Parents of preschoolers at risk for attention
deficit/hyperactivity disorder (ADHD) may first want to try behaviour training
before they put their children on medications, suggests a new analysis of past
Researchers found medications improved young children's
behaviours but put them at risk for mood and growth problems. Training that
teaches parents to understand their children's needs, however, did the same
without side effects."Training also helps the parent feel more
confident," said Dr. Alison Charach, the study's lead author from the
Hospital for Sick Children in Toronto.
Children with ADHD tend to have a hard time paying
attention, to be forgetful, fidget and be easily distracted, to the point that
it creates problems at school, at home and with their friends. A recent
analysis of Centers for Disease Control and Prevention numbers by The New York
Times found about 11% of US school-aged children are diagnosed with ADHD.
While it's difficult to diagnose children younger than six
years old with the condition, Charach said it's important to start children
with disruptive behaviours – including ADHD – on the right
path."Immediately intervening at this age puts the child on an improved
trajectory for school and adolescence," she said.
But Charach and her fellow researchers, who published their
findings in Paediatrics on Monday, wrote that there's no information on the
effectiveness of parent behaviour training compared to the popular ADHD drug
Ritalin – sold generically as methylphenidate.
For the new study, the researchers analysed 55 studies from
1980 through 2011 that looked at the different treatments among preschoolers at
risk for ADHD. They found eight "good" studies that looked at parent
behaviour training, which consists of about 10 to 12 sessions that teach
parents how to better understand their child. Those led to a moderate
improvement in behaviour, Charach said."The main thing is really helping
the parent understand their child and read their child," she said.
For example, the sessions may help parents understand their
child acts up after an hour of being at a birthday party, and that they should
leave earlier. Only one "good" study evaluated Ritalin use in
preschoolers. That study showed a similar improvement in behaviour, but the
preschoolers were at risk for side effects, including irritability and slowed
growth."For whatever reason children in this age group are more sensitive
to the Ritalin side effects," said Charach.
While it's hard to compare the effectiveness of parent
behaviour training and Ritalin to each other, the researchers concluded that
there is more evidence that the training sessions are effective in
Parent behaviour training
Thomas Power, director of the Center for Management of ADHD
at The Children's Hospital of Philadelphia, said there are many cases where
training does not work and people do have to use medication. But Power, who was
not involved with the new analysis, agreed with the findings."In general,
with preschool- and kindergarten-age children with ADHD and ADHD-related
problems, you'd typically want to start with parent behaviour training," he
Charach cautioned, however, that the previous studies showed
that parents needed to follow through with their training sessions."If
parents only go to about half the sessions, they don't get nearly as much
benefit," she said. Dr William Barbaresi, who researches ADHD at Boston
Children's Hospital, also said that it may be difficult for parents to find the
Although a behavioural approach is clearly the most
appropriate first line of intervention, it is often extremely difficult for
families to access high-quality behavioural therapy, due to the inadequate level
of insurance funding for these services," Barbaresi, who wasn't involved
with the analysis, told Reuters Health in an email. He added that the new
findings support the American Academy of Pediatrics (AAP) guidelines on
treating children with ADHD.
The AAP recommends doctors evaluate children from age four through
18 years old for ADHD if they have academic or behaviour problems. They
recommend behaviour therapy for four and five year olds, and US Food and Drug
Administration-approved medications for those six years old and older. Charach
said she didn't look at which treatment is more cost-effective."In the
immediate term, it may look like the session is more expensive, but it depends
on the medication," she said.