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Treatment of ADHD
Behavioral Therapy
The goal of behavioral therapy is to change behavior by reducing symptoms and improving function of people with ADHD. Behavioral therapy helps the person with ADHD develop effective ways to modify their disabilities by working on their thinking and coping skills. There is no effort to modify the emotional status. Some of the ways this is achieved include:
- Making expectations of the child very clear through easily understood commands and instructions
- Reorganizing the child's home and school environment to be more organized, easy to negotiate, and less confusing
- Giving rewards for appropriate behavior and instituting negative consequences for inappropriate behavior.
- Teaching the child ways to self-monitor their behavior
An article in the New England Journal of Medicine notes that behavior therapy is not recommended as a first-line therapy for uncomplicated of ADHD in school-age children. The AACAP also recommends that behavior therapy should be initiated in combination with medication if:
- There is no response to first-line medication of stimulants or amoxetine
- There is a suboptimal response to stimulants or amoxetine
- There is a comorbid disorder that needs to be addressed
- There are particular causes of stress in the child's family life
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Clinical trials have shown that behavioral therapy alone is not as effective as drug therapy alone, and results of studies of the two treatments given simultaneously are inconclusive. However, combination therapy may be more effective in treating oppositional behavior or conflict between child and parent.
Behavioral therapy typically consists of sessions with children and parents together. The focus of behavioral therapy includes:
- Setting reasonable and clear expectations for the child to meet
- Greater understanding of ADHD
- Teaching parenting skills to parents of children with ADHD
- Teaching behavioral techniques such as rewarding behaviors and disincentives such as using discipline for inappropriate behavior
- Modifying the physical and social environment so that the child meets with more success in their efforts to control their behavior
- Creating routines for the child to follow during the course of the day to help the child tackle and complete any daily routine tasks
Teachers are also trained in the various behavioral techniques that are effective for the child such as encouraging good behavior through rewards and discouraging poor behavior by withholding of reward or enacting certain consequences (e.g., time-out). Some children may benefit from social skills training in which they are able to practice in a group under professional guidance regarding what constitutes appropriate social behavior.
Adults may benefit from cognitive-behavioral therapy which adds the component of helping them manage residual symptoms of ADHD and functional impairments that may affect their social life, employment, and academic performance. This type of therapy is being actively investigated as it provides patients will skills for coping with their impairments and compensatory strategies for dealing with functional impairment. The result of improvement in this area is not only improved function for the person suffering from ADHD, but also improved self esteem where they may always have felt inadequate. Some of the issues that may be addressed in cognitive-behavioral therapy include:
