Behavioural Treatments for ADHD

Attention Deficit Hyperactivity Disorder is a neurological disorder that causes poor impulse control, poor concentration and attention spans and general restlessness and ‘fidgeting’ that can be uncontrollable. It can impact significantly on a child’s education and on their social development.

Treatment is normally a combination of drug therapy and behaviour-management techniques. There are many parents, though, who do not relish the thought that their child’s behaviour is being controlled by drugs. Often, they complain that their child is no longer ‘their’ child, that taking the drugs has controlled the symptoms of ADHD but has also taken away something of their child’s very essence.

Such parents prefer to rely solely on behaviour-management techniques and treatments, which are summarised below – these are also the same therapies available alongside drug treatments.

The basic aim of behavioural treatments for ADHD is to adjust the environment to suit the child, rather than trying to make the child fit into the environment. The aim of this is to improve the child’s social development and interactions with other children and adults. Techniques that are known to help include simple things like setting clear boundaries and encouraging structure and routines.

Social Skills Training (which is also available for children on the Autistic Spectrum) is a way of changing how the child thinks about social situations, so that they will also alter their behaviour in those situations. It’s a form of CBT (cognitive-behavioural therapy) and is aimed at improving social relationships and other social skills like saying ‘please’ and ‘thank you’ and ‘hello’ in appropriate situations.

The type of behaviour-management training rather depends on the age of the child and their stage of development. These are broken down into three levels:

1. Up to the age of five years:Providing consistency, routine and warning the child of any change to their routines, however minor, to give them chance to mentally prepare for that. They need to be given clear instructions on what is expected of them, and rewards that work for that child. Every child is different, so whilst a star chart may work wonders for one, it might have no effect at all on another, who may prefer food treats as rewards, or perhaps even verbal praise. Any reward has to be immediate, associated with the behaviour, and as strong as it can be. Engage in structured activities with your child, getting down to their level and playing with them with your full attention.
2. Age six to twelve years:Make sure that instructions and explanations for events and expectations are given in a clear way. Break down the instructions into manageable chunks, as the child may have difficulties in memorising or organising information. For example, don’t say ‘You can go out to play after dinner,’ since the child may only process the ‘go out to play’ part and leave without having their dinner first. Instead, say ‘Have your dinner, then you can go out to play.’ Keep up the reward system that works for that child, and be sensitive when disciplining them in front of other children as they can find that very hard to deal with. Liaise closely with the child’s school to ensure that the school is aware of the condition and how to support it, and listen to any advice they may have to offer.
3. Teenagers:Allow them to participate in setting boundaries and in choosing their rewards. This will improve self-esteem. They are going through normal hormonal changes as well as dealing with their condition, so try to understand how difficult they must be finding things at the moment.