What is ADHD?

Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most common mental health disorders found in children with prevalence rates ranging from about 2% to 6%. Since so many children are affected by the disorder, multiple interventions have been developed to treat the cognitive and behavioral symptoms associated with ADHD (Barkley, 2003). Treatment services have increased substantially in the past 20 years due to formal advocacy groups such as Children and Adults with ADHD and the fact that special education laws now recognize ADHD as a disability that is eligible for specialized services in schools. Nonpharmacological treatments, such as behavior modification and behavioral parent training (BPT), are being used to treat the secondary problems associated with ADHD (Smith, Barkley, & Shapiro, 2006).

Understanding the essential features of the disorder is necessary in order to comprehend the effectiveness of its interventions. According to the fourth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR, 2000), five criterion areas make up the diagnostic criteria for ADHD. The main feature of ADHD is a persistent pattern of inattention and/or hyperactivity-impulsivity that occurs frequently and is more severe than what is typical for an individual at that age. Some of the inattentive or hyperactive-impulsive symptoms must have been present before age seven years. Some impairment must be present in at least two settings such as home, school, or work. Clear evidence of interference with developmentally appropriate social, academic, or occupational functioning must be present. The symptoms cannot occur only during the course of a Pervasive Developmental Disorder, Schizophrenia, or another Psychotic Disorder and cannot be better explained by another mental disorder. There are three types of ADHD: Combined, Predominantly Inattentive, and Predominantly Hyperactive-Impulsive. To be considered to have Combined Type, the person must have six or more symptoms of inattention and six or more symptoms of hyperactivity-impulsivity that have persisted for at least six months to a degree that is maladaptive and inconsistent with developmental level. For Predominantly Inattentive Type, they must have six or more inattention symptoms but not six or more hyperactivity-impulsive symptoms. The reverse is true for the Predominantly Hyperactive-Impulsive Type. ADHD is usually diagnosed during elementary school when the symptoms begin to interfere with school adjustment and academic performance.

There are many methods of treatment for ADHD. Stimulants, antidepressants, and antihypertensives are medications commonly used to increase attention and decrease activity level. Behavioral interventions are used in addition to medication or in place of drugs if they are not an option for a particular child. BPT is a behavioral intervention in which parents are trained to use reinforcement and punishment to help manage their child's behavioral symptoms. Studies have supported the efficacy of BPT in reducing secondary ADHD symptoms. Several similar BPT programs exist, including: Community Parent Education, The Incredible Years, parent-child interaction therapy, and Defiant Children. These programs are all based on reinforcement, such as praise, privilege, or tokens, for positive behavior and on punishment, such as loss of positive attention, privileges, or tokens, or formal time out, for noncompliant behavior (Smith, 2006).