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Efficacy of Cognitive Behavior Therapy
Cognitive Behavior Therapy (CBT) refers to a set of intervention strategies devised to cause behavioral changes among children with ADHD symptoms or other similar conditions. As opposed to medical interventions, which involve the administration of medicinal drugs, CBT revolves around eradicating the negative behaviors exhibited by children suffering from the condition.
Even though skeptics maintain that CBT is a short-term intervention strategy, which is meant to cause short-term changes in behavior, research indicates that the coping skills imparted to individuals suffering from ADHD remain viable even after withdrawal of the interventions (Jarrett, 2013). CBT involves organizing sessions with the subjects in which coping strategies are trained to the beneficiaries.
This paper seeks to support the hypothesis that CBT is an effective intervention strategy in the treatment of ADHD through a review of the literature available on the topic. The research question is the efficacy of Cognitive Behavior Therapy in children with ADHD.
Components of CBT
CBT can be performed in either an individual or a group setting depending on the characteristics of the clients. Ideally, an individualized CBT involves training each client separately and these sessions take shorter periods, usually 60 minutes (Cabiya et al., 2008). On the other hand, group therapies involve training the entire group simultaneously.
Usually, these sessions last for longer periods, usually 90 minutes per session, to allow each client to comment on his or her personal experiences (Daley et al., 2015). In most cases, CBT is executed on both outpatient and inpatient basis. However, psychologists argue that the therapy produces better results when executed in an outpatient setting since it allows the counselor to understand the environment of the client.
The interventions offered to clients vary from one individual to another depending on the intensity of the ADHD symptoms exhibited by that individual. Conversely, Ghafoori and Tracz (2001) recommend the following standardized interventions for all victims of ADHD
- Functional analysis of the symptoms
- Examining the patient’s cognitive processes
- The identification and debriefing of past and future high-risk situations
- Personalized training in coping with undesirable behaviors
- Practicing skills during sessions
- Encouraging and reviewing extra practice of skills between sessions
The administration of CBT may vary from one group to the other depending on the severity of the symptoms and the anticipated end results from such interventions. However, a normal CBT involves daily 60 minutes sessions divided into three 20-minutes sub-sessions.
Under the arrangement, each 20 minutes session centers on a special theme distinct from the themes of the subsequent sessions. The first 20-minutes session involves the identification of the patient’s negative behaviors and the practical difficulties experienced by the individual in implementing skills learned in the previous session.
In this session, the client does much of the talking while the counselor listens carefully and poses various questions to gain insight on the perception of the beneficiary regarding the previous session (Ghafoori & Tracz, 2001). The counselor utilizes the next 20 minutes to introduce the topic of the day. In this session, contrary to the first session where the client does most of the talking, the therapist talks while the clients listen.
In this phase, the counselor may pose questions to assess whether the client understood the presented theme in the first session. Repetition of major concepts may be inevitable to ensure that the client understands the topic introduced. Some of the common topics that form the themes for this session include, but not limited to
- Coping with undesirable behaviors
- Shoring up motivation and a commitment to quit such behaviors
- Refusal skills/assertiveness
- Seemingly irrelevant decisions
- An all-purpose coping plan
- Problem solving
- Case management
The last 20 minutes session is tailored towards igniting discussion between the client and the therapist guided by the topic introduced in the previous session. Towards the end of the session, the clients are asked to propose a theme of their choice to be explored in the next lesson.
The Efficacy of CBT in children suffering from ADHD
A research conducted by Abdollahian, Mokhber, Balaghi, and Moharrari (2013) reveals that CBT is effective both in the short run and in the long-term. The study was conducted quantitatively on children aged between seven and nine years. The study confirmed that children who received cognitive behavior treatment exhibited fewer symptoms of ADHD both in the short run and in the long-term.
The study revealed that the skills acquired by the children in the sessions were relevant in the long term since the children’s behaviors were modeled entirely (Abdollahian et al. 2013). The results of the study concurred with that of Cabiya et al. (2008) in that children who received cognitive behavior treatment exhibited fewer symptoms of ADHD both in the short run and in the long-term.
Breinholst, Esbjørn, Reinholdt-Dunne, and Stallard (2012) add to the data available on the efficiency of CBT in the treatment of ADHD through a review of the literature by different researchers. To qualify for inclusion, an article had to be a randomized controlled trial (RCT) making a comparison between child-only cognitive behavioral therapy (CBT) and CBT coupled with active parental involvement.
