Therapy Dogs and ADHD

We've written numerous times about the benefits of dogs as pets. We've shared research that found that children with dogs at home had fewer respiratory or ear infections and needed fewer courses of antibiotics than children who had no exposure to dogs.

We've looked at how using dogs as reading companions can help struggling readers gain skills and confidence. And we've shared how psychotherapists are using dogs in their therapy practices to help their young patients.

Now, a new randomized controlled study (the "gold standard" of how research is conducted) has found that children with ADHD who received Canine-Assisted Interventions (CAI) with a certified therapy dog significantly improved attention and social skills and exhibited fewer behavior problems after only eight weeks. Of note, hyperactivity and impulsivity were not affected. The study, from researchers at the University of California, Irvine, involved 88 children ages 7-9, none of whom had taken medication to treat their attention difficulties. Both the CAI group and the control group received standard behavioral interventions for their ADHD and the control group did improve with these (as did the CAI group), but the children in the CAI group did better and improved more quickly (eight weeks vs. 12 weeks) than those without canine support.

While it is not a cure-all, families whose children have ADHD might consider a certified therapy dog in conjunction with more standard behavioral interventions for their children.

Photo by Andy Omvik on Unsplash

ADHD Treatments for Young Children - A New Study

A new study just released by the Centers for Disease Control and Prevention (CDC) finds that while more than 75% of young children (ages 2-5) with attention-deficit/hyperactivity disorder (ADHD) are prescribed medication, only about half receive behavior therapy* to address their attention difficulties.

 

This preference for medicating young children runs counter to the clinical guidelines established by the American Academy of Pediatrics, which in 2011 recommended:

"For preschool-aged children (4–5 years of age), the primary care clinician should prescribe evidence-based … behavior therapy as the first line of treatment and may prescribe [medication] if the behavior interventions do not provide significant improvement and there is moderate-to-severe continuing disturbance in the child's function."

The AAP guidelines go on to caution that, “…in areas where evidence-based behavioral treatments are not available, the clinician needs to weigh the risks of starting medication at an early age against the harm of delaying diagnosis and treatment.” The AAP noted that even students whose attention difficulties do not rise to the diagnostic criteria of ADHD may benefit from a behavioral approach to their attention issues.

The CDC study observed that approximately 6.4 million U.S. children ages 4-17 years had a diagnosis of ADHD in 2011-12, which was an increase of 42% increase compared to 2003. The study used insurance claims for psychological services (which includes behavior therapy) and ADHD medication from both Medicaid and private insurance to determine the frequency with which each approach was utilized. 

The CDC reported that the strength of evidence for behavior therapy exceeds that for ADHD medications. It noted that behavior therapy might require more time to impact child behavior and might require more resources but that the impact lasts longer relative to ADHD medication and does not have the side effects associated with these medications. Most of these side effects are minor but they are experienced by approximately 30% of children aged 3–5 years who take ADHD medications and more than 10 % of the children in this group stopped medication treatment because of such side effects.

Here at The Yellin Center we always recommend behavioral strategies for school and home when dealing with attention issues. When appropriate, we can also provide consultation and ongoing prescription management for medications, but we strongly believe that medication should only be considered in the context of a student's overall educational plan, and never thought of as a "quick fix" for school difficulties.

*Behavior therapy in this context includes any psychological interventions that are designed to change problem behaviors, including ADHD symptoms, by modifying the physical or social contexts in which the behavior occurs and can be delivered to the child by a therapist, teacher, parent, or other provider.

Behavioral Therapy and ADHD

Scientific American has reported on findings from the recent Experimental Biology meeting in San Diego that look at the relative effectiveness of cognitive and behavioral therapies versus medications in helping children and young adults with Attention Deficit Hyperactivity Disorder (ADHD). 

Included in the research reported at the meeting were findings by Dr. Claire Advokat of Louisiana State University, who looked at college students with attention difficulties and found that it was not medication, but good study habits, that determined several parameters of college success, such as grades. Dr. Advokat noted, according to the Scientific American report, that this does not mean that medication had no effect for these students, but that it may help students develop good study habits, which then improves student performance. 

Other researchers at the Experimental Biology meeting included Dr. William Pelham of Florida International University, who noted improvement in children's ADHD behaviors, such as classroom disturbances, when their parents received training in behavioral tools and in managing their own stress. Dr. Pelham has also conducted studies suggesting that children with ADHD who receive low doses of medication combined with behavioral therapy do better than children receiving only medication or only therapy. 

While there is much work to be done, none of the researchers whose findings were discussed in this article by Scientific American suggested going back to the days before ADHD medications became available and only cognitive and behavioral therapies could be offered; they generally agreed that it is important to explore the relative uses of all available modes of treatment. While medications generally work more quickly and are more cost effective than longer term behavioral therapies, they can have side effects. The real question that remains is what works best for each individual child and young adult in the long run.