Areas › Focus, starting, and ADHD › Treatment and medication
After a working lifetime in this field, Barkley names the change in how a family sees the child as the most important step of all. Not the medication, not the charts.
The reason is practical rather than sentimental. Every other part of treatment asks parents to keep going for weeks with very little to show for it, and nobody sustains that for a child they still believe is choosing to defy them. Those parents apply the plan unevenly, drop it early, and read the first bad week as proof they were right. The reframe is what makes everything else get done.
This explains how treatments work. Never start, stop or change a medication because of something you read here.
Qur’an and Sunnah
God does not change the condition of a people unless they change what is in themselves (Quran 13:11). Something inward shifting first, and the outward following, is the order being described.
لَهُۥ مُعَقِّبَٰتࣱ مِّنۢ بَيۡنِ يَدَيۡهِ وَمِنۡ خَلۡفِهِۦ يَحۡفَظُونَهُۥ مِنۡ أَمۡرِ ٱللَّهِۗ إِنَّ ٱللَّهَ لَا يُغَيِّرُ مَا بِقَوۡمٍ حَتَّىٰ يُغَيِّرُواْ مَا بِأَنفُسِهِمۡۗ وَإِذَآ أَرَادَ ٱللَّهُ بِقَوۡمࣲ سُوٓءࣰ ا فَلَا مَرَدَّ لَهُۥۚ وَمَا لَهُم مِّن دُونِهِۦ مِن وَالٍ
each person has guardian angels before him and behind, watching over him by God’s command. God does not change the condition of a people [for the worse] unless they change what is in themselves, but if He wills harm on a people, no one can ward it off–– apart from Him, they have no protector
Qur’an 13:11read it in the library
Translation: M.A.S. Abdel Haleem, The Qur'an, Oxford University Press, 2004.
What the research says
A meta analytic review of nine randomised and three uncontrolled trials asked whether the gains from psychosocial treatment in adult ADHD are still present at long term follow up. Whether people keep doing something, and whether the benefit lasts, is a live question in this literature rather than an assumption. That is consistent with the point here, though the review looked at adults in treatment and not at what parents believe about their children.
López-Pinar C, Martínez-Sanchís S, Carbonell-Vayá E, Fenollar-Cortés J, Sánchez-Meca J. (2018). Long-Term Efficacy of Psychosocial Treatments for Adults With Attention-Deficit/Hyperactivity Disorder: A Meta-Analytic Review.. Frontiers in psychology doi
Strength of evidence: one line of research. A single study, or a theoretical account.
Why it works
Nobody keeps up slow, effortful help for a child they believe is simply refusing to try.
This one is still a draft. It is waiting on a scholar and a clinician to read it before it is published.
Near this one
If mindfulness is going to help with ADHD, the version with a chance is small and spread out. A few seconds of noticing, several times a day, rather than one long sitting you come to dread.
Think of ADHD as sitting at the centre of an onion. Poor sleep, sleep apnoea, low vitamin levels, allergy, ongoing pain, untreated anxiety or low mood all sit in layers around it, and each one makes the centre look worse than it is.
Programmes built on crossing the midline or on balance and inner ear work do not appear to beat ordinary exercise. If movement is what you are after, movement is available free.