Treatment

A combination of a psychostimulant, most commonly methylphenidate (Ritalin), and cognitive-behavioral therapy is proving to be the best option for treatment of children with ADHD.

In 1999, a large study compared medication, behavior therapy, a combination of both, and standard community care. While all four groups improved, medication, when carefully monitored, was more effective than behavior therapy alone, and its effects were similar to combination therapy. The combined approach, however, allowed lower doses of medication and also improved academic performance and family relations. In addition, it was more helpful for children who also had mood disorders (such as depression or anxiety) or oppositional-defiant disorder.

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A 2001 study further suggested that 80% of adolescents with ADHD who were treated with a combined approach showed an improvement in academic performance.

Developing a Treatment Approach. The following guidelines may be useful in determining a treatment approach for children with ADHD:

• Behavioral techniques, possibly including dietary changes, should be tried first, if possible.
• If the symptoms are severe or do not respond, then a trial using medication (usually psychostimulants), in conjunction with behavior modification therapy, is advisable.

Unfortunately, most children do not have access to behavioral therapies, either because of lack of time or available resources. A 2000 study reported that fewer than half of all doctor's visits involving a psychostimulant prescription included pschologic intervention. In addition, there was no follow-up at all after 21% of these visits. One study suggested that a simple 8-week program conducted in the primary care doctor's office may be of some help. Children in the study received either a combination of drugs with the program or drugs alone. They had no complicating problems, such as anxiety or conduct disorder. Children who received the combination approach showed improved functioning at home that persisted for at least 6 months, although teachers observed no differences in two groups.

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