The New York Times:
Children with attention-deficit problems improve faster when the first treatment they receive is behavioral — like instruction in basic social skills — than when they start immediately on medication, a new study has found. Beginning with behavioral therapy is also a less expensive option over time, according to a related analysis.
Experts said the efficacy of this behavior-first approach, if replicated in larger studies, could change standard medical practice, which favors stimulants like Adderall and Ritalin as first-line treatments, for the more than four million children and adolescents in the United States with a diagnosis of attention deficit hyperactivity disorder, or A.D.H.D.
The new research, published in two papers by the Journal of Clinical Child & Adolescent Psychology, found that stimulants were most effective as a supplemental, second-line treatment for those who needed it — and often at doses that were lower than normally prescribed.
“We showed that the sequence in which you give treatments makes a big difference in outcomes,” said William E. Pelham of Florida International University, a leader of the study with Susan Murphy of the University of Michigan. “The children who started with behavioral modification were doing significantly better than those who began with medication by the end, no matter what treatment combination they ended up with.”
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