A new study, published in the Journal of Clinical Child and Adolescent Psychology, found that typical stimulant medication like Ritalin, prescribed for children diagnosed with ADHD as a first-line of treatment, was actually most effective as a supplemental, second-line treatment for those who needed it. Often at doses that are lower than what is typically prescribed. The study showed that children who started with behavioral treatment before being prescribed medication did better.
The study was unique in the fact that it is the first study that evaluates the effects of altering the treatment in midcourse. For example, adding a drug treatment to a behavioral treatment, or the other way around. The results show that the sequence in which you give treatments makes a big difference in outcomes. It is important to note that this study tracked behavior, and not abilities like academic performance or attention.
The study enrolled 146 children with ADHD diagnosis between the ages of 5 and 12, and assigned half of them randomly on a low dose of generic Ritalin. The other half received no medication, but their parents began attending group meetings to learn some techniques that could help them modify and respond to their children's difficult behaviors.
These techniques were based on a simple system of rewards and consequences. Parents reward positive behavior, ignore irritating but harmless behavior like doing baby talk.
If a child had not improved after 2 months, the child was randomly assigned to eiter a more intense version of the same treatment, or an added supplement, like adding meds to the behavioral treatment.
About two-thirds of the kids that started with the behavior therapy needed a 'booster.' About 45% of those who started on medication did. However, the behavior first group had on average four fewer rule violations an hour at school, than the medication first group.
According to the authors it could be that the parents of the children who started on the medication were less motivated to follow up with the behavioral classes. It was a lot of work, and the parents might have thought that it will not make that much of a difference.
In a different study it was determined that starting with the behavioral treatment before following it with medication, costs on average $700 annually lest per child than treatment as usual.
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