William Pelham Jr., who rethought how ADHD is treated, dies at 75 | ET REALITY


William E. Pelham Jr., a child psychologist who questioned how his field addressed attention deficit hyperactivity disorder in children, advocating for a therapy-based regimen that used medications such as Ritalin and Adderall as an optional supplement, died Oct. 21 in Miami. He was 75 years old.

His son, William E. Pelham III, who is also a child psychologist, confirmed the death at a hospital, but did not provide the cause.

Dr. Pelham began his career in the mid-1970s, when modern understanding of mental health was emerging and psychologists were just beginning to understand ADHD and, with it, a new generation of medications to treat it.

During the 1980s and 1990s, doctors and many parents embraced ADHD medications such as Ritalin and Adderall as miracle drugs, although some, including Dr. Pelham, raised concerns about their effectiveness and side effects.

Dr. Pelham was not opposed to medication. He recognized that the medications were effective in quickly addressing ADHD symptoms, such as restlessness, impulsivity, and poor concentration. But in a long series of studies and articles, he argued that for most children, behavioral therapy, combined with parental intervention techniques, should be the first line of attack, followed by low doses of medication, if necessary. necessary.

And yet, as he repeatedly noted, the reality was very different: The Centers for Disease Control and Prevention reported in 2016 that, while six out of 10 children diagnosed with ADHD were taking medication, less than half received behavioral therapy.

In an important study, which he published in 2016 together with Susan Murphy, a statistician at the University of Michigan, he demonstrated the importance of treatment sequencing: that behavioral therapy should come first and then medication.

He and Dr. Murphy divided a group of 146 children with ADHD, ages 5 to 12, into two groups. One group received a low dose of generic Ritalin; the other received nothing, but his parents received instruction in behavior modification techniques.

After two months, children in both groups who showed no improvement were organized into four new groups: children who received generic Ritalin received more medication or behavior modification therapy, and children who received behavior modification therapy received therapy. more intense or a dose of medication. .

“We showed that the sequence in which treatments are given makes a big difference in outcomes,” Dr. Pelham told the New York Times. “Children who started with behavior modification did significantly better than those who started with medication in the end, no matter which treatment combination they ended up with.”

Not everyone agreed with Dr. Pelham’s conclusions, many for practical reasons. The medications were easy to administer, they said, and proper behavioral therapy could be time-consuming and expensive and therefore difficult to maintain over a long period of time, for both parents and children, especially adolescents, who were more likely to resist it.

Dr. Pelham’s influence can perhaps best be seen in the 2019 guidelines for the diagnosis and treatment of ADHD issued by the American Academy of Pediatrics, the group’s most recent recommendations. For very young children, he recommends treatment first, with medication as an option; For children ages 6 to 12, recommends both simultaneously. But for adolescents, he concludes that behavioral treatment is unproven and only recommends medication.

Dr. Pelham began his career at Washington State University, but spent most of it at the State University of New York at Buffalo. He moved his research program, the Center for Children and Families, to Florida International University in Miami in 2010.

At both schools he led an innovative summer camp for children with ADHD and associated disorders. The camp, which she created in 1980, served as a space for both therapy and research. It has since been the model for similar programs nationally and internationally, including in Japan.

“Dr. Pelham was one of the original giants in the field of ADHD research,” Dr. James McGough, a psychology professor at the University of California, Los Angeles, said in a telephone interview.

William Ellerbe Pelham Jr. was born January 22, 1948 in Atlanta, son of William and Kitty Copeland (Kay) Pelham. The family moved often for William Sr.’s work, first to Kensington, Maryland, where he managed a Canada Dry facility, and then to Montgomery, Alabama, where he sold securities. His mother was a housewife and artist.

William Jr. received a bachelor’s degree in psychology from Dartmouth in 1970. He spent a year teaching special education in Amsterdam, New York, northwest of Albany, before enrolling in the doctoral program in psychology at the State University of New York at Stony Brook , on Big Island. He received his Ph.D. in 1976.

In addition to his son, Dr. Pelham is survived by his wife, Maureen (Cullinan) Pelham, whom he married in 1990; his daughter, Caroline Pelham; and his brothers, Gayle and John.

Dr. Pelham insisted on a therapy-first approach in part because it equipped children with the skills they needed to handle what was often a lifelong struggle.

“Our research has found time and time again that behavioral and educational intervention is the best first-line treatment for children with ADHD,” he said in an interview with The Academic Minute podcast in 2022. “They, their teachers and parents learn skills and strategies that will help them succeed at home, at school, and in their relationships.”

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