It found that children ages 5-13 with ADHD who received therapy first often needed less medication. “If you look at studies that did the combined treatment of both medication and behavioral interventions, you can’t disentangle what leads to the best outcome,” Coles said.Ī study published in 2016 in the Journal of Clinical Child & Adolescent Psychology explored the sequencing of treatment methods and showed that kids with ADHD between ages 5 and 12 who were given behavioral treatment before starting pills had less behavioral problems than kids who started with pills right away.Ī new study co-authored by Coles took it further. While the AAP guidelines advise a combination of meds and behavioral treatment, the research backing this combination is problematic, according to Coles, because the two approaches weren’t evaluated separately. “I want them to be able to think for themselves and make those safe choices, but at this point, that’s just not possible yet for Brody.”īut the techniques - things like counting to keep him on the task of putting away his toys, and rewards like time playing legos after he finishes a chore - are helping him, she admitted. “I don’t like the idea that I have to tell my kids or anybody what to do,” she said. This is supposed to help him internalize the discipline and “grit” needed to complete difficult tasks, but it can feel to her like micromanaging, she said. ![]() These interventions are designed to teach children strategies they can use on a daily basis to help stay focused and to reinforce social skills that may fail to develop when children struggle to concentrate.Īfter school, Ashley Knapp used behavioral techniques to keep son Brody on track with his chores. It can be as simple as parents setting up a system of expectations reinforced by rewards or punishments. “I think it’s a huge disservice to not just the children that we’re trying to treat but also to the parent who would prefer to have behavioral interventions,” said Erika Coles, a psychology researcher at Florida International University.Ī behavioral intervention can range from cognitive therapy to school support. Other experts say the guidelines should have done more to prioritize behavioral treatments. While she wants to see more ADHD patients receive behavioral treatment, she said, she agrees with the AAP’s decision to hold steady on its recommendations about medication. Allan is Brody’s doctor and had a role in drafting the latest guidelines. Carla Allan, an ADHD specialist at Children’s Mercy in Kansas City and a member of the ADHD Clinical Practice Guidelines Subcommittee. “It’s certainly true that when you watch TV, you’re not going to see a lot of commercials about behavioral treatments, but you very well may see some new ones about medication,” said Dr. Still, many experts worry that the role of medication in treatment is too large. Children under 5 should start with behavioral treatment before taking any medications. The new guidelines from the American Academy of Pediatrics recommend that children with ADHD be screened for mental illness and monitored closely, but the treatment recommendations regarding medication are essentially unchanged from previous guidelines published in 2011.Īnyone over age 5 should start taking medication and get behavioral therapy as soon as they are diagnosed. The prevalence of ADHD has shot up in the past two decades, and now, 1 in 10 children in the U.S. More and more families face the same dilemma. Subscribe to KHN's free Morning Briefing. ![]() “I was all for stimulants at the very, very beginning just because I know what they can do to help a neurological issue such as ADHD,” Ashley Knapp said. She’s a school principal with ADHD herself. “I didn’t want to lose that with Brody, ’cause he’s an amazing kid.”īrody’s mother, Ashley, had other ideas. ![]() “You hear of losing your child’s personality, and they become a shell of themselves, and they’re not that sparking little kid that you love,” Brett Knapp said. ![]() When 6-year-old Brody Knapp of Kansas City, Mo., was diagnosed with ADHD last year, his father, Brett, was skeptical. Some experts say, however, they are disappointed the new guidelines don’t recommend behavioral treatment first for more children, as that might lead to better outcomes, recent research suggests. The American Academy of Pediatrics issued new guidelines Monday upholding that central role of medications accompanied by behavioral therapy in ADHD treatment. When children are diagnosed with attention deficit hyperactivity disorder, stimulant medications like Ritalin or Adderall are usually the first line of treatment. This story can be republished for free ( details). This story is part of a partnership that includes KCUR, NPR and Kaiser Health News.
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