Are There Side Effects to Therapy?
When parents are seeking help for their children with ADHD and considering different types of approaches, “side effects” are most commonly associated with medications. Psychiatrists and pediatricians have a pretty easy time in reviewing the most common potential side effects of medication, however psychologists and other mental health professionals have less research to rely on regarding possible side effects of therapy. The latest issue of the ADHD Report by Russell Barkley, Ph.D., and Associates, is titled “Focus on the Side Effects of Psychosocial Treatments for Children and Teens with ADHD: A Special Issue.” This is not a commonly asked question by potential patients, but a worthy one nonetheless. This report reviewed the potential negative side effects of Behavioral Parent Training (BPT), School Behavioral Interventions, and Social Skills Training.
The highlights of the research are:
- Behavioral Parent Training (BPT) – BPT is a behavior management approach which closely involves the parents and the therapist to change or improve targeted negative behavior sof the child. Possible unwanted effects of treatment occur when an unskilled therapist 1) doesn’t choose the right approach, 2) doesn’t implement the approach well, or 3) there are specific characteristics of the child or family that interfere with treatment. It’s extremely important for the therapist to do a thorough assessment of of all underlying emotional, developmental, and physical conditions that can mimic ADHD before starting treatment. BPT IS DIFFICULT and time time consuming, and often families are seeking treatment once things are so bad at home that they feel like they can’t fix it. There are many components on both the therapist’s part and the family’s part that make it time consuming and challenging, and proper assessment, implementation, and follow through are critical to making it successful. Without these, BPT can worsen conflict in the home, prolong the child’s struggles, and disillusion parents with mental health services.
- School Behavioral Interventions – School behavioral interventions can be implemented by a teacher or more formally through a Behavior improvement plan. Surprisingly, these interventions have little impact on academic achievement of students, however potentially a large positive impact on behavior in the classroom. There are many potential pitfalls of classroom management strategies that can lead to unintended frustrations or outcomes for both the teacher and the student (e.g. The intended “reward” causes the child unwanted attention or distracts the student; or when the student doesn’t get the reward, the teacher fails to follow through on a consequence, etc.). The biggest message in the research for SBI is that teachers need to work VERY CLOSELY with clinicians to make sure they are delivering strategies that are supported by research and are meaningful to the student, and when there are problems, seek help and tweak the system.
- Social Skills Training – Despite its popularity, research at this time has concluded that social skills groups are NOT empirically supported for children diagnosed with ADHD. There are social contagion effects (learning negative behaviors from other group members) that occur within groups of similar children (all diagnosed with ADHD). One way to that has been recommended to reduce this effect is to conduct “mixed groups” of children with different social skills challenges.
We are sharing this information with our readers primarily for the purpose of keeping you informed and “in the know.” Although treatment is sought out to help, it may not be what is at the end result. There are many great clinicians in the field and in schools and! Being an informed consumer helps you get the best of any product you are buying; and just because you or your child with ADHD is a “patient” doesn’t mean you should blindly follow along with an intervention if you don’t feel it’s working. Ask questions, stay informed and be your family’s advocate.