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Parents Raising Children with ADHD: Start with Behavior Therapy, Not Medication

A new report released by the CDC shows the gap between medication use and recommended behavioral therapy for young children with ADHD.

May 6, 2016

The Centers for Disease Control and Prevention (CDC) published a report this week revealing that less than half of very young children with ADHD are receiving behavior therapy to treat the condition. Yet overwhelming medical evidence suggests that behavior therapy is a safer option than medication at these young ages.

The study, published online May 3, looked at more than 5 million children with ADHD in the United States, insured either by their parents’ employers or through Medicaid. The children were all between the ages of two and five, and received clinical treatment for ADHD between 2008 and 2014.

The CDC found that less than half of the children were receiving any behavior therapy at all, despite 2011 AAP guidelines recommending that therapy be used as a first-line treatment for all children younger than six. In fact, the percentage of the children receiving behavior therapy decreased after the AAP released the guidelines — from 44 to 42 percent. On the other hand, more than 75 percent of the children were prescribed medication for their ADHD, directly countering the AAP recommendations for the age group.

Children younger than five years may be more susceptible to adverse effects from medication, studies find, with up to 30 percent experiencing negative side effects like sleep difficulties, digestive upsets, and irritable moods. On top of that, many ADHD medications have only been FDA-approved for children ages six and over — though there are exceptions in more extreme circumstances.

As a result of the report, the CDC is formally recommending that more doctors discuss behavior therapy with parents before pursuing medication. Medication can be helpful for young children, they say, but should only rarely be used before psychological options are fully explored.

“We are missing opportunities for young children with ADHD to receive behavior therapy,” said Dr. Anne Schuchat, principal deputy director at the CDC. “Behavior therapy has been shown to help improve symptoms in young children with ADHD and can be as effective as medicine, but without the side effects.”

At these younger ages, behavior therapy usually focuses on teaching parents skills to help them modify and redirect their children’s problem behaviors. It can be a time-intensive process, but multiple studies have demonstrated that it is as effective as medicine for younger children. What’s more, the effects last even after formal therapy has stopped.

“We recognize that these are not easy treatment decisions for parents to make,” said Schuchat, seemingly acknowledging that medication appears the easier route for overwhelmed parents. But, she added, “We know that behavior therapy is effective, and the skills parents learn can help the whole family be successful.

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