This morning, the American Academy of Pediatrics (AAP) released new 2019 guidelines for attention deficit hyperactivity disorder (ADHD) treatment in children. They say medication is central, but behavioral therapy is important, as well. Other experts, though, are worried stimulant medication is prescribed too often, and believe that therapy should come first.
The AAP treatment recommendations are basically the same as the previous guidelines published in 2011. They suggest anyone diagnosed with ADHD over the age of five should start taking medication immediately, along with behavioral therapy. They recommend children under five start with behavioral treatment before medication.
The usual medication prescribed for kids and adults alike with ADHD is a stimulant like Ritalin or Adderall. But recent research suggests behavioral therapy may be even more effective.
Studies show the results of combined treatment through medication and therapy can’t specify which approach works better because they weren’t tested separately. But a 2016 study published in the Journal of Clinical Child & Adolescent Psychology showed that kids aged five-12 with ADHD had fewer behavioral problems when given therapy before starting on pills.
A recent 2019 study went even further: it found that kids aged five-13 with ADHD needed less medication when they got behavioral therapy first, and over a third of the subjects who got therapy first didn’t end up needing medication at all.
These studies do suggest behavioral intervention can reduce or eliminate the need for ADHD medication, but the sample size wasn’t big enough — they evaluated just under 150 children each — to really prove this. That’s why an AAP spokesperson told People magazine evidence isn’t yet strong enough for their guidelines to change.
But with one in 10 U.S. children diagnosed with ADHD, and the many known side effects of stimulant medication — trouble sleeping, loss of appetite, personality changes — this research could make a big difference.
The AAP agrees many kids aren’t getting enough behavioral treatment, especially compared to how many are prescribed medication.
According to a 2018 study published in the Journal of Pediatrics, 90% of kids with ADHD in the US have received medication, but only 60% got the behavioral therapy they needed.
Medication, unfortunately, is a much quicker and easier solution than therapy. There aren’t enough trained therapists, and good therapy is expensive and time-consuming for families. But if the AAP changes its guidelines, therapy might become more accessible.