Against the Grain: A Psychosocial-first Approach to Treating ADHDthe Buffalo Treatment Algorithm William E. Pelham, Jr Center for Children and Families State University of New York at Buffalo Attention Deficit Hyperactivity Disorder: A 21st Century Perspective
Altogether, these studies suggest that most ADHD children can be treated effectively with a relatively simple behavioral intervention and will not need adjunctive medication or intensive behavioral interventions. Conceivably, such an approach to treatment might reduce the number of ADHD children in the US receiving psychoactive medication from more than 4% to no more than 1%. This outcome would be well received by families of ADHD children. An important question is what impact will this have on the societal cost of ADHD?
While it is widely believed that medication is less expensive than psychosocial treatment, an evidence-based but low-intensity behavioral treatment (e.g., 12 group parent training sessions plus a consultant to visit the child’s teacher to establish a DRC) may be implemented for a cost (approximately $1500) that is less than that the annual cost of today’s long-acting stimulant preparations (about $1800 per year, assuming quarterly physician contact; Pelham et al, 2007). Furthermore, because of the lack of long-term gains, medication must be continued indefinitely once it is begun, whereas effective behavioral treatments have been shown to produce longer-term maintenance of treatment gains (Jensen et al, 2007; MTACG, 2004).
A liberal estimate of the cost of the intensive behavioral or combined treatment provided in the MTA was $6000 to $8000 (Jensen et al., 2005)—about equally divided among the parent training, school intervention, and summer treatment program.
This was considerably more than the cost of medication in the MTA study, but as our discussion above shows, the majority of ADHD children do not need either adjunctive medication or behavioral treatment of this intensity. Thus, provision of a low dose of behavioral intervention as the starting treatment for ADHD children may be more cost effective than medication alone and can avoid the expensive, intensive treatments provided in the MTA study if they are not needed for a given child.