Behavior therapy and ADHD

ADHD is Attention-deficit Hyperactivity Disorder which is a biopsychosocial disorder or neurobehavioral problem characterized by numerous problems including hyperactivity, inattention and impulsivity. These problems pose a lot of difficulties in learning at school, home, at work and in relationships. About 3%-5% of children are affected by this problem out of which 30%-70% continue to show symptoms even to adulthood (Curtis, 2008).

The symptoms associated with ADHD are of three types. One is having attention deficiencies in that the affected person is distracted very easily and also exhibits difficulties focusing on a given task.

Secondly, the patient is prone to doing things before thinking about the consequences or the impacts they would have on themselves and the people around them. For instance, becoming too angry than the situation calls for, laughing or talking too loud, teens and adults may hurriedly make decisions that would impact the rest of their lives negatively like spending money recklessly. The third type of symptom is hyperactivity in which affected children may fidget, run around at inappropriate times or squirm while adults and teens are restless and are unable to enjoy their quiet times or studying (Curtis, 2008).

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ADHD causes can be attributed to biological, social, experiential and strong genetic factors. The use of medication for treating this condition is not without serious side effects. By adopting behavioral approaches, the myriad of challenges faced by the affected children such as school failure, school drop out, behavioral disorders, depression, relationship and vocational problems can be significantly reduced and eventually overcome instead of relying on medications which only add more problems by causing serious side effects and whose long term outcome poses a threat to the life of the patient.

Moreover, whether a child is affected by ADHD or not, such problems associated with ADHD may still be evident in psychologically healthy children. This paper will discuss how lack of adequately monitoring and controlling behavioral patterns at early childhood has resulted in many parents branding their children ADHD affected. It will show how behavioral strategies can be used extensively to deal with behavioral problems which may be mistakenly associated ADHD.

Instead of using medications which cause more harm to the children to whom they are prescribed, the paper will justify by use of real and practical examples of other approaches which if well applied would eliminate the harms of relying on medicine.

Why medication is not a remedy for treating ADHD

Though there are several documented benefits associated with using stimulant medication for treating ADHD, it has not offered a complete remedy due to a number of reasons.

It is first of all worth noting that the side effects caused by this medication impedes its administration on a prolonged basis and secondly no real benefits are accrued from medication for up to 20% of children claimed to be affected by ADHD (Rabiner, 2009). Another thing is that ADHD has primary symptoms in addition to other associated problems which cannot be alleviated by medication and therefore the need for employing other means. In addition, some children and many teenagers are strongly opposed to taking medicine which creates more problems when they are forced to take the medication.

Moreover, management of children behavior can be effectively done even without the use of medication especially when the symptoms are relatively mild. This can be done through strategies such as positive reinforcement and punishment.

Side effects of stimulant medications

A stimulant is the commonly used type of medication whose action produces a calming effect on the patient. Other medications are non-stimulants and their mode of action differs from that of the stimulants. There are several side effects caused by the use of stimulants in treating ADHD.

The common ones are sleep problems, decreased appetite, irritability, and anxiety in addition to few cases of headaches and stomachaches. There are also other side effects which are less common including some children developing sudden sounds or repetitive movements known as tics and change in personality in which some children appear to be without emotions (nimh. nih. gov, 2009). The US Food and Drug Administration have also warned against possible side effects which though rare may cause fatal consequences. It has pointed that the use of ADHD medication may cause psychiatric or possible cardiovascular problems.

The medication-related psychiatric problems include becoming suspicious without any reason, hallucinations, hearing voices and becoming manic even among patients with no history of psychiatric complications. In addition, atomoxetine as one of ADHD medication has been found to cause increased suicidal thoughts in teenagers and children who take the medication than those who do not take it (nimh. nih. gov, 2009). Other non-medical treatment measures are therefore no doubt necessary to combat ADHD in a more safe, effective and easy way.

