Adhd
symptoms: Using behavior management
The application of behavior modification
techniques to assist children with ADHD symptoms was founded on the
success of the management of behavior problems among mentally
retarded children, and upon the purported limitations and potential
side effects of stimulant drugs. These stated limitations were a
large part of the rationale behind the implementation of behavior
modification techniques rather than based upon strictly their own
merits. Now at least one of the basic tenets which underlie the use
of behavior management has now been found to be based on outdated
information concerning the side effects of stimulants, which are
believed be much more benign than previously thought to be the case.
Currently, behavioral improvements resulting from the use of
stimulant medication typically is as great or greater than those
resulting from behavior modification techniques, moreover, stimulant
use frequently results in greater improvements in academic
productivity. Given such information, such medications are usually
viewed as first-line treatment for ADHD in place of behavior
modification, which is frequently seen as a necessary adjunct to
medication to achieve maximum treatment effects. Another convincing
justification for using behavior modification techniques in treating
ADHD is the argument that since referral for treatment is frequently
based upon the social distress of the caregivers involved,
interventions to change the interactions between children and their
caregivers is often believed to be useful.
It was first proposed in 1977 that ADHD may
reflect poor stimulus control of behavior by parental commands,
resulting from the inconsistent and inadequate use of child
management methods by the parents. It was believed that by training
parents in more consistent and effective child behavior management,
there should be a reduction or elimination of ADHD symptoms.
However, such a theory has been dismissed on the grounds that the
inconsistent, negative or punitive management techniques of some
parents of children with ADHD have been shown to actually be more
associated with children with oppositional defiant disorder in
conjunction with ADHD, rather than ADHD alone. Further research
seems to suggest that the negative and controlling behavior of
parents with ADHD children is more of a reaction to than a cause of
their children's inappropriate behavior. Also, some parents of ADHD
children seem to have exceptional management skills. Parent training
does not seem to normalize the ADHD symptoms in children and does
not seem to generalized to "no-treatment" settings such as school,
where ADHD symptoms may be equally problematic. The evidence seems
to be against the concept of "bad parenting" as a primary etiology
of ADHD, so this rationale cannot be considered a reasonable
justification for undertaking parent training with ADHD children.
A more recent trend seems to be toward viewing
ADHD as a potential problem in response inhibition and
self-regulation with secondary consequences that may create poor
self-motivation to persist at assigned tasks, which may now provide
a more persuasive rationale for employing behavioral interventions
with ADHD. If ADHD is a developmental delay in self-regulation of
behavior through internal means of representing information and
motivating goal directed behavior, than interventions may be
correctly focused on the nature of the stimuli controlling
behaviors, as well as the pattern, timing, and salience of
consequences, by socially arranging consequences and structure to
focus on symptomatic reduction. The usual procedures for
manipulating the antecedent and consequent events are those provided
by the behavior therapies. However, extension of this argument holds
that such social arrangement will not alter the underlying
neurophysiological basis for ADHD. These techniques must be employed
across various situations, over extended time intervals. Premature
removal of these socially arranged circumstances is believed to
eventually precipitate the eventual return to pretreatment levels of
the behavior symptoms. Also, the use of behavior treatments in one
setting has not been found to generalize to additional settings.
So, in effect, behavior modification techniques
have been found to assist in the behaviors associated with ADHD
children although they have not been found to be very
generalizeability to many or most nontreatement settings.
Information from
Treatment of Childhood Disorders by Eric J. Marsh and Russell A.
Barkley
By
Paul Susic
MA
Licensed Psychologist Ph.D. Candidate
(Health and Geriatric Psychologist)
