Behavioral Therapy Works Better than Medication as a First Step Treatment for Children with ADHD

A related study also revealed that behavioral therapy is a more cost effective approach.

depresionMIAMI, FL—A new study led by William E. Pelham Jr., psychologist and director at the Center for Children and Families (CCF) at Florida International University, revealed that low doses of behavioral therapy works better as a first step treatment for children with ADHD than medication. This study is the first of its kind in the field to alter types of treatment midcourse and evaluate the effects.

The year-long study, which treated 146 children ages 5 to 12, looked at various sequences in treatment strategies for ADHD. The children were broken up into two main groups—one that began with low doses of medication (at half the dose than normally prescribed) and the other group began with low doses of behavioral therapy. If the children needed more treatment at the end of eight weeks, they were randomly assigned to either get more intense treatment of what they began with, or they had the opposite modality added to the treatment they received in the beginning.

Regardless of the treatment the children ended up with, the group that began with the low doses of behavioral treatment first, had better functionality. The study found that stimulants were effective as a supplemental, second-line treatment for the children who needed it after receiving the behavioral therapy first. The group that performed the worst in the study was the one that received medication first and were assigned to receive behavioral treatment later. Initiating treatment with medication appeared to undermine parents and teachers’ willingness to learn and implement behavioral interventions.

“This study proves that the sequence in which we treat children with ADHD makes a big difference in the outcome,” said Pelham. “Giving our children medication doesn’t solve the problem—it only takes away the symptoms temporarily. We need to teach parents, children and teachers the skills they need to truly make a difference long-term.”

Currently, 90 percent of the eight million children and adolescents with ADHD in the U.S. are typically treated with medication as the first-line and often only treatment. The results of the study makes it evident that behavioral therapy should be the first-line treatment used when treating children with ADHD.

Additionally, a cost analysis of the study, led by FIU Associate Professor and health economics expert Timothy F. Page found that beginning treatment with low doses of behavioral therapy first and medication at half the dose than normally prescribed as a supplement if necessary, is by far the most cost-effective approach, compared to the opposite sequence.

“Prior work had found that medication was cheaper than behavioral therapy,” Page said. “However, these studies were done before the introduction of extended release — and very expensive — medications. Our study shows that with the cost of the new medications, it is no longer the case that medication is cheaper than behavioral treatment.”

“Our estimate is that health care costs for ADHD could be reduced by more than $4.5 billion annually in the country if doctors followed the behavioral treatment-first approach instead of medication first for all children treated for ADHD,” Pelham said.


Editor’s note: There are other ADHD natural substitutes (see this reference: ) but please note that any medical decision has to be consulted with a professional and this site is not responsible for independent products. 


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