Sun Sentinel Palm Beach Edition
Treating ADHD by modifying behaviors
FIU researcher to study most effective methods in a classroom setting
For some children, learning how to focus on following a command, helping a peer, or showing good sportsmanship can be a challenge. Now one nationally recognized researcher is out to prove how those basic lessons in changing behaviors can be a more effective treatment than medicine for ADHD.
Dr. William Pelham, based at Florida International University in Miami, used a nontraditional approach this summer to help some children with Attention Deficit/Hyperactivity Disorder stay on task in a camp environment. As the new school year begins, he will study how to most effectively treat children with the disorder in a classroom setting.
A squirmy, 7-year-old Noah may be the best example that Pelham’s approach to treating ADHD through behavior change can work.
Sitting in a circle on a basketball court in West Miami-Dade, Noah looks his summer camp counselor in the eye to hear why he received points or lost them during a skill training drill. Noah wants to talk about the basket he just scored, but he quiets down to listen to the “point check.” For a child with ADHD, this is not an easy task.
This summer, about 300 children with ADHD have learned how to focus on listening to directions and following rules. In week one, the children interrupted the counselors, poked the kids next to them, and wandered from their group between activities. By week eight, they stayed with their groups and lined up quickly for the next activity when the whistle blew.
With the positive results of the summer camp, researchers at Florida International University are recruiting 300 elementaryaged students with ADD/ ADHD for the 2019-2020 school year to try to achieve similar behavior changes in a classroom setting.
ADHD, the most common childhood mental health disorder, makes it difficult for a person to pay attention and control impulsive behaviors. More than 6 million children ages 2 to 17 have the disorder. In academic settings across the country, researchers are studying the possible causes of ADHD — genetic, environmental, diet — as well as treatments and long-term effects.
Pelham, a specialist in the field of ADHD research and director of FIU’s Center for Children and Families, will lead the new three-year study funded through a $3.3 million grant from the Institute for Education Sciences.
Just three years ago, Pelham gained national attention when his research determined behavioral therapy — when used first — is more effective in treating children with ADHD than medication — and more cost effective. His results showed medications like Ritalin were most effective as supplemental, secondline treatment options and at lower doses than typically prescribed.
Pelham said his research in the 2019-20 school year will look more at how to best treat students with ADHD in a school setting. Researchers will work with classroom teachers to study whether low-level positive behavioral interventions can prevent the need for more intensive behavior change treatments or medication.
“We want to focus the best ways to individualize treatment for each child,” Pelham said.
In a school setting, ADHD can cause problems in how well children learn and in their ability to make and keep friends. Over the past decade, the number of children being prescribed ADHD medications has increased substantially, according to the Centers for Disease Control and Prevention. Pelham said studies are starting to show that teaching children functioning skills rather merely prescribing medication can be more effective in the short and longer term.
In the summer program, Erika Coles, the clinical director for FIU’s Center for Children and Families, tested some of the tools Pelham will introduce as part of his school-year study. A key tool, the daily report card, encourages parent participation in rewarding their child for such behaviors as finishing a task within a designated time frame and refraining from interrupting the teacher.
Coles believes behavior modification works, but it takes specialized parent, student and teacher training.
“Teachers are well-intentioned, but they are not trained how to do intervention with kids who can be challenging,” Coles said.
Hussein Echtey of Pembroke Pines, father of Noah, said from his son’s summer camp experience, he realizes it will take all three factors — the teacher, parents and the child — for someone with ADHD to do well in school.
“A change in behavior can be learned, but it’s not something that happens overnight,” Echtey said. “It’s about consistency and using the strategies in our home that they have taught us this summer.”
In the United States, as of 2016, more than 60 percent of children with ADHD were taking medication, according to the CDC. However, ADHD stimulation medications are known to have side effects that include dizziness, weight loss and sleep problems.
“We have avoided medicine for a long time,” Echtey said. “We have always looked for alternatives and we think behavior modification works well. As parents, if given a choice, would you rather do therapy, or just give a pill that might have certain side effects?”
Echtey said at the beginning of camp, his son would not carry his own backpack and forget to put his things inside it. By the end of camp, that had changed.“A change in behavior can be learned, but it’s not something that happens overnight,” Echtey said. “It’s about consistency and using the strategies in our home that they have taught us this summer.”
Because FIU’s approach to behavior therapy focuses on positive interactions with ADHD children, Echtey said he has changed the way he talks to Noah and found his son responds better. He hopes to participate in more FIU studies.
“Ideally, all we want is for Noah to be successful in school and in life,” he said, adding that he believes other parents interested in the ongoing research on ADHD are likely to feel the same way.
Along with research on elementary school children, FIU’s Center for Children and Families is enrolling teens for a study on substance use prevention and programs for adolescents with ADHD. For information on studies visit ccf.fiu.edu.
“Teachers are well-intentioned, but they are not trained how to do intervention with kids who can be challenging.”
Erika Coles, clinical director for FIU’s Center for Children
and Families