Can ADHD be managed without drugs?

5 year study, most ambitious of its kind, identifies effective
strategies for decreasing aggressiveness and improving behavior
Non-medicinal interventions are highly effective in preventing the
behavioral and academic problems associated with Attention Deficit
Hyperactivity Disorder (ADHD), according to a five-year study led by
researchers at Lehigh University's College of Education.

The study, titled "Project Achieve" and funded by the National
Institute of Mental Health (NIMH), was the largest of its kind
focusing on children aged 3 to 5 who have shown significant symptoms
of ADHD. It also involved researchers from Lehigh Valley Hospital in
Allentown, Pa.

The researchers, led by George DuPaul, professor of school psychology
at Lehigh; Lee Kern, professor of special education at Lehigh; and Dr.
John Van Brakle, chair of the pediatrics department at Lehigh Valley
Hospital, studied 135 preschool students with ADHD symptoms. They
evaluated the effectiveness of early intervention techniques in
helping children decrease defiant behavior and aggression, while
improving academic and social skills.

The study's results are reported in a special series on ADHD in the
most recent issue of School Psychology Review. Published by the
National Association of School Psychologists, the quarterly is the
world's second-largest peer-reviewed psychology journal.

"Early identification and intervention are essential, but there has
been a lack of research on how to identify and intervene effectively
with these children during their preschool years," said Thomas Power,
editor of the journal and program director with the Center for
Management of ADHD at The Children's Hospital of Philadelphia.

"The investigation by Kern, DuPaul and their colleagues is the most
ambitious study ever conducted of non-pharmacological, psychosocial
interventions for young children with ADHD."

The results were significant. Using a variety of early intervention
strategies, parents reported, on average, a 17-percent decrease in
aggression and a 21-percent improvement in their children's social
skills. Teachers saw similarly strong results; in the classroom, there
was a 28-percent improvement in both categories. Early literacy skills
improved up to three times over their baseline status.

"Medication may address the symptoms of ADHD," says DuPaul, "but it
does not necessarily improve children's academic and social skills.
And because this is a lifelong disorder, without any cure, it's
important that we start understanding what tools and strategies are
effective for children with ADHD at such an early age.

"There's simply a lack of understanding about the type of non-
medicinal services that are available to preschool children and their
families. Our goal is to address behavioral and academic issues before
they become more problematic in elementary school."

Early intervention techniques include highly individualized programs
that often rely on positive supports to reinforce behavior. For
example, in consultation with parents and preschool teachers, Project
Achieve researchers modified the environments in home and school (such
as altering tasks and activities in the classroom to accommodate for
ADHD students) in an effort to improve behavior. The highly
interactive techniques were presented as alternatives to medicine.

ADHD is a lifelong mental disorder that may become apparent in a
child's formative preschool years. The disorder, which makes it
difficult for children to control their behavior and pay attention,
affects about 7 percent of the school-aged population. The disorder
has become a public health concern, however, because 40 percent of
children who show signs of ADHD are suspended from preschool, while
approximately 16 percent are eventually expelled.

The researchers suggest that a multi-tiered approach to intervention,
offering more traditional services to at-risk children and more
intensive services to children in greatest need, may be the most
practical and cost-effective strategy for helping preschoolers
overcome behavioral and academic challenges.

"While parents of children with ADHD usually trace the characteristic
behaviors back to the preschool years," says Van Brakle,
"pediatricians have long questioned whether such children can
accurately be identified, given the overlap with normal behaviors in
young children. And if so, whether any intervention that does not
involve medicine can be of value. Project Achieve suggests that with
careful assessment, such children can be accurately identified and
that appropriate behavioral interventions are an important part of the
treatment plan."

School Psychology Review's special ADHD issue features two ADHD
articles co-authored by researchers at Lehigh's College of Education.
DuPaul also contributed the Forward for the issue, which is titled,
"School-Based Interventions for Students With Attention Deficit
Hyperactivity Disorder: Current Status and Future Directions."

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For additional information, visit www3.lehigh.edu/about/news/
avnews.asp to watch DuPaul and Kern discuss the outcome of Project
ACHIEVE and its potential impact on the ADHD community.
Source eurekalert Aug 21 /07

http://www.eurekalert.org/pub_releas...-ntt082107.php