Behavioral therapies for Attention-Deficit Hyperactivity Disorder (ADHD)

Behavioral therapies for Attention-Deficit Hyperactivity Disorder (ADHD)

OVERVIEW

This post will describe some of the basic approaches to non-medicine behavioral treatments for Attention-Deficit Hyperactivity Disorder (ADHD). The next post will discuss common medicine treatments for ADHD.

DO BEHAVIORTAL TREATMENTS HELP?

In 1999, a study was published called the Multimodal Treatment Study of Children with ADHD comparing behavioral treatment alone, medicine treatment alone, and combined behavioral and medicine treatment for ADHD in patients 7-9.9 years of age.1 There was also a group of patients who were treated by community physicians without any research interventions. The investigators showed that patients treated with medicines had the best outcomes, while the addition of behavioral treatments led to modest improvements, especially in behavioral function. Interestingly, the medicine-treated patients in the research group had better outcomes than the patients who were treated by community physicians, even though two-thirds of the community-treated patients also received medicine. This might suggest that the doses of medicine were insufficient (or the types of medicine used were less effective) in the community. These results were seen as odd by the psychiatric community, more recent studies have ultimately shown that the combination of medication and behavioral treatments reported the best outcomes.

Behavioral therapies can lead to improvements in key areas of functioning2 and are recommended as an important part of the treatment strategy for ADHD.3

WHAT TYPES OF BEHAVIORAL THERAPIES ARE AVAILABLE?

Several behavioral and psychological interventions have been studied for the treatment of ADHD. The following list addresses some the long-standing treatment strategies.3

  1. Parental training: Involving parents in the treatment process helps to educate them about ADHD in general, some of the behavioral problems that children with ADHD can have, and normal child development. Parent training employs types of actions that have positive effects on behavior. An example includes providing praise and reward when a child displays certain targeted behaviors such as sitting calmly during a family meal.
  2. Classroom management: Classroom management involves close monitoring during class and focusing on ways to improve daily classroom routines and structure.
  3. Peer interventions: Peer interventions focus on social skills training to help improve social behaviors and develop strong social interactions.

COMBINING MEDICINE AND BEHAVIORAL THERAPIES

Current behavioral treatments are designed to improve function, while medicines address the underlying ADHD features of inattention (difficulty staying focused on tasks), hyperactivity (constant, sometimes disruptive, activity), and impulsivity (acting “on a whim” or without considering the consequences). In younger children (ages 4-5 years), behavioral therapies are recommended before a medicine trial; in older children behavioral therapies are recommended in addition to medicine.3

FUTURE POSTS

The next posts will describe medicine treatments for ADHD.

References

1. A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. The MTA Cooperative Group. Multimodal Treatment Study of Children with ADHD. Arch Gen Psychiatry. 1999;56:1073-1086.

2. National Institutes of Health Consensus Development Conference Statement: diagnosis and treatment of attention-deficit/hyperactivity disorder (ADHD). J Am Acad Child Adolesc Psychiatry. 2000;39:182-193.

3. Subcommittee on Attention-Deficit/Hyperactivity Disorder; Steering Committee on Quality Improvement and Management, Wolraich M, Brown L, Brown RT, et al. ADHD: clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics. 2011;128:1007-1022.