Can Parents Be Taught to Improve Symptoms of ADHD?
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"Some might take this study as a commentary against medication, but I don't think it is," says Ann Abramowitz, PhD, an associate professor of psychiatry and behavioral science at Emory School of Medicine in Atlanta. "It's more a study about appropriate interventions with preschoolers."
One problem with the study: "Whether all children in the study have true ADHD is not clear," says Abramowitz. "It relied primarily on mothers' reports of symptoms. There was no teacher input, which is critical to diagnosing this disorder. Symptoms must clearly be present in several environments.
"It could be that the 50% of children who showed improvement were simply children with oppositional behavior -- who are defiant, break rules -- whose parents really do need training in parenting techniques," Abramowitz tells WebMD. "Perhaps they improved because their parents were less effective managers to begin with. Studies have already shown parent training to be [effective] with preschool kids who are oppositional."
Those who didn't respond to behavioral therapy quite possibly had true ADHD, says Abramowitz.
Bottom line: "Medicating preschoolers may be appropriate, but I don't think it's as appropriate to do it as a first intervention for preschoolers," Abramowitz tells WebMD. "I think the authors should say they cautiously suggest this intervention should be attempted before medication is prescribed. Some people are too quick to medicate."
From a psychiatrist's viewpoint, "it's unclear whether these children had true ... ADHD or not," William Wetzel, PhD, an associate professor of psychiatry at Duke University School of Medicine tells WebMD. "But I find it hopeful. It's one of the first studies to ever show that a pure psychiatric approach can have some meaningful effect on ADHD ... that for very young children, behavioral therapy may be effective in ameliorating symptoms, whereas in older children this kind of behavioral therapy is not effective."