Whilemedicationis often the first line of treatment for ADHD, behavior therapy has emerged as an effective complementary or alternative approach to managing the symptoms of this disorder.

This article will explore what behavior therapy is, how it can beused for treating ADHD, the techniques used, its effectiveness, considerations, limitations, and alternative therapies.
What is Behavior Therapy?
Behavior therapy, also known as behavior modification, is a type ofpsychotherapythat focuses on changing specific behaviors and helping individuals develop new, more adaptive behaviors.
The goal of behavior therapy is to reinforce desired behaviors and eliminate unwanted or maladaptive behaviors.
According to Skinner,reinforcement, both positive and negative, increases the likelihood of a behavior being repeated, while punishment decreases the likelihood of a behavior being repeated.
In behavior therapy, the therapist works with the individual to identify the specific behaviors that need to be changed and then develops a plan to modify the environmental factors that contribute to those behaviors.
How Behavior Therapy Can Be Used for Treating ADHD
Behavior therapyhas been shown to be an effective treatmentfor ADHD in both children and adults.
In the context of ADHD, behavior therapy focuses on improving specific behaviors such as organization, time management, and social skills.
The therapist works with the individual to set clear goals and develop strategies for achieving those goals. This may involve teaching the individual new skills, such as how to break down tasks into smaller steps, or modifying the environment to reduce distractions and improve focus.
Techniques Used in Behavior Therapy for ADHD
There are several techniques used in behavior therapy for ADHD, including:
Parent training
Parents learn strategies for managing their child’s behavior, such as setting clear expectations, using positive reinforcement, and implementing consistent consequences for misbehavior.
Classroom interventions
Teachers learn strategies for managing behavior in the classroom, such as providing clear instructions, breaking down tasks into smaller steps, and using positive reinforcement.
Skill-building
The individual learns new skills to help them manage theirADHD symptoms, such as organization, time management, and social skills.
Behavioral contracts
The individual and therapist develop a written contract that outlines specific behaviors to be changed and the consequences for engaging in those behaviors.
Behavior Therapy in Children vs. Adults with ADHD
While the core principles of behavior therapy remain the same, the specific techniques and strategies used may differ depending on the age of the individual with ADHD. Here are some key differences in how behavior therapy is used in children versus adults:
Children with ADHD:
Adults with ADHD:
Regardless of age, behavior therapy for ADHD is most effective when it is individualized to the specific needs and goals of the person receiving treatment.
The therapist should work collaboratively with the individual (and their family members or significant others, as appropriate) to develop a treatment plan that addresses their unique challenges and builds on their strengths.
Regular monitoring and adjustment of the treatment plan may be necessary to ensure that the individual is making progress towards their goals and to address any barriers or setbacks that arise along the way.
Effectiveness of Behavior Therapy for ADHD
Research has consistently shown that behavior therapy is an effective treatment for ADHD.
A meta-analysisof 174 studies found that behavior therapy significantly reduced ADHD symptoms in children and adolescents.
Another study foundthat a combination of behavior therapy and medication was more effective than medication alone in reducing ADHD symptoms.
Behavior therapy has also been shown to have long-lasting effects.A study that followed children with ADHDfor two years found that those who received behavior therapy had significantly better outcomes than those who received only medication.
Considerations and Limitations
While behavior therapy is an effective treatment for ADHD, there are some considerations and limitations to keep in mind.
One potential concern is that behavior therapy could contributeto masking behaviors, leading individuals to suppress their true selves in order to fit into a mold that society deems acceptable.
By focusing on modifying behaviors to meet societal expectations, behavior therapy may inadvertently send the message that there is something wrong with the individual’s natural way of being.
However, it is important to recognize that the goal of behavior therapy is not to change an individual’s personality or to force them to conform to a narrow set of societal norms.
Rather, the aim is to help individuals develop skills and strategies to manage their ADHD symptoms in a way that allows them to function more effectively in their daily lives.
Many of the behaviors targeted in behavior therapy, such asimpulsivityor inattention, can have negative consequences for individuals with ADHD, leading to difficulties in school, work, and social relationships.
By learning to manage these behaviors, individuals with ADHD can experience greater success and satisfaction in these areas of life.
Moreover, behavior therapy is not a one-size-fits-all approach. A skilled therapist will work collaboratively with the individual to develop a treatment plan that is tailored to their unique needs and goals. This may involve finding ways to harness the individual’s strengths and creativity while also addressing areas of challenge.
It is also worth noting that behavior therapy is just one component of a comprehensive treatment plan for ADHD. Other approaches, such as medication, can help alleviate symptoms and allow individuals to function more effectively without necessarily altering their fundamental personality or sense of self.
