Behavior Therapy is recommended treatment for children with ADHD, but there is a lot of confusion about what it means. In a two-part article, I will explain 1) what the doctors mean by Behavior Therapy, and 2) what the research says behavior therapy should include and how you can find it for your family. For more on WHY doctors haven't been recommending it and what can be done about that, please read my article in the Huffington Post.
What is Important about Behavior Therapy?
While there is a lot of confusion around the term “Behavior Therapy,” which I tried to clarify in the first part of this series, there does appear to be a consensus: Behavior Therapy is about training parents “how to create structure and reinforce good behavior” in kids with ADHD.
In an ADDitude webinar in May 2016, “More Than Meds: A Parent's Guide to Using Behavior Therapy,” Dr. William Pelham said:
"Teaching parenting skills is the single most effective and important intervention for treating kids with ADHD.” He went on to say, “There's no therapy that a therapist can do in their office with a child who has ADHD that will have any impact on that child's behavior.” According to Dr. Pelham, parent training using behavioral strategies “is the only therapy that works.”
Which is great!
EXCEPT, in the same month, a CDC Vital Signs report announced that many physicians are not first referring “parents of young children with ADHD for training in behavior therapy before trying medicine.”
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What to Look for in a Behavior Therapy Program
So, that means, for now, parents need to become better informed about what should be included in a Behavior Therapy program, and how to find one.
I've had an opportunity to discuss this challenge with Dr. Beverley Funderburk and Greta Masseti, PhD, the presenters of an upcoming webinar series by the National Council for Behavioral Health. The series promises to define what behavior therapy looks like and what parents can expect.
Dr. Masseti, a psychologist in the Atlanta area, was kind enough to review the following information about “Good Behavior Therapy Programs” for accuracy. I encourage you to sign up for their webinar series if you can. I'll be attending with bells on (but I promise to mute my phone).
A Good Behavior Therapy Program
Who Should Deliver it, and How?
- Counselors, Coaches, Psychologists and sometimes even Educators may offer Behavior Therapy in the form of Parent Training
- It can be delivered effectively individually or in groups
- It can be offered in person or on the phone
- There should be a regular component for parents to monitor progress and receive support from a professional
What Content should be included?
- Classes or private sessions should teach parents:
- How their child's challenges manifest in reality
- Positive communication skills
- Ways to strengthen their child's positive behaviors
- Strategies for minimizing unwanted or problem behaviors
- Skills and strategies to develop effective structures
- Positive ways to interact with their child
- How to set realistic expectations for their child
- Strategies to help their child improve control of his behavior
- Provide specific activities parents can practice with their child
- Focus on using rewards and consequences appropriately
- Provide a format for adjusting strategies as needed
How to Find a Behavior Therapy Program?
If you are committed to an “evidence-based” behavior therapy program, sadly the options are limited. There's a lot of politics involved with what is required for a program to meet that criteria, and most programs developed in recent years will not have had the opportunity for that kind of research.
Still, a 2011 Agency for Healthcare Research and Quality (AHRQ) report recommends four programs, which you can access from this CDC webpage. These programs were not necessarily developed for use specifically with the ADHD population, but they are well-researched and have been proven to improve many of the symptoms our families struggle with.
Evidence Informed or Supported
If you are open to programs that qualify as “evidence-informed” or “evidence-supported,” there are more options available. According to Dr. Masetti, “Evidence informed” means that “the core content is consistent with what's in the evidence, but may be offered to a different population, or delivered in a different context.” In other words, it's important to do your homework and make sure you're choosing a program that has been developed by people with expertise, and in accordance with the criteria for Behavior Therapy listed above.
Below are some programs that have been created specifically for the ADHD population, by reputable, recognized experts in the field of parenting ADHD (myself included). In full disclosure, I am biased towards these programs because I have witnessed their effectiveness in the families I work with, and in some cases I have been part of creating them. I am not claiming to be neutral here. 🙂 I am confirming that these programs meet the requirements identified above for Behavior Therapy.
- Many local communities have medical practices that provide Behavior Therapy training for their patient communities, and occasionally community service organizations offer programs, as well.
- CHADD Support groups may offer Parent to Parent trainings (see below) and may be able to direct you to local resources; special needs schools might, as well. It takes some investigation, but if you want to find something local, keep searching!
- General parent training programs (like Positive Parenting) can be helpful, though they generally do not take into consideration the special circumstances of complex families. If you choose to pursue general parent training, you might want to find a local therapist or coach who can help you apply what you're learning to your child with ADHD or related challeges.
- CHADD's Parent to Parent Training (delivered by trained presenters in local communities; classes available online, as well). CHADD's Parent to Parent program provides an excellent education for helping parents understand ADHD, thus getting a better understanding of their children (and often, themselves). The strength of this program is in the experience and training of its leaders, and foundational info about the specifics of ADHD. It offers some behavior management strategies, but that is not the focus of the program.
- ImpactParents' Sanity School Parent Training (6 classes delivered On Demand with 8 weeks of ongoing support). Sanity School was designed to help parents learn a method for management that includes Positive Parenting, Setting Realistic Expectations, Activating the Brain, and Using Systems & Structures effectively. While originally designed for parents of kids with ADHD, it's applicable to parents of kids with a wide range of related conditions. It fulfills all the expectations of a Behavior Therapy program.
- ImpactParents' Parent Success System (group coaching on the telephone with attention to individual challenges). Parent Success System (PSS) was designed to give parents a full year of ongoing support that includes parent training and implementation. PSS fulfills all the expectations of a Behavior Therapy program and expands on them, combining Training with Coaching and Support, and extending support from a few months to a full year.
We are at a transition point in treatment for ADHD, and the next few years will prove interesting, for sure. At the end of the day, HealthyChildren.org captures it quite succinctly:
“Behavior therapy recognizes the limits that having ADHD puts on a child. It focuses on how the important people and places in the child's life can adapt to encourage good behavior and discourage unwanted behavior. It is different from play therapy or other therapies that focus mainly on the child and his emotions.
Whatever Behavior Therapy program you choose to pursue, I strongly encourage you to choose something. Commit to something. Parents have a sense that they “should” know how to raise their complex kids, and the truth is, we ALL need training, and support.
When you take the plunge to get support for yourself, your kids will benefit even more than you. At the end of the day, THAT is how you'll know for sure that you've found an effective Behavior Therapy approach that works for your family!