Massage therapy improves mood and behavior of students with attention-deficit/hyperactivity disorder

Adolescence, Winter, 2003 by Sonya Khilnani, Tiffany Field, Maria Hernandez-Reif, Saul Schanberg

Medication Therapy

Psychostimulant medication is the most widespread treatment for ADHD. More children/adolescents receive medication to manage ADHD than any other childhood disorder. Recent reports suggest that prescriptions for psychotropic drugs are increasing among children with ADHD (Guevara, Lozano, Wickizer, Mell, & Gephart, 2002). Lately, more girls are being prescribed stimulants as a result of the broadening conceptualization of ADHD (Goldman et al., 1998)--the initial focus on hyperactivity has shifted to attentional problems and impulsivity. The mean number of office-based visits documenting a diagnosis of ADHD among girls tripled in the 1990s, whereas the number for boys increased about twofold (Robison, Skaer, Sclar,& Galin, 2002).

Currently, the disorder consists of the following three subtypes: predominantly inattentive, hyperactive-impulsive, and combined. According to the DSM-IV, most children/adolescents have the combined type. The most common form of stimulant medication is methylphenidate, otherwise known as Ritalin. Other medications such as Adderall, Dexedrine, and Cylert are also used. Numerous studies (double-blind, placebo-controlled) have concluded that stimulants are more effective in ameliorating ADHD's core behavioral symptoms of hyperactivity, impulsivity, and inattentiveness than placebos, nonpharmacological therapies, or no treatment (Spencer, Biederman, Coffey, Geller, Crawford, Bearman, Tarazi, & Faraone, 2002). Improvement in dysfunctional social behavior and internalizing symptoms has also been reported (Schachar, Jadad, Gauld, Boyle, Booker, Snider, Kim, & Cunningham, 2002).

There is little empirical evidence that stimulant use contributes to longer-term improvements in academic functioning. Moreover, this mode of treatment continues to be controversial with this population because of its behavior-modifying properties and associated side effects. The following adverse side effects increase linearly with dosage: nervousness, headache, insomnia, and tachycardia (Klein-Schwartz, 2002). Further, as the therapeutic use of stimulants increases, the risk of abuse, overdose, and medication errors may also increase. According to Goldman et al. (1998), stimulants as a class of drugs have "marked abuse potential, and their misuse can have severe medical and social consequences." Clinical manifestations of overdose include agitation, hallucinations, psychosis, lethargy, seizures, tachycardia, dysrhythmia, hypertension, and hyperthermia (Klein-Schwartz, 2002). Moreover, in a study of 223 ADHD children aged three years and younger, over half received psychotropic medication in an idiosyncratic manner and almost half did not have opportunities for optimal monitoring (Rappley, Eneli, Mullan, Alvarez, Wang, Luo, & Gardiner, 2002).

Nonpharmacological Therapy

Although pharmacotherapy remains the current treatment of choice for ADHD children, benefits from nondrug treatments have been noted. For example, Wilmshurst (2002) reported good results for youths from a home-based preservation program in terms of reductions in clinical symptoms of ADHD, as well as general anxiety and depression, at one-year follow-up. However, behavioral therapy has generally not proven effective except when combined with pharmacotherapy (Barkley, 1990).