Skip the Ritalin and Treat Parents Instead

ngland has a new plan for helping children with ADHD: Treat the parents first.

With that, the National Institute for Health and Clinical Excellence is giving a big “Whoa, Nelly!” to the recent trend toward increased use of Ritalin in the United Kingdom, saying instead that the first response should be to give parents training on how to handle kids who are inattentive, hyperactive, or impulsive.

What would ADHD treatment look like here if the United States adopted the same national standard? With as many as 10 percent of children here medicated, that’s no small question.

The news about England’s new ADHD treatment standard comes at the same time that a new report says American children are three times more likely to be prescribed stimulant drugs like Ritalin than are children in Europe. American kids probably aren’t more hyper than their European counterparts; indeed, international surveys have shown that there’s ADHD in every corner of the world. There are a lot of reasons for the differences in prescribing among countries, including direct-to-consumer drug advertising, different government restrictions and insurance reimbursements, and most important, cultural beliefs. If an American doctor diagnosed a child with ADHD and recommended counseling, most parents would presume it was for the kid.

“Sometimes, parents make that presumption, but when you’re talking about counseling—behavior management, proper rewards, consistency in parenting—it’s really a parent-focused therapy,” says Andrew Adesman, the chief of developmental and behavioral pediatrics at Schneider Children’s Hospital in New Hyde Park, N.Y., who is active with CHADD, an advocacy organization for people with ADHD. In other words, change the parent’s behavior, and the child’s behavior will change, too. The parent training recommended is not specific to ADHD but rather teaches behavior management skills that could be used with all children: having realistic expectations for a child’s behavior, clearly explaining goals and rules, identifying behavior that’s inappropriate, and following through with sanctions for rule violations and rewards for good behavior.

Earlier this year, I spent a lot of time trying to figure out the secrets to raising great kids and learned that we know what works; it’s just that in the heat of the moment, we parents often do the wrong thing. A lot of what works is counter intuitive. Scientists have conclusively proven that nagging doesn’t work, for instance, but we all do it.

Saying that parents of a child with ADHD need training doesn’t mean that the parents are the problem, Adesman says. “But maybe they need to change their approach to the child, or be more realistic. The parents can oftentimes improve the child’s behavior.”

That’s of a piece with the controversial advice from Lawrence Diller, a pediatrician in Walnut Creek, Calif., whose books about children and ADHD include The Last Normal Child. Parents who create and enforce clear rules can often inspire a dramatic turnaround in child behavior, Diller says. The controversy comes because Diller argues that, with some children, discipline can also include spanking.

The British experts don’t say never use Ritalin. Rather, they say it should be reserved for children with severe ADHD. Studies in the United States have shown that medication improves behavior faster than therapy in the short term. But for many families, parent training or family therapy can be the answer to the often-troubling question on Ritalin—yes or no?

Most health insurance doesn’t provide nearly the same coverage for education and counseling as it does for pill-prescribing, and in some communities, it can be hard to impossible to find good services. Now that the powers in the U.K. have decreed that parent education comes first, that means that insurance will pay for it. Wouldn’t it be a wonderful thing if American families had that same opportunity?

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“David F. Velkoff, M.D., our Medical Director and co-founder, supervises all evaluation procedures and treatment programs. He is recognized as a physician pioneer in using biofeedback, qEEG brain mapping, neurofeedback, and neuromodulation in the treatment of ADHD, Autism Spectrum Disorders, and stress related illnesses including anxiety, depression, insomnia, and high blood pressure. Dr. David Velkoff earned his Master’s degree in Psychology from the California State University at Los Angeles in 1975, and his Doctor of Medicine degree from Emory University School of Medicine in Atlanta in 1976. This was followed by Dr. Velkoff completing his internship in Obstetrics and Gynecology with an elective in Neurology at the University of California Medical Center in Irvine. He then shifted his specialty to Behavioral Medicine and received his initial training in biofeedback/neurofeedback in Behavioral Medicine from the leading doctors in the world in biofeedback at the renown Menninger Clinic in Topeka, Kansas. In 1980, he co-founded the Drake Institute of Behavioral Medicine. Seeking to better understand the link between illness and the mind, Dr. Velkoff served as the clinical director of an international research study on psychoneuroimmunology with the UCLA School of Medicine, Department of Microbiology and Immunology, and the Pasteur Institute in Paris. This was a follow-up study to an earlier clinical collaborative effort with UCLA School of Medicine demonstrating how the Drake Institute's stress treatment resulted in improved immune functioning of natural killer cell activity. Dr. Velkoff served as one of the founding associate editors of the scientific publication, Journal of Neurotherapy. He has been an invited guest lecturer at Los Angeles Children's Hospital, UCLA, Cedars Sinai Medical Center-Thalians Mental Health Center, St. John's Hospital in Santa Monica, California, and CHADD. He has been a medical consultant in Behavioral Medicine to CNN, National Geographic Channel, Discovery Channel, Univision, and PBS.”

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