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To treat ADHD or not? To use prescription medications or not? Behavioral therapy or not? Diet or other natural or alternative approaches or not? Partly because the illness primarily affects children, partly because the prescription medications currently available are burdened by stigmas relating to drug abuse, and partly because of societal issues questioning the very existence of Attention Deficit Hyperactivity Disorder (ADHD), its treatment raises many questions whose answers need to be based on science, independently created and unbiased, and easily understood. To those ends, HealthTalk produced a two-part webcast on ADHD treatment.

To supplement the HealthTalk programs, the American Academy of Child and Adolescent Psychiatry and the American Psychiatric Association have published a new ADHD Parents Medication Guide. It is available in both English and Spanish. The guide provides information on ADHD symptoms, treatment options, types of medications, drug side effects, disorders that can co-occur, psychosocial treatments as well as a section on unproven treatments.

Left untreated, ADHD can have profound effects on a child’s school performance and can increase their risk of disciplinary problems and dropping out. I’ve previously written about both the negative impacts it can have on school and the proven improvement that treatment can provide. But ADHD can also lead to a host of other problems as this list from the Parents Medication Guide dramatically shows:

Potential Consequences when ADHD is Left Untreated
• Increased risk for school failure and dropout
• Behavior and discipline problems
• Social difficulties and family strife
• Accidental injury
• Alcohol and drug abuse
• Depression and other mental-health disorders
• Employment problems
• Driving accidents
• Unplanned pregnancy
• Delinquency, criminality, and arrest

Numerous studies have proven the value of medication in treating ADHD. The largest of these is called the Multimodal Treatment Study of Children with ADHD, or MTA for short. It showed that methylphenidate (one type of the various stimulant medications used in ADHD treatment) is effective in treating ADHD, either alone or in combination with behavioral therapy. Moreover, it found that treatment that includes medication is superior to behavioral treatment alone. Best of all are approaches that combine medication with behavioral therapy.

Behavioral therapies include three approaches; namely, parent training, child-focused treatment, and school-based interventions. These methods teach the parents, the children and their teachers about ADHD and how they can all better develop skills needed to manage its frustrating behaviors and their negative consequences.

There are two major groups of ADHD medications: stimulant and non-stimulant. The stimulant medications include methyphenidate and amphetamines, which have been available for decades and are known to be highly effective. They have been shown also to be quite safe when prescribed, taken and monitored properly. Only one non-stimulant medication is currently approved by the FDA for ADHD: Strattera (amoxetine). It too has been shown to be both safe and effective and may be more appropriate for certain children who either don’t respond well enough to stimulants or who have other co-existing disorders.

The ADHD Parents Medication Guide was developed by an independent group of medical professionals and parent advocacy groups. Of note, no pharmaceutical funding or editorial support was used in its preparation. The following organizations contributed to its development:

American Academy of Child and Adolescent Psychiatry (AACAP)
• American Psychiatric Association (APA)
• Children and Adults with Attention Deficit/Hyperactivity Disorder (CHADD)
• Child and Adolescent Bipolar Foundation
• Federation of Families for Children’s Mental Health
• Mental Health America
• National Alliance on Mental Illness (NAMI)
• National Institute on Mental Health (NIMH)

The ADHD Parents Medication Guide is available for free. More information about ADHD including archives of past webcasts, news about upcoming programs, reference materials and blogs is available on our ADHD homepage.

In 1990, Congress designated the first full week of every October to be National Mental HealthAwareness Week. This year that week is October 7-13, 2007 and October 11th is both National Depression Screening Day, sponsored by Screening for Mental Health, Inc., and Bipolar Disorder Awareness Day. Bipolar Disorder Awareness Day is organized by the National Alliance on Mental Illness (NAMI), a non-profit group which is the nation’s largest grassroots mental health organization dedicated to improving the lives of persons living with serious mental illness and their families.

Bipolar disorder is also called manic depression or manic-depressive illness, but its treatment is different from that of depression (see below). It is a chronic brain disorder that causes extreme shifts in mood, energy and ability to function. It is characterized by episodes of mania (being overly ‘high’) and depression (being irritable, sad or hopeless) that can last from days to months. Symptoms often begin in adolescence or early adulthood and can result in poor school performance, poor job performance, damaged relationships, substance abuse, criminal or other irrational behavior and even suicide. Oftentimes depression dominates the clinical picture and mania may go unrecognized, especially if it is mild (called hypomania) or occurs only rarely. However, the recognition of mania is critical to the proper diagnosis of bipolar disorder, which might otherwise be diagnosed as depression (also called unipolar depression).

The treatment of bipolar disorder is different from the treatment of depression. Everyone knows that depression is treated with anti-depressants. But bipolar disorder, even though it has depression as a component, needs to be treated with mood stabilizers first and foremost. Anti-depressants play a much lesser role, if any, in the treatment of bipolar disorder, and they can actually make the illness worse (especially if used alone without mood stabilizers). You can see why proper diagnosis is so important.

In recognition of Bipolar Awareness Day, HealthTalk has created a Special Feature page with a wide variety of useful information, including treatment information, on this illness.

Bipolar Awareness Day was created by NAMI and Abbott Laboratories to, according to the NAMI Web site “increase awareness of bipolar disorder, promote early detection and accurate diagnosis, reduce stigma, and minimize the devastating impact on the 2.3 million Americans presently affected by the disorder.” The government’s National Institute of Mental Health states that about 5.7 million American adults have bipolar disorder in any given year. Other estimates put the number of people with bipolar disorder at 10 million.

When combined with traditional psychotherapy, activities involving horses can help people suffering from a range of mental conditions, including depression and ADHD.

Humans and horses have maintained a healthy relationship for millennia — research suggests people first domesticated the large ungulates 6,000 years ago in the western region of the Eurasian Steppe. But far from being the simple beasts of burden or transportation tools they were in the past, horses today have become key players in the mental rehabilitation of many people around the world.

Equine-assisted therapy is an umbrella term encompassing several therapeutic activities involving horses. Hippotherapy, for example, utilizes the movement of horses for physical, occupational, or speech therapy, and has been used to treat motor and sensory issues associated with cerebral palsy, multiple sclerosis, and stroke, among other things. Though horses have been used for physical therapy since at least the fifth century B.C., the formal discipline of hippotherapy wasn’t established until the 1960s.

RELATED: 6 Ways Dogs Help Ease Depression Symptoms

On the other hand, equine-assisted psychotherapy (EAP) — a type of experiential psychotherapy that uses horses to help in the treatment of psychological and behavioral issues — is a much newer activity that isn’t widely practiced yet, says Hallie Sheade, a licensed professional counselor who runs Equine Connection Counseling, an EAP practice based in Texas. “It is a very exciting and rapidly growing field,” she says.

How Horses Help

While scientists understand how the rhythmic movement of horses can assist with motor and sensory problems, how horses help with mental or behavioral issues hasn’t been completely worked out.

“The mechanism of action hasn’t been well established for equine-assisted therapies with relation to non-physiological, non-mobility activities,” says Alexa Smith-Osborne, an associate professor of social work at the University of Texas at Arlington, who studied equine-assisted therapy. “Nevertheless, on a practical basis, there are some theoretical perspectives.”

For one thing, horses are prey animals, she says. Because of this, horses are more highly attuned to environmental activity and sensitive to people’s emotional states than dogs and other animals typically used in assisted therapies.

“They’re capable of reading or becoming aware of how [a patient’s] feeling before I’m aware of it or the even the client is,” Sheade says. “The horse will then give feedback to the client, such as by moving towards the client or away.”

Additionally, horses are large and powerful and have the potential of allowing people to overcome fear and develop confidence that can be translated into real-life situations. They can also help put people at ease because they’re unbiased and non-judgmental, responding only to people’s intent and behavior. What’s more, they’re social animals with their own personalities, and are most willing to interact when people are engaged and work to build a relationship with them.

Uses and Benefits of EAP

EAP has been used in the treatment of a wide range of conditions, including:

• Depression
• Post-traumatic stress disorder
• Attention deficit hyperactive disorder
• Anxiety
• Behavioral issues, including aggressive behavior
• Substance abuse
• Eating disorders, including anorexia and bulimia
• Relationship problems
• Communication issues

Equine-assisted therapy sessions, which involve a therapist and horse handler, vary depending on the condition being treated and the person(s) involved. In general, traditional experiential psychotherapy techniques, such as role-playing, role-reversal, and mirroring, are combined with equine-based activities, including choosing, grooming, and walking a horse. After the activity, patients then process or discuss their feelings and behaviors associated with the session.

Though qualitative case studies have demonstrated benefits to equine-assisted psychotherapy, well-controlled, quantitative studies are lacking. But in a study published in the journal Health Psychology, Smith-Osborne and her colleague Alison Shelby reviewed previous research on EAP, and found that the practice is a promising adjunct to traditional therapy.

“It’s really only possible to say with any confidence that there’s empirical evidence that equine-assisted activities appear to be helpful as a complementary treatment for a range of disorders,” Smith-Osborne says. “And for people who have not responded well to first-line treatments, it does show promise.”

Anecdotally, the horse-based therapy can provide numerous benefits, which can arise in as little as two to three sessions, Sheade says. Benefits include improved:

• Self-esteem
• Communication skills
• Self-awareness
• Relaxation
• Empowerment
• Interpersonal relationships
• Self-control
• Focus and concentration
• Happiness

Studies have also suggested EAP can decrease anger, depression, dissociation, and aggression.

Adverse effects from EAP are rare, but decreased self-esteem and increased aggression in children and adolescents have been reported. Researchers think these negative effects may be due to attachment and subsequent loss of the horse companion after the therapy ends.

Seeking Horse Therapy

Given that EAP isn’t widely available yet, it may be difficult to find an establishment offering this service in your area. However, PATH International and EAGALA— reputable equine-assisted therapy associations — have listings of accredited centers by location.

When you visit a center, a therapist will discuss with you your background and goals, and come up with a treatment plan. Keep in mind that your insurance may not cover some or all of the therapy costs.

“But there have been cases where individuals have gone to court with insurance companies and won,” Smith-Osborne says.