noted.

William Pelham, Jr., Ph.D., UB Distinguished Professor of Psychology, Pediatrics and Psychiatry, is co-author on the study.

Fabiano noted that ADHD is one of the most common mental health disorders among children. "Prevalence rates place at least one child with ADHD in every classroom in America, highlighting the need for effective interventions.

"Our results suggest that efforts should be redirected from debating the effectiveness of behavioral interventions to dissemination, enhancing and improving the use of these programs in community, school and mental health settings."

In the future, Fabiano plans to work with teachers, parents, pediatricians and clinicians in the community to emphasize the effectiveness of behavior modification treatments.

His additional research includes developing strategies to get fathers more involved in the treatment of children with ADHD, and use of driving simulators to help teens with ADHD learn to drive, while also helping parents learn to provide effective driving instruction to their teens.

Fabiano is a recent recipient of the White House's Presidential Early Career Award for Scientists and Engineers, the nation's highest honor for professionals at the early stages of their independent scientific research careers.

 

[DrMikeMiller]

Wow!!! I wonder why this finding didn't show in the NIMH Multimodal study? I'll have to contact the writer. This could be a boon to therapists, although a parallel finding is that studies show exercise to overall be equal in efficacy to anti-depressants for depressed adults. THANKS.

Mike Miller, PhD

 

[David Baxter PhD]

I would suggest another possibility: That many of the children diagnosed with ADHD are misdiagnosed and are acting out or having difficulty in the classroom for other reasons. Giving stimulants to children who aren't ADHD isn't going to help them, but providing structure and attention to behavior problems will.

The effect of ADHD on children who actually have the disorder is remarkable and virtually instantaneous. If the medication isn't working, I'd strongly suggest taking a look and who provided the diagnosis and how. Too often this is initiated by teachers and parents....

It used to be the case that ADD was not to be diagnosed until other potential causes of the symptoms were ruled out (e.g., family discord, child abuse or neglect, pediatric OCD, learning disability, netc., etc.). Somewhere around DSM-III or DSM-IV, this caveat was dropped. I think that was a mistake.

 

[DrMikeMiller]

Another possibility is that there are different subtypes, as suggested by Amen. However, if one holds If they have ADHD they WILL respond to medications, then by the same logic, a depressed person would respond to all anti-depressants. THe reality of course is that not all who have a dx will respond to the same treatments. We are all different.

 

[Retired]

If they have ADHD they WILL respond to medications, then by the same logic, a depressed person would respond to all anti-depressants.

Can we really draw that conclusion as the etiology of ADHD and depression is different and the mechanisms of action of the medications in question are different.

 

[David Baxter PhD]

I don't think there is any doubt whatsoever that there are different subtypes. That's inherent in the DSM-IV-TR criteria. It's also quite clear that stimulants are almost certainly not appropriate for all subtypes of ADHD.

But that really has little to do with my specific comments on this article.

I don't know about your experience but over the course of my career I have seen individuals who have been diagnosed by teachers or parents predominantly because they are acting out. In my opinion, some of them should not have received the diagnosis of ADHD.

In the context of this thread, it is important to bear in mind that it is a meta-analysis. There are problems with drawing conclusions from any meta-analysis, not the least of which is the issue of variations of quality of the methodologies used in the studies and, especially in this case, accuracy of the diagnoses. I am simply suggesting that we should not jump to accept the conclusion that medication does nothing for ADHD that behavior management would not do just as well without examining the very likely (in my opinion) possibility that some of the subjects were incorrectly diagnosed.

I don't think it's accidental or coincidental than the removal of the caveat to rule out other causes of the behavior before diagnosing ADHD was followed by a sharp increase in the rate of diagnosis of ADHD.

 

[DrMikeMiller]

You lost me David. There is nothing in the paper or my comments that says meds don't work. It IS true that some meds don't work for those correctly diagnosed w. ADHD; depression; etc. I'm NOT taking my da. off of her Concerta. I haven't decided if my Wellbutrin helps me w. my ADD tendencies, but know that it helps my mood - and YES, I DO practice what I preach, i.e., exercise, monitor for/challenge negative thoughts, use strategies to NOT let entropy totally whip me, practice gratitude, etc. I routinely encourage my clients/their parents to try meds for ADHD, severe depression, etc. Hope this clarifies any misunderstandings.

 

[David Baxter PhD]

There is nothing in my comments that says meds don't work either. I'm concerned about medical reporting in the media in general, which is often misleading and/or incomplete, and about the effects of this story on patients in particular.

I haven't read the original paper. I suppose I'm reacting to the title and the headline in the posted article:

For ADHD, It's Better to Teach Skills Than Prescribe Pills, Meta-Analysis Shows

An analysis of ADHD studies conducted by Gregory Fabiano has shown that behavioral treatment works as well as drugs for children with the condition.

That kind of statement is going to be taken by many parents as saying "medications for ADHD aren't needed".

And what I am trying to say is that for some children who can benefit from the medications NOT to give them those medications may well doom them to a whole host of secondary issues including depression, negative self-concept, negative labeling by teachers and peers, etc.

I don't know if you read Dr Charles Parker's blog, CorePsychBlog. If not, it's worth a look, although some of it's over my head. He has some intersting things to say about what he calls "cognitive anxiety" and its link to ADHD.