Caitlin Kennedy, B.A.
There is currently no cure for Attention-Deficit/Hyperactivity Disorder (ADHD). However, there are two treatment options with solid scientific evidence that they improve ADHD symptoms in children: behavioral therapy (such as Parent Behavior Training) and medication. Deciding which treatment or combination of treatments is right for your child is something you will want to do together with a health care professional. Here are several things to keep in mind while making the decision:
Effectiveness: Younger children respond better to parent behavior training than adolescents.1 Through parent behavior training, parents learn how to effectively communicate with and respond to their children who have ADHD. Although research is needed to determine if PBT will improve ADHD symptoms for more than 12 months,2 there is reason to believe that these communication skills will be useful for a long time. Stimulant medication, on the other hand, stops being effective very shortly after the child stops taking them.
One reason why stimulant medicines are so popular is that they tend to work very quickly in children. On the other hand, parent behavior training programs typically take between 8 – 12 weeks with a weekly time commitment of 1-2 hour sessions for parents and sometimes for both parents and children.3 This is a substantial time commitment, but since there are no safety concerns, this can be an excellent investment in a child’s future.
Cost: The costs of either option largely depend on your health care coverage. Check to see whether your health insurance covers medication or behavioral therapy.
- Medication costs, without insurance discounts or coverage, can range from $8/month to $288/month.2
- Behavioral therapy programs can range from $200-$2000 for the entire program, depending on the therapist or program and the number of sessions needed. Some of the cost may be covered by insurance, depending on the type of insurance. If covered, most insurance plans cover 20 behavioral therapy sessions/year with a therapist.4
Child’s Age: In 2011, the American Academy of Pediatrics (AAP) expanded the age range of those recommended for the diagnosis and treatment of ADHD to 4-18 years.5 It was previously ages 6-12.
- The American Academy of Pediatrics, which is the medical organization for pediatricians, recommends behavioral therapy for children who are 4 and 5 years old before trying medication. They recommend evidence-based parent- and/or teacher-administered behavioral therapy.5
- The most popular ADHD medications, which are stimulants with methylphenidate (such as , Ritalin, Concerta, and Focalin), are not approved by the FDA for children younger than 6 years old.6 They have not been proven safe and effective for such young children. In fact, a review of studies looking at ADHD treatments for preschool-age children found that parent behavior training was the only treatment with adequate evidence to support its effectiveness in children younger than 6 years.7
Many parents worry about the long-term effects of stimulant use. Should they?
Stimulant use can cause health problems, including heart problems, whether or not the medications were taken as directed.8 One big concern, especially with young children who may need treatment for a long time, is the long-term effects of stimulant use. Here’s what you need to know:
- Height: Stimulants may slow children’s height and weight. However, children’s growth curves typically return to normal after around 3 years of stimulant use.9 An Australian study found no effect of previous or ongoing stimulant use on weight or height at 14 years or expected weight or height at 14 years (based on age 5 measurements).10
- Physical Health: Previous or ongoing stimulant use led to higher diastolic blood pressure at age 14, compared to non-medicated 14-year-olds with ADHD, according to the same Australian study.
- Substance Abuse and Mental Health: While children diagnosed with ADHD are more likely to develop substance abuse disorders in adulthood,11
childhood stimulant use for ADHD itself has been shown to have no effect12 or may even reduce the risk of later substance abuse.13, 14 The same Australian study mentioned above found that previous or ongoing stimulant use had no impact on depression, self-perception, or social functioning at age 14.
Parent Behavior Training: What is it?
Parent behavior training (PBT) is the recommended and effective treatment option for preschoolers with ADHD. It is also an effective treatment option for school-aged children with ADHD. A common question is, “Why do I, as a parent, need training, if my child is the one diagnosed with ADHD?” PBT teaches parents the best methods to communicate with and respond to a child with ADHD.
PBT teaches parents to give clear commands to their children and to use immediate action, rewards (which can be token economies, such as points or stickers) and time-outs.
PBT emphasizes 3 rules:
- Praise behavior that you want to see continue.
- Ignore behavior that you do not like but is not dangerous or intolerable.
