Self-management and ADHD: A literature review.

Literature on self-management as it is applied to children with Attention Deficit Hyperactivity Disorder (ADHD) is reviewed in the context of Barkley's (1997) theoretical model of ADHD and best practices in overall treatment intervention. Searchers for articles in which self-management was applied to a sample with ADHD were conducted in medical, psychological, and educational databases. A total of fourteen articles and dissertations were located and reviewed. The authors' interpretations are discussed in light of Barkley's theoretical model and best practice in treatment. Future research directions and implications for practice are included. Keywords: Self-management, Attention Deficit Hyperactivity Disorder (ADHD), Behavioral Intervention. ********** Attention deficit hyperactivity disorder (ADHD) is the most prevalent neurobehavioral disorder diagnosed in children today with nearly 3.8 million diagnosed in the United States (Frazier & Merrell, 1997; Root & Resnick, 2003; "Treat ADHD," 2002). Given the prevalence of ADHD, considerable research has explored treatment options for this population. Literature reviews and meta-analyses of treatment options including medical management, psychosocial interventions, and educational treatments are available in their respective fields (see Conners; 2002; DuPaul & Eckert, 1997; Purdie, Hattie, & Carroll, 2002). This literature review briefly summarizes a theoretical model of ADHD and empirically supported best practices in treatment of ADHD as a means of establishing the context for a review of literature on self-management. The literature on self-management applied specifically to ADHD is limited in scope and contains discrepant findings. Variations in treatment methods and effects are considered. Future research directions and implications for professionals in the field of behavior analysis are discussed. Theoretical Model of ADHD and Support for Self-Management Teaching appropriate behavioral skills is a common intervention when an appropriate replacement behavior is warranted or a skill deficit is observed. Prior to teaching skills, it is always important to discriminate between actual behavioral deficits and behavioral performance. Barkley (2000) noted much of the research in the area of psychosocial and educational treatments for ADHD has been conducted based on the assumption that individuals with ADHD have skill deficits due to a lack of learning. He further postulated that these efforts have been misguided because a lack of learning is not the problem for this population. When considering treatment options, it is important to understand the nature of the disorder and the observed behavioral deficits. Barkley's (1997) theoretical model provides a useful context in which to evaluate possible treatment interventions and observed outcomes. Barkley (1997) proposed a theory of behavioral inhibition, sustained attention, and executive function in which he ascribed the fundamental problem of ADHD to a deficit in inhibitory control caused by a neurological difference in the prefrontal cortex. This lack of inhibitory control in individuals with ADHD impairs the executive functions that control organization and planning identified as nonverbal working memory, internalization of speech, self-regulation of affect/motivation/arousal, and behavioral analysis and synthesis. These impaired executive functions directly affect an individual's ability to self-manage behavior by limiting their capacity to a) consider their own behavior in the context of past events or possible future consequences, b) internalize self-directing statements [which is the crux of cognitive-behavioral self-management, Michenbaum, (1977)], c) self-regulate emotional reactions, motivation or effort towards a goal, and arousal, and d) coordinate evaluation of behavior through analysis of events or synthesis of ideas. Empirical research supports this theoretical model and specifically the assumption that children with ADHD present a deficit in self-regulation (Douglas 1989; Miranda, Presentacion, & Soriano 2002; Pennington & Ozonoff, 1996; Sergeant & van der Meere, 1990; Tannock, 1998). …