Conduct Remedy Reduces Want for Medicine in ADHD Youngsters
Both drug treatment and behavior therapy are considered effective treatments for children with ADHD; the combination of these treatments is generally considered to be the ideal approach for many children. While some professionals doubt whether behavior therapy is necessary when medication is effective in a child, many parents have concerns about stimulant drugs for their ADHD children.
A study published in the Journal of Abnormal Child Psychology carefully examined the incremental benefits of behavior therapy to determine whether behavior therapy makes enough of a difference to be worthwhile in treating ADHD in children. Specifically, it investigated whether the combination of behavior therapy and medication could reduce the amount of medication required to effectively treat symptoms.
This is important for two reasons. First, lower doses could reduce the stunted growth associated with prolonged stimulatory drug treatment in some children. Second, it can also reduce general side effects and alleviate family concerns about the ADHD stimulant medication.
Question: Could it actually make it possible for many children to be significantly reduced by means of behavioral therapy for drug treatment Doses of ADHD Drugs?
Forty-eight 5-12 year old children with ADHD enrolled in an intensive summer treatment program (STP) and participated in this study. The summer program ran 9 hours a day and lasted 9 weeks. Children spent 2 hours each day in academic activities; the rest of the time was spent with recreational activities that resemble a regular summer camp.
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In the study, the drug doses were varied (placebo, low, medium, high) and combined with behavioral treatment (none, low intensity, high intensity) so that the behavior of the children could be assessed in each treatment combination. This enabled the researchers to determine the effects of different drug doses combined with different intensities of behavioral therapy.
In this study, behavioral treatment included:
- a point system to encourage desirable behavior,
- clearly formulated rules and expectations,
- social skills and social problem-solving training,
- social praise and reinforcement,
- Training of athletic skills,
- and the use of daily and weekly rewards
The conditions were different depending on the child. For example, in the high-intensity condition, children were given points based on their behavior throughout the day and were rewarded daily for good behavior. In the low-intensity condition, the children received feedback on their behavior but did not gain or lose any points, and weekly rewards for good behavior were provided.
As expected, drug treatment without behavioral therapy led to significant improvements in children’s behavior. And as the dose increased, so did the benefits.
Behavioral therapy alone also led to a significant improvement across a wide range of measures. In general, high-intensity behavior management was more effective than low-intensity behavior management.
The combination of drugs and behavior therapy produced surprising results.
- In almost all interventions, adding high-intensity behavioral therapy to the lowest medication dose resulted in similar improvements as one would expect from high-dose medication alone.
- In many situations, even low-intensity behavioral therapy combined with low-dose medication was as effective as high-dose medication.
The results suggested that a typical child with ADHD could be treated with lower doses of stimulant drugs if they were also receiving moderate to high-intensity behavioral therapy.
Without behavior therapy, the same child would need four times the dose to get comparable benefits. The addition of behavior therapy enabled a significant reduction in stimulant drugs to achieve similar results.
Why is that important?
- The appetite suppressing effect increases significantly with increasing doses of stimulants. In other words, children were more likely to eat their lunch with lower doses of stimulant drugs.
- Adding low or high intensity behavioral therapy can improve results if a child is also taking stimulant medication.
- Adding medication to low or high intensity behavior therapy can improve results.
Summary and implications
This study suggests that adding behavioral therapy to drug treatment can enable many children to receive significantly lower doses of ADHD medication. This could reduce challenges with appetite reduction and stunted growth; It might also be more acceptable to many parents who have concerns about treatment with ADHD stimulants.
It is worth noting that current practice is generally not oriented that way. When children begin drug treatment, the doctor’s goal is usually to find a dose that will bring the most benefit. They don’t usually investigate whether similar benefits could be obtained if behavior therapy were added at a lower dose.
There are limitations to this study that should be noted:
- Even “low intensity” behavioral treatment has multiple components and can be challenging for families over time.
- The intensive summer spa program is a completely different context than what children normally experience.
- The treatment outcomes were only evaluated over a period of 9 weeks, with the various combinations of drugs and behavioral therapy lasting for shorter periods of time. It is therefore unclear whether these effects are sustainable or whether they can be generalized to other more typical situations.
Nevertheless, this study underscores that drug doses can be significantly reduced in combination with well-conducted behavioral therapy.
This can be particularly valuable in treating ADHD in children when children cannot tolerate higher doses of medication and there are concerns about appetite reduction and stunted growth.
So if you have concerns about the side effects of high-dose stimulants for your ADHD child, you can find a better solution by combining drug treatments and behavioral therapy.