Nonpharmacological Approaches to Treating ADHD across Childhood

Nonpharmacological Approaches to Treating ADHD across Childhood

Do you have a child with suspected or diagnosed Attention-Deficit/Hyperactivity Disorder (ADHD)? Have you tried elimination diets and holistic approaches and found that your child is still having symptoms of inattention, hyperactivity, and/or impulsivity?

Experts agree that ADHD medication is the most effective treatment for the majority of kids with ADHD. However, some kids do not tolerate the side effects of medication well, for example, children with autistic spectrum disorder. Fortunately, there are a lot of nonpharmacological therapies that may also help kids manage their ADHD symptoms. Some kids do best with a combination of treatments.

If you are interested in adding therapy to your child’s treatment plan, there are several different therapy approaches for ADHD. Some approaches are be better for younger children and others for older kids.

Behavior Therapy

If your child is under the age of 10, you will likely be referred for parent training in a child behavior management program. This type of behavior therapy involves teaching parents to set up a type of reward system for appropriate and on-task behavior that tends to be effective with children diagnosed with ADHD or ODD. In addition, parents are taught other behavior therapy tools such as differential reinforcement and compliance training. As such, this treatment is usually delivered to the parents in order to give them the necessary tools to manage their child’s challenging behavior at home. The reward systems can also be implemented at school with the cooperation of a child’s teacher.

In my practice, I use Russell Barkley’s system, which has a strong evidence-base behind it. Barkley has empirically supported (i.e., research-based) child behavior management programs for both younger children and adolescents. While the majority of the program is delivered to parents, several sessions around family issues such as positive family communication and family problem-solving also may include the child/adolescent.

Cognitive-Behavioral Therapy (CBT)

Individual cognitive-behavioral therapy involves identifying and changing untrue or unhelpful negative beliefs and behaviors that contribute to emotional problems. CBT is typically applied to treat anxiety and mood disorders. Because at least half of children with ADHD are also diagnosed with an anxiety or mood disorder, many of these children can benefit from CBT treatment. Because it is a talk therapy that involves a certain level of cognitive awareness and insight, CBT is best implemented in children age 10 or older. Children under the age of 10 may be able to participate if they have a parent present during the session to help with the transfer of skills to home. I often use CBT in my practice to address emotional issues involving anger, sadness, anxiety, and fear that are frequently present among children with ADHD.

Social Skills Training

Children with ADHD often struggle with using appropriate social behaviors and can receive a lot of negative feedback from adults and peers. Social skills training in either an individual or group setting can help children with ADHD to learn and practice appropriate communication skills and social behaviors so that they experience less social impairment with family, friends, and at school.

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Video Game Treatment

A new treatment available, EndeavorRx, is the first and currently only FDA-approved video game treatment for kids with ADHD. It is not a stand-alone treatment and not a substitute for ADHD medication, however, it is a safe add-on option for your existing treatment program. I have not had any clients use EndeavorRx yet because it can be fairly expensive so I cannot review it myself. It is possible that the prescription may be covered by insurance and if not, there is a Patient Assistance Program available that may help to reduce costs. If you are interested in looking into it for your child, you can learn more at And if you try it, be sure to let me know what you think!

ADHD throughout Childhood

Because ADHD is a neurodevelopmental disorder that typically arises before age 12, you may find yourself progressing through the different types of therapy as your child develops. That is, you may begin with parent training when your child is in early elementary school and not yet able to take full advantage of CBT by themselves. In late elementary/middle school, your child may benefit from social skills training to help them make and maintain healthy friendships with prosocial peers. Later, if they develop anxiety or depression related to frequent negative feedback from peers, teachers, or family members about their behavioral challenges, they may benefit from CBT to help them improve their mood and reduce social worry, as well as better problem solve social situations. In their mid to late teens, parents may wish to revisit the parent training and family modules around family problem-solving, family communication, and behavioral contracts (think curfew, substance use and other risky behaviors, respect and compliance, school performance and behavior, electronics use, and so on).

In sum, medication is the most effective treatment for ADHD but, for children who are unable to take medication, there are also several therapies that can help alleviate symptoms. Indeed, many children do best with a combination medication + therapy approach. Even if your child is taking medication to treat their symptoms, they may still experience problems related to ADHD which can cause them emotional distress and social impairment. As a parent, arming yourself with knowledge about the treatment options available to your child will help get them off on the right foot.

Local Resources for ADHD Assessment and Treatment

Northern Michigan Psychiatric Services (Sander Weckstein, MD): Call 231-935-0355 to learn more about assessment, therapy, and medication management.

Pine Rest Traverse City: Call 866-852-4001 to learn more about assessment, therapy, and medication management.

Wayne Simmons, PhD: Call 231-947-2442 to learn more about assessment and therapy.

Brain and Behavioral Health: Call 231-935-8900 to learn more about assessment and therapy.


Dr. Rebecca Swenson is a licensed clinical psychologist and parent coach who works with children, adolescents, young adults, and families in Northern Michigan with anxiety, depression, OCD, and eating disorders. If someone in your family is struggling with emotional/behavioral health issues, contact Dr. Swenson today to learn more about evidence-based treatments that can help.