Behavior treatment works as well as drugs for children with ADHD and bypasses the risk of medication's side effects, a meta-analysis of 174 studies on ADHD treatment conducted at the University at Buffalo, has shown. The results, published in the March issue of Clinical Psychology Review, found that teaching parents and teachers how to respond when children do things the right way -- as well as when they display harmful or aggressive behavior -- is effective, and in some cases more effective, than medication for ADHD.

"This review shows that behavioral treatments work, and in general work well," said Gregory A. Fabiano, Ph.D., assistant professor in the Department of Counseling, School and Educational Psychology in UB's Graduate School of Education, and first author on the paper. "For the past couple of decades, there has been considerable professional controversy about the role and adequacy of behavior modification treatments in the care of children with ADHD. The next step is to figure out how to make them work for individual families over the long run, because we now know that ADHD is a lifelong condition."

Through use of behavior modification, children could bypass the risk of side effects from ADHD drugs and achieve the same or better results as drug treatments, Fabiano noted. William Pelham, Jr., Ph.D., UB Distinguished Professor of Psychology, Pediatrics and Psychiatry, is co-author on the study.

Fabiano noted that ADHD is one of the most common mental health disorders among children. "Prevalence rates place at least one child with ADHD in every classroom in America, highlighting the need for effective interventions. "Our results suggest that efforts should be redirected from debating the effectiveness of behavioral interventions to dissemination, enhancing and improving the use of these programs in community, school and mental health settings." In the future, Fabiano plans to work with teachers, parents, pediatricians and clinicians in the community to emphasize the effectiveness of behavior modification treatments.

His additional research includes developing strategies to get fathers more involved in the treatment of children with ADHD, and use of driving simulators to help teens with ADHD learn to drive, while also helping parents learn to provide effective driving instruction to their teens.

Fabiano is a recent recipient of the White House's Presidential Early Career Award for Scientists and Engineers, the nation's highest honor for professionals at the early stages of their independent scientific research careers.

Older adults with generalized anxiety disorder who received cognitive behavior therapy had greater improvement on measures of worry, depression and mental health than patients who received usual care, according to a study in the April 8 issue of JAMA.

Generalized anxiety disorder is common in late life, with prevalence up to 7.3 percent in the community and 11.2 percent in primary care. Late-life anxiety predicts increased physical disability, memory difficulties and decreased quality of life, according to background information in the article. Late-life anxiety is usually treated with medication, but associated risks (e.g., falls, hip fractures, memory problems) with some drugs and patient fears of adverse effects limit their usefulness. Two previous studies suggested benefits of cognitive behavior therapy in primary care for late-life GAD, but the studies were small and conclusions were limited. Older adults most often seek treatment for GAD in primary care.

Melinda A. Stanley, Ph.D., of Baylor College of Medicine, Houston, and colleagues conducted the first randomized clinical trial of CBT for late-life GAD in primary care to examine whether CBT would improve outcomes relative to enhanced usual care. The trial included 134 older adults (average age, 67 years) in two primary care settings, with treatment provided for 3 months. Assessments were conducted at the beginning of the trial, posttreatment (3 months), and over 12 months of follow-up, with assessments at 6, 9, 12 and 15 months. Patients were randomized to either CBT (n = 70), which included education and awareness, relaxation training, cognitive therapy, problem-solving skills training and behavioral sleep management; or EUC (n = 64), in which patients were telephoned biweekly during the first 3 months of the study by the same therapists to provide support and ensure patient safety. Therapists reminded patients to call project staff if symptoms worsened.

Levels of anxiety, worry, depression and physical/mental health quality of life were measured via various tests or surveys. The researchers found that CBT, compared with EUC, significantly improved worry severity, depressive symptoms and general mental health. In intention-to-treat analyses, response rates defined according to worry severity were higher following CBT compared with EUC at 3 months (40.0 percent vs. 21.9 percent).

"This study is the first to suggest that CBT can be useful for managing worry and associated symptoms among older patients in primary care," the authors write. "This study paves the way for future research to test sustainable models of care in more demographically heterogeneous groups."