Behavioral treatment for ADHD

This is also referred to as behavior management or behavior therapy whose basis of operation is pegged to the simple understanding of why children would want to behave or act in a socially acceptable manner. There are three reasons for this one being that children are inclined towards pleasing their parents by doing the right things and through this they feel good about themselves when the parents commend and applaud their positive behavior. This is because children are strongly motivated when the relationship with their parents is positive.

Another reason is that children want to behave well so as to benefit from the positive consequences that rewards and privileges associated with good behavior. The last basic reason is that children would want to avoid the repercussions of acting inappropriately such as being punished. Therefore, behavior therapy endeavors in enhancing the desire to embrace commendable behavior by all children whether affected with ADHD or not in order to please their parents and also to get positive consequences by behaving correctly.

At the same time, inappropriate behavior is suppressed and highly discouraged by creating an environment which guarantees negative consequences after displaying undesirable behavior (Rabiner, 2009). Lack of understanding of this important concept has resulted in many parents making incorrect decisions such as taking their children to psychiatrists who may prescribe medicine for ADHD only to cause health problems to the children who are absolutely normal.

Through the efforts of parents and their children, the tools of this approach can be effectively applied to do away with such predicaments and unwarranted over reliance on medicine since the practicability of the method carries no doubt. There are different tools that are essential for positive behavior outcome to be achieved.

Positive Reinforcement

This is based on the understanding that children would be motivated to behave positively if by doing this there is a reward or positive consequences to be gained.

This therefore calls for the parent to devise means of increasing the frequency of good behavior by simply offering a reward when the child displays good behavior. The parent ought to be keen on noticing the desired behavior such as putting away toys or playing quietly and not hesitating to comment on the behavior. This approach also entails helping the child to understand what the parent wants him or her to do and ensuring that positive comments or praise is directed to the child every time the behavior occurs.

The logic behind these social rewards is that the desire of the child to behave well is enhanced by realizing that the parents are keen to notice and appreciate them (Rabiner, 2009). This keeps at bay defiant or undesirable behavior for which most may be tempted to contemplate using medicine. Apart from social rewards, tangible rewards are a form of positive reinforcement. Parents should be enthusiastic to give tokens or privileges to children whether affected with ADHD or not every time positive behavior occurs. This enhances compliance and obedience to requests made by parents.

For instance, a parent can explain to a child that each time a request is obeyed, a point is earned. The accumulated points can then be used to obtain a privilege such as access to computer time.

Punishing appropriately

Punishment is an appropriate strategy to use especially when the behavior is as a result of direct non-compliance or violation of rules. However, punishment cannot be done in solidarity and expect that it will change the long term behavior of children whether ADHD affected or not. Rather, it should always be accompanied with a managing strategy so as to precipitate the anticipated results.

The logic behind punishment is that every time a certain behavior is accompanied with consistent negative consequences, the frequency and intensity with which it will occur over time will diminish and eventually disappear. The child should be made to understand that every time the behavioral expectations are not met, negative consequences are always the result and that bad behavior has absolutely no pay-off. Many parents have failed to apply this important approach resulting in a rise in inappropriate behavior and poor performance in academics by many children.

Due to this kind of reluctance on the side of the parent, many normal children have continuously displayed defiance and many have resulted into using antipsychotic medicine on these children in an effort to curb the problem. Punishment is critical in stopping negative behavior and can take many forms such as reprimands, detention, criticism, extra work, and corporal punishment (kidscoinsproductions. com, n. d). The different forms of punishment should be used interchangeably so that if one fails to give the expected change, a different one is employed.

Response cost techniques

This refers to different forms of punishment in which the likelihood of losing what has already been earned is determined entirely by the mode of behavior or conduct of a child. Parents with children displaying inappropriate behavior can apply this practical approach to influence their behavior instead of making the conclusion that ADHD is the problem. Its effectiveness is as good as those of giving social and tangible rewards but is especially suitable when used in older children and teens.

