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by Anthony Kane, MD



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ADHD and Psychotherapy

by Anthony Kane, MD

In conventional medicine we refer to the "multi-modality" approach to treating ADHD. We view stimulant medication as the most effective treatment, but realize that it is not a complete solution. Since medication has its limitations, psychotherapy has been used in addition to medication.

You may ask why specifically psychotherapy has been employed. After all, ADHD has just as many educational and social ramifications as it does psychological ones. It would make just as much sense to have social skills training or learning assistance be used as an adjunct to medication.

The real reason that psychotherapy as the next step after medicine is that for most of its recent history, ADHD was considered a psychological problem. Psychologists were the ones who put the most effort into studying and treating ADHD. It is not surprising that what they came up with were treatment plans based on psychology. What else could anyone expect? Psychology is what they know.

So for better or worse, it turns out that medication and psychology go hand in hand and are now the main focus of the multi-modality treatment for ADHD.

There are numerous psychotherapeutic approaches to treating ADHD. How well do children do with psychotherapy?

I discuss this at length in How to Help the Child You Love. In the section discussing how to pick the right program for your child, I explain that your child's success depends in part upon which psychological approach you use. Certain techniques work extremely well, and can even reduce or eliminate the need for medication. Others are a big waste of time and money.

There are even some instances were psychological intervention can be dangerous to your child and your family. I am saying this from experience. I have seen this. Regarding psychotherapy, like everything else, you have to know exactly what you are doing if you want to help your child.

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Goals of Psychotherapy

Psychotherapy addresses six basic problems encountered by ADHD children and their families.

These are:

Stress and anxiety resulting from struggles to meet life's demands
Low self-esteem
Feelings of incompetence
Grief over lack of accomplishments
Feelings of helplessness
Poor social skills

None of these problems are part of the core symptoms of ADHD. Instead, they result from the psychological trauma that occurs as a result of having ADHD.

Psychotherapy tends to focus on the development of better coping skills to help ease the impact of problematic situations. It does not eliminate ADHD symptoms.

However, the appropriate therapy can help a child develop organizational skills, time management skills, and communication skills, which become essential to master as the child matures.

Again, as I point out in How to Help the Child You Love, there are many different therapeutic approaches, but not all enjoy the same success. You really have to know what you are doing before you commit your child to therapy.

I am going to discuss briefly a few of the current therapy approaches so that you know what they are.

Behavioral Therapy

The goal of behavioral therapy is to change your child's behavior. This is accomplished by making certain modifications in your child's environment in order to encourage desirable behavior and to discourage undesirable behavior.

Your child is given a set of goals. He is rewarded positively for executing the desired behaviors and given consequences for failing to perform the desired behaviors. This is often done in both the home and the school, and requires more structure, closer attention, and limitations of distractions. The result is that the behavioral therapy shapes the child's behavior over time.

Behavioral therapy is one of the most common forms of therapy used with ADHD children. Like other therapies, it is expensive, but if it is well targeted, behavioral therapy can be quite effective.

A good example of a targeted behavioral therapy program is the online course, How to Improve Your Child's Behavior. I designed this course to help parents more constructively discipline their children and foster a better, more loving relationship. If discipline is an issue for you, this is a very effective and cheap option. The entire 20-week program, along with complete online support costs less than one behavioral therapy session. To find out more about this option, go to http://addadhdadvances.com/betterbehavior.html.

Social Skills Training

ADHD is best known as a condition that seriously interferes with the child's ability to be successful in the school setting. That is because this is where the problems are first noticed and their behavior causes the most problems.

However, a more significant problem is that these children do not develop normal social interaction skills. As a result, they do not develop normal peer relationships. This aspect of ADHD will cripple the child decades after he has left school and will set him up for life-long difficulties and unhappiness.

Social skills training programs are designed to help your child deal with this problem. How effective are these programs? This depends on a number of factors. Again, you have to know what you are doing in order to choose wisely.

Parent Counseling and Parent Training

Parent counseling and parent training are two of the most commonly recommended psychological interventions offered to the parents of ADHD children. These are usually offered in the form of cognitive-behavioral training, either in an individual, family, or group family setting.

The idea is that most of the child's life is spent not under the influence of medication. In addition, medicating the child does nothing to improve the parents' parenting skills. Therefore, parent counseling and parent training are employed to better empower the parents to deal with the periods when the child and his ADHD behavior are in full bloom.

Conclusion

The conservative traditional approach to treating ADHD usually includes medication with some form of psychotherapy. Psychotherapy may be helpful in treating some of the psychological problems that accompany ADHD. As your child gets older, these problems could be more significant than the actual core ADHD symptoms. However, psychotherapy does not make your child more attentive or less impulsive.

Psychotherapy is very tricky. There are many different forms of psychotherapy being used today. Some work, some do not. All these techniques are expensive.

Psychotherapy can be a monetary sinkhole. If you choose a modality that does not work well, you could be in for years of expensive, only moderately effective treatment. On the other hand, if you choose correctly, you might see significant improvement in your child in a relatively short period of time. You might be able to reduce or eliminate the amount of medication your child takes.

I feel the need to repeat one word of caution. We generally think of medicines as being dangerous because they have side effects or toxic properties that can harm you if they are not used correctly. We are not used to thinking about psychological counseling the same way. Nothing could be further from the truth.

When therapy is done properly it can change your child's life. In conjunction with medication it can be a very powerful and effective combination. But if you choose the wrong therapy or the wrong therapist the consequences can be very severe. It may not be just a question of wasting your money. The wrong therapist can inflict serious harm to your child. I have seen this happen to others. You must make sure it does not happen to you. I deal with this danger much more thoroughly in How to Help the Child You Love as well as how you can avoid it.

Appropriately psychotherapy is definitely a part of treating ADHD. You should make it part of your child's treatment plan. Just be careful when you choose your program. As helpful as therapy can be, it can be that destructive.

Anthony Kane, MD

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