Beyond the Medication: Behavioral Treatment for ADHD

little girl trying to do homeworkWhen most people learn that their child has attention-deficit hyperactivity (ADHD) or hear about treatment for it, stimulant medication (Ritalin, Adderall, etc.) often is the first type of treatment that comes to mind. For many children, teens, and even adults, stimulant medication can make a huge difference in curbing ADHD symptoms. However, stimulant medication alone often does not provide comprehensive treatment. Medication improves focus, reduces impulsiveness, and enables one to sit still more easily, as well as other similar benefits. However, underlying most individuals with ADHD are executive functioning deficits that impede their ability to plan, organize, initiate tasks, use good time-management skills, and so forth.

Stimulant medication often helps individuals to focus better, which in turn can improve the above-mentioned skills in some individuals. Nonetheless, the majority of individuals—especially children and teens—lack the skills necessary to be successful with tasks associated with executive functioning. Therefore, even with medication, focusing better won’t fully help them to plan, organize, and use good time-management skills. It also won’t always help address related mood or anxiety symptoms.

Thus, behavioral treatment in the form of psychotherapy is important and necessary for many people with ADHD in order to cope most successfully with symptoms. Treatment will help the individual with practical strategies for time management, organization, etc. More importantly, it will help the child, teen, or adult to implement strategies into daily life. Most individuals with ADHD struggle most with the application of time-management/organization strategies.

If someone really just wanted strategies to improve these issues, there are a lot of books out there that provide these. However, many individuals need the intensive work associated with therapy in order to be effective at implementing strategies. Furthermore, therapists can tailor specific strategies to meet your or your child’s individual needs and determine which types of strategies are likely to be most effective.

Behavioral treatment is also helpful in supporting individuals emotionally as they work to better manage symptoms. Anxiety and depression are fairly common in individuals with ADHD. Such symptoms can be caused by or exacerbate ADHD symptoms. Low frustration tolerance and anger-management issues are also common in individuals with ADHD. Therapists can help individuals to reduce the presence of these symptoms.

Behavioral treatment is also useful for managing behavior at home for children and teens. Many therapists spend considerable time working with parents to support them with their child or teen. The way parents manage problematic behavior, inattention, impulsivity, and other issues can make a big difference in functioning.

In some cases, inappropriate interventions can make a child’s or teen’s symptoms worse. Problematic interventions can also increase the presence of anxiety, depression, and other issues.

Finding the right fit in a therapist—one who can connect with your child or teen—is important no matter what difficulties he or she is struggling with. Many children and teens with ADHD understandably have a short attention span, have trouble sitting still, and thus may make traditional talk therapy difficult at times. Therefore, it is important to find a clinician who can use a variety of activities and be flexible in his or her approach in order to connect with your child or teen.

In my work with children and teens with ADHD, I use a variety of methods to build good rapport. For children and teens who feel they need to be active during sessions, I play catch, floor hockey, badminton, mini golf, and other active games in my office with them. I also allow individuals to stand up or walk around the office while talking. In some cases, I allow individuals to draw or doodle while we are talking. I also use more traditional board and card games.

For individuals who still have significant difficulty connecting even with these methods, I may use nonviolent and basic video games sparingly in the session (with prior parental permission and assuming that I deem it appropriate to do so on a case-by-case basis). Usually I would use a racing, snowboarding, or other simple game that does not involve too much focus, so that the child or teen can talk with me while playing. I also use only those games that allow both the child/teen and I to play together.

With any game or activity, the initial purpose is to help the child or teen build a connection with the therapist. Following that, the use of games and activities can be helpful for children and teens because it allows them to let down their guard and talk about what is going on in their life without being as aware that they are doing so (since they are also engaged in a game).

I hope that this article has been helpful in shedding some light on the importance of individual therapy for children and teens with ADHD. In addition, I hope that this information provides a basic understanding of how therapy can benefit your child or teen in the short and long term.

© Copyright 2014 GoodTherapy.org. All rights reserved. Permission to publish granted by Carey A. Heller, PsyD, therapist in Bethesda, Maryland

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • Louisa

    Louisa

    May 7th, 2014 at 3:31 PM

    To be blunt I guess that I am afraid to not tryt he meds for my child because I don’t want this to hurt her academically in a way from which she can never recover. I don’t mind trying therapy along with that but the meds to me seem like they would be faster in getting her to the point where she can focus better in class and hopefully do a little better behaviorally and academically. What are your thoughts on that? Again I am not opposed to trying other things too but the meds seem like a starting point.

  • Genevieve

    Genevieve

    May 8th, 2014 at 3:23 AM

    I understand what you are saying Louisa but I think that I would look at this from an overall standpoint of what is best for the health of my child instead of only looking at the one aspect. There are many different therapists who can work with children and adults on the same issues that the medications are designed to help with and you know when you go that route you are not putting anything potentially harmful into your body. Not only can therapy like this help with the specific ADHD issues that someone could be dealing with but think about the many other ways that this could help in life as well. I think that I would at least pursue this before assuming that medication is going to be the fastest path to success and overcoming this because that is not always the case and there are so many other methods that could help on different levels without placing you in harm’s way.

  • AMH

    AMH

    May 9th, 2014 at 3:33 AM

    I took my child to someone like this and I am telling you that from the very first session onwards I saw marked changes and improvements. The strategies that he gave us to work on I think gave both of us a feeling of getting some control back over the things that he was experiencing. It was not only strategies for homework and stuff like that but also general coping strategies that I think helped out with the snall things in life that can grow and accumulate too. Very worthwhile to try this even just a few times and then to have someone to bounce ideas off of and check in with every now and then.

  • marc

    marc

    May 12th, 2014 at 3:48 AM

    If you place your trust in a therapist like this who ends up being the right fit for your family, I think that you will see that there is not only a world of difference in that child at school, but also at home and this can do wonderful things for the family dynamic as a whole.
    I know that many times when the children are struggling with academic or behavioral issues then there is a tendency to let this flood over into how the family interacts with each other and it can create so much tension in the home that it is impossible for there to remain a strong relationship However working with a behavioral therapist could help to change some of that and give everyone the tools that they need to make some positive steps forward in the home, and to all help one another come to a more manageable point.

  • Vernon y

    Vernon y

    May 13th, 2014 at 3:56 AM

    many of us have become very susceptible to the belief that only medication can change our health that you know that there will be plenty of people who are resistent to trying anything other than medication to help their children with these problems. Even though it has been proven over and over again that behavioral therapy can be just as effective in helping these kids as any medication could be. Does it take a little more work? My instinct would be to say yes, it does. But on the other had, I know that I am not making my child dependent on something chemical based to get through the day and that the lessons that they get from therapy will likely be ones that can help them throughout life, and not just in the school classroom.

  • martha d

    martha d

    May 14th, 2014 at 11:02 AM

    Most parents only want what is best for their children. I recommend talking to both a pediatrician and a youth counselor to determine what is going to be the best course of action for your child.

  • Carey Heller, Psy.D.

    Carey Heller, Psy.D.

    May 26th, 2014 at 5:34 AM

    Thank you for sharing your own experiences and taking the time to read and think thoughtfully about the content of this article.

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