Behavior Therapy for ADHD Children

Detailed info on behavior modification for ADHD children and the positive impact of providing stimulant medication plus therapy.

Behavior Modification Techniques For Treatment of Children and Adolescents with ADHD

Psychosocial treatment is a critical part of treatment for attention-deficit/hyperactivity disorder (AD/HD) in children and adolescents. The scientific literature, the National Institute of Mental Health, and many professional organizations agree that behaviorally oriented psychosocial treatments -- also called behavior therapy or behavior modification -- and stimulant medication have a solid base of scientific evidence demonstrating their effectiveness. Behavior modification is the only nonmedical treatment for AD/HD with a large scientific evidence base.

Treating AD/HD in children often involves medical, educational and behavioral interventions. This comprehensive approach to treatment is called "multimodal" and consists of parent and child education about diagnosis and treatment, behavior management techniques, medication, and school programming and supports. The severity and type of AD/HD may be factors in deciding which components are necessary. Treatment should be tailored to the unique needs of each child and family.

This fact sheet will:

• define behavior modification
• describe effective parent training, school interventions and child interventions
• discuss the relationship between behavior modification and stimulant medication in treating children and adolescents with AD/HD

Why use psychosocial treatments?

Behavioral treatment for AD/HD is important for several reasons. First, children with AD/HD face problems in daily life that go well beyond their symptoms of inattentiveness, hyperactivity and impulsivity, including poor academic performance and behavior at school, poor relationships with peers and siblings, failure to obey adult requests, and poor relationships with their parents. These problems are extremely important because they predict how children with AD/HD will do in the long run.

How a child with AD/HD will do in adulthood is best predicted by three things -- (1) whether his or her parents use effective parenting skills, (2) how he or she gets along with other children, and (3) his or her success in school¹. Psychosocial treatments are effective in treating these important domains. Second, behavioral treatments teach skills to parents and teachers that help them deal with children with AD/HD. They also teach skills to children with AD/HD that will help them overcome their impairments. Learning these skills is especially important because AD/HD is a chronic condition and these skills will be useful throughout the children's lives².

Behavioral treatments for AD/HD should be started as soon as the child receives a diagnosis. There are behavioral interventions that work well for preschoolers, elementary-age students, and teenagers with AD/HD, and there is consensus that starting early is better than starting later. Parents, schools, and practitioners should not put off beginning effective behavioral treatments for children with AD/HD^3,4.

What is behavior modification?

With behavior modification, parents, teachers and children learn specific techniques and skills from a therapist, or an educator experienced in the approach, that will help improve children's behavior. Parents and teachers then use the skills in their daily interactions with their children with AD/HD, resulting in improvement in the children's functioning in the key areas noted above. In addition, the children with
AD/HD use the skills they learn in their interactions with other children.

Behavior modification is often put in terms of ABCs: Antecedents (things that set off or happen before behaviors), Behaviors (things the child does that parents and teachers want to change), and Consequences (things that happen after behaviors). In behavioral programs, adults learn to change antecedents (for example, how they give commands to children) and consequences (for example, how they react when a child obeys or disobeys a command) in order to change the child's behavior (that is, the child's response to the command). By consistently changing the ways that they respond to children's behaviors, adults teach the children new ways of behaving.

Parent, teacher and child interventions should be carried out at the same time to get the best results^5,6. The following four points should be incorporated into all three components of behavior modification:

1. Start with goals that the child can achieve in small steps.

2. Be consistent -- across different times of the day, different settings, and different people.

3. Implement behavioral interventions over the long haul?not just for a few months.

4. Teaching and learning new skills take time, and children's improvement will be gradual.

Parents who want to try a behavioral approach with their children should learn what distinguishes behavior modification from other approaches so they can recognize effective behavioral treatment and be confident that what the therapist is offering will improve their child's functioning. Many psychotherapeutic treatments have not been proven to work for children with AD/HD. Traditional individual therapy, in which a child spends time with a therapist or school counselor talking about his or her problems or playing with dolls or toys, is not behavior modification. Such "talk" or "play" therapies do not teach skills and have not been shown to work for children with AD/HD^2,7,8.

References