Attention Magazine June 2021

Leading experts on ADHD find specific parent behavior management training approaches to be effective in helping children with ADHD improve their behavior. They find that aerobic exercise helps these children as well. If we bundled these interventions together, would it result in even greater improvement?

That’s the question explored by psychologist Erin Schoenfelder Gonzalez, pediatrician Pooja Tandon, and their colleagues at Seattle Children’s Hospital. Preliminary results suggest that combining these approaches does indeed seem to yield extra benefits.

Dr. Gonzalez’s team has piloted the Lifestyle Enhancement for ADHD Program, or LEAP, for the last several years. Three separate components comprise the program:

• a nine-week parent group-based behavior management training curriculum, now held virtually because of the pandemic
• a Garmin activity tracker worn on the wrist by both parent and child, accompanied by goal setting
• a parent Facebook group facilitated by a LEAP team member

The behavior management training (BMT) curriculum is based on specific practices Russell Barkley, PhD, describes in his book, Defiant Children. LEAP also incorporates a number of practices specifically focused on improving children’s health, including promoting physical exercise and sleep, addressing the barriers to good habits, and using approaches designed to set limits on screen time.

In addressing the health-related risks associated with ADHD in children, Dr. Gonzalez and her team are heeding advice Dr. Barkley gave in his keynote presentation at the 2018 Annual International Conference on ADHD in St. Louis. He described some of the later-life risks of ADHD in detail, among them a possible shorter lifespan.

Increasing the amount of daily physical exercise is a major focus of LEAP, and eliminating barriers is key. For children with ADHD, Dr. Gonzalez says, common barriers include losing interest in sports or other physical activities, symptoms that impact participation in sports and group activities, and day-to-day behavior management challenges, to name just a few. Dr. Gonzalez finds that family involvement is very important to address these and other challenges. She and her colleagues designed LEAP’s weekly groups and Facebook content to strongly support, encourage, and reinforce family involvement.

Family meetings also address common sleep-related difficulties experienced by children with ADHD. Dr. Gonzalez notes, for example, how often these children have difficulty winding down at bedtime. For some, screen time can also be a major problem in this regard. Dr. Gonzalez notes as well that up to 25 percent of children with ADHD can experience an actual sleep disorder. Meetings thus help parents on matters related to sleep hygiene, along with providing helpful behavior strategies for bedtime.

Parents and children are supported in setting weekly personalized goals that are ten percent above their previous week’s step counts. Group members receive goals for the week via text messages. Should a weekly goal not be met, step counts simply remain the same for the following week.

Dr. Gonzalez and her team recently completed a study that explored engagement in a population of children with ADHD. The study was accepted for publication by the Journal of Pediatric Psychology, and will be published in the near future. A larger randomized trial of LEAP is currently underway.

While Dr. Gonzalez notes that preliminary findings are positive, the team is working on improvements to their model. She thinks it may someday serve as an effective approach to helping children with ADHD not only improve their behavior and quality of life, but also minimize health-related risks years down the road.

Reach Dr. Gonzalez or members of her team at leapstudy@seattlechildrens.org to learn more.

A clinical and consulting psychologist, Mark Katz, PhD, is the director of Learning Development Services, an educational, psychological, and neuropsychological center in San Diego, California. As a contributing editor to Attention magazine, he writes the Promising Practices column and serves on the editorial advisory board. He is also a former member of CHADD’s professional advisory board and a recipient of the CHADD Hall of Fame Award.

ADDITIONAL READING

Barkley, Russell.  (2013). Defiant Children: A Clinician’s Manual for Assessment and Parent Training. The Guilford Press: New York.