You may also know that the most common medication is actually a stimulant, Ritalin.
Ritalin is currently prescribed to approximately six million people in the US. 75% of these are children, with boys receiving Ritalin about four times more often than girls. In the UK it effects between 2-5% of children and young people.
However this drug is not without controversy not least because not enough is known about the long-term effects.
Alternatives using behavioural techniques have not been fully endorsed by doctors because in trials medication was shown to be more effective in the short run. Longer term however there are no real differences between medication and behavioural interventions.
Gregory A Fabiano, an Associate Professor of counselling, school and educational psychology at the State University of New York, carried out a large scale study of 174 previous studies of behavioural treatments (this is called a meta-analysis). These treatments fell into three broad areas:
1 Parent programs. These encouraged parents to focus on good behaviour rather than when the children were naughty or disruptive. So parents were encouraged to notice when they did the right thing, label it and comment on it, so the children are getting attention for good behaviour.*
2 Teacher programs. These included step by step instructions for children, rewarding them as they progressed through each stage, and announcing the consequences of not paying attention ahead of time. Teachers also used contingency management where they provided daily report cards that showed how well the children had met goals such as taking turns or completing homework and for which they were rewarded. (A bit like star charts).
3 Therapeutic recreational programs. In these children with ADHD interact with each other at Summer camps or similar events. In addition to the usual sports and craft events there are behavioural interventions which can last all day or even for several weeks. These include social skills training, coached group play, and team membership skills.
The American Academy of Pediatricians 2011 treatment guidelines recommends behavioural intervention as the first line of treatment for young children with ADHD. Early intervention is important to ensure that the children don’t fall behind socially and academically.
This means parents introducing pre-schoolers to literacy and numeracy activities to give them a head start. Psychologists can also help parents to identify the reasons behind behaviours and teach children to communicate their desires and that there are consequences for not complying or for future transgressions (useful for all children).
There are other things that can help especially healthy lifestyles. An extra 30 minutes of sleep can help and just a few minutes of exercise can help children with ADHD ignore distractions, stay focussed, and improve their academic performance.
Experiments with children either reading or using an exercise bike showed that the ones who exercised, whether or not they had ADHD, did better on maths and reading comprehension tests. The exercisers with ADHD did better on a computer game where they slowed down and made fewer mistakes.
Personally I think the fewer drugs we use the better so these behavioural interventions are all worth the effort.
Based on “Easing ADHD without meds” byRebecca A Clay in APA Monitor on Psychology February 2013
NB In America 25% of people taking Ritalin are adults and it is becoming increasingly common for students, among others, to use it as a brain booster (a topic I’ve posted on elsewhere)
In the UK, where it’s illegal without a prescription, some experts have suggested that if it’s safe for children it should be safe for adults to use in this way.
* This is similar to the approach used in the Parent-Child Game for improving family relationships.