Treating Children with ADHD with Behavior Management - S. DuBose Ravenel, MD

ADD is the most commonly diagnosed childhood behavior disorder today, with most experts estimating that more than two million (3 to 5 %) children have attention deficit disorder, causing symptoms of inattention, impulsivity, and hyperactivity, In addition, ADD children also experience social and academic difficulties with many ADD children considered to be underachievers. Currently the prevailing treatment model relies primarily upon stimulants such as methylphenidate (Ritalin) or an amphetamine (Adderall), combined with behavior modification. It is estimated that approximately 80% to 90% of ADD children receive Ritalin or other stimulants at some stage of their childhood, but only a minority are managed with serious attempts to modify behavior, even though both the both drug manufacturers and experts advise against the use of stimulants alone without other remedial measures in the total treatment program of ADD.

Although historically, medication helps the majority of children with ADHD, as many as 20% derive no real benefit from medication and some children experience side effects that prevent them from receiving medication on an extended basis. Also, some children, particularly teenagers, have objections to taking medication. In these circumstances, trying to force medication on a child can create more problems than it solves.

The key non-medical approach used in treating children with ADHD is behavior management. This involves understanding what factors lead children to behave in socially appropriate ways. Generally, they want to please their parents and feel good about themselves when their parent is proud of them. When the relationship between parent and child is basically positive, it becomes a very important source of motivation. Children also behave well when there are positive consequences for doing so or to avoid the negative consequences that follow inappropriate behavior.

The goal of behavior management is to increase the frequency of desired behavior by increasing the child’s interest in pleasing his or her parents and by providing positive consequences when the child behaves. Inappropriate behavior is reduced by consistently providing negative consequences when such behavior occurs.

In many situations, the first step in behavior management is to enhance the amount of positive feelings between parent and child by increasing time spent together working on projects that are totally focused on communicating in a positive way. The second focus of behavioral treatment involves providing the child with positive consequences for behaving in appropriate ways. This can be as basic as noticing when the child is doing something you want to encourage. One way to increase a child's compliance is to make a tangible reward or privileges contingent on his or her following requests for proper behavior.