Non-pharmacological therapy

Behavioural therapy at school

School-focused interventions are aimed at enhancing academic performance, and improving classroom behaviour and peer relationships. These may be targeted specifically to one child, or integrated into classroom routines.1-3

These should include:

Many of the techniques described for behavioural therapy at home also apply in the classroom setting. A summary of effective behavioural techniques for children with ADHD that can be implemented in the classroom is given below.


Technique Description Example

Positive reinforcement Providing rewards or privileges contingent on the child's performance Child completes an assignment and is permitted to play on the computer
Time-out Removing access to positive reinforcement contingent on performance of unwanted or problem behaviour Child hits sibling impulsively and is required to sit for 5 minutes in the corner of the room
Response cost Withdrawing rewards or privileges contingent on the performance of unwanted or problem behaviour Child loses free time privileges for not completing homework
Token economy Combining positive reinforcement and response cost. The child earns rewards and privileges contingent on performing desired behaviours and loses rewards and privileges based on undesirable behaviour Child earns stars for completing assignments and loses stars for getting out of seat. The child cashes in the sum of stars at the end of the week for a prize.

Reproduced with permission from Pediatrics, Vol. 108, pages 1033–1044, Copyright © Oct 2001 by the AAP.

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References:
1. American Academy of Pediatrics Subcommittee on Attention-Deficit/Hyperactivity Disorder and Committee on Quality Improvement. Clinical practice guideline: Treatment of the school-aged child with attention-deficit/hyperactivity disorder. Pediatrics 2001; 108: 1033–44.
2. Taylor E, Döpfner M, Sergeant J, Asherson P, Banaschewski T, Rothenberger A, et al. European clinical guidelines for hyperkinetic disorder - first upgrade. Eur Child Adolesc Psychiatry 2004; 13: I7–I30.
3. Dulcan M. Practice parameters for the assessment and treatment of children, adolescents, and adults with attention-deficit/hyperactivity disorder. American Academy of Child and Adolescent Psychiatry. J Am Acad Child Adolesc Psychiatry 1997; 36: 85S–121S.

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