One tantrum too many? There are other options for ADHD besides medication.

RODALE NEWS, EMMAUS, PA— In a single day, a child with attention-deficit/hyperactivity disorder (ADHD) may seem to receive as much negative feedback as a child without the disorder receives in an entire year. The first 10 minutes of a morning might sound like this: “Hurry up, get dressed. You’re going to miss the bus! Stop playing with your food! Pay attention! Go find your homework.” And that’s before the hyperactive child even steps foot onto a bus or into a classroom. About 5 percent of today’s school-age kids have been diagnosed with ADHD—that tallies to about one child in every classroom. Researchers also have found that teachers suspect at least another 5 percent suffer from the disorder but haven’t been diagnosed. Stimulant medications like Ritalin often are used to treat ADHD, but a new analysis of 174 studies suggests that parental skills can be just as effective as prescription pills.

THE DETAILS: The analysis, published recently in Clinical Psychology Review, looked at published and unpublished studies that used a range of methods and settings (school, home, recreation) and concluded that behavior-based methods, like focusing on behavioral triggers and improving parent-child communication, are highly effective in improving the functioning of children with ADHD. For parents looking to reduce or avoid the side effects of treating the disorder with medication, a behavioral approach is their only credible alternative, says the study’s lead author, Gregory Fabiano, Ph.D., assistant professor in the Department of Counseling, School, and Educational Psychology at the University of Buffalo in New York. “There are two approaches with evidence that research supports,” he says. “It [research] supports stimulants, like Ritalin (where there are sometimes side effects), and behavioral treatment.”

WHAT IT MEANS: ADHD medications may work, but the long list of possible side effects range from insomnia, anxiety, and nausea to anorexia, psychosis, heart problems, and addiction. This study suggests parents can try another approach. “It’s not rocket science,” says Fabiano, who recently received the White House’s Presidential Early Career Award for Scientists and Engineers. “Things we suggest are things that aren’t really hard to understand or do. The real trick is keeping them up every day for weeks, months, or years.”

Here are some strategies for a pill-free approach to managing ADHD: