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

William E. Pelham Jr., a child psychologist who questioned the approach to ADHD in children and advocated a therapy-based regimen that used medications such as Ritalin and Adderall as optional supplements, died Oct. 21 in Miami. He was 75.

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

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

In the 1980s and 1990s, doctors and many parents embraced ADHD medications such as Ritalin and Adderall as wonder drugs, although some, including Dr. Pelham, raised concerns about its efficacy and side effects.

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

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

In a major study published in 2016 with Susan Murphy, a statistician at the University of Michigan, he demonstrated the importance of the sequence of treatments: that behavioral therapy should come first, and medication second.

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

After two months, the children from both groups who showed no improvement were divided into four new groups: the children who received generic Ritalin received either more medication or behavior modification therapy, and the children who received behavior modification therapy received either more intensive therapy or a dose of medication. .

“We have shown that the order in which you deliver treatments makes a big difference in outcomes,” said Dr. Pelham to The New York Times. “The children who started with behavior modification did significantly better at the end than those who started with medication, regardless of which treatment combination they ended up with.”

Not everyone agreed with Dr.’s conclusions. Pelham, mostly on practical grounds. Medication was easy to administer, they said, and good 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 teenagers, who were more likely to resist it.

The influence of Dr. Pelham is perhaps best seen in the 2019 Guidelines for ADHD Diagnosis and Treatment issued by the American Academy of Pediatrics, the group’s most recent recommendations. For very young children, treatment is first recommended, possibly with medication; for children aged 6 to 12 years, both are recommended at the same time. But for adolescents, it is concluded that behavioral treatment is unproven and only medication is recommended.

Dr. Pelham started 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 related disorders. The camp, which he founded in 1980, served as a space for both therapy and research. Since then, it has served as a model for similar programs at home and abroad, including in Japan.

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

William Ellerbe Pelham Jr. was born January 22, 1948 in Atlanta, the son of William and Kitty Copeland (Kay) Pelham. The family moved frequently for William Sr.’s work, first to Kensington, Maryland, where he managed a Canada Dry facility, and later to Montgomery, Ala., 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 taught special education for a year in Amsterdam, NY, northwest of Albany, before enrolling in the doctoral program in psychology at the State University of New York at Stony Brook, on Long Island. He received his Ph.D. in 1976.

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

Dr. Pelham pushed for a therapy-oriented approach in part because it gave children the skills they needed to cope with what was often a lifelong struggle.

“Our research has shown 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.”