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Can Behavioral Interventions Reduce the Need for ADHD Medication?
A study conducted in a summer treatment program of 127 unmedicated children with ADHD showed that when concurrently receiving behavioral intervention, many did not need medication or responded best at very low doses. In a subsequent study, researchers from Florida International University followed those children into the school year to find out whether the same would be true when they were in their regular home and school settings.
The children were randomly assigned to receive low- or high-intensity behavioral interventions, or no intervention. The interventions included a daily report card as a tool to help manage behavior and academic performance. Teachers also used reward systems, point systems, and other measures. The children were evaluated by teachers and parents each week to determine whether medication was needed.
The children who received continued behavioral intervention were about half as likely as those who didn't to start medication each week at school or at home. They also continued to use lower doses when getting medicine at school. With every additional year in age, a child was 13% less likely to initiate medication each week.
Given the delay and in some cases elimination of medication use, the researchers say, children in the behavioral consultation group were exposed on average to 1,820 fewer total mg of methylphenidate (MPH, Ritalin) over the school year, a reduction of more than 40%. Their findings suggest that the “widely adopted practice” of extended-release, 7-days-a-week dosing regimens that cover evening/home hours “may be unnecessary” for many children if behavioral therapy is provided before medication.
"[The] results add to a growing literature suggesting that the use of low-intensity behavioral intervention as a first-line treatment reduces or eliminates the need for medication in children with ADHD," wrote Ericka Coles and her coauthors.