Running Head: TREATMENT OF ADHD 1

3 Journal Review on the Treatment of ADHD

Alex Richardson

Brandman University
Treatment of ADHD 2

Attention deficit/hyperactivity disorder (ADHD) is one of the most common and

disruptive behavior disorders among children and adolescents (Jones 2002). Stimulant

medication and behavioral treatments are both evidence based treatments for children with

ADHD (Pelham et al., 2005). This paper looks at three studies conducted by Pelham et al.,

(2005) Arnold et al., (2004) and Gillberg et al., (1997) who investigate medication and its impact

on ADHD.

There is debate among professionals whether behavior interventions or medication is

better for the management of ADHD in children. Pelham et al (2005) conducted a study looking

at; the use of medication (methylphenidate); behavior modification, and the combination of both,

during a summer treatment program. They were able to study the difference in a child’s behavior

using a point system, a daily report card (DRC) and teacher/counselor ratings.

In their study, Pelham et al., (2005) found that medication alone was able to improve

academic productivity, compliance and rule following in every setting during the summer

treatment program. In addition to this, medicated students also rated themselves as behaving

better on the days they were medicated, even though they did not know if they were medicated or

not. Lastly, parent ratings also indicated that positive behavioral effects continued into the

evening on the days their children were medicated. This shows that medicating ADHD children

can have a beneficial impact on their behavior and attention.

Pelham et al., (2005) also looked into the use of behavior modification without

medication and the impact it had on ADHD children. Children were 19 times more likely to

reach their daily point goal with a placebo pill and behavior modification, compared to days

where they had a placebo pill and no behavior modification. This also shows the huge impact
Treatment of ADHD 3

behavior modification can have on ADHD children and argues that medication does not always

need to be the only treatment. This contradicts reviews that concluded that behavioral treatments

are relatively ineffective for ADHD.

Pelham et al., (2005) also looked at the impact of combined treatments. Their biggest

finding was that a much lower dose of medication is needed to help the children, and the

combined treatment helped children the most. Interestingly, many may believe that a higher dose

of medication will have a greater chance of improving ADHD behaviors. However, Pelham et

al., (2005) illustrate that a low dose of medication combined with behavior modification gave

better results than a high dose of medication alone, or behavior modification alone. Therefore, a

combined treatment plan makes more sense. They argue that “if a physician or parent desires to

keep the dose of medication low for a child, they can obtain that result...by instating an in-school

behavior program” (p.123). Therefore, a high dose of medication does not necessarily correlate

with better management of ADHD. In fact, this study argues that the implementation of a

behavior modification plan combined with a low dose of medication is the appropriate treatment

plan.

Similarly to Pelham et al., (2005), Arnold et al., (2004) also looked at stimulant

medication and behavioral treatment for ADHD. However, Arnold et al., (2004) conducted a 14

month study compared with Pelham et al., (2005) whose study was over a course of a summer

treatment program that lasted only 8 weeks. Another difference was that Pelham et al., (2005)

only included 25 children, whereas Arnold et al., (2004) included 579 children. Therefore it can

be argued that Arnold et al., (2004) conducted a more reliable study as they included more

participants and also conducted their study over a longer time frame.
Treatment of ADHD 4

Although there are differences among the two studies, Arnold et al., (2004) also studied

similar treatment strategies. These were medication management; intensive behavioral treatment;

combination of medication and behavioral treatment, and routine community care. They found

through their study that “medication management, whether alone or in combination with

behavioral treatment, was significantly superior to behavioral treatment alone” (p.40). This

finding supports the argument that medication, along with behavioral treatment, is an effective

way to treat ADHD.

However, Arnold et al., (2004) also states that their study results found that combination

of treatments does not differ significantly from medication management alone. This finding does

not support Pelham et al., (2005) as their argument states behavioral intervention was an

important aspect of the management and treatment of ADHD.

Moreover, Arnold et al., (2004) recognizes that certain subgroups may have an excellent

response to either medication or behavioral intervention, or may require the combination of both

to have a better impact on them. This shows that treatment of ADHD is a unique experience and

can differ greatly on the child and their background.

In support of Arnold et al., (2004), Gillberg et al., (1997) studied the stimulant

medication treatment of children with ADHD. 62 children participated and had all been through

some kind of intervention before the study. Gillberg et al., (1997) found that “all 62 children

improved significantly during single-blind amphetamine treatment according to Conners parent

and teacher ratings” (p.856). Furthermore, they found that those who were receiving medication

had improved behavior rating compared with those who were taking placebo. Additionally, the

medication had a positive effect on the children's learning, as they had a greater increased mean

IQ compared to those who were receiving placebo. Overall this study also demonstrates that a
Treatment of ADHD 5

medication treatment for ADHD proves to be beneficial and can help children in a multitude of

ways.

However, there are some limitations to this study in comparison to Arnold et al., (2004)

and Pelham et al., (2005). Gillberg et al., (1997) did not look at other methods to compare with

the results of those who were taking medication. Therefore this study only compared children on

medication with children on placebo. This does not provide any argument for alternative

treatments to medication. Additionally, this study also points out that only 27% of the original

cohort assigned to placebo completed their treatment through the entire 15 months. Therefore,

the data may not be as valid as not all participants were able to fully complete their treatment

plan. Lastly, this journal was published in 1997. This was over 20 years ago and therefore the

studies on medication and the impact it has on children has developed since then. Therefore it

may be considered outdated and should not be used alone as an argument for the medication

treatment of ADHD.

Overall, all three of the published journals showed that the use of medication can be

extremely beneficial for the treatment of ADHD. Although there are arguments for alternative

treatments, overall, the three studies showed that medication is an effective way to manage

ADHD when trying to increase positive behavior and attention in children.

Treatment of ADHD 6

References

Arnold, L. E., Chuang, S., Davies, M., Abikoff, H. B., Conners, C. K., Elliott, G. R., Wigal, T.

(2004). Nine Months of Multicomponent Behavioral Treatment for ADHD and

Effectiveness of MTA Fading Procedures. Journal of Abnormal Child Psychology,32(1),

39-51. doi:10.1023/b:jacp.0000007579.61289.31

Gillberg, C., Melander, H., Knorring, A., Janols, L., Thernlund, G., Hägglöf, B., Eidevall-

Wallin, L., Gustafsson, P. and Kopp, S. (1997). Long-term Stimulant Treatment of

Children With Attention-Deficit Hyperactivity Disorder Symptoms. Archives of General

Psychiatry, 54(9), 857-865.

Jones, J. D. (2002). Plea for a measure of understanding: The importance of intensive

psychotherapy in the treatment of children with ADHD. Psychotherapy: Theory,

Research, Practice, Training,39(1), 12-20. doi:10.1037/0033-3204.39.1.12

Pelham, W. E., Burrows-Maclean, L., Gnagy, E. M., Fabiano, G. A., Coles, E. K., Tresco, K. E.,

Hoffman, M. T. (2005). Transdermal Methylphenidate, Behavioral, and Combined

Treatment for Children With ADHD. Experimental and Clinical Psychopharmacology,

13(2), 111-126.