A thoughtful Applied Behavioral Analysis (ABA) program can be an effective non-pharmaceutical intervention for children diagnosed with ADD/ADHD. More and more, ABA serves as an important treatment complement for children on stimulant medications. But ABA is often unfamiliar to parents of children with uncertain or emerging diagnoses, or who may be hoping to avoid stimulants. A behaviorally trained psychologist or Board-Certified Behavior Analyst should be an option of first resort for these families.  

ADHD: The Feedback Loop

The diagnosis of ADHD refers to individuals who have a chemical imbalance affecting impulse control and attention span at a biological level. This imbalance, naturally, impacts that individuals’ behaviors. An ADHD diagnosis indicates specific behaviors in how someone with ADHD participates with their environment; and, critically, how their environment responds.  Everyone is perpetually learning from the feedback they get from their environment, and this includes children with ADHD.  This feedback loop constantly adds information about what kind of behaviors will produce specific reactions in the environment.  When and how to avoid challenging tasks, when and how to produce a desired reaction, and when and how to access preferred items and activities are all informed by how one’s environment responds.  Everyone invariably uses this kind of information to guide decisions about how to behave.  All children experience such a feedback loop, but for the child with ADHD, the feedback loop can quickly increase maladaptive behaviors rather than functional behaviors.  These disruptive behaviors are easier to engage in and often produce desired results. And this is where behavioral therapy becomes crucial–when the chemical imbalance becomes actualized through what individuals learn through how they behave in their environments. These learned behaviors of children with ADHD—and learned responses of their teachers and parents—can create a thick learning history of problematic behaviors that reinforces and exacerbates the underlying chemical imbalance.

We know that medication can be hugely helpful for kids with ADHD symptoms—but we also know medication alone is seldom a silver bullet, and non-pharmaceutical interventions can be powerful agents for change in the lives of children with attention deficit feedback loop histories.

Benefits of behavioral intervention for ADHD

Behavioral intervention can be especially meaningful for parents who are not completely convinced that their child has an attention disorder, or parents who are not comfortable with the idea of medicating their children; even though they recognize something is not going well and their child might need help.  A non-pharmaceutical intervention can make an enormous positive impact and be a launching point to the decision-making process around ultimately assessing the need for medication. The children of diagnosis-skeptical parents tend to be identified by their teachers. Parents may get constant communication from their school, identifying that this type of child struggles to attend, doesn’t follow the routines that have remained constant all year, isn’t actualizing their potential, or displaying their “best effort”. Teachers may note that these children become frustrated easily, express anxiety around timed assignments, need frequent reminders to attend to tasks at hand, or are developing a reputation as a “bad kid”.  

Well-designed behavioral interventions can be game-changing for the children described above. At this point, parents might be thinking “my kid isn’t badly behaved, so why should they need behavior therapy?” What most people do not assume about behavioral therapy is that in addition to reducing problem behaviors, it also, crucially, increases skills and adaptive behaviors. Behavior therapy simultaneously helps children increase the behaviors that enable them to be successful in school and reduce behaviors that get in the way of actualizing their potential. 

For example–if a child is staring vacantly instead of attending to their teacher, a behaviorist might describe goals for them in two ways: reduce the behavior of “spacing out” (staring at nothing in particular, not visibly attending), and increase the behavior of being “on task” (looking at the teacher, taking notes, interacting by asking relevant questions, etc.).  

Ways to change behaviors via ABA

There are plenty of ways a BCBA might tackle this challenge. One of the most popular methods is called a Token Economy. A lot of people know of this as a “sticker chart”. It works by giving children attention and rewards for engaging in the behaviors that we want to see instead of behaviors that are interfering with their success. Once a child has collected enough stickers, they can trade them in for a preferred prize. So, for our child who is “spacing out”, we may start by giving them a sticker for every minute they are displaying “on task” behavior. As they become successful, we would fade the frequency of sticker reward to every 3 minutes, every 5 minutes, every 10, etc., until they no longer need the reward. Regardless of whether your child meets criteria for a diagnosis, if spacing out is a consistent problem for them at school, a properly implemented Token Economy will meet them where they are and guide them to where they need to be by teaching attending at the same time as they are learning whatever subject is being imparted. 

It sounds simple, but the problem is, it’s pretty complicated. Plenty of well-meaning educators try to implement such procedures in their schools and classrooms, but without specific behavior-training can design token economies in a way that will make things worse. This is in no way a dig at educators—their job is to teach a whole group of kids. One child who has different needs can’t always come before the rest of the class. Teachers might not have the time or resources to research individualized behavior strategies while tackling the many, many other tasks they have on their plates. 

A Board-Certified Behavior Analyst can be a huge asset here. BCBAs can go into schools, observe, write individualized behavior plans (that a teacher can comfortably enforce in a classroom setting) and train parents and teachers to implement them as well.  These systems, when written properly, are designed to be faded so children will not need them permanently. If a child can be successful without medication, or needs a support in addition to medication, a BCBA at Manhattan Psychology Group would be happy to help support your family.

Written by  Dorrie Barbanel, LMSW, BCBA, LBA

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