When children are diagnosed with ADHD, depression, or anxiety disorders, parents have to make some tough decisions. Should we medicate? Try therapy? Do both? Medication is often immediately considered in extreme cases. If a child is too depressed, or too hyper or anxious to learn coping strategies and make gains during therapy sessions, medication might get him to a level where he can be attentive and learn. However, in more moderate cases, cognitive behavioral therapy (CBT) can be as effective as medication in reducing symptoms, and it has more long-lasting effects.
ADHD. Children with ADHD who are first treated with a behavioral approach are less likely to need medication and are more likely to be prescribed a lower dose if they do. Children who are medicated for ADHD are often prescribed stimulants, which can cause dependence, as their effects tend to diminish over time. Cognitive and behavioral therapy programs involve skill building, parent training, and classroom modifications. Children learn how to modify their environment (e.g. sitting in the front of the room) and to self-regulate in order to pay attention and focus on the task at hand. Parents are trained to help reinforce learned skills. In one large study that investigated both treatment options, parents who medicated their children before beginning a behavior program were more likely to drop out of the behavior program. In addition, all parents who began with the behavior program attended parent-training sessions, while nearly 70 percent of parents who first tried medication dropped out of parent training. Because stimulants often help a child initially, parents and children may become overconfident about the pill’s magical effects and fail to put effort into implementing behavior change. In the long run, the child needs to learn skills for continued success.
Anxiety and Depression. Cognitive behavioral therapy (CBT) has been shown to be as effective as medication for treating both anxiety and depression. Both types of treatment are scientifically approved and are considered appropriate; however, CBT tends to have longer-lasting effects. In one study conducted by the University of Pennsylvania and Vanderbilt University, it was discovered that CBT was even effective for severely depressed patients. In this study, the patients receiving medication and the ones receiving CBT both showed improvement after 16 weeks, but the CBT patients were less likely to relapse in the two years following treatment termination. The researchers believed that the medication may have treated the symptoms not the causes of depression. CBT teaches skills and techniques that help people overcome anxiety and keep depressive symptoms at bay. A depressed or anxious individual learns to identify and challenge negative thinking patterns and behaviors and to replace them with positive ones. CBT helps prevent relapse because patients learn tools to manage their problems.
Parents and professionals need to collaborate to devise the most effective treatment course for your child. The same goes for parents who have their own mental health concerns. In some individuals, physiological factors are so severe that medication is absolutely necessary to get a person functioning. However, in order to keep that person functioning optimally, new methods of coping will have to practiced and learned. Many people find a combined approach to treatment to be the best option.
Dr. Jaime Black is a licensed psychologist practicing in Westchester and New York City. In addition to providing general mental health services, Jaime works with individuals of all ages on the autism spectrum, doing psychotherapy, conducting evaluations, and facilitating social skills groups. Visit www.spectrumservicesnyc.com, e-mail JaimeBlackPsyD@gmail.com or call (914)712-8208.
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