Behavioral and psychosocial treatments
Behavioral interventions are used to identify and provide positive reinforcement of adaptive coping behaviors to reduce problem behaviors. Behavior parent training and social skills training are one of the primarily recommended alternatives to medication management of ADHD. They are usually regarded as first-line treatments for very young children or those with mild to moderate ADHD. They are also the standard addon to medication treatment for severe presentations at any age. In summary, most guidelines recommend behavioral interventions for ADHD in any situation, either alone or in combination with medication treatment and these are the most frequently used nonpharmacological treatment among children and adolescents.
The efficacy of behavioral therapy in the treatment of ADHD is a matter of controversy. Current appraisals of the available evidence do not agree on whether the balance of evidence supports or refutes the efficacy of psychosocial treatments for ADHD. One meta-analysis concluded that behavioral treatments were effective for ADHD, and a review for the Agency for Health Care Research and Quality concluded that the A. Caye et al. evidence for positive effects of behavioral treatment on preschool children was strong enough to guide clinical practice. However, a Cochrane systematic review and meta-analysis of randomized trials concluded that while BPT may have a positive effect on the behavior of children and adolescents with ADHD, the evidence is not strong enough to guide clinical practice. A separate Cochrane meta-analysis concluded that the evidence was insufficient to support social skills training for adolescents. Several clinical guidelines have recommended both BPT and social skills as behavioral treatments. Some of these discrepancies may be explained by the type of rater considered by reviews. Two recent meta-analyses identified a moderate and statistically significant pooled effect size for behavioral therapies on ADHD symptoms when all probably unblinded raters were included but that this effect was not maintained when considering only probably blinded raters. The same group did, however, confirm that behavioral therapies were effective in improving positive parenting and conduct problems of children with ADHD, even on blinded ratings.