Friday, May 23, 2014

Beyond the Medication: Behavioral Treatment for ADHD

When 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.

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.

Written by: Carey A. Heller, PsyD

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