The researchers randomized 130 youth with ADHD to treatment with methylphenidate, neurofeedback, or neurofeedback plus methylphenidate. The youths in the neurofeedback group had scalp sensors and were given feedback regarding their brain activity to enhance theta and depress beta activity when playing video games or watching films. There were 30 40-minute neurofeedback sesions 3 times a week.
Youths in the medication group received methylphenidate twice a day at doses of approximately 1 mg per kg daily: 91 children (70%) completed treatment. There were no significant differences in demographic factors between subjects who completed treatment and those who dropped out of treatment. The outcome measure was a clinician administered rating scale to assess attention and hyperactivity. All three treatment groups showed significant improvement in inattention and hyperactivity, with the greatest gains for reduction in hyperactivity as per parent report. There were no significant differences among the treatment groups. The authors suggest that neurofeedback be used as alternative therapy for children who do not respond to stimulant treatment.
What factors are involved in parents’ decision to begin medication treatment for a child with ADHD? Coletti and colleagues5 conducted a focus-group study to determine factors that influenced parents’ decision. The study consisted of 27 parents of children aged 5 to 9 years with a diagnosis of ADHD. Parents were given a recommendation for stimulant treatment by a child psychiatrist. The majority of the parents (81.5%) had pursued recommended stimulant treatment.
The factor most related to parents’ decision to initiate stimulant treatment was the belief that stimulant medication was effective and that improvement of the child’s ADHD symptoms would lead to functional improvement such as better social and academic functioning. They also felt that medication might prevent more serious outcomes in the future such as juvenile delinquency. A major barrier to stimulant treatment was the parents’ concern about adverse effects such as tics and reduced appetite. Another concern was that the medication would change the child’s personality.
Some parents wanted to defer medication treatment until nonpharmacological modalities had been tried such as behavior modification or nutrition therapy. Parents had positive perceptions of psychiatrists who were collaborative, provided information about ADHD, and were empathetic. The investigators conclude that parents’ attitudes about stimulant treatment for ADHD needs to be carefully assessed at the initial evaluation in order to address the concerns and to foster adherence to sound clinical treatment recommendations.
The children’s perspectives
What are children’s views of taking stimulants for treatment of their ADHD? Singh6 examined children’s experiences with taking stimulant medication for treatment of ADHD. Children, ages 9 to 14 years, who were diagnosed with ADHD and taking stimulant medication were interviewed. They were asked whether they felt like themselves or whether the medication made them feel like a different person (which the investigator termed “a threat to authenticity”). The majority of children denied that the medication made them feel like a different person; rather they believed the medication helped them to behave better. Overall, children were positive about receiving stimulant treatment for ADHD.
This article was originally posted online on 2/3/2014.
Dr Wagner is the Marie B. Gale Centennial Professor and Vice Chair in the Department of Psychiatry and Behavioral Sciences and Director of Child and Adolescent Psychiatry at the University of Texas Medical Branch at Galveston.
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