Nonpharmacologic Approaches to Treating ADHD

Michele Dadson, PhD; Adelaide S. Robb, MD


July 31, 2006

In This Article

Who Benefits From Behavior Therapy?

In 2001, Conners and colleagues[26] developed expert consensus guidelines for the diagnosis and treatment of ADHD. These guidelines indicated that behavioral treatment was an appropriate first-level treatment in several scenarios: for milder ADHD, when the family prefers psychosocial treatment; for preschool-age children with ADHD; and in the presence of comorbid anxiety disorders. Although these guidelines were influenced by the MTA study, they are reconsidered here in light of newer research.

As noted, considerable evidence supports the short-term efficacy of behavior therapy for treating ADHD symptoms compared with other nonpharmacologic interventions, or wait-list controls. In the MTA study, patients who received behavioral treatment alone displayed fewer or less prominent ADHD symptoms following treatment. For mild ADHD symptoms that do not warrant a trial of stimulant medication, behavior therapy is strongly recommended.

In their recent study, Krain and colleagues[27] found that parent ratings of medication acceptability significantly predicted pursuit of medication treatment 3-4 months later. Thus, for those families who are unwilling to try medication, an initial referral for behavior therapy is appropriate.

As noted by Kratochvil and colleagues,[28] given that information concerning the efficacy, safety, and administration of psychotropic medication in preschool-age children is still limited (neither of the aforementioned large landmark studies included preschool-age children), treatment of ADHD in this group should start with behavior therapy. The recently completed multisite Preschool ADHD Treatment Study (PATS)[29] may provide new information about the safety of medications with this population. It is of note that all subjects in the PATS study initially completed a trial of behavior therapy. Only those preschoolers who failed to show significant improvements in symptoms following a trial of parent training participated in the medication trial.

Results of the MTA study suggested that patients with comorbid anxiety disorders benefited from combined medication management and behavior therapy. This finding was particularly robust for children with a comorbid anxiety disorder and comorbid disruptive behavior.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.