An example would be to start by giving the whole token say $5 at the start of the week instead of giving it at the end of the week after the child has behaved as expected. This allowance may be placed somewhere in a transparent vessel and a promise made to the child that as long appropriate behavior is maintained throughout the agreed time period, all the $5. 00 belongs to the child. Whenever the child violates the agreed upon set of rules, a dollar is removed from the vessel and this continues to the end of the week upon which the child gets whatever is remaining (Goldstein, 1999).

This is a good way of making the child work hard to maintain appropriate behavior so as not to lose the already available reward.

Special time

Children sometimes find themselves having frustrations caused different challenges they face at school or even at home which can easily jeopardize the good relationship between them and their parents. The frustrations can also be caused by mood swings or being disappointed with friends which thus does not mean that they are having ADHD.

These frustrations can create feelings of anger and trigger conflicts which only put the children-parent relationship at risk with the good times completely dwindling if the situation is not strategically contained. With the understanding of how behavior therapy works, parents can capitalize on the natural inclination of children to please their parents when relationships are positive. This calls for the creation of a special time program whose entire focus is mending the badly affected feelings between parent and child.

The parent can allocate at least 30 minutes everyday which is designated “special time” for the child during which the child can choose the desirable activity which must be commensurate with the purpose of the program (Rabiner, 2009). The parent ought not to give commands or ask a lot of questions during this time and the whole focus should be having quality time with the child. The parent should tune into the activity of the child in a complementary and interested manner such that the child will become more motivated to carry on with the activity.

The parent should express the feelings of being pleased by for instance commenting positively on the efforts of the child. With time, the natural inclination to please the parent will find its way in and the child will now focus on doing it right and avoiding anything that would displease the parent. Through this, limit setting and discipline is done with ease.

Non-Compliance vs. Incompetence

Children whether having ADHD or not may display non-compliance to given rules or instructions and therefore there needs to be effective means of dealing with this problem as early as possible in the life of the child.

The best way to overcome non-compliance is through manipulating and applying different consequences with the most effective being that of negative consequences through different forms of punishment. On the other hand, children who display incompetence for instance in understanding academic concepts in school should be helped through intensive skill building and educational training. Such children should also be allowed to make choices of what activity they feel they are capable of excelling in. This calls for the parents and teachers to be highly observant and assist the children to make the appropriate choices.

This will eliminate the misplaced thoughts in such children that they are incapable of performing which is a source of depression and hopelessness which creates more defiant behavior. Instead of hastening to use medicine with the notion that ADHD has clipped in, such practical approaches are the best since they help avoid the harms associated with using drugs. 4. 0 Conclusion ADHD may be a disorder which is in existence or not but either way, lack of proper use of practical means to ensure sustainable appropriate behavior has resulted in many kids in the US being labeled ADHD-affected.

The consequences of using medication to improve behavior and school performance have only created more problems than solutions which indicate that the right approaches are not yet exploited. Behavioral therapy as opposed to chemotherapy ought to be upheld and strategies like punishment properly used by parents and teachers. Assumptions that all behavioral problems emanate from a mental disorder should not be made.

References

1. Curtis, J. (2008). Attention Deficit Hyperactivity Disorder: What It Is and Who Is Affected. Retrieved July 22, 2010, from http://www. health. com/health/condition-article/0,,20251884,00. html
2. Goldstein, S. (1999). The Facts About ADHD. Retrieved July 22, 2010, from http://www. samgoldstein. com/node/21 kidscoinsproductions. com. (n. d).
3. Designing a Behavioural Modification Program. Retrieved July 22, 2010, from http://www. kidscoinsproductions. com/Research/Behavioural_mgt. htm nimh. nih. gov. (2009).
4. Attention Deficit Hyperactivity Disorder (ADHD). Retrieved July 22, 2010, from http://www. nimh. nih. gov/health/publications/attention-deficit-hyperactivity-disorder/complete-index. shtml
5. Rabiner, D. (2009). Behavioral Treatment for ADHD: An Overview. Retrieved July 22, 2010, from http://www. athealth. com/Consumer/farticles/Rabiner. html

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