Leeann
Attention Deficit Disorder (ADD) or Attention-Deficit/Hyperactivity Disorder (ADHD), in
case of hyperactivity, is also a neurodevelopmental disease that causes impairment of attention,
impulse control, and self-regulation. The symptoms of these children can be treated using
medications. At the same time, clinical practice involves the use of non-pharmacological
interventions as a significant aspect of treatment, particularly if dealing with school-age children
(Centers for Disease Control and Prevention [CDC], 2023) The American Academy of Pediatrics
(2019) reports that behavioral therapy and psychosocial interventions are mandatory to be added
to the treatment of children aged 6 years and above. This discussion examines four of the non-
pharmacological interventions with evidence-based support in the treatment of a 6-year-old child
with ADD: parent training in behavior management, classroom behavioral interventions,
organization training, and structured physical activity and sleep hygiene.
Parent Training in Behavior Management
One of the best non-pharmacological methods of dealing with children with ADD is parent
training in behavior management. It allows the parents to implement positive reinforcement,
always employing the same strategy, to improve the self-control and attention of the child
(Shrestha et al., 2020). Disruptive behaviors at home can be reduced using techniques such as
predictable routines, brief instructions, recognition of appropriate behaviors, and time-outs
related to impulsivity. One of the first lines of behavioral therapy is parent training, which is
facilitated by the fact that organized parental involvement increases the generalization of
acquired behaviors in different environments(CDC, 2023). Psychiatric Nurse Practitioners (NP)
play a very important role in referring the parents to an evidence-based program such as Triple P
(Positive Parenting Program) or Incredible Years, whereby they get step-by-step advice. In the
case of a 6-year-old, regular parental coaching sessions and home practice may be used to
improve consistency, emotional regulation, and attention.
Classroom Behavioral Interventions and School Support
Since school is one of the primary settings in which the symptoms of inattention and
distractibility are noted, behavioral management interventions are needed in the classroom.
According to the guidelines given by AAP (2019), individualized classroom plans containing
token reward systems, visual schedules, frequent feedback, and preferential seating help the child
stay focused in class. The daily behavior charts offer teachers the ability to break lessons into
segments, incorporating breaks, and provide the ability to communicate with parents regarding
their progress. Ogundele and Ayyash (2023) pointed out that cooperation among parents,
educators, and healthcare givers is an important factor in the reinforcement of good behaviour
and academic performance. The communication on a multidisciplinary basis of the school nurse
and the school counselor can help plan these interventions and follow the child’s progress, to
ensure continuity between the home and school.
Training in Organizational Skills and Executive Function
Executive functions involve planning and organization – skills which children with ADD
will struggle with. Training in organizational skills also teaches them how to organize their time,
work, and resources. Shrestha et al. (2020) concluded that use of visual aids, planners, and
checklists may be beneficial in improving daily activities and school results. These steps involve
color-coded folders, working with picture-based work charts, working for a short amount of
time, and working for short breaks. Nurses and behavioral therapists can teach parents and
teachers how to use them and make them a normal occurrence. In the long run, such training
helps the child to be independent and have confidence in the way he or she goes about school
practices.
Physical Activity, Structured Routine, and Sleep Hygiene
Exercise and habits also have a large impact on improving cognitive and behavioral
functions of children with ADD. Regular workouts increase attention, executive functioning, and
emotional control by increasing the activity of dopamine and norepinephrine in the brain
(Ogundele & Ayyash, 2023). The CDC (2023) goes on to promote healthy lifestyles with proper
diets, adequate sleep and physical exercise. For a 6-year-old, it would be active play for 30-60
minutes a day and good sleep hygiene (8-12 hours a night), which is of great importance in
enhancing concentration and reducing hyperactivity. Nurses are able to educate families on how
to reduce time in front of the screens prior to bedtime, create relaxing bedtime routines, and use
visual supports to maintain structure in their daily lives.
