NOEL KING, HOST:
When kids are diagnosed with ADHD, the first line of treatment is usually stimulant medications like Ritalin. New guidelines largely agree those medicines are important, but other doctors just take a different approach. Here's Alex Smith from member station KCUR in Kansas City.
ALEX SMITH, BYLINE: When 6-year-old Brody Knapp of Kansas City, Mo., was diagnosed with ADHD last year, his father, Brett, was skeptical. He didn't want his son taking pills.
BRETT KNAPP: You hear of losing your child's personality, and they become a shell of themselves and they're not that sparkling little kid that you love. And I didn't want to lose that with Brody 'cause he is an amazing kid.
SMITH: Brody's mother, Ashley, had other ideas. She's a school principal and has ADHD herself.
ASHLEY KNAPP: I was all for stimulants at the very, very beginning because I know what they can do to help a kid who has a neurological issue such as ADHD.
SMITH: More and more families have been facing the same dilemma. The prevalence of ADHD has shot up in the last two decades, and now almost 1 in 10 children in the U.S. is diagnosed with it. The new guidelines from the American Academy of Pediatrics recommend that when children are diagnosed with ADHD they also get screened for other mental illnesses. But the treatment recommendations remain mostly the same as previous guidelines. They advise that anyone over the age of 5 should start taking medication and get behavioral therapy as soon as they're diagnosed. Children 5 and younger should start with behavioral treatment first. But many docs still worry that the role of medications is too large.
CARLA ALLAN: It's certainly true that when you watch TV, you're not going to see a lot of commercials about behavioral treatments, but you very well may see some new ones about medication.
SMITH: Dr. Carla Allan is an ADHD specialist in Kansas City and Brody Knapp's doctor. Some experts are disappointed that the new rules don't call for starting with therapy first for kids over 5. too.
ERIKA COLES: I think it's a huge disservice to not just the children that we're trying to treat but also the parents who prefer to have behavioral intervention.
SMITH: Erika Coles is a psychology researcher at Florida International University. A 2016 study found that giving kids, parents and teachers an eight-week course in behavioral techniques before starting medications led to fewer symptoms in the kids. Another study by Coles and other researchers published last month found that a similar program of interventions actually reduced the amount of medication needed by many kids with ADHD, and 37% of kids getting that training didn't need medications at all.
COLES: So we really need to think about a more global treatment perspective when it comes to treating kids with ADHD, and behavioral treatments do a much better job of addressing the domains of impairment that children with ADHD experience.
SMITH: Fewer meds also means fewer side effects. Some kids have trouble sleeping, lose their appetite or even experience personality changes. And there's not much research on what it means to stay on these drugs for years, especially when you're still growing. A member of the subcommittee that drafted the guidelines says it reviewed the research on starting therapy before meds, but the evidence was not strong enough to change the guidelines.
For Brody Knapp, his parents decided to start out with behavioral treatment first. His mom, Ashley, still uses techniques she learned to keep Brody on track with his chores...
A KNAPP: OK. I'm going to give you a 10-count then. You ready? And go. One.
SMITH: ...Like picking up his toys.
A KNAPP: Five. Hustle. Fast, fast, fast. You're halfway through. Six.
SMITH: Ashley admits this took some getting used to. She says it feels like micromanaging, and she doesn't love it, but it's helping.
UNIDENTIFIED PERSON: Shall we play some Legos?
UNIDENTIFIED CHILD: Yes. You're this team.
UNIDENTIFIED PERSON: Great.
UNIDENTIFIED CHILD: And I this team.
SMITH: They're in a good place now, but they did decide to give Brody medication after a few months of behavioral treatment when Brody had a violent tantrum. He now takes Concerta. His dad, Brett, says he's OK with his son taking pills now.
B KNAPP: It's not necessarily for the child. It really is for the parent to realize what an ADHD kid looks like. From that perspective, I think it helped out greatly to realize how I need to interact, and how I need to talk and how I need to work with my child.
SMITH: And Brett realized how valuable the right treatments started at the right time can be for children like his son.
For NPR News, I'm Alex Smith in Kansas City.
KING: That story came from a reporting partnership between NPR, KCUR and Kaiser Health News. Transcript provided by NPR, Copyright NPR.
