Medication or Therapy for ADHD?

Often when parents wonder about their child’s inattentive or hyperactive behaviors, they bring these concerns to their pediatrician. Their pediatrician asks a series of questions, and may give the parents and teachers forms to fill out regarding their child’s behaviors and symptoms. Depending on the interview and responses on the forms, the pediatrician may make a diagnosis of ADHD. Alternatively, parents may seek out a psychiatrist or social worker who also follows similar steps as the pediatrician in interviewing and diagnosing. No matter which of these professionals you ask, the first treatment recommendation is usually medication. Who hasn’t heard of Adderall, Ritalin, or even Concerta? These are common stimulants used to treat the symptoms of ADHD. They are well-known and often effective.
 
The first line of treatment has been medication for some time; however, medication is no longer recommended as the first line of treatment. It can still be an important component of treatment and be very helpful to those with ADHD, but it is not the first recommendation anymore.
 
Research by William Pelham, PhD, of the State University of New York at Buffalo, and others shows that when children are treated with behavioral interventions and their parents are trained to better manage their children’s behavior, medication is used less often and smaller doses are effective when it is used.
 
Why is this? Behavioral interventions are effective at increasing attention and reducing hyperactive impulsive behaviors, which are the symptoms targeted by medication. Because once people experience some relief from medication, they often aren’t as motivated to make the difficult behavioral changes that they would still need. This then results in less overall improvement than if patients had first made the behavioral changes which, yes, are difficult and require time and perseverance, and then add in medication to get even more benefit from there if still needed.
 
In addition, while medication can be effective at reducing the inattention and hyperactive symptoms, it is not as effective at improving other symptoms including low self-esteem, difficulty with social skills and interactions with peers, difficulties in reading and math, and difficult relationships with parents and other family members.
 
Therapy and mediation both have their place in the effective treatment of ADHD and both are important to consider given your child’s difficulties. If only medication is recommended for you or your child, please do not hesitate to ask questions about what other treatments are available.  The CDC recommendations state that, in most cases, ADHD is best treated with combination of both medication and behavior therapy. School interventions are also highly beneficial. Be sure your treatment provider recommends all of these areas and closely monitors treatment. If you have questions about obtaining an evaluation for ADHD or treatment recommendations, please do not hesitate to contact Dr. Weissglass for a consultation.