Drug-free treatments for ADHD

	Lee Kern

As more and more children receive the diagnosis of attention deficit and hyperactivity disorder (ADHD), increasing numbers of them are being put on drugs such as Ritalin and Adderall—even children as young as age 3.
The problem is that these drugs are being used off-label. They have not been tested in the preschool age group, and they have a lot of side effects, says Lee Kern, Iacocca Professor of Special Education. My colleague George DuPaul and I were very concerned about this, and we wanted to look at psychological interventions to see if we could improve behavior in children with ADHD without using medications.
The research she refers to became the largest study ever funded by the National Institute of Mental Health to analyze the impact of non-medicinal treatment for preschoolers and young students who demonstrate ADHD symptoms. The study was published in the June 2007 issue of School Psychology Review.
To prove their point, Kern and DuPaul, professor of school psychology, compared two types of interventions on 135 children between the ages of 3 and 5 who were in the 93rd percentile for ADHD.
One intervention focused primarily on parent education, and the other was more comprehensive—we actually went into the preschools and homes of the children and did assessments to find out what kind of issues they were having and developed individualized plans for them accordingly, Kern says.
The results of the study were what the researchers had expected: Both groups did well, Kern says. Both had significant decreases in symptoms of ADHD.
From the findings, Kern and her colleagues hope to identify effective techniques for children with ADHD so they can postpone or eliminate altogether the need for medication.
In addition to her work with children with ADHD, Kern is leading a team of researchers in establishing the National Research and Development Center on Serious Behavior Disorders at the Secondary Level. The researchers received a highly competitive $9.6 million grant from the U.S. Department of Education to create the center.
Kern also assists children with extremely intensive emotional, social, and behavioral problems through Project REACH, a five-year national center grant Lehigh is working on in collaboration with the University of California-Riverside.
We are working on a longitudinal study to develop individual interventions for students who have been identified by their schools as having the most intensive needs, Kern says. For the most part, they have referred middle- and high-school students, but we did have a kindergartener who attacked a bus driver with scissors and a fourth-grader who had attempted suicide several times.
Kern says effective intervention for these students is critical.
These students are neglected both because they tend to have acting-out behaviors and because of their life circumstances, so they often don't get the services they need.
Project REACH has given Kern and Lehigh the funding to help identify interventions that work and put them into practice, thus helping these students break out of a downward spiral.
For example, in Riverside, students associated with Project REACH took a number of kids at risk of getting involved with gangs to a recording studio run by a former gang member.
The recording studio allowed the children to come in on a weekly basis to help out, and the former gang members talked to them about their experience with gangs and what a bad lifestyle choice that was, Kern says. Overall, we have found that the most effective interventions are the most comprehensive ones, whether the children are doing some vocational work in addition to class work, or it means we have to provide parents with some support as well.
Kern points out that because the students addressed in Project REACH have a 50 percent dropout rate from high school -- and more than 70 percent of those dropouts are arrested within a few years of dropping out -- they are a real burden on society.
So in addition to helping the behaviorally and emotionally challenged children improve their own lives, Kern and others involved in Project REACH are doing a good thing for society as a whole.
It is important that we continue to identify interventions and address the stigma of mental health issues, so the students and families can come forth and get the services they need, Kern says.
--Elizabeth Shimer Bowers