Many Children With ADHD Are Not Receiving Behavioral Therapy

Patients under age 18 with ADHD often only receive stimulants, which can have a host of negative side effects. We should do better.

Children under the age of 18 with a diagnosis of Attention Deficit and Hyperactivity Disorder  (ADHD)  require some sort of behavioral therapy, as stimulants alone have significant side effects that can lead to diminished growth, increased blood pressure, weight loss, sleep problems, personality changes, and come with the risk of potential abuse and addiction. Children are often not given proper behavioral therapy, which is an essential protocol with current stimulant guidelines for ADHD. Children on stimulant medications are at risk of future problems such as criminal activity, addiction, uncontrolled anger, and increased risk of suicide. Behavioral therapy, including documenting academic performance, assessing behavior frequently, providing healthy coping mechanisms, and assessing irrational behaviors, are vital in treating children with ADHD. The American Academy of Pediatrics (AAP) released revised guidelines for the care of children with ADHD.  

Behavioral therapy continues to be recommended as the first line of care and is most efficacious and constructive if this is initiated early on. According to the Centers for Disease Control (CDC), approximately 50% of young children with ADHD enrolled in Medicaid received psychological services, despite this being the recommended first-line treatment. This demonstrates that the first-line treatment for pediatric ADHD is underused, as a significant number of children are not referred for behavior therapy before initiating controlled substances to mitigate the symptoms.

Parents need to essentially become directly involved in training under a trained professional, and then transfer the care to home. Applying these valuable techniques into the daily routine is crucial for a better outcome. By learning and utilizing the strategies, parents can support their child at home, often requiring just a few behavioral changes, which can often lead to less doses of stimulant medications. Unfortunately, only 40 to 50% of young children diagnosed with ADHD received the recommended psychological services. As a result, more children are on medications compared to receiving psychological services, including behavior therapy.  

Figure shown as  table1  depicts the main evidence-based behavioral intervention approaches in three various settings, based on 22 studies conducted between 1997 and 2006. ADHD is a chronic condition, and implementing a chronic care model will contribute to positive long-term effects.

There are six components to the Chronic Care Model for Child Health:

  • Decision support
  • Delivery system design
  • Clinical information systems
  • Family and self-management support
  • Community resources and policies
  • Health care organization

Behavior therapy includes a broad range of interventions by modifying, adding, or eliminating specific physical and social changes that will alter the child’s behavior. Each initial evaluation should be conducted with an open mind, and a bit of trust is required to have your child gauged by another provider. The combination of medication management and behavior therapy treatment demonstrated the use of lower dosages of controlled substance stimulants medications, most likely reducing the risks of possible side effects, future abuse, and addiction.  Given the fact that only half the children are even given the opportunity to integrate behavior treatment reveals the vital extra step that we must take as providers for these children in order to make sure that we are doing everything to prevent future addiction and abuse.

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