Post by Amtram on May 2, 2014 10:37:46 GMT -5
In a very small number of cases, medications alone or psychotherapy alone will help people. The gold standard is both, though. (And the options available in pharmaceutical and psychological approaches allow a good amount of customization!) This is an old interview from Dr. William Dodson, but it still holds a lot of good advice.
Multimodal treatment is best. The place that everybody often at least explores and starts with is medication. Medications help level the neurologic playing field, so that the person can have an equal shot at success. Now, medication is not a panacea. Pills don't give skills. But what it does is it gets the person in the door, so that then they can do all the remedial work that they need to do. They need to get caught up on their schoolwork, where they couldn't do it before, because they couldn't pay attention or they couldn't sit still long enough to study. And they need to go back and pick up skills in the social realm. . . . They have to go back and learn organizational skills, because these folks are terribly disorganized. There are a number of things that they have to learn, but the medication makes it possible. . . .
Over the last 20 years, if you read the literature, there are two great trends. One is validating the diagnostic criteria to say that this is a valid, reliable set of criteria if you apply them in order. The other one is saying what works in treatment. There are now over 170 double-blind control studies showing that the stimulant class of medications is effective. . . .
There are also a whole bunch of studies that show that a whole bunch of other things have an effect. And so the federal government, about six years ago . . . established the Multimodal Treatment Study of ADHD--the MTA--which was published in December,1999. That's the largest study ever undertaken of a mental health disorder in children. It's a huge study.
They took 579 elementary school-aged boys and girls who had the combined type of ADHD. And they broke them into four different treatment arms. The first group got just medication, and the medication was fine-tuned to the . . . child. The second group got intensive behavior management. By intensive, I mean two months of an immersion summer camp program--12 weeks of somebody coming in every day into the school to work with the teachers; 26 weeks of parent training, so the parents could use these techniques at home; 26 weeks of the kids getting individual and group treatment. In other words, a very money-, labor-, and time-intensive treatment. A third group got medication plus behavior management. And a fourth group, armed with world class work-ups, got referred out into their communities to see what would happen.
At the end of the study in 14 months, more than a year, the results were striking. . . . The two groups that got medication did wonderfully. They did exceptionally well. Adding the behavior management component did not improve the outcomes, unless you had an anxiety disorder, a co-existing condition, or you came from a single-parent family; then it made a difference. But it didn't make a huge difference. It didn't make a detectable difference in the outcome for ADHD.
And down from those was the intensive behavior management program. . . . It was nowhere near as effective as medication was. The big disappointment was that, when they came back after the intensive behavior management program had ended, there was no evidence that it had ever occurred. The hope had been that these techniques would be internalized by the children and that eventually, this very expensive treatment could be attenuated and ultimately stopped. What they found was that, as soon as the treatment stopped, so did the benefits.
Over the last 20 years, if you read the literature, there are two great trends. One is validating the diagnostic criteria to say that this is a valid, reliable set of criteria if you apply them in order. The other one is saying what works in treatment. There are now over 170 double-blind control studies showing that the stimulant class of medications is effective. . . .
There are also a whole bunch of studies that show that a whole bunch of other things have an effect. And so the federal government, about six years ago . . . established the Multimodal Treatment Study of ADHD--the MTA--which was published in December,1999. That's the largest study ever undertaken of a mental health disorder in children. It's a huge study.
They took 579 elementary school-aged boys and girls who had the combined type of ADHD. And they broke them into four different treatment arms. The first group got just medication, and the medication was fine-tuned to the . . . child. The second group got intensive behavior management. By intensive, I mean two months of an immersion summer camp program--12 weeks of somebody coming in every day into the school to work with the teachers; 26 weeks of parent training, so the parents could use these techniques at home; 26 weeks of the kids getting individual and group treatment. In other words, a very money-, labor-, and time-intensive treatment. A third group got medication plus behavior management. And a fourth group, armed with world class work-ups, got referred out into their communities to see what would happen.
At the end of the study in 14 months, more than a year, the results were striking. . . . The two groups that got medication did wonderfully. They did exceptionally well. Adding the behavior management component did not improve the outcomes, unless you had an anxiety disorder, a co-existing condition, or you came from a single-parent family; then it made a difference. But it didn't make a huge difference. It didn't make a detectable difference in the outcome for ADHD.
And down from those was the intensive behavior management program. . . . It was nowhere near as effective as medication was. The big disappointment was that, when they came back after the intensive behavior management program had ended, there was no evidence that it had ever occurred. The hope had been that these techniques would be internalized by the children and that eventually, this very expensive treatment could be attenuated and ultimately stopped. What they found was that, as soon as the treatment stopped, so did the benefits.