For decades, Ritalin and similar stimulants have reigned over other treatments for attention deficit hyperactivity disorder, also known as ADHD or ADD. The meds are seemingly tried and true, with numerous studies backing their effectiveness. However, the latest results from the Multimodal Treatment Study of Children with ADHD, the largest investigation of the benefits of medication against behavioral therapy, found that stimulants' effects wane over time. In addition, the study found that more than 60 percent of the children on stimulants stopped taking the medication within eight years. What's more, the medications used in the study might have stunted participants' growth, researchers concluded.
The vast majority of kids respond positively to one or more of the approved medications for ADHD, according to Mina Dulcan, head of child and adolescent psychiatry at Children's Memorial Hospital in Chicago. (She is a member of an advisory board sponsored by the manufacturer of a nonstimulant used to treat ADHD.) But it's not as simple as finding an ADHD drug that works. Many of these children, she observes, have problems besides ADHD that may also need to be addressed.
Experts have a lengthy list of techniques other than prescription drugs that may help manage ADHD symptoms. Here's a quick look at some of them:
Positive parenting. Authors of a review published last year in Clinical Pediatrics wrote that parents of kids with ADHD are often more controlling and disapproving of their children, are more likely to reprimand, and are less supportive than parents of kids without the disorder. Training programs can teach parents how to reward good behavior by, for example, awarding points or privileges to kids for focusing on their homework. Considerable scientific evidence indicates that receiving training in key parenting skills helps parents manage their kids' behavioral problems, although studies showing the long-term benefits of the treatment are lacking. "Absolutely essential to any treatment program for ADD should be positive relationships," both at home and at school, says Edward Hallowell, psychiatrist and author of Superparenting for ADD. U.S. News contributor Nancy Shute interviewed him recently.
Treatment programs. Along with parent training sessions, summer programs for kids were examined in the MTA study. As behavioral therapeutic interventions, summer programs and parent training initially were found to be less effective than medication in children with ADHD. But these behavioral therapies are recommended by the American Academy of Pediatrics as acceptable treatments for ADHD. Summer treatment programs, pioneered by William Pelham, a research psychologist at the State University of New York-Buffalo, are offered at several university medical centers and aim to teach kids social skills and improve academic performance. Shute covered such programs in detail, as well as those that deal with parent retraining, earlier this year.
Neuro feedback. Also called EEG biofeedback, this treatment tries to train patients to control brain waves typically associated with focus and attention. Unlike medication, which must be taken for years, neurofeedback is said to work permanently after the training sessions are completed. It seems to be safe. Numerous studies of the technique "all have some flaws, but it looks like a promising treatment," says Eugene Arnold, professor emeritus of psychiatry at Ohio State University and lead researcher of a current federally funded clinical trial of neurofeedback on a group of children with ADHD. He notes, however, that this approach is difficult, labor intensive, and expensive—as much as $5,000, a cost that health insurance is unlikely to cover until there is clear evidence that neurofeedback works. Such evidence, Arnold says, is accumulating.
Interactive Metronome training. Many kids with ADHD can't form and execute a plan one step at a time, as other kids do. Interactive metronome training, which employs a computerized tool, was developed to help kids with ADHD improve their motor skills and ability to plan. Users tap their hands or feet in time to a beat they hear through headphones, and the technology records their accuracy. In a study that included 56 boys with ADHD, the training seemed to focus attention and improve motor control, reading, and other skills in the patients, compared with those who either got no treatment or played video games.