Cognitive, Behavioral, and Combined Treatments

Behavioral Treatments

 Behavioral treatment of ADHD has been used for many years and shows promising results. Additionally, this is also a good alternative for those who may not want to deal with the side effects of medication. Daniel O’Leary and William Becker (1967) were one of the first to introduce the use of a token reinforcement system in the classroom to manage behavior. O’Leary and Becker (1967) found that when the teacher would attempt to set up rules or simply ignore problem behavior, children were still disruptive. However, with the use of token reinforcement, disruptive behavior decreased among several students (O’Leary & Becker, 1967). This finding suggests that there is hope in finding a behavioral treatment for ADHD. The development of behavioral treatments for ADHD gained importance following suspicions of the negative side effects of pharmacological treatments. 

Below you will find a video including several sequences showing teachers using a token economy in order to shape the children’s behavior.



Cognitive-Behavioral Treatments

With behavioral treatment yielding somewhat positive results in managing ADHD symptoms, there is still some room for improvement. Cognitive-Behavioral treatments were explored due to the rising belief that the brain and thinking has something to do with ADHD. Cognitive-Behavioral treatments help children control themselves and engage in reflective problem-solving to help monitor their own behavior (DuPaul & Eckert, 1997).

In one study, a group of students were placed in the following groups: Contingency Management (positive reinforcement for good behaviors and punishment to reduce negative behaviors), Academic Interventions (changing the way the students were presented with learning materials, and finally Cognitive-Behavioral Management.

Children in all three groups showed improvement in their behavior as well as adjustment to school; however, the Cognitive-Behavioral group showed the lowest improvement (DuPaul & Eckert, 1997). Like behavioral treatments, we see positive outcomes, but researchers believed there must be something more that could be done to reduce problem behavior.


Development of combined medication and behavioral treatment

Recent research on the treatment of ADHD suggests that combining behavior modification with stimulant medication is more effective than either treatment separately (Pelham, Burrows-MacLean, Gnagy, Fabiano, Coles, Tresco, Chacko, Wymbs, Wienke, Walker, & Hoffman, 2005; Chronis, Jones, & Raggi, 2006). For example, in one study, children were placed into the four following different treatment groups: Behavioral treatment, medication management, combined behavioral treatment and medication management, and finally community comparing control (Chronis et al., 2006).

These results showed that the combined treatment group showed the highest rate of decreased ADHD symptoms (Chronis et al., 2006). It is extremely important to the development of the treatment of ADHD that the study found significant results regarding the combination of drugs and behavior modification. 

Further support was found in 2000 among a group of children attending a summer camp. At that point, only three treatments had shown effectiveness in treating ADHD including: central nervous stimulants, behavior modification, and a combination of stimulants and behavior modification (Pelham, Gnagy, Greiner, Hoza, Hinshaw, Swanson, Simpson, Shapiro, Bukstein, Baron-Myak, & McBurnett, 2000). However, long-term effects of these treatments were still relatively uncertain. While stimulants had dominated the main treatment of ADHD for the past 30 years, research does not support stimulants producing long term improvements in achievement or prognosis (Pelham et al., 2000). While pharmacological and behavioral treatments have their respective limitations, the combined use is the most recently accepted treatment yielding positive results in the study of the treatment of ADHD (Pelham et al., 2000).


Please view the video below to further understand the newest Summer Program type treatments for children with ADHD developed by Dr. Pelham. The video discusses elements of this effective evidence-based treatment to help children develop learning skills and social skills as well as differentiate between acceptable and unacceptable behavior. 


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