Treatment ADHD – Implications

Implications from the Cognitive Model-

Barkley pointed out, that therapies should stem from the model of executive functions and self-regulation (Barkley, 1997). Therapy must address weak executive functions like working memory, alertness regulation and motivation.

He goes on to add that ADD is an issue of behavioural performance and not skill or knowledge. The individual needs help with doing what they already know, when it should be performed and not with giving them more knowledge  (Barkley, 1997). Thus treatments focusing on skill training such as social skills, self-control or cognitive behaviour training will not be successful in aiding the core problems in ADHD (Barkley, 1997). Skills-training may help an individual who has been deprived of education or socialization and has co-morbidities as a result oh his/her ADD (Brown, 2005)

The most useful treatments are those ‘that are in place in natural settings at the point of performance where the desired behaviour is to occur’ (Barkley, 1997).  Clinic delivered treatments like play therapy or counselling are not likely to reduce ADHD core symptoms because the knowledge is not the issue (Barkley, 1997). Hence, external prompts, cues, reminders, for example posters and listed rules and at the same time reducing high appealing distracters make the environment more supportive to executive function skills.

EF problems result in time blindness too (Barkley, 1997). For example, if the time between when an instruction is given and when the task is to be completed is too long, then the chances of success actually decrease. Reduction this gap or more external sources of behavioural motivation is therefore important. When the gaps cannot be eliminated then the sense of passage of time needs to be externalised for example through a timer.

A component of the EF model deals with self-regulation, motivation and arousal. Inner sources of motivation that are weak need to be improved with immediate rewards.

Implications from the Medical Model

The implication of ADD being an organic disorder and not one of learned behaviour or faulty parenting (Mash & Barkely, 1989) leads to the attitude of those surrounding the person. Attitude of compassion, accommodation and acceptance needs to replace criticism, censure and derogatory judgements of their moral worth.

Treatment ADHD – Options

Treatment options have altered according to the understanding of the disorder through the decades. Controversy on which is the best are hotly debated. Several therapies abound and include taking Omega-3 (Adams, 1972), Feingold diet (Feingold, 1975), retraining the brain through cognitive rehabilitation (Klingberg, et al.), behaviour modification (National Institute of Mental Health, 1999) counselling (Bennett, et al. 1996), social skills training ( Spence, 2003) and psychotherapy(Hinshaw, Henker & Whalen1984).  Nonetheless, the newer understanding of ADHD determines that certain behavioural therapies, educational adaptations and pharmacotherapy are the mainstay of its management (Brown, 2005). Goldstein (Goldstein et al., 1995) advocates a multidisciplinary and multimodal therapy for ADHD that last a long time. Of these the most effective evidence based interventions are medication and the use of behavioural techniques.

The American Academy of Paediatrics assert in their ‘Treatment Guidelines for Attention Deficit Hyperactivity Disorder’ that  psychological interventions should be used alongside any prescribed medication.