“Children with attention-deficit problems improve faster when the first treatment they receive is behavioral therapy — like instruction in basic social skills — than when they start immediately on medication,” the New York Times reports.
Pelham was one of the lead investigators in the MTA study, and was gracious enough to acknowledge that the long-term data did not support the initial contention of stimulants providing benefits over behavioral treatment or no treatment. He was, not surprisingly, castigated by many in the mental health industry for his courage in putting science above personal benefits. It’s good to see him doing this work. I applied very similar approaches to my very active young children with excellent long-term results. To relegate “medication” to a secondary role would be a very big help to a lot of kids, second only to providing alternative open-classroom environments making the diagnosis primarily irrelevant and unnecessary.
Important article, useful New York Times commentary, but when the newspaper note this
Other experts cautioned that the study tracked behavior but not other abilities that medication can quickly improve, like attention and academic performance, and said that drugs remained the first-line treatment for those core issues.
“I think this is a very important study, and the take-home is that low-cost behavioral treatment is very effective,” said Mark Stein, a professor of psychiatry and pediatrics at the University of Washington, “but the irony is that that option is seldom available to parents.”
They didn’t also note this about Mark Stein (which took me two minutes in web search) – Disclosure: Grant/Research Support: Cephalon, Eli Lilly & Company, McNeil Pediatrics, Novartis; Speakers’ Bureau: McNeil Pediatrics, Novartis, Shire Pharmaceuticals, Inc. http://www.medscape.org/viewarticle/571123
It is lazy, inadequate, and irresponsible of journalists to not directly note easily accessible disclosures regarding conflicts of interest. Seen all the time, and quite unacceptable nowadays.
Well said. I’d also add that improvements in “academic performance” have not been consistently noted, even in the short run, and when they have showed up, they are very mild and transient. Long-term research has never revealed any consistent improvement in academic performance for medicated vs. non-medicated kids with “ADHD” diagnosis. So his resort to “improvements in academic performance” is either ignorant or disingenuous, or both.
If you combine the lack of long-term outcome improvements with stimulants and the data from this latest research, it becomes very clear that the BEST that stimulants can ever be is an adjunct “treatment” for the short term, and that it is psychosocial intervention that actually change the long-term outcomes for these kids. Of course, it’s somewhat questionable to even call it a “treatment,” when what it’s “treating” is not something wrong with a child, but behavior that adults find annoying or difficult to manage.