If you use only medication to try and treat attention deficit hyperactivity disorder (ADHD), you’re likely to only get a partial response that does little to help the child or adult with all of the effects of living with ADHD. Psychotherapy and other specific therapeutic interventions are not only important options to consider — they are mandatory in order to treat the long-term issues that go hand-in-hand with attention deficit disorder.
Once some of the behavior problems are under control, the child may be better able to understand the challenges they may have caused to the people around them. Everyone involved can benefit from techniques to manage the past and present consequences of ADHD behavior, and counseling the child and the family group may offer a solution.
Parenting training has been shown to be an effective and an important component of any treatment of ADHD in children. Parents who have a child with an attention deficit disorder should look into getting such training from an ADHD coach or therapist with experience in helping parents with ADHD. These parent training exercises help the parent learn to help their child who has attention deficit disorder, keep their behavior on-task, and correct it in a positive and reinforcing manner when needed. Think of the TV show, “Super Nanny” — except that the therapist helps the parents learn how to best help their child with ADHD.
Psychotherapy for ADHD
We have decades’ worth of research demonstrating the effectiveness of a wide range of psychotherapies for the treatment of ADHD in both children and adults. Some people turn to psychotherapy instead of medication, as it is an approach that does not rely on taking stimulant medications. Others use psychotherapy as an adjunct to medication treatment. Both approaches are clinically accepted.
In psychotherapy (commonly, cognitive-behavioral therapy for ADHD), the child can be helped to talk about upsetting thoughts and feelings, explore self-defeating patterns of behavior, learn alternative ways to handle emotions, feel better about him or herself despite the disorder, identify and build on their strengths, answer unhealthy or irrational thoughts, cope with daily problems, and control their attention and aggression. Such therapy can also help the family to better handle the disruptive behaviors, promote change, develop techniques for coping with and improving their child’s behavior.
Behavioral therapy is a specific type of psychotherapy that focuses more on ways to deal with immediate issues. It tackles thinking and coping patterns directly, without trying to understand their origins. The aim is behavior change, such as organizing tasks or schoolwork in a better way, or dealing with emotionally charged events when they occur. In behavior therapy, the child may be asked to monitor their actions and give themselves rewards for positive behavior such as stopping to think through the situation before reacting.
Psychotherapy will also help a person with attention deficit disorder to boost their self-esteem through improved self-awareness and compassion. Psychotherapy also offers support during the changes brought about through medication and conscious efforts to alter behavior, and can help limit any destructive consequences of ADHD.
Social Skills Training for ADHD
Social skills training teaches the behaviors necessary to develop and maintain good social relationships, such as waiting for a turn, sharing toys, asking for help, or certain ways of responding to teasing. These skills are usually not taught in the classroom or by parents — they are typically learned naturally by most children by watching and repeating other behaviors they see. But some children — especially those with attention deficit disorder — have a harder time learning these skills or using them appropriately.
Social skills training helps the child to learn and use these skills in a safe practice environment with the therapist (or parent).
Skills include learning how to have conversations with others, learning to see others’ perspective, listening, asking questions, the importance of eye contact, what body language and gestures are telling you.
Social skills training is done in a therapy office, or parents can learn them and teach them in the home. The therapist teaches the behaviors that are appropriate in different situations and then those new behaviors are practiced with the therapist. Clues that can be taken from people’s facial expressions and tone of voice may be discussed.
Support Groups for ADHD
Mutual self-help support groups can be very beneficial for parents and individuals with ADHD themselves. A sense of regular connection to others in the same boat leads to openness, problem-sharing, and sharing of advice. Concerns, fears and irritations can be released in a compassionate environment where members can safely let off steam and know that they are not alone.
As well as this type of support, the groups can invite experts to give lectures and answer specific questions. They can also help members to get referrals to reliable specialists.
