Behavioral and cognitive-behavioral treatments have been used with
ADHD children, with parents, and with teachers. Most of these techniques
attempt to provide the child with a consistent environment in which on-task
behavior is rewarded (for example, the teacher praises the child for raising
his or her hand and not shouting out an answer), and in which off-task behavior
is either ignored or punished (for example, the parent has the child
sit alone in a chair near an empty wall, a “time-out chair,” after the child im
pulsively throws a book across the room). In addition, cognitive-behavioral
treatments try to teach ADHD children to internalize their own self-control
by learning to “stop and think” before they act.
One example of a cognitive-behavioral treatment, which was developed
by Philip Kendall and Lauren Braswell, is intended to teach the child to
learn five “steps” that can be applied to academic tasks as well as social interactions.
The five problem-solving steps that children are to repeat to themselves
each time they encounter a new situation are the following: Ask “What
am I supposed to do?”; ask “What are my choices?”; concentrate and focus
in; make a choice; and ask “How did I do?” (If I did well, I can congratulate
myself; if I did poorly, I should try to go more slowly next time.) In each therapy
session, the child is given twenty plastic chips at the beginning of the session.
The child loses a chip each time he or she does not use one of the steps,
goes too fast, or gives an incorrect answer. At the end of the session, the
child can use the chips to purchase a small prize; chips can also be stored in
a “bank” in order to purchase an even larger prize in the following sessions.
This treatment approach combines the use of cognitive strategies (the child
learns self-instructional steps) and behavioral techniques (the child loses a
desired object, a chip, for impulsive behavior).
Overall, behavioral and cognitive-behavioral treatments have been found
to be relatively effective in the settings in which they are used and at the time
they are being instituted. Like the effects of medication, however, the effects
of behavioral and cognitive-behavioral therapies tend not to be long-lasting.
There is some evidence to suggest that the combination of medication and
behavior therapy can increase the effectiveness of treatment. In the long
run, however, no treatment of ADHD has been found to be truly effective,
and in a majority of cases, the disorder persists into adulthood.
pulsively throws a book across the room). In addition, cognitive-behavioral
treatments try to teach ADHD children to internalize their own self-control
by learning to “stop and think” before they act.
One example of a cognitive-behavioral treatment, which was developed
by Philip Kendall and Lauren Braswell, is intended to teach the child to
learn five “steps” that can be applied to academic tasks as well as social interactions.
The five problem-solving steps that children are to repeat to themselves
each time they encounter a new situation are the following: Ask “What
am I supposed to do?”; ask “What are my choices?”; concentrate and focus
in; make a choice; and ask “How did I do?” (If I did well, I can congratulate
myself; if I did poorly, I should try to go more slowly next time.) In each therapy
session, the child is given twenty plastic chips at the beginning of the session.
The child loses a chip each time he or she does not use one of the steps,
goes too fast, or gives an incorrect answer. At the end of the session, the
child can use the chips to purchase a small prize; chips can also be stored in
a “bank” in order to purchase an even larger prize in the following sessions.
This treatment approach combines the use of cognitive strategies (the child
learns self-instructional steps) and behavioral techniques (the child loses a
desired object, a chip, for impulsive behavior).
Overall, behavioral and cognitive-behavioral treatments have been found
to be relatively effective in the settings in which they are used and at the time
they are being instituted. Like the effects of medication, however, the effects
of behavioral and cognitive-behavioral therapies tend not to be long-lasting.
There is some evidence to suggest that the combination of medication and
behavior therapy can increase the effectiveness of treatment. In the long
run, however, no treatment of ADHD has been found to be truly effective,
and in a majority of cases, the disorder persists into adulthood.
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