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Combined ADHD Treatment Lowers Need for Drugs

Behavior Therapy Combined With Stimulants May Let Children Use Low-Doses of Drugs
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WebMD Health News

May 11, 2005 -- Most kids who are treated for attention deficit hyperactivity disorder take stimulant medications, but new research suggests that the need for these drugs can be reduced dramatically in those who get behavioral therapy as well.

When the two approaches were combined, the amount of medication needed to achieve the same results as drugs alone was reduced by two-thirds, researchers from the University at Buffalo reported.

The study was also the first to test the effectiveness of a new ADHD patch containing methylphenidate, the stimulant also known as Ritalin. The study was funded by the patch's manufacturer, Shire Pharmaceuticals Group.

Smaller Doses

"One of the major findings of the study is that when using behavior modification, you can get away with tiny, tiny doses of medication, much lower than previously thought, says ADHD researcher William E. Pelham Jr.

Pelham tells WebMD that the patch, which is not yet on the market, allows more dosing flexibility than oral medications because it can be put on and taken off when needed.

The researchers write that studies have shown that behavioral therapy works to improve some ADHD symptoms. The improvements are comparable to low-dose stimulant medication, they add. However, not all researchers agree with the effectiveness of this approach to ADHD treatment.

A Medical Debate: Drugs vs. Behavior Therapy

The debate over how well behavioral approaches work in the treatment of ADHD is long and contentious. Behavioral therapy advocates like Pelham claim that far too many children are being overmedicated with stimulants like Ritalin, Adderall, and Concerta.

On the other side of the argument are ADHD experts who say drug treatments have been shown in study after study to be far more effective than behavioral treatments.

The largest and most widely publicized of these investigations was the National Institute of Mental Health-funded Multimodal Treatment Study (MTS), reported in 1999.

But Pelham says the findings have been largely misinterpreted by the press and the medical establishment.

"The ADHD community has embraced this study as proof that behavioral therapy is not effective, but that was not the finding at all," he says. "A combination of behavioral therapy and drugs was the most effective intervention in the study, followed by drugs alone."

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