Might behavioral therapy help preschoolers diagnosed with ADHD improve their ability to learn and reduce problem behaviors? If it does, is an intensive, customized intervention more helpful than a simpler educational program? This brief article suggests the answers are yes and no. Using a reasonable range of sources, the story nicely sums up the new research and the problems faced by preschoolers with ADHD. The news story says ADHD may afflict a small portion of preschoolers (1% to 4%). But the wide net cast by the story’s diagnostic criteria could ensnare some innocent victims—“extreme symptoms when compared to youngsters of the same age,” including kids who don’t listen, who “drive their families crazy,” and who are injury-prone. Fortunately, a child psychiatrist cautions readers not to “jump on the bandwagon too quickly in making early diagnoses.” Mention of additional criteria–adapted from the Diagnostic and Statistical Manual of Mental Disorders, for example–might help readers distinguish “extreme” from normal variations in behavior. (New Engl J Med 2005;352:165-73). The story neglects mention of cost or how readers might find professionals to implement the more-intensive program. It might also have provided more context on treatment harms and alternatives. Can behavioral therapy go wrong—and if it can, how might it harm a vulnerable preschooler? The article explains that the main treatment option, medication, is not yet approved for these youngsters. However, it fails to note that behavioral therapies have proven to be less effective as medications in older, school-age kids. (New Engl J Med 2005;352:165-73).
There is no mention of costs—an important omission, considering that there was no difference in outcome between the individualized treatment approach and a more standard educational format.
The article explains that preschoolers showed about a 30% improvement in learning and problem behaviors regardless of which behavioral intervention they received. However, it does not provide an estimate of the absolute improvement.
The article does not mention potential harms of behavioral treatment, though it does mention one harm associated with drug therapy. Taking parenting classes and learning skills to manage children with ADHD takes time. Do these interventions detract from the rest of the family or from other duties at home or work? Can behavioral therapy go wrong—and if it can, how might it harm a vulnerable preschooler?
The news story appears to describe a randomized, controlled trial comparing parent-education classes alone to parent education plus individualized behavioral therapy directed by a clinician in both the home and classroom. “Surprisingly, both groups fared equally well,” according to the article. It does not mention potential biases. For example, might these families be self-selected with pre-existing notions about the effectiveness of behavioral therapy? The article also does not say whether researchers assessing the children were blinded to the intervention each child received. More description of the study’s methods and limitations would be helpful.
The news story says ADHD may afflict a small portion of preschoolers (1% to 4%). But the wide net cast by the story’s diagnostic criteria could ensnare some innocent victims—“extreme symptoms when compared to youngsters of the same age,” including kids who don’t listen, who “drive their families crazy,” and who are injury-prone. Fortunately, a child psychiatrist cautions readers not to “jump on the bandwagon too quickly in making early diagnoses.”
The short article cites four sources–two coauthors and two academics, one of whom cautions readers not to “jump on the bandwagon too quickly in making early diagnoses.”
The story makes a brief mention of medications for ADHD, the mainstay treatment among school-age children. However, it fails to note that behavioral therapies have proven to be less effective than medications in this older group of youngsters. A sentence that placed the current study in the context of other research that has looked at behavioral therapy for children with ADHD would also be helpful.
It is difficult to determine where parents would find the kind of customized behavioral therapy described in this article. More typically, psychologists or social workers working with school-age children provide community- or school-based educational programs that bring together teachers and parents over the course of 8 to 12 weeks. (Pediatrics 2001;108:1033-44)
The article accurately suggests that the use of individualized, multifaceted behavioral therapies in preschoolers is relatively new.
No obvious use of text from the Lehigh University press release.
Systematic, Criteria-Driven
Puleeeeease... this 'game changer' weight loss drug causes more nausea and vomiting than a placebo. Some game, some change. My friend Gary would spank you for using the eighth word medical reporters should never, ever use. @garyschwitzer @thackerpd
https://www.healthnewsreview.org/toolkit/just-journalists-writing-tips-case-studies/7-words-and-more-you-shouldnt-use-in-medical-news/ https://twitter.com/OttawaCitizen/status/1361426796126830597
A scary @statnews Op-Ed warns that govt attempts to rein in Pharma may cut off access to "life-changing" drugs.
It takes @garyschwitzer to let us know: the author spent 10 years as Pfizer's public-policy chief. https://twitter.com/garyschwitzer/status/1360325022578053123
.@TranspariMED criticizes STAT op-ed for not disclosing pharma funding of author’s institute - similar to criticism we’ve made of STAT op-eds in the past. @transparify @ThinkTankWatch @icer_review https://www.healthnewsreview.org/2021/02/transparency-watchdog-criticizes-stats-non-disclosure-on-pro-pharma-op-ed/
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