Ultimately, the decision to pursue behavior therapy or any other treatment for ADHD is a personal one that should be made in consultation with a qualified healthcare provider.
While it is important to be mindful of the potential for behavior therapy to contribute to masking behaviors, it is equally important to recognize the potential benefits of this approach in helping individuals with ADHD lead more fulfilling and successful lives.
Alternative Therapies to Consider
While behavior therapy and medication are the most well-established treatments for ADHD, there are some alternative therapies that may be helpful for some individuals. These include:
Conclusion
Behavior therapy is a highly effective treatment for managing the symptoms of ADHD. By focusing on changing specific behaviors and developing new skills, individuals with ADHD can improve their daily functioning and quality of life.
While behavior therapy requires a significant time commitment and may not be effective for all individuals, it is a valuable tool in the treatment of this common disorder.
References
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.).
Arns, M., De Ridder, S., Strehl, U., Breteler, M., & Coenen, A. (2009). Efficacy of neurofeedback treatment in ADHD: the effects on inattention, impulsivity and hyperactivity: a meta-analysis.Clinical EEG and neuroscience,40(3), 180-189.https://doi.org/10.1177/155005940904000311
Barkley, R. A. (2002). Psychosocial treatments for attention-deficit/hyperactivity disorder in children.Journal of clinical psychiatry,63, 36-43.
Cairncross, M., & Miller, C. J. (2020). The effectiveness of mindfulness-based therapies for ADHD: A meta-analytic review.Journal of attention disorders,24(5), 627-643.https://doi.org/10.1177/1087054715625301
DuPaul, G. J., & Weyandt, L. L. (2006). School‐based Intervention for Children with Attention Deficit Hyperactivity Disorder: Effects on academic, social, and behavioural functioning.International journal of disability, development and education,53(2), 161-176.https://doi.org/10.1080/10349120600716141
Fabiano, G. A., Pelham Jr, W. E., Coles, E. K., Gnagy, E. M., Chronis-Tuscano, A., & O’Connor, B. C. (2009). A meta-analysis of behavioral treatments for attention-deficit/hyperactivity disorder.Clinical psychology review,29(2), 129-140.https://doi.org/10.1016/j.cpr.2008.11.001
Huang, Y. S., & Tsai, M. H. (2011). Long-term outcomes with medications for attention-deficit hyperactivity disorder: current status of knowledge.Cns Drugs,25(7), 539-554.https://doi.org/10.2165/11589380-000000000-00000
Molina, B. S., Hinshaw, S. P., Swanson, J. M., Arnold, L. E., Vitiello, B., Jensen, P. S., … & MTA Cooperative Group. (2009). The MTA at 8 years: prospective follow-up of children treated for combined-type ADHD in a multisite study.Journal of the American Academy of Child & Adolescent Psychiatry,48(5), 484-500.https://doi.org/10.1097/CHI.0b013e31819c23d0
Ng, Q. X., Ho, C. Y. X., Chan, H. W., Yong, B. Z. J., & Yeo, W. S. (2017). Managing childhood and adolescent attention-deficit/hyperactivity disorder (ADHD) with exercise: A systematic review.Complementary therapies in medicine,34, 123-128.https://doi.org/10.1016/j.ctim.2017.08.018
Pelham Jr, W. E., Fabiano, G. A., Waxmonsky, J. G., Greiner, A. R., Gnagy, E. M., Pelham III, W. E., … & Murphy, S. A. (2016). Treatment sequencing for childhood ADHD: A multiple-randomization study of adaptive medication and behavioral interventions.Journal of Clinical Child & Adolescent Psychology,45(4), 396-415.https://doi.org/10.1080/15374416.2015.1105138
Raghibi, M., Fouladi, S., & Bakhshani, N. M. (2014). Parent training and behavior therapy on behaviors of children with attention deficit-hyperactivity disorder.Health Scope, 3(2), e15418.https://doi.org/10.17795/jhealthscope-15418
Skinner, B. F. (1963). Operant behavior.American Psychologist, 18(8), 503-515.https://doi.org/10.1037/h0045185
Van Den Hoofdakker, B. J., Van der Veen-Mulders, L., Sytema, S., Emmelkamp, P. M., Minderaa, R. B., & Nauta, M. H. (2007). Effectiveness of behavioral parent training for children with ADHD in routine clinical practice: a randomized controlled study.Journal of the American Academy of Child & Adolescent Psychiatry,46(10), 1263-1271.https://doi.org/10.1097/chi.0b013e3181354bc2
![]()
Saul McLeod, PhD
BSc (Hons) Psychology, MRes, PhD, University of Manchester
Saul McLeod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.
Olivia Guy-Evans, MSc
BSc (Hons) Psychology, MSc Psychology of Education
Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.