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