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The majority of the articles reviewed in this study revealed that both child-only CBT and CBT combined with active parental involvement were equally effective in treating the condition. Various studies concur that CBT is effective in the treatment of ADHD among children diagnosed with the condition. Cabiya et al. (2008) proved this theory from a quantitative research conducted on children aged between 8 and 13 years.
The research recruited 608 children with ADHD symptoms drawn from either gender. The sample was divided into two research groups, viz. the treatment group, and the control group. Teachers were actively involved in the selection of children to be recruited in the study due to their outstanding knowledge they had regarding the children’s behaviors in the classroom.
The study revealed that CBT was effective in the treatment of ADHD among children as it produced positive results on the treatment group as opposed to the control group. The treatment group showed great improvement regarding the notable behavioral changes through increased self-esteem and enhanced ability to share ideas.
Chavira, Bustos, Garcia, Ng, and Camacho (2015) employed qualitative techniques to extract information from the target population, regarding their proposals on the best ways to avail CBT among children in Latin America. Phone calls were made to individual participants and suggestions from each participant recorded.
Besides, interviews with parents of the children suffering from ADHD were conducted to gain insight into their perception regarding the effectiveness of CBT. The results showed that the parents perceived the therapy positively. Besides, most parents were of the opinion that the treatment was effective in containing the severity of the disease.
However, parents cited the need to address specific issues hampering the effectiveness of the intervention method. Some of the barriers identified included time, convenience, and illiteracy. Daley et al. (2015) analyzed research findings by different researchers documented in the available literature. Data collection was done quantitatively from various databases such as the Ovid, Web of Knowledge, ERIC, and CINAHAL.
The study reviewed 32 articles containing evidence regarding the effectiveness of CBT in the treatment of ADHD. The reviewed articles contained findings from researches conducted on defined samples of children suffering from the illness. The research concluded that there is no direct connection between CBT and the reduction of symptoms. However, the intervention assists in averting undesirable behaviors associated with the illness.
The study also established that training parents on the appropriate ways of handling their children’s behaviors would go a long way in averting the negative behaviors. Some researchers have based their studies on the evidence available in the literature to prove the hypothesis that CBT is an effective cure for ADHD amongst children.
Fabiano et al. (2009) conducted a meta-analysis of 174 articles exploring the topic on CBT with the aim of comparing the recommendations by different authors. The studies to be reviewed in this research had to meet certain inclusion criteria, viz. they had to be based on children yet to join the school.
The reviewed studies involved both qualitative and quantitative methods of data collection and analysis. The review revealed that children who received CBT were more likely to respond positively to behavioral changes than their counterparts who did not receive the therapy. In almost all the studies reviewed, children involved showed improvements in behavior, thus prompting the researchers to conclude that CBT is an effective treatment procedure for children with disruptive behaviors.
Fehlings, Roberts, Humphries, and Dawe (1991) also proved the effectiveness of CBT in the treatment of ADHD. The authors conducted research on a sample of 25 children aged between 7 and 13 years. The study was conducted quantitatively whereby the participants were divided into two groups with the treatment group receiving CBT while the control group received supportive therapy.
The results of the findings revealed that CBT was effective in the treatment of ADHD among children. It was successful in eliminating the undesirable behaviors amongst the participants. Parents and teachers reported great changes in the children’s behaviors that were characterized by the elimination of undesirable actions.
Similarly, Jarrett (2013) proved the effectiveness of CBT in the treatment of ADHD. The author designed a research to target children with ADHD symptoms aged between 8 and 12 years. Parents of the participating children were also recruited into the study. They were afforded some training regarding CBT to handle their children’s behavior back at home effectively.
Interventions in this research involved ten sessions each week in which parents and their children were engaged separately for 50 minutes and 30 minutes respectively. The research sought to unravel the effectiveness of CBT in reducing both anxiety and ADHD symptoms. The results revealed a great reduction in both anxiety and ADHD symptoms among the participating children. This aspect indicated that the therapy is an effective treatment method for both conditions.
Klassen, Miller, Raina, Lee, and Olsen (1999) carried out research on a sample of 999 children below 18 years with participants being grouped into three groups. CBT was availed to the first group. The second group received medical treatment alone while the final group received both treatments. The research was conducted quantitatively to compare the efficacy of the mentioned interventions.
