By Dennis Thompson Health Day Reporter
TUESDAY, Oct. 19, 2021 (HealthDay News) – Preschoolers with Attention Deficit Hyperactivity Disorder (ADHD) rarely receive the American Academy of Pediatrics (AAP) recommended gold standard treatment for their condition, according to a new study.
The AAP recommends a behavioral therapy technique called “Behavior Management Parent Training,” or PTBM, as the first-line treatment for ADHD children aged 4 and 5.
But only 1 in 10 children in this age group with a diagnosis of ADHD or ADHD-like symptoms actually receive a referral for PTBM treatment, according to results published online Oct. 18 in the journal. JAMA Pediatrics.
Instead, parents are often given general advice that wouldn’t be out of place on a visit to a healthy child: reduce your sugar intake, adopt good sleep habits, and limit screen time.
In fact, more preschool children were prescribed medication for ADHD than those referred for PTBM therapy, even though AAP guidelines say the medications should only be considered if behavior therapy is not used. ‘brings no significant improvement.
“The reason [PTBM] is recommended is evidence-based. There is more evidence of its effectiveness when we compare it to drugs, âsaid lead researcher Dr. Yair Bannett, a developmental and behavioral pediatrics instructor at Stanford University School of Medicine.
PTBM therapy focuses on the parents rather than their child with ADHD.
Parents undergo training that teaches them skills and strategies for positive reinforcement, structure and consistent discipline, as well as positive ways to interact and communicate with their child, according to the US Centers for Disease Control and Prevention. United.
âYou are providing the parent and child with skills that will last a long time and really have a real effect on how the child and parents do in the real world,â Bannett said.
Train the parent to help the child
âOn the other hand, the drug route is very effective and reduces some of the symptoms, but it’s kind of a temporary fix,â Bannett continued. “It doesn’t really give the child or the parents any skills to move forward.”
The goal of PTBM therapy “is that small children learn better from positive reinforcement than punishment,” said Dr. Max Wiznitzer, co-chair of the professional advisory board of CHADD, an ADHD patient advocacy group. “If we encourage the behavior we want them to adopt, the unwanted behavior tends to subside.”
For this study, Bannett and colleagues reviewed the medical records of more than 22,700 children aged 4 and 5 treated by primary care physicians with the Packard Children’s Health Alliance, a pediatric care network in the San Francisco area. Of these children, about 1% (192) had a diagnosis or symptoms of ADHD.
About 41% of the time, parents of a child with signs of ADHD received routine counseling about diet, sleep and screen time, the researchers found.
âWe’re happy that these healthy habits are recommended, but on the other hand, there’s really no evidence that they alleviate the ADHD symptoms we’re talking about,â Bannett said.
Only 21 children were referred for PTBM therapy, while 32 were prescribed medication for ADHD.
Many pediatricians probably don’t know enough about PTBM to offer it as a treatment option, Bannett said.
âReally, there is more need for training on this topic, to provide resources available to pediatricians,â Bannett said. âA lot of times they’re just not aware of what’s available for each community, for each child with specific insurance coverage. It gets pretty complicated.â
Many Doctors May Not Be Familiar With Parenting Therapy
Children with ADHD were about 13% less likely to be referred for PTBM if they were covered by Medicaid as opposed to private insurance, according to the study.
Even if the doctor is familiar with PTBM therapy, there is still a good chance that such training will not be readily available to parents, Wiznitzer added.
âBehavioral therapy resources are not as available as we would like,â said Wiznitzer. âFor me, this is the step that limits the rate – finding someone who really knows how to work with a preschooler like this and can help them. It’s better now, but he There are still backlogs. There are waiting lists. “
Finally, PTBM involves a lot of work on the part of parents, and some just aren’t up to the challenge, Bannett and Wiznitzer said.
âSometimes families feel like it’s too much work, they just can’t handle it with their daily schedule, it’s a bit too much,â Bannett said. “It is in a way sometimes easier to give medicine to a child than to learn these skills and practice these kinds of parenting skills which are more demanding.”
âAmericans want an instant fix. They don’t want to spend time with behavior management strategies, some people say. They say give me a pill and make it better,â Wiznitzer said.
Medication can be a good option for preschoolers with ADHD, but they need to be prescribed wisely, Wiznitzer said. These young and developing brains are more susceptible to the side effects of drugs, and it can be difficult to find the right dose.
ADHD medications should only be prescribed by behavioral specialists to children this age, not by pediatricians, according to Wiznitzer.
âIf these children end up with a specialist who has determined that even at this young age they have ADHD, then judicious use of medication in conjunction with behavioral programming may be appropriate,â said Wiznitzer. “I don’t want a general pediatrician to do this for fear that he may misdiagnose.”
Wiznitzer gave the example of a child who appears to have symptoms of ADHD but actually suffers from anxiety.
âYou put them on a stimulant, you just make the anxiety disorder worse,â Wiznitzer said.
SOURCES: Yair Bannett, MD, instructor, developmental-behavioral pediatrics, Stanford University School of Medicine, California; Max Wiznitzer, MD, co-chair, professional advisory board, CHADD; JAMA Pediatrics, October 18, 2021, online
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