Applied behavior analysis is used in the treatment of attention deficit disorder and attention deficit/hyperactivity disorder by instituting behavioral changes to help make the socially disruptive symptoms less prominent and to allow patients to function more easily and with greater success in both public and private settings.
Any parent can tell you that every child can become fidgety, bored, ill mannered, and disruptive from time to time. Developing the maturity to cope with boredom and inattention is part of the process of growing up.
But for some kids, it’s more of a challenge, because their attention issues are not simply the normal expressions of a maturing mind. Instead, they are affected by a still-mysterious syndrome that disrupts the process of focus and causes almost uncontrollable outbursts at inappropriate moments.
This is attention deficit/hyperactivity disorder (ADHD), and applied behavior analysis (ABA) is currently the best available treatment for it.
A 2011 survey conducted by the Centers for Disease Control and Prevention found that around 11 percent of American children between the ages of 4 and 17 suffer from this disorder to some degree. As a long-term, chronic condition with no known cure, almost all of these children will grow to adulthood while still coping with the disorder. To adjust to normal lifestyles and to realize their full capabilities, they have no choice but to manage it. In many cases, this is accomplished through some level of intervention at the hands of an applied behavior analyst.
Behavioral Issues Related to ADHD Have Behavioral Solutions
There are three types of ADHD:
- Inattention – Identifiable by being easily distracted and having inattention to matters that other people would focus on in a particular situation.
- Hyperactivity and Impulsivity – Identifiable by fidgeting and squirming, a general inability to sit still, and blurting out speech while interrupting others.
- Combined – This is the most commonly diagnosed type of ADHD, and combines both the inattention and hyperactivity elements of the other types.
There are 9 measurable symptoms for each category, of which 6 must be met for a positive diagnosis. The diagnosis also has a severity component: mild, moderate, or severe.
Mild cases are rarely treated by applied behavior analysts since the symptoms do not rise to clinical significance for most patients.
Patients with moderate or severe symptoms can be treated with the common operant conditioning techniques that ABAs routinely employ:
- Differential reinforcement of behaviors – Positive reinforcement is offered for appropriate behaviors while negative or (more commonly) no reinforcement is given when negative behaviors are expressed.
- Discrete Trial Training – This method involves breaking down complex behaviors into a number of elements, which are separately and sequentially reinforced to build up into the desired behavior.
- Self-management training – Used primarily with older patients, this technique teaches self-awareness and provides a toolbox of skills, including self-praise, that can help with the self-management of problematic behaviors.
Scaling the levels of reinforcement is particularly key for ADHD patients, since studies show that, on average, kids with ADHD have one or two negative interactions per minute with parents or educators. Although it is natural for parents and teachers to respond negatively to disruptions based on their experience with non-ADHD kids, it is profoundly discouraging and ineffective in actually resolving behavioral issues related to ADHD.
A skilled ABA has the ability to evaluate the level of positive and negative reinforcement and to help guide the response of parents and teachers to balance that feedback in such a way that they achieve the desired results.
Working with Parents and Educators to Ensure Students with ADHD Succeed
Almost all ADHD cases begin with a functional behavioral assessment (FBA), which involves both observing and interacting with the patient, as well as looking at disciplinary or other records and interviewing parents or teachers. This process establishes concrete criteria for problematic behaviors and provides the necessary basis of information the ABA will use to formulate a behavior intervention plan (BIP).
Because so many ADHD patients are still in school, the BIP is often incorporated into a federally-mandated educational plan called an Individualized Education Plan (IEP) used for special needs students. The ABA will work closely with educators to incorporate behavioral treatments into teaching and disciplinary plans for the student.
ABAs working with ADHD also commonly work very closely with parents. Because the difficulties rising from ADHD are a constant challenge during every waking minute, the brunt of the reinforcement cycle will fall on the people around the patient the most. This is true to such a large extent that many of the ABA treatments for ADHD in the home environment are actually called “parent training” since the focus is on teaching parents to apply ABA methods without direct oversight. Some of these programs include:
- Parent-Child Interaction Therapy
- Parent Management Training
- Positive Parenting Program
ADHD Represents a Long-Term Problem For Patients
Researchers are still unsure what causes ADHD so definitive medical treatment is unavailable. Managing the symptoms remains the best hope for anyone diagnosed with the disorder.
In fact, the CDC recommends that applied behavior analysis treatments be used initially in all ADHD cases in children, and should be attempted before any medications are prescribed or other types of treatment are given.
A 2009 analysis of 20 years worth of studies on ABA treatment of ADHD indicated that this sort of faith is well-placed: all behavioral methods tested showed significant effects, in some cases measuring up to 80 percent improvement. The effect was measurable across all techniques tested and included implementation by professional behavior analysts, by educators and other healthcare workers, and by parents in a home environment.
ADHD patients commonly experience other psychological issues that include:
- Learning disabilities
- Conduct disorders
- Addiction and other substance abuse problems
The presence of these complications can also affect how the ABA approaches the case. As always, the FBA will result in an individualized perspective that accounts for all the factors influencing patient behavior.
Preparing for a Career Working With ADHD as an Applied Behavior Analyst
According to a 2015 survey by research organization Burning Glass, 39 percent of all applied behavior analysts are employed in either educational service roles or with social assistance agencies. In both of these roles, ABAs are likely to encounter a high proportion of patients who are afflicted with ADHD.
Some parents seek the services of ABAs in private practice directly for in-home interventions for their kids with ADHD. Most clinics offering these services do not specialize in ADHD but offer more general services.
In many cases, particularly in the social assistance services, these positions require you to have an official certificate as a Board Certified Behavior Analyst (BCBA®®). Offered as a national credential through the non-profit Behavior Analyst Certification Board (BACB), the BCBA®® establishes certain minimum requirements and professional and ethical standards for the practice of applied behavior analysis.
A master’s degree, usually in psychology, education, or applied behavior analysis is required to obtain a BCBA®®. Any of these degrees are good preparation for working with ADHD patients.
Some behavior analysts working in school systems are not required to hold a BCBA®® and may be exempted from state licensing requirements for behavior analysts. These positions typically have a strong focus in special education services, however, and advanced degrees in special education may be required.
School districts around the country are constantly in search of volunteers to work in both general and special education classrooms. Volunteering for these positions is a great way to gain experience with students suffering from ADHD and many other common developmental disabilities.
Further Reading on Applied Behavior Analysis in the Treatment of ADHD
National Institute of Mental Health ADHD Resource Page – NIMH offers an overview of the disorder and discussion of common treatments and prognoses.
American Academy of Pediatrics ADHD Best Practices Guide – A non-profit organization focused on pediatric medicine, the AAP provides clinical best practice guidelines for healthcare professionals working with children with ADHD.