Behavioral Interventions and ADHD

A new study (Pelham, et al., 2016) published in the Journal of Clinical Child and Adolescent Psychology reports that when children with ADHD receive behavioral therapy, particularly along with medication therapy, they follow the classroom rules better and receive better ratings from adults.  The abstract states “The group beginning with behavioral treatment displayed significantly lower rates of observed classroom rule violations (the primary outcome) at study endpoint and tended to have fewer out-of-class disciplinary events.  Further, adding medication secondary to initial behavior modification resulted in better outcomes on the primary outcomes and parent/teacher ratings of oppositional behavior than behavior modification to initial medication.”  

 

This finding continues to support the findings that behavioral interventions for children are superior to the application of medication alone.  Here, the authors found that use of behavioral strategies first, then introduction of medication when the children don’t meet behavioral goals, is superior to the other way around.  Schools that invest in “pull-out” only strategies (social skills training) may wish to consider the use of the brief classroom management training described in Pelham et al., and parents may wish to seek early behavioral parent training as soon as they receive the diagnosis of ADHD for their child. 

One key implication of this study is the important of primary prevention through the use of screening, early diagnosis, and application of behavioral parent training. While social skills groups were applied in this study, I would argue that the use of consistent behavioral parenting, along with school-based classroom management strategies, create both positive outcomes on their own, and when medication is necessary, likely provide the skills needed by children when they benefit from the meds.  

Pelham is well-known for his series of studies on summer camps for ADHD children with behavior problems. Those camps have been consistently shown to produce, through the application of behavioral methods, both remarkable improvements in children after attendance, and at follow-up after the intervention is withdrawn.