Evidence - Based Psychological Treatment for Children with ADHD

In their Treatment Guidelines for Attention Deficit Hyperactivity Disorder, the American Academy of Pediatrics clearly states that a care plan for children with this condition should include psychological interventions along with any prescribed medication. For some children with mild to moderate symptoms psychological intervention may prove sufficient to improve or alleviate symptoms. Also, some research studies indicate that the use of psychological-behavioral interventions along with medication may reduce the dose of medication necessary for effective treatment.

Data from a major national study conducted by NIMH known as the Mutlimodial Treatment Study of ADHD (MTA) shows that 33% of children with ADHD were "normalized" [exhibited test scores within the normal range for ADHD and ODD (oppositional defiant disorder)] as a result of receiving psychological treatment only without any medication while 68% were normalized as a result of medication combined with psychological treatment as compared to only 56% of those treated with medication only. Thus, roughly one third of children diagnosed with ADHD may achieve normal behavior from a comprehensive program consisting of treatment strategies similar to those used in Total Focus. Also, there is about a 20% increase in the number of children normalized by combining medication with psychological treatment. Finally, after 2 years 97% of those in the psychological treatment only group remained normalized as compared to only 66% for the medication only group.

According to a study conducted at State University of New York at Buffalo, "combining behavior modification therapy with medication is the most effective way to improve the behavior of many ADHD children. In fact, when the two are combined, the study showed, the amount of medication required to achieve the same results as use of medication alone can be reduced by two-thirds".

Unfortunately, psychological interventions are often only minimally addressed or left out entirely. This is often due to time constraints for the physician as well as the parents and the child. A 1998 study of the treatment of ADHD among special education students found that almost 75% received their care from a primary care physician and 68% of those receiving care from a PCP had no contact with a mental health professional. The study also noted that care from PCPs “was characterized by fewer sessions, less time with the patient, and less use of multimodal therapies.” In 2005 a study concerned with adherence to diagnostic and treatment guidelines stated, “many primary care physicians report poor access to mental health services, limited insurance coverage, and other potential system barriers to the delivery of ADHD care”.

Making appropriate educational materials easily available may prove to be difficult for a busy practice. Referral to a mental health professional may be hindered by the cost of the care or the time and commitment involved and also the ability to connect the patient and family with a qualified mental health professional who specializes in the treatment of ADHD. Therefore, a program like Total Focus can provide an efficient means to make this valuable help easily, readily and affordably available to those who can benefit from it.

One major finding of the MTA Study conducted by the National Institute of Mental Health was that the children of parents who developed a disciplined yet positive approach to parenting were able to maintain treatment gains during the 14 month period of the study. One of the primary goals of the parent education module of Total Focus is to enable parents to adopt a parenting style that will work not only for the ADHD child but also for the entire family.

When parents implement the major components of the program, they end up developing a family culture that is healthy and supportive to the entire family and therefore likely to endure for many years if not become a permanent fixture in their daily lives.

During the course of coaching their child through the various modules such as problem solving and relaxation training both the parent and the child develop valuable coping skills. This along with implementing the “The Special 20” technique also builds the type of positive bond between parent and child that has been found through research to result in the development of a teenager and young adult who is capable of successfully navigating the dangerous shoals encountered at school and in the community.

Some of the psychological interventions such as problem solving training and social skills training included in Total Focus have not always been recommended as part of a treatment plan for a child with ADHD due to research based on the use of these techniques in a group setting. However, newer research indicates that when these techniques are implemented through a parent/child collaborative approach to learning they can be very effective.

Review of the Evidence Based Psychological Treatment for Children with ADHD Used In Total Focus:

Descriptions of the various techniques discussed below were provided by National Institute of Mental Health and include all of the recommended psychological interventions provided in Attention Deficit Hyperactivity Disorder 2006 (rev) NIH Publication No. 3572 (3) Evidence from scientific research studies indicating the usefulness for each component in Total Focus is provided below along with a description of how each component provides the recommended treatment.

Parenting skills training, offered by therapists or in special classes, gives parents tools and techniques for managing their child's behavior. One such technique is the use of token or point systems for immediately rewarding good behavior or work. Another is the use of "time-out" or isolation to a chair or bedroom when the child becomes too unruly or out of control. During time-outs, the child is removed from the agitating situation and sits alone quietly for a short time to calm down. Parents may also be taught to give the child "quality time" each day, in which they share a pleasurable or relaxing activity. During this time together, the parent looks for opportunities to notice and point out what the child does well, and praise his or her strengths and abilities.

This system of rewards and penalties can be an effective way to modify a child's behavior. The parents (or teacher) identify a few desirable behaviors that they want to encourage in the child—such as asking for a toy instead of grabbing it, or completing a simple task. The child is told exactly what is expected in order to earn the reward. The child receives the reward when he performs the desired behavior and a mild penalty when he doesn't. A reward can be small, perhaps a token that can be exchanged for special privileges, but it should be something the child wants and is eager to earn. The penalty might be removal of a token or a brief time-out. Make an effort to find your child being good. The goal, over time, is to help children learn to control their own behavior and to choose the more desired behavior. The technique works well with all children, although children with ADHD may need more frequent rewards.

In addition, parents may learn to structure situations in ways that will allow their child to succeed. This may include allowing only one or two playmates at a time, so that their child doesn't get over-stimulated. Or if their child has trouble completing tasks, they may learn to help the child divide a large task into small steps, then praise the child as each step is completed. Regardless of the specific technique parents may use to modify their child's behavior, some general principles appear to be useful for most children with ADHD. These include providing more frequent and immediate feedback (including rewards and punishment), setting up more structure in advance of potential problem situations, and providing greater supervision and encouragement to children with ADHD in relatively unrewarding or tedious situations.

Parents may also learn to use stress management methods, such as meditation, relaxation techniques, and exercise, to increase their own tolerance for frustration so that they can respond more calmly to their child's behavior.



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Children with ADHD should be consulted immediately to your physician to give them the right medications and treatment your children needs.

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