Contrary to popular thinking, medications for child attention deficit disorder (ADHD) are not always the best first-line treatment. Instead, parents should seek out behavioral treatments according to new research presented this past weekend at the annual convention of the American Psychological Association.

That’s because while medications address ADHD symptoms such as restlessness and fidgeting in a classroom, they don’t address the impairments caused by ADHD. Those include a lack of successful interactions with peers, deficits in reading and math skills, and difficult relations with parents and family members.

Behavioral interventions are not just one-to-one general psychotherapy. They are targeted, specific techniques targeted at the problematic behaviors commonly associated with attention deficit disorder — impulsivity, inattentiveness and hyperactivity. There are over 175 studies showing the effectiveness of these techniques.

But perhaps most controversial is the recommendation to also include parent training in child ADHD treatment. Why should parents also need help if the ADHD is a problem with their child? William Pelham, the lead researcher presenting at the APA convention, suggests these reasons:

Parents of ADHD children have significant stress, psychopathology, and poor parenting skills

ADHD children contribute greatly to parental stress and disturbed parent-child relationships

Parenting styles characteristic of ADHD parents predict long term negative outcomes

Parenting mediates most negative outcomes and needs to be the main focus of intervention

So what are some behavioral interventions parents can try out in the home? Pelham suggests the following:

  1. Rules for the home
  2. Ignore mild inappropriate behaviors and praise appropriate behaviors (choose your battles)
  3. Appropriate commands:
    • Obtain the child’s attention: say the child’s name
    • Use command not question language
    • Be specific
    • Command is brief and appropriate to the child’s developmental level
    • State consequences and follow through
  4. Daily charts (e.g., School, Home Daily Report Cards)
  5. Premack contingencies (e.g., watch TV or phone time contingent upon homework completion)
  6. Time out from positive reinforcement/work chores
  7. Point/token system with both reward and cost components
  8. Level system
  9. Homework hour
  10. Contracting/negotiating with adolescents

While these techniques might seem common-sensical or obvious, many parents don’t know how to give their child a proper time-out or have ever considered using a point or token system to reward positive behavior (which has been proven time and time again in the research to be very effective in modifying child behavior).

In combination with psychotherapeutic behavioral interventions, you can treat many children (if not most) with these techniques and keep medication to a minimum. Some children can even be treated for ADHD without any medication whatsoever.

Michael Phelps, the USA Olympic-gold swimmer, was diagnosed with ADHD as a child. After taking medications, he chose to discontinue them and worked on his symptoms on his own.

Read the full article: Therapy as First-line Treatment for ADHD

View the ADHD slideshow (PDF) from lead researcher William Pelham