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Parent training more effective than meds for children with ADHD

A recent study commissioned by the US Agency for Healthcare Research and Quality has found that parent behaviour training is a more effective intervention in improving Attention Deficit Hyperactivity Disorder (ADHD)/combative behaviour in pre-schoolers rather than giving them psychostimulant medications like methylphenidate.

The research was based on the fact that symptoms of ADHD are usually detected in primary school, and signs of the condition are normally seen as disruptive to parents and teachers of the affected children. Because it was noted that pre-schoolers already exhibit temper tantrums and behaviour that may be qualified as Disruptive Behaviour Disorder (DBD), including Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD), which had been shown to develop into ADHD by grade school, the study on pre-schoolers was conducted.

The research, led by Alice Charach, MD, of the Department of Psychiatry, University of Toronto, and The Hospital for Sick Children, Toronto, Ontario, Canada, examined fifty-five published studies from 1980 to May 31, 2010 about interventions for pre-schoolers at high risk of ADHD and the long-term outcomes following interventions for ADHD in persons of all ages. Publications such as MEDLINE®, Cochrane CENTRAL, EMBASE, PsycInfo, and ERIC (Education Resources Information Center) were included in the study.

The interventions in the study utilised placebo, the same medication different dose or duration, other medication, behavioral intervention, psychosocial intervention, academic intervention and any combination of medication, academic, behavioral, or psychosocial intervention. The non-medication interventions consist of parent behavior training, which are programs that help control a child’s behaviour through rewards and actions that are not penalising; psychosocial interventions, which include psychoeducational, parent counseling and social skills training; behavioral interventions which are similar to parent behaviour traning except it include teachers and other adults; and finally, school-based interventions, where teachers control the child’s behaviour in a school setting.

The researchers concluded that behaviour of pre-schoolers improved considerably with PBT, and that the only possible limitation for the success of the training is parents’ attrition.

Meanwhile, the use of methylphenidate medication had less improvement on behaviour of children aged six and below.

Evidence for long-term outcomes of the intervention had been few among persons of all ages except for primary school-aged children consisting of mostly boys, who demonstrated improvements for 12 to 14 months following use of the medication methylphenidate or atomoxetine.

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