Nonpharmacologic Approaches to Treating ADHD

Michele Dadson, PhD; Adelaide S. Robb, MD


July 31, 2006

In This Article


Attention-deficit/hyperactivity disorder (ADHD) is one of the most prevalent psychiatric disorders of childhood, affecting approximately 5% to 10% of school-age children in the United States.[1] Researchers have estimated that in a classroom of 25-30 children, at least 1 child will likely have ADHD.[2] Children with ADHD experience significant problems at school, resulting in a higher risk for school failure and grade retention.[3] Family interactions also suffer significantly, with ADHD children being less compliant with parents' instructions than same-age peers.[4] Likewise, their parents are more controlling, more disapproving, and experience more stress than parents of children without ADHD.[5,6] Longitudinal research has suggested that ADHD is a relatively chronic condition, with at least 50% to 70% of diagnosed children continuing to manifest symptoms into adulthood.[7] Taking into account the chronicity, prevalence, and level of impairment associated with ADHD, Pelham and colleagues[8] noted that "effective treatment for childhood ADHD is a major public health agenda."

In a 2001 Clinical Practice Guideline, the American Academy of Pediatrics (AAP), suggested that when treating target ADHD symptoms, clinicians should recommend stimulant medication and/or behavior therapy, "as appropriate.[9]" Drawing upon the available research, the AAP noted that although "stimulant medication is highly effective in the management of the core symptoms of ADHD . . . behavioral interventions are valuable as primary treatment or as an adjunct . . . based on the nature of coexisting conditions, specific target outcomes and family circumstances." Unfortunately, specific referral guidelines are notably absent, leaving the clinician to consider whether a trial of behavior therapy is appropriate in a given case. This column reviews the current research on the effectiveness of behavior therapy with ADHD children and identifies patients who are likely to benefit from behavioral treatment.


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