Childhood Attention-Deficit/Hyperactivity Disorder: Nonpharmacological Treatments and Their Combination With Medication

Abstract

Attention-deficit/hyperactivity disorder (ADHD) is a persistent disorder of childhood and adolescence that mandates early and effective intervention. Among psychosocial interventions, direct contingency management applies systematic manipulation of rewards and punishments in specialized settings. It typically yields large effects on behavior and academic performance, but (a) outcomes are often appraised through single-case experimental designs, outside the typology of clinical trials used in this volume, and (b) their effects tend not to generalize or maintain beyond the settings in which they are applied. Clinical behavior therapy involves consultation with parents and teachers regarding optimal home and school management practices. A number of Type 2 trials demonstrate the clinical value of such procedures for the behavior problems of children with ADHD as rated by parents and teachers but typically not by independent observations. Several Type 1 investigations of systematic combinations of direct contingency management plus clinical behavior therapy have yielded findings indicating significant improvements, but effects on symptoms are smaller than those found with medication. Multimodal treatment—combining intensive behavioral intervention with well-delivered pharmacological agents—does not always reveal significantly superior outcomes to medication alone, but it more consistently yields normalization of behavior patterns among children with ADHD. Further work on tailoring psychosocial interventions to ADHD-related deficits and impairments and on promoting generalized change beyond specifically targeted behaviors is urgently needed.