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Behavioral Therapy Difficult for Parents and Teachers, But Sends a Better Message Than Drugs

February 18, 2016

Benedict Carey’s article in today’s NYTimes reports on a study comparing the effectiveness of behavioral interventions with drug interventions in treating ADHD in young children. The findings, published in two papers by the Journal of Clinical Child & Adolescent Psychology:

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.

The article details the research and describes the challenges parents and teachers face in implementing the behavioral therapies which cost less than the drug therapies:

Having children and their parents begin with behavioral treatment and follow with medication, if needed, cost an average of $700 less annually per child than treatment as usual, in which a doctor writes prescriptions and periodically monitors behavior, the team found.

The analysis did not account for the psychological cost to parents — in terms of a child’s tantrums, slammed doors and hurled tableware — of carrying out behavioral techniques.

Those psychological costs also play out in classrooms, where teachers must closely monitor children who are on behavioral therapies. Moreover, it is far less costly to medicate students in schools than it is to provide a classroom teacher with the training needed to administer such a program or to provide a 1:1 classroom aide to monitor and administer a behaviorally based program. By the time a school district adds in those costs it is far more economical to administer medicine than it is to adapt to a student’s idiosyncrasies.

But the if the short term costs for behavioral intervention avoids a lifelong dependency on drugs— and ADHD does not end when a child leave school— isn’t it better for the child to learn how to regulate his or her behavior than it is to medicate the child? What message do we send a child who needs to take medication in order to “behave” in class? Is the behavior we seek reasonable for ALL children? If not, we are arguably over-medicating scores of children… and based on data I’ve observed that seems to be precisely what is happening.

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