Parenting Skills Training for ADHD
Parenting Skills Training provides parents with tools and techniques in order to manage their child’s behavior. For example, immediately rewarding good behavior with praise, tokens or points that can be exchanged for special privileges. Desirable and undesirable behavior is identified in advance by parents and/or teachers. Parents can try using “time-out” when the child becomes too unruly, but also sharing enjoyable quality time each day.
Through this system, the child’s behavior can often be effectively modified. They can be taught how to ask politely for objects rather than grabbing them, or to complete a simple task from start to finish. The expected behavior is made clear to the child so the decision of whether to earn the reward or not is in their hands. The rewards should be something that the child truly wants, and with ADHD children they may need to be given more often than with other children. Over time, the child will learn to associate good behavior with positive results, so will control their behavior naturally.
Some lessons from parenting skills training which are particularly relevant to ADHD are: to structure situations in ways that will allow the child to succeed (e.g. avoid allowing the child to get overstimulated), help the child divide large tasks into small steps, provide frequent and immediate rewards and punishment, set up a structure ahead of potentially problematic situations, and provide more supervision and encouragement during unrewarding or tedious situations.
The parents themselves can benefit from methods of stress management, including meditation, relaxation techniques and exercise.
Suggestions to help children with ADHD with organizing:
- Have the same schedule every day, from the moment the child wakes up until they go to sleep. The routine includes homework time and playtime. Keep it written down somewhere prominent, like the refrigerator door or a noticeboard. Changes should be planned well in advance.
- Use organizers for homework and other activities which need to be given thought. This will highlight the importance of writing assignments down, and gathering the necessary books.
- Keep everyday items in the same place, so they are easily found, “a place for everything and everything in its place”. Include clothing, bags and school items.
When consistent rules are in place, the child with ADHD is more likely to understand and follow them, at which point small rewards can be given. This may work particularly well if the child has previously become used to criticism.
Issues around schooling
The better informed you are as a parent, the more effective advocate you can be for your child. Take advice on how ADHD affects your child’s life at school, and meet with teachers to discuss management techniques.
Either way, teachers need to be kept up to date when a child is being assessed, diagnosed, and treated for ADHD, including behavior modification therapies, medications or a combination of both.
If you are unsure whether ADHD is the problem, you can either ask the local school district to conduct an evaluation, or you may prefer to seek the services of an outside professional.
When requesting that that the school system evaluates your child, send a letter including the date, your and your child’s names, and the reason for requesting an evaluation, and keep a copy of the letter in your own files.
It is now the law that schools must conduct an evaluation for ADHD if one is requested. This is their legal obligation, but if the school refuses to evaluate your child, you can either get a private evaluation or enlist some help in negotiating with the school.
Help is often as close as a local parent group. Each state has a Parent Training and Information (PTI) center as well as a Protection and Advocacy (P&A) agency.
Following diagnosis, the child will qualify for special education services. This includes a joint assessment between the school and parents, of the child’s strengths and weaknesses. After the assessment, an Individualized Educational Program (IEP) will be drawn up, which will be regularly reviewed and approved.
The transition to a new school year can be difficult, bringing with it a new teacher and new schoolwork. Your child will need lots of support and encouragement at this time, so never forget — you are your child’s best advocate.
Learn more: Medication Treatment for ADHD
Barkley, R.A., Murphy, K.R. & Fischer, M. (2010). ADHD in Adults: What the Science Says. New York: Guilford Press.
Hallowell, E.M. & Ratey, J.J. (2011). Driven to Distraction (Revised): Recognizing and Coping with Attention Deficit Disorder. Anchor Press.
Millichap, J.G. (2011). Attention Deficit Hyperactivity Disorder Handbook: A Physician’s Guide to ADHD (2nd ed.). New York: Springer.
National Institute of Mental Health. (2018). Attention deficit hyperactivity disorder. Retrieved from https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml on February 27, 2018.
Nigg, J.T. (2017). Getting Ahead of ADHD: What Next-Generation Science Says about Treatments That Work—and How You Can Make Them Work for Your Child. New York: Guilford.