Comprehensive treatment for ADHD should always include a strong psychosocial (that is, not medical) component. In fact, many professionals believe that effective psychosocial intervention is the backbone of good treatment for ADHD. Moreover, research evidence has demonstrated that when medication is utilized as the only form of treatment, it has not been shown to improve long-term outcomes for children with ADHD. If psychosocial treatments alone are insufficient, however, medication can be a useful addition for many children, yielding a combination approach that may be more effective than psychosocial treatments alone. The scientific literature on treatment for ADHD has shown that behavior therapy is the only type of psychosocial treatment that is effective for ADHD.
There are several reasons that behavior modification is critical in treatment of ADHD. First, the problems faced by children with ADHD go well beyond their core symptoms of inattentiveness, hyperactivity, and impulsivity. Most children with ADHD have problems in daily life functioning, including academic performance and behavior at school, relationships with peers and siblings, noncompliance with adult requests, and relationships with their parents. How a child with ADHD will do in adulthood is influenced by four things: (1) whether his or her parents use effective parenting skills; (2) how he or she gets along with other children; (3) his or her success in school; and (4) whether behavioral treatments can be successfully applied to these critical areas. This is done by teaching skills to parents, teachers, and the children themselves. If learned and implemented by parents and teachers, these skills help the children overcome their problems in daily life functioning. Because ADHD is a chronic condition, teaching skills that will be valuable across the child's lifetime is especially important.
There are three components to effective behavioral interventions for children with ADHD: parenting training, teacher consultation/school interventions, and child-focused treatments. Although teaching parents more effective ways of dealing with their children is the most important aspect of psychosocial treatment for ADHD, ideally parent, teacher, and child interventions should be integrated to yield the best outcome. Three points are essential: (1) start with goals that the child can achieve and improve in small steps; (2) be consistent--across different times of the day, different settings, and different people; (3) don't expect instant changes--teaching and learning new skills take time, and children's improvement will be gradual; (4) constantly monitor the child's response and adjust treatment as necessary; and (5) begin intervention as early as possible--although behavior modification works for all ages, early treatment is more effective than later intervention.
Parent training is typically provided in weekly individual or group sessions for 12 to 16 weeks. Parents are taught skills by a therapist (e.g., how to use time out effectively) and asked to go home and practice the skill for a week with their child, reviewing progress, problem-solving, and learning a new skill in subsequent sessions. School interventions involve having the teacher implement simple interventions with the child in the classroom (e.g., providing stickers for work completion) and using a daily report card to provide feedback to parents who can provide a reward at home for a good day at school (instruction packet available by clicking here) . Child-focused behavioral treatment involves teaching children how to improve their interactions with other children. It is typically implemented in school or recreational settings, and involves more frequent contact than parent training (e.g., daily work at school, Saturday or summer therapeutic recreational programs). Individual or small group counseling sessions with children in a therapist's office are ineffective.
Fabiano, G., Pelham, W. E., Coles, R., Gnagy, E., Chronis, A., & O'Connor, B. (2009). A meta-analysis of behavioral treatments for attention-deficit/hyperactivity disorder. Clinical Psychology Review, 29, 129-140.
Greenhill, L. L., & Ford, R. E. (2002). Childhood attention-deficit/hyperactivity disorder: Pharmacological treatments. In P.E. Nathan & J. M. Gorman (Eds.), A Guide to Treatments that Work (2nd ed., pp. 25-55). New York: Oxford University Press.
Pelham, W. E., & Fabiano, G. A. (2008). Evidence-based psychosocial treatment for attention deficit/hyperactivity disorder: An update. Journal of Clinical Child and Adolescent Psychology, 37, 185-214.