An ADHD Treatment to Improve Behavior

With ADHD, parenting can be a nightmare. But an ADHD treatment called behavioral intervention may help. Discover why.

By Kristen Stewart

Medically reviewed by Pat F. Bass III, MD, MPH

ADHD behavior issues can range from difficulty in paying attention and staying on task to impulsivity and hyperactivity. So for children with ADHD, or attention deficit hyperactivity disorder, even simple tasks like cleaning their rooms and doing their homework can border on the impossible.

But a treatment called behavioral intervention could help. “The focus of behavioral interventions [that is, behavior modification] is to change behavior,” says Erin M. Floyd, PhD, a clinical psychologist in Atlanta. Behavioral interventions involve reinforcing desirable behaviors through rewards, and discouraging unruly behavior through punishment and limit setting.

Behavioral Intervention as an ADHD Treatment

The uses of behavioral interventions can range from implementing routine and structure, to teaching social skills, and even working with caregivers on how to provide constructive feedback. They can be used at home, at school, and even in special places such as summer camp.

“Adults and kids with inattentive ADHD cannot start and sustain boring or semi-boring activities such as homework (over time ‘cannot’ gradually becomes ‘can’ with proper accommodations),” says Gary M. Unruh, MSW, LCSW, a practicing clinician in

Colorado Springs, Colo., and author of Unleashing the Power of Parental Love. “The treatment is behavioral intervention: What the ADHD person and support persons [parents and teachers] must do is to accommodate for what the ADHD person currently cannot do.”

For example, a common approach to help a child with ADHD is to assign fewer math problems for homework and use a reward chart to encourage the child to complete the assignment given. Then over time, as the child has begun to succeed with the lightened workload, additional problems are added until the student is united with the rest of the class.

Does This ADHD Treatment Really Work?

The success of behavioral intervention depends on the severity of the individual’s ADHD behavior and the level of seriousness with which adults are able to make accommodations and offer rewards.

If the problem is moderate to severe — meaning that inattention or hyperactivity and impulsivity noticeably affect the person’s life 75 percent of the time or more, then behavioral intervention alone will not allow the person to reach his potential, says Unruh. “In this situation, medication, physical activity, and accommodations need to be utilized.”

Teachers and caregivers must also realize the importance of their role in child ADHD treatment. Many wrongly believe kids with ADHD are being lazy or irresponsible and are hesitant to offer accommodations to allow a child with ADHD to finish a task. Goals must also be reasonable, with the aim of starting small and building to bigger successes.

Pros and Cons of Behavioral Intervention

On the plus side of behavioral intervention, the treatment offers a concrete approach for improved behavior. “It provides structure and a plan for change,” says Richard Horowitz, EdD, a parenting and relationship coach in Flemington, N.J. and author of Peaceful Parenting: Parent Empowerment & Child Empowerment. “Small steps can be rewarded and built upon as the child progresses.” Also, as the individual experiences regular success, his self-esteem will grow.

As for the cons, behavioral intervention involves lots of time and effort. Caregivers must follow through on, and sustain, the behavioral strategies to continue benefits, says Floyd. For example, when rewards are stopped, or become less interesting to the child, the improved behavior is often affected. Behavioral intervention can also require a lot of consultation and coordination between experts and caregivers, which can be difficult and time consuming.

Before setting up a behavioral intervention plan, it’s important for the child to have a personalized psychological evaluation for a proper diagnosis and to understand what symptoms — inattention, hyperactivity, impulsivity — need to be addressed. Once these determinations are made, a doctor or therapist can help set up a specific intervention plan.

That said, there are some general parameters that can be helpful with many children, with and without ADHD.

For example:

• Choose just one or two behaviors to try to change at the outset — more than that can be overwhelming.
• Make sure you have the child’s attention. “Lower yourself to the child’s eye level and make sure he or she is looking at you when you are speaking,” says Nancy Konigsberg, MA, an occupational therapist specializing in pediatrics in N.J. “If you’re not sure the child listened — ask her to repeat back what you said. In doing so you will know whether she heard you and in repeating the directive, the child reinforces it to herself.” Also, remove anything that can be distracting such as TVs, computers, doodle paper, and so on.
• Use reward charts and keep them visible for reinforcement. If results are not being met, consider modifying the chart for different goals and rewards.
• Don’t be afraid to use time-outs for younger children and loss of privileges for older children when they do not follow directions.
• Be consistent. “Caregivers need to be consistent and follow through,” says Konigsberg. “Once you have taken a stand, you cannot change even if you think you made a bad choice. It sends the message that you might change your mind if they try hard enough.”

There’s no doubt ADHD parenting can tax your mental, physical, and emotional energies, but with some effort, behavioral intervention can often help. 

(www.everydayhealth.com)