- Punish behavior that you must – behavior that is dangerous or intolerable.
PBT can be done in individual or group counseling sessions. Individual sessions, with just the parent/family and the therapist, can be tailored to your family, whereas group sessions may be less expensive and allow you to connect with other families of ADHD children.
If you have a child who has recently been diagnosed with ADHD and you can try parent behavior training, it is the recommended option because it is the safest and most effective.
For more information about PBT programs, go to:
- Dishion TJ, & Patterson, GR. Age effects in parent training outcomes. Behavior Therapy. 1992; 23: 719-729. ▲
- Effective Health Care Program. “Treatment Options for ADHD for Children and Teens.” Accessed April 5, 2013. http://www.effectivehealthcare.ahrq.gov/ehc/products/191/1148/adhd_con_fin_to_post.pdf ▲
- Chronis, A.M., Chacko, A., Fabiano, G.A., Wymbs, B.T., & Pelham, W.E. Enhancements to the Behavioral Parent Training Paradigm for Families of Children with ADHD: Review and Future Directions. Clinical Child and Family Psychology Review. 2004; 7(1): 1-27. ▲
- McCarthy, LF. “Behavior Therapy for ADHD Children: More Carrot, Less Stick.” ADDitute: Living Well with Attention Deficit. Accessed April 5, 2013. http://www.additudemag.com/adhd/article/3577-2.html ▲
- Subcommittee on Attention-Deficit/Hyperactivity Disorder, Steering Committee on Quality Improvement and Management. ADHD: Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents. Pediatrics, 2011; 128(5): 1007-1022. ▲
- National Institute of Mental Health. “Attention Deficit Hyperactivity Disorder (ADHD).” Accessed April 4, 2013. http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder/complete-index.shtml ▲
- Charach A, Carson P, Fox S, Ali MU, Beckett J, & Lim CG. Interventions for Preschool Children at High Risk for ADHD: A Comparative Effectiveness Review. Pediatrics. 2013; 131(5): 1-21. ▲
- Zarbalian G. “ADHD Treatment: Medications and Alternatives.” National Research Center for Women and Families. Accessed April 12, 2013. http://center4research.org/child-teen-health/1-general-health-and-mental-health/adhd-treamtent-medications-and-alternatives/ ▲
- Faraone, S.V., Biederman, J., Morley, C.P., & Spencer, T.J. Effect of Stimulants on Height and Weight: A Review of the Literature. Journal of the American Academy of Child and Adolescent Psychiatry. 2008; 47(9): 994-1009. ▲
- Government of Western Australia Department of Health. “Raine ADHD Study: Long-term Outcomes Associated with Stimulant Medication in the Treatment of ADHD in Children.” Accessed April 3, 2013. http://www.health.wa.gov.au/publications/documents/MICADHD_Raine_ADHD_Study_report_022010.pdf ▲
- Wilens TE, Martelon M, Joshi G, Bateman, C, Fried R, Petty C, Biederman J. Does ADHD Predict Substance Use Disorders? A 10-Year Follow-up Study of Young Adults with ADHD. Journal of the American Academy of Child and Adolescent Psychiatry. 2011; 50(6); 543-553. ▲
- Biederman J, Monuteaux, MC, Spencer T, Wilen, TE, MacPherson, HA, & Faraone, SV. (Stimulant Therapy and Risk for Subsequent Substance Use Disorders in Male Adults with ADHD: A Naturalistic Controlled 10-Year Follow-Up Study. American Journal of Psychiatry 2008; 165(5): 597-603. ▲
- Mannuzza S., Klein RG, Truong NL., Moulton, JL., Roizen, ER, Howell, KH, Castellanos, FX. Age of Methylphenidate Treatment Initiation in Children with ADHD and Later Substance Abuse: Prospective Follow-Up into Adulthood. American Journal of Psychiatry 2008; 165(5): 604-609. ▲
- Wilens, TE, Faraone, SV, Biederman, J, Gunawardene, S. Does stimulant therapy of attention-deficit/hyperactivity disorder beget later substance abuse? A meta-analytic review of the literature. Pediatrics. 2003; 111(1): 179-185. ▲