Parenting children with ADHD is often very difficult, and can cause significant disruption and distress within the family. Psychosocial treatments for children and their families are designed to address the special challenges associated with parenting a child with ADHD. Psychosocial treatment refers to a variety of non-medication based approaches that are typically administered by mental health professionals, such as psychologists, psychiatrists, and social, workers. It may be administered on an individual or group basis, depending on the nature of the child's difficulties. In either modality, treatment is typically administered either directly to the parent or to the parent and child together. Treatment for ADHD is rarely administered to the child alone, unless there is a co-occurring condition (i.e., depression, anxiety, divorce, abuse, etc.) that requires additional intervention. There are three commonly used and well-researched approaches for children with ADHD:
Behavior management treatment
Social skills training
Collaborative problem solving treatment
Behavior Management Treatment
Behavior therapy consists of several different interventions that are all intended to change behavior through the modification of social and physical environment. Typically, behavior management strategies are taught to parents and teachers, and then implemented at home and school. Behavior management treatments involves providing skills training to parents to help them better manage their child's behavior by using a structured system of rewards and consequences. Behavior management often focuses on areas such as:
Teaching parents how to give clear and effective instructions to children
Teaching parents and children how to set up structured routines and distraction-free environments for tasks such as homework and chores
Training parents and children how to use rewards and consequences to modify and improve the child's behavior
Positive reinforcement/praise for positive
Example: A child completes chores and is allowed to watch an extra half hour of television
Time-out for negative behavior
Example: A child hits a sibling and must spend 5 minutes sitting in a corner
Response cost for negative behavior
Example: A child does not complete homework and loses television privileges
Developing a "token economy" or "point system," whereby a child earns points/tokens for specific positive behaviors and loses points/tokens for specific negative behaviors. Points/tokens are then "cashed in" at the end of the day or week for rewards, such as special privileges or positive one-on-one time with a parent.
Improving the parent-child relationship by increasing praise and positive attention.
Teaching a child how to monitor his or her own behavior.
Research has indicated that behavior management treatment is particularly helpful for children with ADHD and co-occurring behavior, anxiety, or mood/frustration difficulties. The MTA Study indicated that children with ADHD and anxiety had better outcomes from combined medication and behavior management treatment than from medication alone.
Collaborative Problem Solving
Collaborative Problem Solving is a treatment method developed by Ross Greene, Ph.D. Treatment focuses on reducing parent-child conflict and emotional distress in children by training parents and children in effective problem solving techniques. This treatment was designed specifically for children who experience outbursts of emotional and behavioral distress (i.e., "meltdowns") in addition to noncompliance or defiance.
Collaborative Problem Solving relies on two primary techniques:
A "pick your battles approach," whereby the parent assigns common areas of conflict to 1 of 3 "baskets." "Basket A" is where the parent is willing to endure misbehavior and emotional distress to enforce compliance; "Basket B" is where the parent is willing to collaborate with the child to find an acceptable compromise, and "Basket C" is where the parent is willing to allow the child to select their desired outcome.
A 3 step problem solving technique, where the parent empathizes with the child's distress, clearly articulates their concerns, and then collaborates with the child to develop a solution that is acceptable to parent and child.
Initial research suggests that Collaborative Problem Solving is effective at reducing parent-child conflict in children with high levels of irritability and/or emotional distress.
Social Skills Training
Many children with ADHD also experience frequent problems interacting with peers. Social skills training helps children with ADHD improve their ability to relate appropriately to peers. Treatment is typically administered in groups of children to allow for the opportunity to practice skills in a safe and supportive environment. The focus to treatment is on the social deficits demonstrated by children with ADHD and other social difficulties. Examples of skills commonly taught in social skills groups include initiating social interactions, socializing in groups, taking turns, sharing with others, and responding to teasing.
Treatment Efficacy
Psychosocial treatments such as behavior therapy are an important element of effective treatment of ADHD. The National Institute of Mental Health (NIMH) as well as scientific literature and many professional organizations believe that psychosocial treatment when paired with a stimulant medication can be an effective method of managing ADHD symptoms. In fact, behavior modification is the only non-medical treatment for ADHD with a large, scientific base.
Research has consistently demonstrated that the combination of medication and behavior therapy produced significantly more positive outcomes across several domains as compared to medication or behavior therapy alone. Studies have indicated that children who receive psychosocial treatment in combination with medication treatment require lower doses of medication than children who receive medication treatment alone. When medications are combined with psychosocial treatment, demonstrated positive outcomes include:
Improved parent-child relationship and reduced misbehavior at home
Improved academic performance and reduced misbehavior at school
Improved peer relationships
Higher parent satisfaction with treatment
Improvement of ADHD symptoms in the short and long term
In addition, psychosocial treatment is often indicated to address the emotional, social, academic and behavioral difficulties that often co-occur with ADHD. These difficulties are unlikely to resolve with medication alone, and thus require psychosocial intervention. For example, the MTA study also found that the combination of behavior therapy and medication was the most successful at treating children with ADHD and a co-occurring condition (such as anxiety). These children demonstrated significantly better outcomes on ratings of attention, behavior, and anxiety then did children who received medication alone.
