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Neurology Now:
doi: 10.1097/01.NNN.0000418733.67349.92
Departments: Your Questions Answered

Ask the Experts: ADHD

Denckla, Martha Bridge M.D.

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Martha Bridge Denckla, M.D., is a professor of neurology, pediatrics, and psychiatry at the Johns Hopkins University School of Medicine, and a member of the American Academy of Neurology.

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Is there a way to reduce or eliminate ADHD in children without medication?

Q Is there a way to reduce or eliminate ADHD in children without medication?


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A First, it's important to do a thorough neurologic and neuropsychological examination in order to determine whether the child has ADHD—in other words, a brain that is not age-appropriate with respect to motor, cognitive, and emotional control. Medication for ADHD can help to improve the child's emotional control, which is very important for social relationships.

However, I find two non-pharmaceutical approaches for children with ADHD useful as well. The first is positively oriented behavior modification. Behavior modification is based on identifying a behavior that needs to be modified and then identifying the antecedent and the consequence of that behavior. Here's an example: a child is homesick (antecedent) so he starts crying in class (behavior) and gets reprimanded by his teacher for being disruptive (consequence). Unfortunately many people—child psychologists and school systems included—assume that consequences must always be something painful or negative: Three strikes and you're out.

Research has demonstrated that you can achieve better learned behaviors if you use positive behavior modification. So, for example, if you catch a child doing something constructive, you give him or her a check mark or a happy face and then dole out awards based on the child earning a certain number of check marks or happy faces. Parents might want to consult with their child's psychologist or therapist to decide what kinds of awards are appropriate. Punishment is reserved only for things that are harmful to the child or to others. Studies have shown this positive approach to be very effective.

The second method is specialized tutoring in the school setting: how to study, how to write a paper, and how to manage time. The children become more organized learners and can sometimes succeed without drugs.

©2012 American Academy of Neurology

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