Medication is the typical form of intervention provided to individuals with ADHD 94 Medication typically includes psychostimulants (e.g. Methylphenidate) and/or non-stimulants (e.g. Atomoxitne). Psychostimulants such as Methylphenidate are associated with reductions in symptomatology of hyperactivity and impulsivity as well as the promotion of cognition and academic performance among children with ADHD 94, 95. Strand et al. (2012) found that stimulant medication, in addition to incentives, promotes verbal working memory in contrast to a placebo, no-incentive condition. Importantly, the combination of incentives and stimulant medication improved verbal working memory in comparison to either approach alone 96. Likewise, Holmes et al. (2009) found that stimulant medication improved visual-spatial working memory 97. As with stimulant medication, there has been research on the benefits of non-stimulants such as Atomoxitine. Specifically, Atomoxotine leads to improvements in ADHD symptomatology and academic productivity 98, 99. Further, research suggests that Atomoxitine leads to improvements in inhibitory control 100.
Medication is one approach facilitating cognitive protective factors and research has indicated that receiving medication to treat ADHD improves the social skills and performance on standardized achievement tests among those with the disorder 101, 102. However, research does not indicate that medication used to treat ADHD improves grades or grade retention 102. On the other hand, Promoting Alternative Thinking Strategies (PATHS) was an intervention designed by Greenberg (2006) that directly promoted resiliency among children through fostering cognitive protective factors 103.
In PATHS, second and third grade children were instructed three times a week with lessons ranging from 20 and 30 minutes. In these lessons children were helped to identify and label their feelings verbally in order for them to then manage them. This was accomplished through integrating “feeling faces” within the intervention whereby the children during the day were to identify both their feelings and the feelings of others. Moreover, the children’s educators facilitated their students' adoption of PATH skills in the context of their school days in order to help them manage situations eliciting high levels of emotional arousal, such as conflicts between themselves and the student or the student and their peer(s), or while experiencing frustration academically. The rationale underling PATHS is that children will develop the ability to plan and to reduce their levels of impulsivity while interacting socially and to adopt language in order to regulate their behaviours and to successfully communicate with their peers and the adults in their life 103.
It was determined that PATHS resulted in a reduction in ratings of both internalizing and externalizing symptomatology by both the children’s educators and parents; as well, it led to an increase in emotional and social skills. Importantly, it was found that gains in inhibitory control (an EF) mediated the relationship between being involved in PATHS and educator ratings of externalizing and internalizing symptomatology one year later. It was concluded that neurocognitive functioning is necessary in adaptive functioning at both the emotional and social levels and making direct changes to EFs leads to reducing problematic behaviours among children. Finally, while PATHS is preliminary, it is considered a “case example” of how one might go about implementing a “transdisciplinary” relationship between neuroscientists and prevention scientists 103, p. 146.
Furthermore, educators who help their students compensate for executive dysfunctions through the use of planning and organization strategies that draw on the existing abilities of children and youth with ADHD may also help them become more independent learners and facilitate their self-efficacy 21. These compensatory strategies that children and youth adopt to overcome their executive dysfunctions can lead to their becoming successful as they transition into adulthood 21.
An alternative approach to developing cognitive skills among individuals with ADHD was the Chicago School Readiness Project (CSRP). CSRP offered Head Start Educators with wide-ranging behaviour-management instruction to limit the stress of educators and promote their ability to instruct students. Strategies included the implementation of clearer rules and procedures, rewarding behaviour that is positive and redirecting behaviour that is negative. CSRP developed the verbal strategies and emotion regulation of educators. Further, mental health consultants led stress-reduction workshops for the educator throughout the year and children with the most problematic externalizing behaviours were offered individual counselling. Because of CSRP the inhibition, attention and impulsivity of 4-year-olds improved during the course of the year compared to the control group 104.
Moreover, Dowsett and Livesey (2000) demonstrated that repeated exposure to activities designed to facilitate the development of acquiring progressively intricate rule structures may lead to improvements in inhibitory control 105. These activities encompassed a version of Diamond and Boyer's (1989) Wisconsin Card Sort Task and a change paradigm that was simplified 106, 107. It was suggested that, through practicing these activities, one will begin to acquire the ability to follow complex rules as a result of the development of executive processes. EFs developed included response control, representational flexibility, working memory, ability in error correction and the selective control of attention.
Lastly, restraint inhibition was improved upon through an 8-week (twice each week, 90 minutes each) aquatic exercise intervention including components of both aerobic and coordinative exercise among children with ADHD between the ages of 5 and 10. Specifically, this approach led to improvements in reaction time and accuracy 108. This result replicates the findings by Smith et al. (2013) and Verret, Guay, Berthiaume, Gardiner, and Béliveau (2012) that physical exercise improves the response inhibition of children with ADHD 109, 110.
Older youth with ADHD in college may benefit from cognitive-behavioural therapy (CBT) as it is considered to be the most efficacious psychosocial intervention for adults living with ADHD 111. CBT involves reducing thoughts one has about one-self, one’s world and one’s future that are critical and dysfunctional and brought about by experiences perceived to be difficult 111. In addition to reducing maladaptive thought patterns it may also be used as a preventive method. For instance, CBT may have the ability to prevent attitudes that are negative that lead to discouragement and impede academic progress among college student youth with ADHD 111.
The research on ADHD and CBT primarily focuses on adults but has implications for college student youth with ADHD 112. For instance, Safren et al. (2005) found that compared to adults solely receiving medication to treat their ADHD, those adults both receiving medication and participating in CBT (targeting the reduction of distractibility, promoting planning and organization as well as promoting adaptive thought patterns) led to improvements on the ADHD Rating Scale 114 as well as on the Clinical Global Impressions Scale 113, 115. Ratings came about through assessors blind to the condition of the participants 113. Moreover, these findings were found to be consistent with self-reported ratings 113.
Similarly, Solanto, Marks, Mitchell, Wasserstein, and Kofman (2008) determined that a CBT treatment program named Meta Cognitive Therapy produced positive results for adults with ADHD that could be transferred to college student youth with ADHD 112, 116. The emphasis of Meta Cognitive Therapy was to instill the skills and strategies needed to be able to manage one’s time, organize and plan effectively. It also addressed thinking patterns contributing to depression and anxiety making it difficult to successfully self-manage 116. Meta Cognitive Therapy, compared to supportive therapy, led to more reductions in inattentive symptomatology among the adults with ADHD 116. It was concluded by Green and Rabiner (2012) that these two approaches to CBT provided to adults with ADHD led to the development of skills necessary for academic success among college student youth with ADHD (e.g. planning, organization, time management, adaptive thinking patterns) 112. Thus, it is necessary for future research to demonstrate whether the outcomes of CBT for adults can be transferred to college student youth. While interventions that aim to develop protective factors among academic, interpersonal and cognitive domains may lead to greater resiliency and, in turn greater levels of success, it is important to address the notion of perceived competency in the context of ADHD, irrespective of receiving an intervention aimed at fostering protective factors in the academic, interpersonal and cognitive domains.