In conventional medicine we refer to the "multi-modality"
approach to treating ADHD. We view stimulant medication as
the most effective treatment, but realize that it is not a
complete solution. Since medication has its limitations,
psychotherapy has been used in addition to medication.
You may ask why specifically psychotherapy has been
employed. After all, ADHD has just as many educational
and social ramifications as it does psychological ones. It
would make just as much sense to have social skills
training or learning assistance be used as an adjunct to
medication.
The real reason that psychotherapy as the next step after
medicine is that for most of its recent history, ADHD was
considered a psychological problem. Psychologists were the
ones who put the most effort into studying and treating
ADHD. It is not surprising that what they came up with
were treatment plans based on psychology. What else could
anyone expect? Psychology is what they know.
So for better or worse, it turns out that medication and
psychology go hand in hand and are now the main focus of
the multi-modality treatment for ADHD.
There are numerous psychotherapeutic approaches to treating
ADHD. How well do children do with psychotherapy?
Your child's success depends in part upon which
psychological approach you use. Certain techniques work
extremely well, and can even reduce or eliminate the need
for medication. Others are a big waste of time and money.
There are even some instances were psychological
intervention can be dangerous to your child and your
family. I am saying this from experience. I have seen
this. Regarding psychotherapy, like everything else, you
have to know exactly what you are doing if you want to help
your child.
Goals of Psychotherapy
Psychotherapy addresses six basic problems encountered by
ADHD children and their families.
These are:
• Stress and anxiety resulting from struggles to meet
life's demands
• Low self-esteem
• Feelings of incompetence
• Grief over lack of accomplishments
• Feelings of helplessness
• Poor social skills
None of these problems are part of the core symptoms of
ADHD. Instead, they result from the psychological trauma
that occurs as a result of having ADHD.
Psychotherapy tends to focus on the development of better
coping skills to help ease the impact of problematic
situations. It does not eliminate ADHD symptoms.
However, the appropriate therapy can help a child develop
organizational skills, time management skills, and
communication skills, which become essential to master as
the child matures.
There are many different therapeutic approaches, but not
all enjoy the same success. You really have to know what
you are doing before you commit your child to therapy.
I am going to discuss briefly a few of the current therapy
approaches so that you know what they are.
Behavioral Therapy
The goal of behavioral therapy is to change your child's
behavior. This is accomplished by making certain
modifications in your child's environment in order to
encourage desirable behavior and to discourage undesirable
behavior.
Your child is given a set of goals. He is rewarded
positively for executing the desired behaviors and given
consequences for failing to perform the desired behaviors.
This is often done in both the home and the school, and
requires more structure, closer attention, and limitations
of distractions. The result is that the behavioral therapy
shapes the child's behavior over time.
Behavioral therapy is one of the most common forms of
therapy used with ADHD children. Like other therapies, it
is expensive, but if it is well targeted, behavioral
therapy can be quite effective.
I designed a course to help parents more constructively
discipline their children and foster a better, more loving
relationship. If discipline is an issue for you, this is a
very effective and cheap option. The entire 20-week
program, along with complete online support costs less than
one behavioral therapy session.
Social Skills Training
ADHD is best known as a condition that seriously interferes
with the child's ability to be successful in the school
setting. That is because this is where the problems are
first noticed and their behavior causes the most problems.
However, a more significant problem is that these children
do not develop normal social interaction skills. As a
result, they do not develop normal peer relationships.
This aspect of ADHD will cripple the child decades after he
has left school and will set him up for life-long
difficulties and unhappiness.
Social skills training programs are designed to help your
child deal with this problem. How effective are these
programs? This depends on a number of factors. Again, you
have to know what you are doing in order to choose wisely.
Parent Counseling and Parent Training
Parent counseling and parent training are two of the most
commonly recommended psychological interventions offered to
the parents of ADHD children. These are usually offered in
the form of cognitive-behavioral training, either in an
individual, family, or group family setting.
The idea is that most of the child's life is spent not
under the influence of medication. In addition, medicating
the child does nothing to improve the parents' parenting
skills. Therefore, parent counseling and parent training
are employed to better empower the parents to deal with the
periods when the child and his ADHD behavior are in full
bloom.
Conclusion
The conservative traditional approach to treating ADHD
usually includes medication with some form of
psychotherapy. Psychotherapy may be helpful in treating
some of the psychological problems that accompany ADHD. As
your child gets older, these problems could be more
significant than the actual core ADHD symptoms. However,
psychotherapy does not make your child more attentive or
less impulsive.
Psychotherapy is very tricky. There are many different
forms of psychotherapy being used today. Some work, some
do not. All these techniques are expensive.
Psychotherapy can be a monetary sinkhole. If you choose a
modality that does not work well, you could be in for years
of expensive, only moderately effective treatment. On the
other hand, if you choose correctly, you might see
significant improvement in your child in a relatively short
period of time. You might be able to reduce or eliminate
the amount of medication your child takes.
I feel the need to repeat one word of caution. We
generally think of medicines as being dangerous because
they have side effects or toxic properties that can harm
you if they are not used correctly. We are not used to
thinking about psychological counseling the same way.
Nothing could be further from the truth.
When therapy is done properly it can change your child's
life. In conjunction with medication it can be a very
powerful and effective combination. But if you choose the
wrong therapy or the wrong therapist the consequences can
be very severe. It may not be just a question of wasting
your money. The wrong therapist can inflict serious harm
to your child. I have seen this happen to others. You
must make sure it does not happen to you.
Appropriately psychotherapy is definitely a part of
treating ADHD. You should make it part of your child's
treatment plan. Just be careful when you choose your
program. As helpful as therapy can be, it can be that
destructive.
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Anthony Kane, MD is a physician and international lecturer
who has been helping parents of children with ADHD and
Oppositional Defiant Disorder online since 2003. Get help
with Oppositional Defiant Disorder child behavior
(http://addadhdadvances.com/bbsya.html), help with defiant
teens (http://addadhdadvances.com/teenhelp.html ) ADHD
treatment (http://addadhdadvances.com/cylsya.html ) and
ADHD information.
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