How Effective Are the Treatment Options for Children with ADHD?

Provided by the New England Comparative Effectiveness Public Advisory Council (CEPAC), based on their Action Guide for ADHD.

Health experts estimate that ADHD affects between 6 and 16 percent of children in the U.S. — that's at least 5 million kids ages 4 to 17 years. More than 2.5 times as many boys have a diagnosis of ADHD as girls, and children from lower income families are at nearly double the risk than those from higher income households. The following is a guide to help parents understand ADHD treatment options for children preschool-age and up, based on CEPAC's review of treatment options outlined in the Agency for Healthcare Research and Quality's (AHRQ's) ADHD report. Also check out these 6 action steps for parents of children with ADHD.

ADHD treatment options, mother and son working together
Parent-Behavior Training
Parent-behavior training involves individual or group training sessions, which typically track progress through a training manual. Sessions generally last one to two hours per week over a treatment course of 8 to 20 weeks. The main objectives include management of problem behaviors and fostering of positive and caring parent-child relationships. While programs differ somewhat in their approach, all of them utilize rewards and non-punitive (punishment-free) tools to modify child behavior. Manual-based programs include the Triple P – Positive Parenting Program®, The Incredible Years® parenting program, and Parent-Child Interaction Therapy.

CEPAC's Stance on Parent-Behavior Training:

  • Parent-behavior training is effective in improving the outcomes of preschoolers (children ages 4 and 5) with ADHD and is an appropriate first-line treatment for most preschoolers. (Medications may still be appropriate as a first-line therapy for preschoolers with severe symptoms or certain psychological conditions.)
  • For children over age 6 with ADHD, there is not enough evidence to indicate parent-behavior training is beneficial in the long-term.
ADHD treatment options, ADHD and other medication bottles
Several stimulants are used in children of all ages for the treatment of ADHD symptoms. Stimulants work to improve symptoms by increasing and balancing levels of neurotransmitters (chemical "messengers") in the brain.

While other FDA-approved medications are available, the ones that were evaluated in the AHRQ's report include methylphenidate (such as Ritalin®), dextroamphetamine (such as Dexedrine®), and mixed amphetamine salts (such as Aderall®).

CEPAC's Stance on Medication:

  • Taking methylphenidate (such as Ritalin®) can be as good or better than usual care (taking no medications or treatment steps to manage ADHD) for preschoolers, and better than usual care for children over age 6.
  • For children over age 6 with ADHD, other medications may be as effective as methylphenidate, particularly in the cases of certain symptoms or issues (such as tics). However, other medications have comparatively lower long-term effectiveness than methylphenidate.
ADHD treatment options, boy playing on playground
Combined Therapy
Some parents of children with ADHD are advised to use combined therapy — a combination of behavioral therapies and medication, particularly for children with other psychiatric issues). Behavioral therapies can include parent-behavior training, school-based interventions, or other forms of therapy, such as individual psychotherapy, play therapy, or cognitive behavioral therapy.

CEPAC's Stance on Combined Therapy:

  • For children under age 6, there is not enough long-term evidence to indicate that combined therapy is as good as or better than medication alone.
  • For children over age 6, combined therapy is better than medication alone.
ADHD treatment options, teacher reading to grade school kids
School-Based Interventions
Multiple school-based interventions exist for ADHD, including classroom-based special education services, individualized student training, and specialized teacher training.

Specialized classroom environments may have teachers and aides specifically trained and supervised by child psychologists, using behavioral techniques and unique treatment curriculums. Use of communication tools, such as daily school behavior report cards, facilitates communication about behavior trends in children. Positive reinforcement, peer-tutoring, and organizational skills training are other school-based approaches for children with ADHD.

CEPAC's Stance on School-Based Approaches:

  • School-based interventions are an especially important component of ADHD treatment, as they may provide the only access to behavioral/psychosocial interventions for children from low-income households and/or rural areas.