6 Research-Based Interventions for the Treatment of ADHD in Children

In ADHD, Attention Deficit Hyperactivity Disorder (ADHD), Counselors, Educators, Parents by Rachel Wise

Children with Attention Deficit Hyperactivity Disorder (ADHD) or ADHD-like symptoms often have difficulty in school, at home or in the community. Teachers and parents often report that their child has trouble concentrating on a task long enough to complete it, following through on instructions, following a daily routine, staying on topic, or remaining seated. They also may report that their child is overly active, interrupts or disrupts others activities, or makes impulsive decisions without thinking them through. This article discusses interventions for symptoms of ADHD which have been supported by research studies. For more specific information on the diagnosis and symptoms of ADHD see Diagnostic Criteria for ADHD.

Six Research-Based Interventions for the Treatment of ADHD in Children

1 – Family-Based Interventions
An evidence-based component of effective treatment for ADHD involves working with parents to teach them how to respond to their children with ADHD or ADHD symptoms, in order to increase positive outcomes for their child. Ineffective parenting styles show to increase negative long-term effects for children who have ADHD and behavior problems associated with ADHD. (Chamberlain & Patterson, 1995).

Behavioral parent training provides parents with instruction for how to implement behavior support techniques. Parents are taught to identify and manipulate the antecedents (what happens before the behavior of concern) and consequences (what happens after the behavior of concern), target and monitor the behaviors that are problematic, acknowledge positive behavior through specific positive feedback, positive attention, and the ability for the child to earn desired items/privileges for positive behavior. Parents are also taught to decrease undesired behavior through planned ignoring (e.g., letting your child know that you will not respond to something unacceptable-of course dangerous behavior must be responded to), time-outs (should be used when a child needs to calm down/recollect themselves-not as a punishment), and sticking to previously decided rules/consequences (e.g., if the child had to complete a task  to earn a desired privilege, they would not earn that privilege).

Parent training for treating ADHD has been evaluated in at least 28 published studies. Overall, these studies showed that parent training leads to improvements for children with ADHD in several areas, most notably, in the parents’ own ratings of their child’s problematic behaviors. These studies suggest that parent behavior training is one of the most effective ways to treat symptoms of ADHD. Children with Oppositional Defiant Disorder and Conduct Disorder also demonstrate improvement when parent behavior training is a central part of treatment.

Related Article: Top Ten Discipline Tips for Kids with Oppositional Defiant Disorder

2 – Classroom Behavior Management
Interventions in the classroom are also an empirically-supported treatment for ADHD. Similar to parent training, classroom interventions involve regular consultation with a teacher on the part of a behavior specialist, school psychologist, or similar professional. An assessment of behavior can be completed to determine the antecedents and consequences of the problematic behaviors. Teachers are educated about how ADHD impacts the child’s ability to focus, control impulsive behaviors, etc., and then are instructed on how to use specific behavioral techniques such as:

-specific positive feedback (you worked so hard during math today)

-planned ignoring (not responding to undesired behavior when possible)

-clear directions phrased in the positive (tell the child what to do, instead of what not to do…such as “keep writing your sentence” instead of “stop talking”)

-time-out if they need time/space to calm down

-the Daily Report Card (DRC) – this is where the child is trying to attain specific behavior goals each day. These goals are documented on a daily report card, and based on the outcome of the report card, the child can earn desired privileges at home. For example, if the report card says use kind words, hands/feet to self, and follow teacher directions and the child meets those goals, he/she could earn time to play their favorite video game of play with a friend after school. You want your child/student to feel successful and to be successful, so start with small goals that you know they can attain and slowly require more as they achieve success. Younger children or more impulsive children may require fewer goals and more frequent feedback and reinforcement than older or less impulsive students (Pelham, 2002).

Sometimes other similar whole-class or individual behavior management programs are used. The DRC is one example. The DRC and similar programs allow parents to attain daily feedback on their child’s behaviors and progress.

Check out the positive outcomes of the DRC and other school-based behavioral interventions such as the ones discussed above in ADHD n the Classroom: Effective Interventions Strategies and Evidenced-Based Psycho-Social Treatments for Children and Adolescents with ADHD.

Keep in mind that parent and teacher behavior intervention programs are only effective if they are implemented consistently and correctly. Therefore, training, either through one’s own extensive research or through consultation with professionals (e.g., school psychologists, child psychologists, or other experts in the field of ADHD) is paramount if we want to see behavioral improvements in children with ADHD or symptoms of ADHD.

