Formal training in parenting strategies is a low-risk, effective method for improving behavior in preschool-age children at risk for developing attention-deficit/hyperactivity disorder (ADHD), while there is less evidence supporting the use of medications for children younger than 6 years old, according to a new report from the U.S. Department of Health and Human Services’ Agency for Healthcare Research and Quality (AHRQ).
The report found that formal parenting interventions—known as parent behavior training (PBT)—are supported by strong evidence for effectiveness for children younger than the age of 6, with no reports of complications or harms. However, one large barrier to the success of PBT is parents who drop out of therapy programs, the report found. For children older than age 6, the report found that methylphenidate (Ritalin) and atomoxetine (Strattera), are generally safe and effective for improving behavior, but their effects beyond 12 to 24 months have not been well studied. Little information is available about the long-term effects of other medications used to treat ADHD symptoms.
The report, a comparative effectiveness review prepared for AHRQ’s Effective Health Care Program by the McMaster Evidence-based Practice Center in Hamilton, Ontario, is available at www.effectivehealthcare.ahrq.gov.
“ADHD can place many challenges on families with young and school-age children,” says AHRQ Director Carolyn M. Clancy, MD. “This new report and these summary publications will help children, parents and their doctors work together to find the best treatment option based on the family’s values, preferences, and needs.”
In the past 25 years, four major PBT methods have been developed. These programs are designed to help parents manage their child’s problem behavior with more effective discipline strategies using rewards and nonpunitive consequences. Each promotes a positive and caring relationship between parents and their child, and seeks to improve both child behavior and parenting skills.
The AHRQ report found that these PBT interventions are effective, with no reported risk of complications for preschool-aged children with disruptive behavior disorder, including ADHD. For older children, the report found that methylphenidate and atomoxetine are effective in controlling ADHD symptoms without significant risk of harms for up to 2 years, although research on longer-term effectiveness and possible adverse effects is sparse.
— Source: Agency for Healthcare Research and Quality