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Since the 1970s, stimulant drugs have been seen as the dominant way to help ADHD students focus. But research now suggests that behaviorally-based changes are more effective in the long run.
An article in Scientific American on May 15 2012 reports that a new synthesis of behavioral, cognitive and pharmacological findings emerged when experts in ADHD research presented their work at an Experimental Biology meeting in San Diego.
The findings suggest that behavioral and cognitive therapies focused on reducing impulsivity, and reinforcing positive long-term habits, may be able to replace current high doses of stimulant treatment in children and young adults.
Recently, surveys have shown that 9 percent of all children in the US have been diagnosed with ADHD. The core symptoms of ADHD include hyperactivity, inattention, inability to perform monotonous tasks, and a lack of impulse control.
Such children have difficulty in school as well as in forming relationships. Nearly sixty percent will continue to suffer from the disorder well into adulthood.
By 2007, 2.7 million children were being treated with stimulant drugs. Psychologist Claire Advokat of LSU has looked into the effects of stimulant medications in college students. She is interested in finding what improves with medication and what does not.
She found, to begin with, that people diagnosed with ADHD have lower grades and lower ACT scores. In addition, they drop more courses than their peers.
She also found that these issues were not improved by stimulant medication treatment.
Instead, Advokat discovered that — naturally — ADHD students divided into those who had good study habits and those who did not, regardless of treatment. It appeared that those with good study habits did not need medication to bolster their grades.
She hypothesizes that it is not that medication has no effect, but that “it may be that the medication can help, not in helping you remember, but in helping you form the good study habits.” Her findings suggest that if ADHD patients could learn good study habits early on, medication would become less necessary.
Other research examined the role of behavioral interventions, not only for children, but also for their parents.
Parents of children with ADHD exhibit more parenting-related stress and difficulties than parents of students who are not afflicted. After training parents in stress management, and giving them behavioral tools to help their children, says psychologist Bill Pelham of Florida International University, he and his colleagues saw significant improvement in the youngsters’ ADHD-related behavior, such as frequency of classroom disturbance.
Pelham has also shown that behavioral therapy for the children themselves produces equivalent results to those seen from medication. He feels that his data suggests that a lower drug dosage, combined with behavioral therapy, may provide a far better outcome than either medication or therapy alone.
Additionally Julie Schweitzer and colleagues, at the MIND Institute at UC Davis, published a 2011 PLoS ONE paper, with results showing extra activity in brain areas associated with “task-irrelevant” information during working memory tasks. It appears that such students have less efficient cognitive control. Schweitzer’s recent work indicates that cognitive therapy could improve control, thereby potentially reducing the need for medication to “drown out” extraneous information.
At the San Diego meeting, Advokat, Schweitzer, Pelham and others agreed that behavioral therapies deserve renewed focus. Therapies come with no drug tolerance; they offer no fear of subsequent substance abuse.
The trick, they feel, will be in identifying which of the new therapies are most effective and, additionally, making those therapies affordable. While stimulant medications are much cheaper and faster at the moment, the “long run” is what matters most to those involved.
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