Stimulant drugs such as Ritalin are commonly prescribed for
children whose impulsiveness, distractibility, and frenzied behavior earn them a diagnosis
of attention-deficit hyperactivity disorder (ADHD). Now, a program that trains parents how
to deal with such youngsters shows promise as an effective, lasting ADHD treatment that
avoids the potential dangers of extended stimulant use.
"With rigorous management of behavioral consequences
by the parents, these children can function well, at home and at school, without
medication," holds David B. Stein of Longwood College in Farmville, Va.
Current ADHD treatments combine medication with behavior
therapy, which includes rewarding a child's good behavior with tokens redeemable for toys
and having parents remind him or her about daily duties. ADHD responds to this
approach but typically flares up once treatment stops, Stein Says.
His program teaches parents to encourage children to pay
attention to their own behavior and to plan ahead, thinking skills that Stein suspects
become ingrained as children gradually discover that they reap social benefits.
Parents of 37 children, ages 5 to 11, received six training
sessions. The tactics taught included identifying a child's problem behaviors, punishing
children immediately after a misdeed and having the child recall what he or she did wrong,
and using social activities as rewards for good behavior.
At the same time, each child stopped taking previously
prescribed stimulant medication and attended six sessions of cognitive therapy.
Therapists helped the children think about situations that trigger problem behavior,
discussed alternative ways to act, and instructed them in social skills.
Once parents put their training into practice, children's
ADHD symptoms worsened slightly for one week and then improved over the next 3 weeks. At
that point, only seven kids continued to frequently misbehave at school and skip homework.
Their parents completed four more training sessions, which focused on enforcing
after-school attention to academic material.
One year after completing the training, parents reported
that the children's improved behavior, obedience, and attention had not faded, although
they still became overly aggressive at times. None of the children had resumed taking
medication.
Much prior evidence indicates that ADHD responds best to a
combination of Ritalin and behavior therapy, cautions George J. Dupaul of Lehigh
University in Bethlehem, Penn.
