Behavioural therapy

What is behavioural therapy?

Behavioural therapy for ADHD can include behavioural interventions, cognitive behavioural therapy (CBT) and neurofeedback (Table).1-4 Behavioural interventions for the treatment of ADHD may include teaching parents and teachers strategies to cope with disruptive behaviour and address problematic behavioural habits at home or at school.1,2 CBT is administered directly to patients, particularly adolescents or adults, on an individual or group basis.1 It aims to improve motor behaviour and symptoms of ADHD by helping patients to understand how their thoughts, feelings and behaviours may result in negative consequences and by helping them change these thoughts, feelings and behaviours to produce more desirable outcomes.1 Neurofeedback typically involves computer-based exercises, which provide feedback regarding attention levels to promote self-regulation and enable behavioural training.3,4

Behavioural therapy approaches to management of ADHD

Parent-led behavioural interventions At home or during family activities, the parent can:
  • Analyse positive and negative consequences of appropriate and problem behaviours (possibly in consultation with the clinician) and implement a reward system to reduce problem behaviours1,2
  • Use time-out as a punishment for more severe problem behaviours.1,2
Classroom-based behavioural interventions At school, the teacher can:
  • Analyse positive and negative consequences of appropriate and problem behaviour (possibly in consultation with the clinician) and implement a reward system to reduce problem behaviours2
  • Use brief time-out as punishment for more severe problem behaviours.2
Cognitive behavioural therapy
Self-instructional training administered on an individual or group basis.1 Helps the patient to:
  • Develop a more planned and reflective approach to thinking and behaving, including social interactions1,2
  • Adopt a more reflective, systematic and goal-oriented approach to everyday tasks, activities and problem solving, including academic functioning.1,5,6
Neurofeedback Typically involves computer-based exercises, which provide feedback regarding attention levels to enable behavioural training.3,4

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  1. NICE (2008) Attention Deficit Hyperactivity Disorder: Diagnosis and Management of ADHD in Children, Young People and Adults. NICE clinical guideline 72. Available at www.nice.org.uk/CG72 [NICE guideline]. Last accessed May 2015.
  2. Taylor E, Döpfner M, Sergeant J, et al. European clinical guidelines for hyperkinetic disorder – first upgrade. Eur Child Adolesc Psychiatry 2004; 13 (Suppl 1): I7-30.
  3. Steiner NJ, Frenette EC, Rene KM, et al. In-school neurofeedback training for ADHD: sustained improvements from a randomized control trial. Pediatrics 2014; 133: 483-492.
  4. Meisel V, Servera M, Garcia-Banda G, et al. Neurofeedback and standard pharmacological intervention in ADHD: a randomized controlled trial with six-month follow-up. Biol Psychol 2013; 94: 12-21.
  5. Sibley MH, Pelham WE Jr, Molina BS, et al. Treatment response to an intensive summer treatment program for adolescents with ADHD. J Atten Disord 2012; 16: 443-448.
  6. Prevatt F, Yelland S. An empirical evaluation of ADHD coaching in college students. J Atten Disord 2013 Mar 18 [Epub ahead of print].

 


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