Evidence - Based Psychological Treatment for Children with ADHD - Treatment for Children with ADHD

Written by Robert Myers, PhD

Behavioral Therapy

Behavioral Therapy helps people develop more effective ways to work on immediate issues. Rather than helping the child understand his or her feelings and actions, it helps directly in changing their thinking and coping and thus may lead to changes in behavior. The support might be practical assistance, like help in organizing tasks or schoolwork or dealing with emotionally charged events. Or the support might be in self-monitoring one's own behavior and giving self-praise or rewards for acting in a desired way such as controlling anger or thinking before acting.

Evidence: The MTA Study (2) found that the combined treatment (medication management with behavior therapy), compared with medication alone, offered improved scores on academic measures, measures of conduct, and some specific ADHD symptoms (although not on global ADHD symptom scales). Although these trends were consistent, few reached statistical significance. In addition, parents and teachers of

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children receiving combined therapy were significantly more satisfied with the treatment plan. Using a different approach to data analysis, a team lead by Wigal concluded that "with the overall measure used in this analysis, combined multimodal therapy has a clinically meaningful and statistically significant advantage over monotherapies and community treatment." (7)

Total Focus: Audio and workbook lessons teach problem solving techniques for use at home and school. The lessons also help children to develop a positive attitude about themselves and those around them.

Social Skills Training

Social Skills Training can also help children learn new behaviors. In social skills training, the therapist discusses and models appropriate behaviors important in developing and maintaining social relationships, like waiting for a turn, sharing toys, asking for help, or responding to teasing, then gives children a chance to practice. For example, a child might learn to "read" other people's facial expression and tone of voice in order to respond appropriately. Social skills training helps the child to develop better ways to play and work with other children.

Evidence: In general, "research suggests that SST alone is unlikely to produce significant and lasting change in psychopathology or global indicators of social competence. Rather, SST has become a widely accepted component of multi-method approaches to the treatment of many emotional, behavioral and developmental disorders." (24) Several recent studies have shown that SST works better when the parent works as a coach with the child to teach social skills and rehearse them for real-life situations. (10) (8) (18)

Total Focus: An audio lesson using FRIEND as an acronym teaches basic social skill concepts. The workbook provides materials that teaches appropriate skills for specific social situations and includes a "Feeling Faces" chart to teach recognition of emotions in others. Parents are given specific instructions on how to implement the module.

Relaxation Training

Relaxation Training Teaching children with attention deficit disorder how to relax can be effective in reducing hyperactivity and disruptive behavior while increasing attention span and task completion. The purpose of biofeedback is to enhance an individual's awareness of physical reactions to physical, emotional, or psychological stress, and their ability to influence their own physiological responses. The overall purpose is to develop self-regulation skills that play a role in improving health and well-being.

Evidence: Relaxation training conducted by parents in the home has been found not only to be effective in improving behavior and other symptoms but also improves over all relaxation when measured by biofeedback equipment (9) (20) A review of a number of studies related to relaxation training with children concluded, "Findings suggest that relaxation training is at least as effective as other treatment approaches for a variety of learning, behavioral, and physiological disorders . . ." (21) Goldbeck found that "autogenic relaxation training is effective in a mildly disturbed outpatient population of children and adolescents with mostly internalizing symptoms, and/or some aggressive, impulsive, or attention deficit symptoms". (11)

Total Focus: Audio lesions combining relaxation training with guided imagery and positive suggestions are used to apply relaxation training to a variety of situations likely to be encountered by a child in the home and at school. Additional audio and workbook lessons teach general relaxation that can also be applied to help improve attention, concentration and frustration tolerance. Children are taught to use a deep breathing and a "secret word" to quickly relax when they start to feel "uptight." Audio and workbook exercises are also provided to help parents cope with stress and develop a positive parenting attitude. A temperature biofeedback card is included to facilitate the relaxation training sessions to help achieve maximum benefit.