In 2001, Conners and colleagues 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.
Behavior Therapy Can Be Beneficial in Treating Mild ADHD Symptoms
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.
Psychosocial Treatments Can Be Beneficial When the Family Prefers It
In their recent study, Krain and colleagues 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.
Parents of Preschoolers With ADHD Should Participate in Behavior Therapy Before Considering a Medication Trial
As noted by Kratochvil and colleagues, 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) 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.
Behavior Therapy Combined With Medication Management Is Recommended for ADHD Children With Comorbid Anxiety Disorders
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.