Behavioral Therapy for ADHD

People diagnosed with attention deficit hyperactivity disorder (ADHD) face emotional and behavioral challenges that disrupt their daily life. Medications are one line of treatment, but when they are used together with behavioral therapy, the outcome is improved. This is important because even though the symptoms are evident and diagnosed during childhood, the challenges continue into adulthood.

Definition

• The symptoms of ADHD must be present before the age of 7 and last for at least six months before a diagnosis can be made. Additionally, the behaviors associated with hyperactivity, inattention and impulsiveness must be more frequent and severe than typical children of the same age. They also must be observed across environments, occurring in at least two different places such as home and school.

Treatment

• The goal of treatment for ADHD is to reduce symptoms and improve functioning. Stimulant medication is frequently used because it helps calm down the hyperactivity and improve focus. Behavioral therapies, such as behavior modification, and cognitive behavioral therapy address core issues and teach skills that support improved daily functioning.

Behavior Modification

• Behavior modification encourages desired behavior while extinguishing undesired behavior. The process begins with an assessment of the child's strengths and weaknesses and targets a specific behavior. Then the "ABCs" are defined. This means that the antecedent ("A"), behavior ("B") and consequences ("C") must be determined. This should be done for the existing undesirable behavior and for the new behavior that you want to teach. The antecedent is whatever causes the behavior. A close look at the antecedent and what is achieved by the behavior helps define what purpose the behavior serves and provides a better focus for changes that need to be made.

Implementing Behavior Modification

• Parents, teachers and therapists should work together to create a plan to control "A" and "C" in order to prompt the desired behavior in the child. Consistency is very important so the plan should be implemented by everyone who deals with the behavior. The plan should state what the new behavior is and then break the goal down into small attainable steps. For each step, specific instructions should be written describing what will be done to prompt the desired behavior (antecedent), what the resulting behavior should be and the consequences that will be used.
  The goal should be to focus on the positive and reward a successful response but the team also should agree on any negative consequences from the start. This is a long process where behavior may need to be prompted many times until the new behavior or skill is learned and can be done without prompting. Rewards should be given immediately after every successful response, but they can take the form of stickers on a chart and then once the chart is full, a bigger reward may be given.

Cognitive Behavioral Therapy

• Cognitive behavioral therapy (CBT) helps people with ADHD learn to recognize negative thoughts and inaccurate perceptions along with the resulting patterns of behavior. Worksheets are used to identify an event, note what they were thinking, how they interpreted the event and to describe their feelings and behavior. In this way they start to see the connection between how their thoughts influence what they do and how they feel. Once this connection is understood, then the next step is to consider whether reality supports their thoughts. The goal is to learn how to assess whether feeling and behaviors are appropriate for the situation and to learn what they could do differently.