Table 3 Non-pharmacological treatments for attention deficity hyperactivity disorder (ADHD)

Parent training in behavior management

A training intervention is to gather a detailed accounting of behavioral problems including when and in what situations misbehaviors occur. It is also useful to record how parents and other adults react to the behaviors, and what subsequent interactions take place as a result of those reactions. In sum, what are the social contingencies that might be cueing, exacerbating or sustaining inappropriate behavior, if any? What disciplinary methods are used in the home now and in the past, and what formalized help have parents sought and obtained for managing the problems? Both parents need to be involved if both have contact with the child. At the very least, the non-attending parent must be supportive of the one attending training if the transfer of skills from the group to the home setting is to be enhanced. If others regularly care for the child, they may also be involved in the training, so that the child experiences consistency across the routine caregivers in his life.

School interventions

Often include alterations to the curriculum and workload to better mesh with the limited attention, persistence and disorganization of the child with ADHD; special educational services ('push-in' or mainstreaming assistance to regular teachers; 'pull-out' services to focus on more individualized child training, self-contained classes); increases in sources of positive reinforcement for work productivity; occasional use of immediate and systematic negative consequences for disruptive or inappropriate behavior; implementation of a daily school behavior report card (the ratings on which are linked to a home token economy), peer-tutoring or other innovative approaches to using peer influence to achieve classroom goals; and more communication with parents. In short, greater accountability of the child to teachers and others, including more immediate, frequent and salient feedback for performance, and increased structuring of the classroom environment and teaching materials have all been shown to benefit the child with ADHD in school.

Cognitive behavioral therapy

The emphasis on the process of restructuring or modifying an individual's thoughts to create behavioral effects is what differentiates CBT therapists from behavioral therapists. Aspects of CBT that differentiate the treatment from other therapeutic orientations such as psychodynamic therapy and interpersonal therapy include the following.

• Use of homework and outside-of-session activities.

• The CBT therapist is more active and directs session activity.

• CBT focus is clearly on the future.

• The CBT therapist explicitly teaches skills for coping with symptoms.

• The CBT therapist focuses on cognitive experiences (especially dysfunctional thoughts and beliefs).

• The therapist provides explicit information to the patient about the treatment, the disorder and its symptoms.