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Combined ADHD Treatment Lowers Need for Drugs

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

Combined Treatment Works Better

In his newly reported study, researchers followed 27 children with ADHD, aged 6-12. The children participated in a highly intensive behavioral therapy program developed by Pelham almost a decade ago. The summer-treatment program includes both recreational and classroom components with a very high ratio of teachers to students.

When used alone, the Ritalin patch and the intensive behavior modification were found to be equally effective treatments.

When the two treatments were combined, however, children required much lower doses of medication -- as much as 67% less -- to achieve the same effects as high-dose medication used alone, Pelham says.

He adds that a lower dosage of drugs means a lower risk of long-term drug-related side effects, which can include loss of appetite.

"Long-term side effects of ADHD drugs are almost always related to dosage," Pelham says. "If you want to lower a child's dosages daily and throughout their lifetime, the best way to do that is to combine the medication with behavior modification."

Treatment Approach Difficult to Replicate

ADHD specialist Howard Abikoff, PhD, agrees that intensive behavior modification can be very effective while the child is getting the treatment. The problem, he says, is that highly intensive approaches like Pelham's summer program are difficult to replicate in real-world settings.

Abikoff directs the Institute for ADHD and Related Disorders at the New York University Child Study Center.

"Basically that means at home and in school," he tells WebMD. "When we try this approach outside of the summer-treatment program it is very difficult to achieve the same level of improvement in ADHD symptoms."

Abikoff says drug therapy alone works well to normalize ADHD symptoms in just over half of children.

"It is clear that in most children with severe symptoms, behavioral therapy alone is usually not sufficient," he says. "But children and their parents and teachers also need to learn management skills to help cope with the ADHD. Many kids have problems that medication doesn't address."

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