Behaviour modification therapy is preferable to drugs for treating children two to five years old who have attention deficit hyperactivity disorder (ADHD), U.S. health officials say.
Long-term effects unknown
"Behaviour therapy has been shown to help improve symptoms in young children with ADHD and can be as effective as medicine, but without the side effects," said Dr Anne Schuchat, principal deputy director of the U.S. Centres for Disease Control and Prevention.
"Research has shown that the benefits of behaviour therapy can last for years," she said during a midday media briefing.
Read: CBT: How therapy works
Medicines such as Ritalin are appropriate for some children, Schuchat said. But behaviour therapy doesn't have the side effects such as stomach aches, irritability, appetite loss and sleep problems often associated with ADHD medications, she said.
Also, the effects of long-term use of ADHD medications by young children are still unknown, she added.
Because of this, the CDC is "encouraging paediatricians and other health care providers to work with families to make sure children with ADHD are receiving the most appropriate treatment," Schuchat said. This should include a discussion about behaviour therapy as a first step, she said.
ADHD causes hyperactivity, impulsiveness and attention problems. About two million of the more than six million American children with ADHD were diagnosed before age six. Young children with ADHD tend to have the most severe symptoms and benefit from early treatment, according to the CDC Vital Signs report.
Encouraging positive behaviour
In 2011, the American Academy of Paediatrics also recommended that before giving medicine to a young child, parents should be referred for training in behaviour therapy.
But according to the new CDC report, about 75 percent of young children being treated for ADHD are started on drugs, and only about half get any type of psychological services, including behaviour therapy.
In eight or more behavioural training sessions, a therapist teaches parents how to encourage positive behaviour while strengthening the bond with the child, according to the CDC.
Brandon Korman, chief of neuropsychology at Nicklaus Children's Hospital, in Miami, agrees with the report. "I am a big proponent of behavioural training," he said.
"The therapy provides a structure for kids who have problems concentrating, staying focused, organising their world and planning ahead," he said.
Some parents would rather give their child drugs to solve the problem, Korman said. "But when parents can not only learn to deal with their children's behaviour but also be a conduit to improving behaviour... that's the best way to go," he said.
A worthwhile investment
Improved behaviour, self-control and self-esteem can help kids at school, at home and in relationships, the CDC said. While learning and practicing these skills requires more effort than opening a pill bottle, the lasting benefits make this approach a worthwhile investment, the agency said.
Key skills emphasise:
- Positive communication: Parents learn to give children their full attention and reflect their words back to them. This shows you're listening and care about what they say.
- Positive reinforcement: Praise for doing something right helps kids behave the same way again.
- Structure and discipline: Children do better when their world is predictable. Establishing routines and schedules helps the child know what to expect each day. And responding to the child's behaviour the same way each time fosters faster learning.
Behavioural training is not available everywhere, or covered by all insurance plans, Schuchat said. However, some centres base their fees on income or offer group sessions, which are less costly than individual sessions, she said.
For the report, CDC researchers looked at annual health care claims starting in 2008 for at least five million young children (two to five years old) insured by Medicaid and another 1 million young children with employer-sponsored insurance.
Overall, a little more than 75 percent of young children received ADHD medicine. Only 54 percent of kids with Medicaid and 45 percent of kids with employer insurance received any type of psychological services, which might have included parent training. The number of children with ADHD receiving psychological services has not changed over time, the agency said.
"Parents aren't the cause of their child's ADHD, but they can play an important role in treatment," Schuchat said.