Contrary to findings by most researchers in this field, the researchers found that CBT alone was not effective in the treatment of ADHD. The research proposed a combination of both interventions if the desired results are to be obtained. Children who received both treatments concurrently recorded a huge decrease in the ADHD symptoms as compared to their counterparts who received either CBT or medical treatment alone.
The research disputed findings by other researchers who have found CBT as an effective treatment method for the condition. Another significant contribution to the evidence on efficacy of CBT was made by Kerns, Read, Klugman, and Kendall (2013) based on findings from a qualitative research conducted on a sample of 91 children with developmental disorders including children suffering from ADHD.
The study availed two forms of treatment to the beneficiaries, viz. CBT treatment, and waitlist treatment condition. CBT involved engaging the participants in daily sessions aimed at eliminating the undesirable behaviors exhibited by children suffering from the condition. Results from the research showed that both interventions were successful in reducing anxiety among victims of ADHD.
Besides, the results indicated a great change in behavior of the participants illustrating the effectiveness of CBT as a treatment strategy. In another study, Moreno-García, Delgado-Pardo, de Rey, Meneres-Sancho, and Servera-Barceló (2015) found CBT as an effective intervention strategy for the treatment of ADHD among children. The research was conducted on a sample of children to determine the effectiveness of the three ADHD intervention strategies, viz. neurofeedback, pharmacological treatment, and behavioral therapy.
The study recruited 57 participants selected randomly from children with symptoms of the illness. The participants were aged between 7 and 14 years. They were picked randomly to obtain the three treatments plans. Records regarding each patient’s progress were maintained, and medical practitioners involved in the research were required to report on all the observable changes.
Results of the study indicated that the three types of interventions produced similar results regarding behavior change. Therefore, the research team concluded that each of the three interventions were effective for the treatment of ADHD among children. Ozsivadjian, Knott, and Magiati (2012) conducted a qualitative research to gain insight on the parents’ perception regarding their children’s behaviors.
Parents participating in the study cited certain undesirable behaviors exhibited by their children such as reluctance to engage in social relations, repetitive behaviors, somatic problems and concentration deficiency among others (Ozsivadjian et al., 2012). Besides, parents expressed their children’s reluctance in sharing ideas with others for fear of being victimized.
However, most parents emphasized the undesirable behaviors by their children, which heightened their dependence on others. The high dependence was attributable to the view that the children perceive that their counterparts are only focusing on the negative side, thus creating anxiety. Since the ADHD is compounded by such negative perception by children, CBT could be useful in modeling the victims’ behaviors, thus alleviating the negative behaviors.
Webster-Stratton, Reid, and Beauchaine (2011) investigated the effects of encouraging parents and guardians to embrace non-punishment strategies when attempting to alter their children’s behaviors. The research recruited parents and children to participate in the training that centered on behavioral change.
Data was collected through interviews coupled with questionnaires. Ninety-nine (99) children aged between four and six years were recruited to the program with the sample being divided into two groups, viz. the treatment and the control groups. The study combined both qualitative and quantitative techniques to collect data regarding behavioral changes from the participants before and after interventions.
Parents were then asked to report on the changes notable on their children’s behaviors following the interventions afforded by both the guardians and the researchers. Most parents reported significant changes regarding hyperactive, oppositional, and aggressive behavioral problems that were prevalent among the kids before the interventions.
Additionally, the reports indicated that the children’s confidence level had improved significantly following the behavioral interventions afforded by the researchers in partnership with the parents. Young (2012) found that CBT was effective in averting undesirable behaviors among children suffering from ADHD. The study recruited 68 children with symptoms of ADHD who were not under any form of medication at the time of the study.
The participants were aged between 14 and 18 years. The research invoked both quantitative and qualitative methods whereby all the participants received CBT in six consecutive phases. Interviews were used to collect data from children and parents to supplement data collected through observations and the questionnaires.
Various stakeholders were given a questionnaire on which they were to record behavioral changes on each child upon the completion of each stage of CBT interventions. The research escalated with the parents and teachers reporting positive changes in the participating children’s behaviors. The children also displayed some improvements in their self-esteem levels.
CBT is an intervention strategy that aims at altering the behaviors of an individual in place of administering medicinal drugs. Literature reviewed in this paper reveals that CBT is an effective treatment intervention strategy for children suffering from ADHD.
The studies reviewed in this article are based on quantitative, qualitative, and mixed methods, and they all concur that CBT is an effective treatment strategy for the condition. However, the studies recommend further research on the topic using a larger sample to fill gaps in the available findings.
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