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A Study on Drug Efficacy for ADHD is Challenged

An article in the NYT’s health section at the end of December 2013 caught our eye at Think:Kids.

Twenty years ago ADHD experts funded by the National Institute of Mental Health did a study called the Multimodal Treatment Study of Children With A.D.H.D. that concluded that medication like Ritalin and Adderall trounced behavioral therapy. This finding became the bedrock of powerful pharmaceutical companies to promote medication. And promote they did!

Some of the studies researchers have had doubts about that conclusion and have published follow-up work that has criticized and challenged the notion of medication as the most effective treatment for ADHD.

A subsequent paper by one of those authors, Keith Conners, a psychologist and professor emeritus at Duke University, showed that using only one all-inclusive measurement — “treating the child as a whole,” he said — revealed that combination therapy was significantly better than medication alone. Behavioral therapy emerged as a viable alternative to medication as well. But his paper has received little attention.

Others have pointed out flaws in the study of 20 years ago. The fact that many of the 19 categories measured classic symptoms like forgetfulness and fidgeting — over academic achievement and family and peer interactions — hampered therapy’s performance from the start, several of the study’s co-authors said

“When you asked families what they really liked, they liked combined treatment,” said Dr. Peter Jensen, who oversaw the study on behalf of the mental health institute. “They didn’t not like medicine, but they valued skill training. What doctors think are the best outcomes and what families think are the best outcomes aren’t always the same thing.”

“My belief based on the science is that symptom reduction is a good thing, but adding skill-building is a better thing,” said Stephen Hinshaw, a psychologist at the University of California, Berkeley, and one of the study researchers. “If you don’t provide skills-based training, you’re doing the kid a disservice. I wish we had had a fairer test.”

Comments in the NYT’s article by folks like Ruth Hughes, a psychologist and the chief executive of the advocacy group Children and Adults With Attention-Deficit/Hyperactivity Disorder make sense to us. “Medication helps a person be receptive to learning new skills and behaviors, but those skills and behaviors don’t magically appear. They have to be taught.”

This is where Collaborative Problem Solving enters the scene. Our model focuses on skill building, on helping a child function better in the world, not just on symptom reduction. While reducing symptoms, such as blurting out in school, is helpful it doesn’t address the more complicated thinking skills such as problem solving, frustration tolerance and flexibility that allow a child to make friends, enjoy their family, ride the bus successfully, or ask a teacher for help after a poor test performance. These activities require skills such as social awareness and reciprocity, good language, and ability to see the gray of a situation that are not improved by ADHD sympton reduction. Allievating ADHD symptoms paves the way to learn these more complicated skills. (Effectiveness of Collaborative Problem Solving in Affectively Dysregulated Children With Oppositional-Defiant Disorder: Initial Findings, see more.

Furthermore, the longer retention of CPS is a huge benefit. Based on our research we found that kids retained the skills they learned through the Collaborative Problem Solving model at a much higher rate than other behavioral interventions.

There is an important role for medication but as the NYT’s article points out there is also an important role for skills focused therapies of which Collaborative Problem Solving is one.

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