William E. Pelham Jr., a child psychologist who challenged the way his field approached attention deficit hyperactivity disorder in children, advocating a treatment regimen using drugs like Ritalin and Adderall as an optional supplement, died October 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 a cause.
Dr. Pelham began his career in the mid-1970s, when modern understanding of mental health was beginning to emerge 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 like Ritalin and Adderall as wonder drugs, even though some, including Dr. Pelham, expressed concerns about their effectiveness and their side effects.
Dr. Pelham was not opposed to medication. He acknowledged that medications were effective in quickly treating ADHD symptoms, such as agitation, impulsivity and lack of concentration. But in a long series of studies and articles, he argued that for most children, behavior therapy, combined with parental intervention techniques, should be the first line of attack, followed by low doses of medication if necessary.
And yet, as he repeatedly pointed out, the reality was very different: The Centers for Disease Control and Prevention reported in 2016 that while six in ten children diagnosed with ADHD took medication, fewer than half received behavioral therapy.
In a major study, which he published in 2016 with Susan Murphy, a statistician at the University of Michigan, he demonstrated the importance of treatment sequencing: behavioral therapy should come first, then medications.
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 rest received nothing, but their parents received training in behavior modification techniques.
After two months, the children in the two groups who showed no improvement were divided into four new groups. Children who received generic Ritalin received either more medication or behavior modification therapy, and children who received behavior modification therapy received either more intense therapy or a dose of medication.
“We showed that the order in which you give treatments makes a big difference in outcomes,” Dr. Pelham told the New York Times. “Children who started by changing their behavior did significantly better than those who started on medication at the end, regardless of what combination of treatments they ended up with.”
Not everyone agreed with Dr. Pelham’s conclusions; many disagreed on practical grounds. The drugs were easy to administer, they said, and appropriate behavioral therapy could be time-consuming and expensive and therefore difficult to maintain over a long period, both for parents and for children, especially adolescents, who were more likely to resist it.
Dr. Pelham’s influence is perhaps best seen in the 2019 guidelines for the diagnosis and treatment of ADHD published by the American Academy of Pediatrics, the group’s most recent recommendations. For very young children, he recommends treatment as a priority, with medication as an option; for children ages 6 to 12, it recommends both simultaneously. But for adolescents, he concludes that behavioral treatment is unproven and recommends only medication.
Dr. Pelham began his career at Washington State University, but spent most of his career at the State University of New York at Buffalo. In 2010, he transferred his research program, the Center for Children and Families, to Florida International University in Miami.
At both schools, he led an innovative summer camp for children with ADHD and related disorders. The camp, which he established in 1980, served as both a therapy and research space. Since then, it has served as a model for similar programs nationally and internationally, notably in Japan.
“Dr. Pelham was one of the early giants in the field of ADHD research,” Dr. James McGough, a professor of psychiatry at the University of California, Los Angeles, said 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 often for William Sr.’s job, first to Kensington, Maryland, where he ran a Canada Dry factory, 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 at doctoral program in psychology at the State University of New York at Stony Brook, Long 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 allowed children to learn the skills they needed to manage what was often a lifelong struggle.
“Our research has repeatedly found that behavioral and educational intervention is the best first-line treatment for children with ADHD,” he said in an interview for “The Academic Minute” podcast in 2022. “They, their teachers and their parents learn skills and strategies that will help them succeed at home, in school and in their relationships.