Drugs May Not Be More Effective Than Behavioral Interventions in Treating A.D.H.D.

At the end of last year, an interesting article appeared in The New York Times.

In essence, it said that everything we knew about treating attention deficit hyperactivity disorder was wrong.

The child psychiatrists quoted in the article did not challenge the effectiveness of stimulants and other medications in treating A.D.H.D. or the helpfulness of behavioral interventions. But what they did say was that more than 20 years ago a dozen leaders in psychiatry, who had an $11 million grant from the National Institute of Mental Health, got it wrong about medications like Ritalin and Adderall trouncing behavioral interventions.

The authors in that study went as far as to argue that combining behavioral interventions with medications did little to improve outcomes from clients. That has become a crucial piece of the argument of pharmaceutical companies trying to market A.D.H.D. drugs and a key reason that coaching modalities that are helping in treating A.D.H.D. are not more prominently taught in psychology graduate schools.

The authors, however, are beginning to seriously question those conclusions, according to the article, noting that while study focused on impulsivity and inattention symptoms -- areas where medications can be rapidly effective -- it did not look at longer-term academic success, social skills and other areas that most effectively treated by behavioral interventions.

The coauthor of the study, Dr. Lily Hechtman of McGill University in Montreal, told The Times of the Multi modal Treatment Study of Children with A.D.H.D, “I hope it didn't’t do irreparable damage. The people who pay the price in the end is the kids. That’s the biggest tragedy in all of this.”

As we re-examine the conclusions of that study, what’s clear working in clinical practices with psychiatrists, therapists and A.D.H.D. coaches is that our clients with A.D.H.D. often benefit from treatment from each of those disciplines. Medication management serves as a front-line method of treatment impulsive and inattentive symptoms that give clients a fighting chance to allow for practical behavioral interventions to allow them to modify their way of operating.

A.D.H.D. is a disorder of executive function -- meaning the part of the prefrontal cortex that manages time management, organization, prioritizing, impulse control -- and other higher end functioning. Medication, no doubt, can play a role in improving executive function, leading to less social problems, academic problems and other issues. Behavioral interventions, such as coaching and psychotherapy, can help people develop new symptoms, ways of approaching challenges and forging past some of their prior disappointments. Coaches, and hands on therapists, also help clients stay on track, provide accountability and assist with follow through.

It may have taken the study’s authors 20 years to recognize it,
but we’ve known for a long time that coaching an A.D.H.D. brain to health is an effective form of treatment.

For information on Social Skills groups visit our website or contact us at 703-574-6271 ext 1. 

The Importance of "Me Too"

Most human beings have the opportunity to experience the various stages of development along the way to adulthood. During each phase of our lives we are presented with various opportunities, challenges, and changes. There are also similarities across the phases of development and one very important feeling is being connected with someone else and having a “me too” feeling. These feelings of connection are created through having a similar thought, feeling, opinion, idea, interest, or experience as someone else.

When we engage in conversation with others, we are inviting others to get to know us and possibly for the opportunity to connect. Children thrive on their connections with their parents and feel fulfilled in those relationships. Then suddenly to the dismay of parents, teenagers crave connection and validation from their peers.

Sometimes teenagers have difficulty communicating with their peers, which decreases their opportunities for connection. Usually difficulties with communication are related to self-confidence, feelings of embarrassment, feelings of anxiety, or diagnosed disorders. During a time in life when social connections are the number one priority, fewer connections can cause varying amounts of sadness and anxiety.

How do we create opportunities for our teenagers to make connections? Teenagers can participate in group activities at school or in the community. It is important to find a group that matches the teenager’s personal interests since that will increase their opportunity to find another peer who has similar interests.

For teenagers who struggle with moderate to severe levels of anxiety or a diagnosed disorder, the setting of a social skills group may be more appropriate. Social skills groups consist of a group of similar aged children or adolescents with related social difficulties and a trained facilitator. The benefit of having a trained facilitator run the group is their ability to encourage and increase opportunities for connection as well as manage any group dynamics that may distract from the connection process.

I have observed children and teenagers make connections through simple statements during groups, such as my favorite color is green or my favorite food is pizza. The listening group members jump at the chance to say I like green too and I like pizza too! I feel excitement and warmth when I witness two individuals making a connection even if the interaction only lasts a few seconds. Groups create opportunities for a greater number of connections and the possibility of meaningful connections. Statements about favorite colors and pizza transform over time to teenagers sharing their thoughts and feelings. It is a special experience to witness a teenager share they are experiencing a feeling and for their peer to share yeah, me too.

For more information on Victoria McKenna, or Social Skills groups visit our website or contact us at 703-574-6271 ext 1.