Reply To: Behavioral Therapy Not Working

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More power to your son. I have always thought that the model of behavioural therapy in ADHD, and in fact the whole “executive functions model” is fragile, to say the least.

In fact, to put it more baldly than that it is effectively an extension of the teaching methods that are already failing the ADHD person- but, what the hell– “if at first something soesn’t work do it again- but louder”
Im almost 56 and despite ADHD I work as a health professional. One thing I can say very clearly is that there are many times (in fact most times) when my executive functions work extremely well.
Non ADHD individuals do not see this and do not see the times when we are functioning well and the nature of the way most people (including most professionals) see the problem is that it is relatively constant.

The behavioural reward strategy seems predicated on a model which assumes we (us ADHD individuals0.don’t know these behaviours or why they are worthwhile. Personally, I find that insulting- and I suspect your son feels the same way.

We do actually know thesebehaviours, and how and whyto use them, but sometimes we can’t access them. It makes it infuriating to then be treated as though we dont know stuff that we do- it usually gets our back up and brings out our oppositional side– which is best seen as a healthy and highly necessary ego defence.

ADHD can be conceived as a disorder of self regulation- and the most important item to be regulated is autonomic function.
Additionally the challenge of sitting in a chair and keeping enough blood flow to maintain circulation to the brain is a substantial one and if this mechanism fails we get either hyperactive, fidgety and impulsive, or worse we lapse into a state of low cerebral blood flow.
I was pleased recently to encounter this analysis from an expert in autonomic nervous system dysfunction in Arizona– it explains my troubles perfectly:

Note that “bad behaviours” like being fidgetty and tapping with ones feet are actually unconscious strategies to improve blood return from the legs into the central circulation—- but you can bet ADHD kids will be told off for that.

I also quote from an article called “Somatic Perspectives in Psychotherapy” by a Prof Stephen Porges, who is one of the most influential people working in the field of neurology. The full article can be accessed at his website:

Physical and mental illness may be a consequence of an adherence to Descartes’ dictum. Thus not responding to the body’s own responses and filtering visceral feelings, over time may contribute to illness by damping (appropriate) bi-directional feedback between brain and body.”

My comment here relates to the first video- ADHD kids are suffeing a powerful stress response because sitting still and upright in a chair is impairing the blood flow to their brains. The key command in the classroom is to NOT RESPOND to the body’s own responses and damping appropriate feedback- thus setting the stage for the many illnesses that adults with ADHD are prone to.

P2 answer 3
“Understanding the prerequisites for feeling safe is a critical issue in the modern world. Our culture takes a paradoxical perspective in defining safety. We focus on words and cognitive representations and minimise bodily responses and feelings to define safety.”
– And again- the feeling of lack of safety comes from a physiological response to a situation that none of us have been aware of. It doesnt matter what anyone says- it FEELS LIKE there is threat because of the way the body is reacting.

“If we observe children in a classroom, we see a variety of behavioural features that illustrate that some children are safe and can sit comfortably in the same situations that trigger in other children the hypervigilant behaviours characterising a lack of safety.
Moreover, the children who are chronically monitoring the room for danger cues are the same children who have difficulties in learning, while those with the features of feeling safe can attend to the teacher and learn efficiently.

Unfortunately, the traditional classroom model for education assumes that if some children can perform well in a classroom, every child should. Our society treats the behaviour of children who are behaviourally or viscerally reactive as “bad”. Society assumes that children should be able to turn these behaviours off voluntarily.”

This is so important to understand- with an active stress response stable attention focussed on one item of school work is extremely difficult. It is even difficult as an adult- but not impossible.

I much prefer mindfulness based therapies, which effectively ask “how does it feel when you are fuctioning well/hyperactive/ vague and inattentive” and how can you bring yourself into the zone where you function best.