The synergistic effects of stimulants and parental psychotherapy in the treatment of attention deficit hyperactivity disorder.

A 5-year-old boy presented with attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder and separation anxiety disorder. The clinical assessment revealed longstanding parent-child relationship problems, ongoing family stress, and a chronic level of low grade depression in the mother. The treatment approach consisted of drug treatment of the child and long-term psychotherapy of the mother. At termination symptoms associated with ADHD were markedly reduced and parent-child relationship problems were no longer evident. It is argued that in a subgroup of children family stress and attachment difficulties may be involved in the development of ADHD. These difficulties should be considered separately in the treatment of children with ADHD, especially if still present after the symptomatic treatment. The treatment outcome raises the question whether or not certain symptoms attributed to ADHD may be reversible, and the long-term adverse outcome of the condition preventable.