Medication, Behavioral Therapy Can Both Play Roles in Treating Children with ADHD

According to the National Institute of Mental Health (NIMH), attention deficit hyperactivity disorder (ADHD) is the most commonly diagnosed disorder of children, affecting an estimated 3-5 percent of school-age kids.

ADHD is characterized by symptoms of inattentiveness and lack of concentration, impulsivity and hyperactivity. Not all cases of the disorder include all of the symptoms - some may exhibit hyperactivity, while others show signs of inattentiveness.

One of the medications used to treat ADHD, the stimulant drug Ritalin®, became a buzz word of the 90s and the subject of controversy. "We're not sure exactly how it works in the brain, but it [Ritalin] seems to help wake up those parts in the brain that help kids pay attention," says Dr. Cynthia Santos, associate professor of clinical psychiatry at The University of Texas-Houston Medical School. "For children, it helps them pay attention better, it seems to help decrease their overactivity when they have hyperactivity, and it also seems to help decrease their impulsiveness."

According to Dr. Santos, Ritalin can also help improve the social skills of someone with ADHD. "A lot of times, children who have ADHD have poor social skills and part of that is because they are very impulsive," she says. Dr. Santos gives the example of a child with ADHD taking another child's toy out of impulsivity or aggression without thinking to ask first. "By decreasing some of those things, it [Ritalin] does seem to help with their social skills."

The results of the first long-term study of Ritalin and other treatment modalities for children with ADHD were released recently by NIMH and Columbia University. The study, the largest clinical trial ever conducted by the NIMH, found medication and a combination of medication and behavioral therapy to be more effective than intensive behavioral therapy or community medicine alone for treating children with ADHD.

When comparing medication and the combination of treatments, the study showed that no significant benefit was gained when behavioral therapy was added versus when medication was used alone. However, in cases where other problems like anxiety or oppositional behaviors co-existed with ADHD, behavioral therapy was found to be effective, especially when given in conjunction with medication. The study followed 600 elementary school children, ages 7-9, over a 14-month period.

"We have had a lot of good evidence suggesting that Ritaln is very effective in the short term, usually meaning six weeks or maybe a couple of months," says Dr. Santos. "But we haven't had studies that show it is effective long term until now."

Not every child exhibiting inattentive behavior is a child with ADHD, says Dr. Diane Treadwell-Deering, assistant professor of psychiatric and behavioral sciences at Baylor College of Medicine. In fact, there are many disorders in which inattention is a symptom. Other causes for the behavior may be a learning disability, language disorders, depression, obsessive-compulsive disorder and anxiety disorders.

ADHD can also take the form of inattentiveness alone. These children may be more difficult to detect in the classroom because they are not acting out and getting noticed in the ways their hyperactive counterparts are. "People are looking more carefully at inattention alone, which is often seen in girls," says Dr. Treadwell-Deering. "Oftentimes, I think those cases have been underdiagnosed. They are often thought of as daydreamers or not applying themselves."

While a diagnosis of ADHD requires an onset of symptoms before age 7 and it is usually thought of as a disorder that affects children, for some, it can be a lifelong struggle.

"We used to think that people outgrew ADHD once they hit their teenage years, but we are learning now that not everybody does outgrow it," says Dr. Santos. "There is probably about a third of people that go on and don't have symptoms, there is a third of people that, after their teenage years, have some symptoms but may not be disabled by them, and then there is a third that meet the full criteria for ADHD and have a lot of problems because of it."

"What we are finding is that medications that tend to work in youngsters with ADHD tend to work in adults and there are a lot of research projects going on about that," says Dr. Treadwell-Deering.

"If someone continues to meet the criteria for ADHD and continues to be disabled by it, they can respond to treatments as adults and should be treated," she adds.

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©2006 Texas Medical Center

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