Attention Deficit/Hyperactivity Disorder (ADHD)
Only two intervention strategies have shown research-based evidence for the treatment of ADHD: (a) stimulant medications, such as methylphenidate or dextroamphetamine, which regulate dopamine neurotransmission and (b) behavioral strategies such as parent management training, school consultation, and direct contingency management in classroom or special educational settings (Pelham, Wheeler, and Chronis 1998). Indeed, individual therapies that do not directly target the child's social, behavioral, and academic problems have not yielded clear support regarding intervention for ADHD. Medication typically yields stronger effects than behavioral interventions in terms of improving core symptomatology, but (a) psychosocial treatments may be preferable for some families (who may be philosophically opposed to medication); (b) perhaps as many as 20 percent of the youths with ADHD either do not respond optimally to medication or show prohibitive side effects; (c) medication alone is typically insufficient for helping the child learn new academic or social skills or for the family to learn and practice new management skills; and (d) combining well-delivered pharmacological intervention with systematic behavioral family and school treatment is most likely to yield normalization of behavioral, social, and academic targets (Pelham, Wheeler, and Chronis 1998). It is important to note that both pharmacological and behavioral treatments for ADHD share a common limitation: their benefits tend to persist only as long as the intervention is delivered. ADHD is a chronic condition and may well require chronic treatment.
Unfortunately, in light of the strongly heritable nature of ADHD and the documented success of pharmacological interventions, it could be concluded that family and school environments are not particularly important and that psychosocial interventions have limited potential for success. Such thinking fails to take into account the demonstrated facts that (a) conditions with clear psychosocial etiology may respond to biological treatment regimens and (b) conditions with strong psychobiological underpinnings may respond to treatments emphasizing skill enhancement or environmental manipulation. In fact, recent evidence suggests that even for a condition as heritable as ADHD a combination of treatments may be the answer: when combined pharmacological and behavioral treatments produce optimal benefits for youth with ADHD, a key explanatory factor is the family's reduction of harsh and ineffective discipline strategies at home (Hinshaw et al. 2000). Thus, the family's learning of more productive management strategies at home and their coordination of intervention efforts with the school are necessary components of a viable treatment plan for ADHD. The development of self-regulation requires active teaching by parents and teachers, often in concert with pharmacological interventions to enhance attention and regulate impulse control. Such consistent intervention from families appears necessary to break the intergenerational cycle that is often found with ADHD.
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STEPHEN P. HINSHAW
Marriage and Family EncyclopediaFamily Health IssuesAttention Deficit/Hyperactivity Disorder (ADHD) - Demographics, Developmental Course, And Etiology, Family Processes And Adhd, Culture And Ethnicity, Treatment