Last week, we reviewed the major pharmaceutical approaches for the treatment of ADHD. While medication is often necessary in order to fully manage symptoms of ADHD, psychosocial interventions also play an important role in helping individuals achieve successful lives and healthy relationships. There are a wide range of psychosocial approaches to the treatment of ADHD that address challenges in an individual’s home life, academic performance, peer and intimate relationships, and other aspects of their personal and professional lives.
Therapy can help children and adults address aspects of ADHD that medication cannot (or, in cases where the individual chooses not to use medication). This includes the subtler symptoms of ADHD, such as difficulty with social skills and organizational strategies, as well as consequences of ADHD, such as low self-esteem that develop as a consequence to years of impaired social relationships, trouble with authority figures, impulsive decision-making, and struggles with academic and work performance. Therapy may involve learning specific skills (social, organizational, etc.), exploring thoughts, feelings, and behaviors, and/or developing new and more productive habits and approaches. It may also involve working with parents (or partners) and teachers (or bosses) in order to facilitate modifications at home, school, or work that better support the individual in achieving their goals and minimizing the interference of their ADHD symptoms on their daily lives and relationships.
Home-, school-, and work-based modifications are an important aspect of treatment for many people with ADHD. Behavioral therapy techniques can be utilized in all of these environments, especially for children who are disruptive at home or school. In general, immediate and consistent feedback is helpful for encouraging individuals with ADHD to stay on track; a powerful way parents/partners and teachers/bosses can help, is by checking-in often with reminders and performance feedback. They can also help the individual create a manageable to-do list, prioritize activities, and organize materials.
Parents may find that a token economy system in which children are rewarded for staying focused and getting their work done is quite effective. Younger children respond well to tickets and points, while older children tend to be more motivated by real coins and dollar bills; in either case, they are encouraged to perform their best in order to save up for valuable items (e.g., a new phone case or movie) or privileges (e.g., an extra hour of screen time or a day off from chores). In order for this program to be successful, parents must clearly state the expectations for rewards and the ways in which the accumulated rewards can be used. The best rewards are ones in which your children will be excited about, but that you can also afford (in terms of time and money!). You want to be on the look-out for reasons to reward your children, rather than reasons to punish them; a ratio of at least 5 rewards to every 1 punishment will help ensure that your child feels motivated and encouraged rather than defeated and disengaged.
If the person is hyperactive, it is also helpful to allow that person the freedom to move around, manipulate an object in their hand, and take frequent breaks. Many therapists work alongside family members and school administrators to create an effective and comprehensive approach to supporting children with ADHD. When parenting children with ADHD, behavior modification skills that can be learned from a trained therapist can be invaluable for improving the child’s functioning at home as well as developing their skills in their daily interactions overall. For adults, the onus of responsibility generally lies with the individual with ADHD and may require creative thinking about how best to function in their work environment.
Another approach to ADHD treatment that has received increasing attention in recent years is neurofeedback. Neurofeedback is based on the finding that the brain emits various types of waves when engaged in a focused state (as compared to a dreamy state or sleep state, for example). The goal of neurofeedback is to help the individual practice producing the brain-waves associated with focus to the extent that they are better able to control and manage symptoms such as impulsivity and distractibility. The major pro of neurofeedback is that it’s relatively low-risk and painless; the downside is that it tends to be time-consuming and expensive. Research on the effectiveness of neurofeedback for ADHD is encouraging but limited. Over time, well-controlled research studies will help to establish how effective this approach is compared to other interventions and in conjunction with those interventions. In the meantime, if other therapies have not worked or are not sustainable, neurofeedback may be a worthwhile consideration for you or your child.
ADHD is a complex neurological disorder that presents a variety of challenges. The most effective approach to managing the varied and nuanced symptoms of this condition is to address it from a variety of angles, incorporating a combination of pharmaceutical and psychosocial interventions. With proper treatment, symptoms of ADHD can be well-managed; in fact, once appropriately treated, many people discover hidden strengths and abilities associated with ADHD that serve to enhance their success throughout life.
Next week, we’ll finish off our ADHD series by exploring the impact of receiving an ADHD diagnosis for the first time as an adult (and therefore, being undiagnosed/untreated throughout childhood). See you then!