ADHD Medication: Can Your Child Go Without? Behavioral Therapy for ADHD Can be a Good Alternative
March 6, 2009 by Dr. Robert Myers
In a recent commentary in The Boston Globe, pediatrician Claudia Meininger Gold wrote, “medication can’t fix a broken childhood.” She goes on to say, “with our over-reliance on psychoactive medication, we have created another Ponzi scheme where, just as Bernard Madoff’s investment fund was not really earning any money, we are fooling ourselves into thinking that we are helping these children in any significant way.”
In fact, a recent US News & World Report also provides in-depth coverage of this topic, starting first by citing the recent recommendation of the National Institute for Health and Clinical Excellence of the UK. They recommend the trial of behavioral intervention prior to medication for the treatment of children diagnosed with ADHD.
This is similar to recommendations of US professional organizations, including the American Academy of Pediatrics and the American Academy of Child and Adolescent Psychiatry. Both recommend a trial of behavioral interventions as the initial treatment for children with mild to moderate symptoms. They also recommend the initiation of the intervention when children have a poor response to stimulant medication before initiating treatment with other drug classes. These recommendations are based on controlled research investigating the relative effectiveness of various methods of treatment.
Recently, the Hastings Center also published a report in Child and Adolescent Psychiatry and Mental Health, which states “the facts surrounding the most effective treatments of ADHD are complicated and incomplete.” They cite an influential, federally-funded study comparing stimulant medication with behavioral therapy and combination treatment — which was widely interpreted as finding medication superior in reducing ADHD symptoms, even though a follow-up study found “all three treatment options to be similarly effective.”
With all of the research and guidelines supporting the use of behavioral interventions as essential in the treatment of ADHD, it is disheartening to find that few children and parents have access to these services. Busy primary care physicians lack the time to train parents and counsel children. Insurance carriers often make it difficult to obtain the services of a mental health professional with the expertise to provide these evidence-based services to ADHD children. Even when available, parents often do not have the time to keep the necessary appointments. Thus, for many reasons, this highly effective intervention is highly underutilized.
In answer to this problem, I developed the Total Focus Program to provide a comprehensive package of behavioral interventions to use in the home. It’s geared not only towards parents, but to children with ADHD as well. It provides six interventions recommended by the National Institute of Mental Health: parent training, behavior modification, cognitive behavioral therapy, social skills training, relaxation training and cognitive rehabilitation “brain training” exercises. It has also been reviewed and endorsed by several leaders in the ADHD field and is the key component in an outpatient program for ADHD children provided by the Department of Psychiatry at UC Irvine School of Medicine.
Perhaps most importantly, as the parent of a son with ADHD, I made sure that when I created Total Focus, I wrote it in a way that would bring the whole family together to work as a team. I wanted parents to be able to help their kids feel good about themselves while giving them a sense of being able to positively influence their child’s psychological development.