ADHD Medication: Can Your Child Go Without?

Behavioral therapy for ADHD—and parent retraining, too—can be good alternatives to medication.

Video: ADHD

Video: ADHD

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Attention deficit hyperactivity disorder can be a distressing diagnosis, but families have more treatment options than they might realize. Although Ritalin and other stimulant drugs are the most common prescription, ADHD treatments that don't involve medication have a proven track record. And here's a surprise: One of the most beneficial options treats the parents, not the child. For children, skills training programs and ADHD summer camps can help teach techniques to overcome everyday problems that often make life miserable, such as remembering to bring assignments home from school or to listen without interrupting.

How training parents helps the child. Parent skills training has been used for years to improve the behavior of children, and multiple clinical trials have validated its effectiveness. Those same programs improve the behavior of kids with ADHD. Although it may seem odd to be changing parents' behavior to treat what's considered a medical condition in children, research has found that for children with ADHD, having parents who use effective parenting techniques is one of the best predictors of success in adulthood. These programs teach parents to make clear, specific requests of children, for instance, and to use praise and rewards for good behavior far more often than punishment.

In fact, parent training for ADHD is considered so mainstream that last fall the British government mandated parent training as the first choice for treatment in many cases. "For milder cases, we recommend starting with behavioral therapy," says Eric Taylor, a professor of psychiatry at King's College Hospital and an ADHD authority who helped write the new standards for the National Institute for Health and Clinical Excellence. In England, parents of children with ADHD are offered free government-funded classes where they learn to set clear limits for the child, be consistent in enforcing those limits, and reward good behavior.

In a perfect world, all children with ADHD would get coordinated, "multimodal" treatment, which would include parent training; a tailored program at school; education about ADHD for kids, parents, and teachers; and medication if necessary. But all too often, kids get just the pills. Most children are treated by pediatricians, who may not be aware of the data on the benefits of behavioral treatments such as parent training, despite the fact that the American Academy of Pediatrics recommends both behavioral interventions and medication. The various professional societies favor their own strengths, not surprisingly, with the psychologists endorsing behavioral therapy and the psychiatrists big on medication as the first line of treatment. "The behavioral treatment had no side effects," says William Pelham, a research psychologist who directs the Center for Children and Families at the University at Buffalo-SUNY and who was a pioneer in the use of parent training as a behavioral intervention for ADHD. Side effects of medication include insomnia, loss of appetite, and stunted growth. That, he says, is reason enough to follow the British model.

Parents who want to give parent training a try may need to ask around for evidence-based classes. (The National Resource Center on AD/HD is a good place to start, as are community mental health clinics. Ask if the program offered has been validated in clinical trials.) Some popular parenting books are based on clinically validated behavioral treatment. Three good ones: Parenting the Strong-Willed Child by Rex Forehand and Nicholas Long, The Incredible Years by Carolyn Webster-Stratton, and The Kazdin Method for Parenting the Defiant Child by Alan Kazdin. (Here's in-depth information on evidence-based parenting programs.)

"There are some caveats," says Russell Barkley, a clinical psychologist specializing in ADHD treatment and coauthor of the evidence-based parenting manual Your Defiant Child. Parent skills training tends to work better for younger children than for teenagers, Barkley says, probably because parents have less influence on teens than they do on 6-year-olds. And in his own research on preschoolers, parent training didn't improve children's behavior at school unless the teacher was also on board. Finally, parent training takes time and effort, because it means not only learning new techniques but also abandoning old habits (adios, nagging).