Combination Therapy for ADHD

Attention Deficit Hyperactivity Disorder is the most prevalent neurological disorder of childhood. It is estimated that as many as three to seven percent of school-age children have an official diagnosis of ADHD, and it occurs across cultures. One of the most effective ways to treat this frustrating disorder is to use a multi-modal or combination therapy, which combines the use of medication with behavioral therapy. Combination therapy is intensive and time-consuming---and may be costly---but it produces the best overall results.

Identifying ADHD

• According to the fourth edition of the American Psychiatric Association's Diagnostic Statistical Manual of Mental Disorders, ADHD can be divided into three subtypes: predominantly hyperactive-impulsive type, predominantly inattentive type, or the combined type. ADHD usually begins before age seven, is present in two or more settings (at home and at school, for example), and interferes with day-to-day functioning, especially in socializing and completing tasks. For someone to have ADHD, he or she must also exhibit six or more symptoms of inattentiveness or hyperactivity-impulsivity that have lasted at least six months, as defined by the American Psychiatric Association. The inattentive type will have symptoms including failure to give close attention to details, difficulty with focused or selective attention, poor follow-through on instructions, failure to finish work, difficulty organizing tasks, misplacement of things, distraction by extraneous stimuli and forgetfulness. The hyperactive type will have symptoms including fidgeting, running about, difficulty playing quietly, acting as if driven by a motor, talking excessively, blurting answers and interrupting.

Treatment Types

• There are four basic approaches to treating ADHD: pharmacological treatment, parent training in child behavior management methods, teacher implementation of behavior management approaches and a combination of approaches in a multimodal therapy. The most effective of these treatment options appears to be combination therapy, which involves medication and cognitive behavioral therapy, as well as the optional use of parental training and school interventions. Because ADHD is considered a performance disorder, rather than something that affects mental function or skill sets, the goal of therapy is to improve the client's attention span and motivate or encourage the client to display knowledge. The use of medication should effectively stimulate the production of neurochemicals, meaning the brain will function on a higher level and symptoms will be somewhat alleviated. Parental education and school interventions give parents a better grip on handling their child's disorder, including understanding how to use behavior management and how to work with their child's school system to make sure treatment is consistent.

Features

• A child in combination therapy will take some form of medication to manage behavioral symptoms. In The Multimodal Treatment Study of ADHD (MTA, 2004), the largest study ever completed on one specific disorder, researchers concluded that stimulant treatment is very effective in reducing the symptoms of ADHD. It concluded that active treatment involving stimulant medication was more effective than treating ADHD solely with behavior therapy.

  The researchers did about 200 studies on various psychostimulants, and found that 70 percent of children responded well to the medication, and that the effects lasted over a period of two years. However, combination therapy is more effective because it also includes behavioral therapy. Usually therapy involves behavioral interventions, which are intended to reduce problems in various settings. These interventions are structured around operant conditioning, which aims to shape the behavior through positive reinforcement. Individual therapy is also beneficial in improving socialization skills and addressing low self-esteem, stress and co-occurring anxiety or mood disorders. Parent training and school interventions are not mandatory, but involve training programs and appropriate classroom intervention techniques that have been agreed upon between parents, teachers and therapists.

Considerations

• Another type of behavioral therapy, group therapy, is largely ineffective in treating ADHD. The MTA study found that children who received general treatment in the community made fewer improvements than the children who received stimulant therapy or combination therapy. This may be because community physicians do not have adequate training to effectively treat ADHD, but studies have also shown that children with ADHD may actually increase their negative or antisocial behaviors if they are in group settings with other clients who have disruptive disorders.

  Although using medications to treat ADHD seems to have the most promising results, an optimal treatment plan should still include behavioral therapy, as not every individual responds well to drugs. Ritalin, which is the most popular ADHD medication, is not as effective in treating clients who have co-occurring anxiety disorders. Researchers believe that children who respond best to medication are those with low anxiety levels, less severe forms of the disorder and high IQs.

Benefits

• One of the benefits of combination therapy is that it allows for lower dosages of medication, which may alleviate some concerns about side effects and drug interactions. Combination therapy will not necessarily reduce the core symptoms of the disorder, but it will improve positive functioning and alleviate other symptoms that are related to ADHD. Overall, combination therapy is the most accepted treatment for ADHD and should lead to the best overall outcome for the client, including reducing behavioral or emotional difficulties that stem from ADHD, improving socialization skills and improving family and school or work relationships.