Conclusion
Non-pharmacological treatment remains the core of the overall treatment of ADD in young
children. Individually, parent training, school-based behavioral interventions, organizational
skills training, and arranged physical activity and sleep hygiene help to control the behavioral,
environmental, and developmental components of the disorder. Nurses play a crucial role in
these interventions, as the coordination, education, and support of families with long-term
functioning results are mainly achieved following the directions of the clinical recommendations
by the United States of America (AACAP, 2019) and backed by the recent evidence (Ogundele &
Ayyash, 2023; Shrestha et al., 2020).
Reply from Stacy Weiner
Attention Deficit Disorder (ADD), as a variant of Attention-Deficit/Hyperactivity
Disorder (ADHD), is still among the most common neurodevelopmental disorders in children.
The United States Centers for Disease Control and Prevention guidelines and standards provided
by the American Academy of Pediatrics (AAP), the non-pharmacological intervention is the
main cornerstone of the treatment in children aged six years or less, as it forms the first-line
treatment or as a combination treatment with pharmacological treatments. It aims to create long-
term behavioral, cognitive, and environmental aids that focus on the reduction of symptoms and
enhancement of functionality. Four evidence-based non-pharmacological interventions are
discussed below.
Behavioral Parent Training (BPT)
Parents can take advantage of behavioral training as an essential intervention in
managing their children’s behavior. The main focus of such an undertaking revolves around the
benefits; comprising positive discipline interventions, well-defined routines that manage habits,
and enabling parents to reinforce activities or processes that enable to ensure consistency in
maintaining desirable behavioral traits among their children. As a result, Chacko et al. (2024)
highlight the significance of Behavioral Parental Training. It is discussed as an important element
in psychological interventions provided to children with ADHD.
As a result of its effectiveness, it manages symptoms and enhances parental
efficacy. The outcome of its use is improving fidelity and modifying different modules associated
with parent-training for a more home-appropriate status in the long run. Practically, the
structured programs, like Parent-Child Interaction Therapy or Triple P, can be designed to fit the
behavioral tendencies of the child, so that the consistency with the parent and the strengthening
of positive effects can be guaranteed.
School-Based Behavioral Interventions
The only way to maintain consistency in both the classroom and home environment
is through behavioral modification programs. These have ensured well-structured outcomes. The
reason is that they involve different approaches, such as token economies and positive
reinforcement. They are also instrumental in encouraging teacher-mediated feedback. Hence,
Yegencick et al. (2025) reiterate that the results include hyperactive and inattentive symptom
changes, which are meaningful in managing the disorder. These results are in line with the AAP
guideline, which suggests that teachers coordinate with clinicians to monitor and manipulate
behavioral targets. In the case of a six-year-old child, classroom measures, like the daily report
cards or seating organization, will help to enhance the level of attention and the rate of
completing a task.
Cognitive and Executive Function Training
Three main areas associated with the executive function (EF) training remained
important. It focused on areas such as lack of cognitive flexibility and working memory apart
from decreased attention level. These became central to the issue of attention deficit disorder. In
relation to the above, Wu et al. (2023) reiterate that there have been significant benefits related to
multi-component cognitive training. Among these benefits have included attention control and
positive working memory among children. As a result, this has become instrumental in ensuring
the addition of consistent behavioral outcomes related to cognitive training. Hence, children are
able to regulate their behavior in the long run.
Programs Initiating Structure Physical Activities among Children
Even though many people fail to consider physical activities and exercises a cure,
structured aerobic exercises can be used as a basis for managing or eliminating symptoms
associated with ADHD. For instance, in modern United States, the mental healthcare sector has
guidelines that categorize physical activities and exercises as important supplements to support
other initiatives. The integration of their initiative is instrumental in ensuring they self-manage
their behavior and stabilizes their mood, if practiced consistently. Children can manage their
hyperactivity via activities such as martial arts and well-planned outdoor activities among others.
These are also crucial for the stimulation of neurocognitive processes.
Conclusion
Generally, the use of evidence-based structure of physical activity and school-
based behavior system and executive functional training should be used in the treatment of ADD
among young children, although they should be used in congruity with the U.S. clinical
guidelines. Such interventions, when applied and enforced systematically across environments,
target the behavioral and cognitive domains of the disorder and reduce the need for medication at
an early stage of development.
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