Answer

May 1, 2000 (Lexington, Mass.) -- Yes. Behavioral therapy can help, but it often works best when combined with medication. And for the core symptoms of ADHD, medication seems to be more effective.

Behavioral therapy involves working to discourage disruptive or inattentive behavior and to reward good social and work skills. For instance, when a child focuses on solving problems in the classroom, a teacher might reward the child with praise. A parent might require a boy or girl who acts up at home to take a time-out and sit alone for a few minutes.

Recently, the National Institute of Mental Health (NIMH) and the U.S. Department of Education completed a large study that compared behavioral therapy with stimulants such as Ritalin. In the behavioral therapy groups, parents were taught how to reward good behavior and discourage bad, and children were helped in school by specially trained staff. Another group of children was treated with stimulants alone, and a third group with both medication and behavioral therapy. Results published in the December 1999 issue of the Archives of General Psychiatry found that while all forms of treatment helped, medication alone and the combination treatment worked better than behavioral treatment alone.

The NIMH Consensus Statement, released Nov. 16, 1998, found similar results. It looked at studies that tracked children's progress for several months and confirmed that stimulants alone are more effective than behavioral therapy alone.

This does not mean that you should discount behavioral therapy. Many children with ADHD also have other social or psychological problems. They may be anxious or easily stressed. In fact, a third of the children studied by the NIMH had an anxiety disorder. For those children, behavioral therapy worked about as well as medication or combined treatment, and in some cases, combined therapy worked best.

The NIMH Consensus Statement also noted that parents and teachers report greater improvement in children's social skills when medication and behavioral therapy are combined.

As you work with your son, you'll likely hear about many other treatments for ADHD, including everything from sugar-free diets to biofeedback. Unfortunately, documented evidence backing any of these therapies is pretty thin.

To find the best treatment for your child, consult with his pediatrician or a psychiatrist recommended by his pediatrician. A study in the February issue of the Journal of the American Academy of Child and Adolescent Psychiatry found these specialists are far more likely than family doctors to prescribe follow-up counseling, behavioral therapy, and education -- along with Ritalin.

Ronald Pies, MD, is a clinical professor of psychiatry at Tufts University and a lecturer on psychiatry at Harvard Medical School. He is the author of A Consumer's Guide to Choosing the Right Psychotherapist and The Handbook of Essential Psychopharmacology. His newest book is Ethics of the Sages.

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