3 – Academic Interventions
While behavioral interventions in the classroom usually focus on time on task and minimizing other behaviors that disrupt classroom instruction and routine, academic interventions focus on manipulating academic instruction or materials with the intent of improving behavioral and academic outcomes. Examples of research-based academic interventions include:
-Reducing length of assignments

-Dividing tasks into sub-units (often referred to as chunking work into manageable steps)

-Findings ways to make the task more stimulating [e.g., including bright colors, interesting textures, changing the rate/style of how information is presented (for instance, instead of a half-hour lecture to teach a concept, use three short ten minute activities such as a demonstration, hands-on activity, and computer-based activity, to teach the same concept)]

-Modifying the delivery of instruction based on a student’s individual strengths (e.g., visual, hands-on, auditory, etc.)

-Using computer-assisted instructional programs, which include strategies such as: providing specific instructional objectives which are tracked by the program, highlighting essential material, using multiple sensory modalities (e.g., sight, sound, touch), breaking content into smaller chunks, and providing immediate feedback about response accuracy.

-Providing strategy training for students – this involves teaching student a variety of skills/strategies to meet the academic demands of a situation (e.g., note-taking, study skills, homework completion, self-reinforcement).

-Implementing peer-tutoring – this is when one student provides assistance, instruction and feedback to another, thereby simultaneously working on academic and social skills. To read more about this research-based strategy and how it was implemented in the research-studies see Peer Tutoring for Children with Attention Deficit Hyperactivity Disorder: Effects on Classroom Behavior and Academic Performance and Class-Wide Peer Tutoring: Information for Families.

The studies available on the academic interventions discussed above indicate positive effects on academic performance. To read more about the research available on academic interventions for students with ADHD, and any possible limitations associated with these studies see Academic Interventions for Students with ADHD: A Review of the Literature.
Related Article: 14 Strategies to Help Children with  ADHD in the Classroom or At Home

4 – Social Skills Interventions
Social skills interventions focus on the development and reinforcement of appropriate social skills such as communication, cooperation, participation, emotional regulation, emotional understanding, empathy, and enhanced levels of attention. Some research studies, such as Effect of Social Skill Group Training in Children with Attention Deficit Hyperactivity Disorder, support the use of social skills training alone to improve behavior and peer relationships in children with ADHD. Other studies, such as Combining Parent and Child Training for Young Children with ADHD suggest that social skills training is most effective when used in combination with parent training. This refers to training that teaches parents how to help their child generalize the social skills they learn, when the child is outside of the social skills training sessions. A mental health expert, such as a licensed counselor or child psychologist, that has expertise in the field of ADHD and social skills, should be able to assist children and parents with participation in social skills interventions. School counselors can also provide students with social skills training.

Recommended Article: 5 Activities to Do with Your Social Skills Group

5 – Exercise
Preliminary research also supports the use of regular physical activity for the treatment of ADHD. Research studies indicate that regular exercise improves behavior and information processing (i.e., the speed and accuracy that one is taking in information) for children with ADHD. Some pediatricians are starting to recommend exercise in combination with or as an alternative to medication for the treatment of ADHD. For an example of this research see A Physical Activity Program Improves Behavior and Cognitive Functions in Children With ADHD.

Related Article: Exercise Ideas to Support Children with Autism and ADHD

6 – Medication
I am in favor of sharing non-pharmological (without medication) based treatments for ADHD, because medication is not an option or a consideration for everyone; however, simply looking at the facts, studies show that stimulant medications have a positive affect on approximately 70 percent of children with ADHD.

Stimulants have been found to reduce classroom disruptions and increase on-task behavior, compliance, and academic productivity. They have also been shown to decrease negative social behaviors such as inappropriate peer interactions, negative parent-child interaction, and aggression. However, using medication without other treatments is not recommended. In fact, professional guidelines suggest trying non-pharmological treatments such as the ones discussed above, before trying medication.

Additionally, for some children, stimulant medication has no effect or has negative side effects such as insomnia or appetite loss. Up to 30 percent of children do not show a clear, beneficial response to stimulant medication. There can also be long term side effects to stimulant medication and there is not much research to support the long-term benefits of medication treatment for ADHD. Studies indicate that children who receive combined treatments (medication & behavioral treatment) show greater improvement than those who receive medication alone. Extended release stimulants (i.e., stimulants that release slowly throughout the day and last longer) are shown to be more effective and practical than immediate release stimulants (i.e., stimulants that release quickly and wear off faster).

Studies on the efficacy of non-stimulant medications for ADHD also show positive effects for a large percentage of children; however, it is still recommended that behavioral treatment strategies are utilized first and in combination with these medications. Side effects and long term use are also a concern. Read more about non-stimulant medications for ADHD at Non-Stimulant Treatment for Attention Deficit Hyperactivity Disorder.

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