American Academy of Pediatrics Clinical Practice Guideline, (2018). ADHD: “Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention Deficit Hyperactivity Disorder in Children and Adolescents. “Pediatrics, Volume 128 (5). Retrieved from

Recognizing that Attention Deficit Hyperactivity Disorder (ADHD) is the most common neurobehavioral disorder of childhood, and left untreated can profoundly affect the academic achievement, well-being, and social interactions of children; the American Academy of Pediatrics (AAP) first published recommendations for diagnosis, evaluation and treatment in 2000 and 2001. This present document updates those publications incorporating research and information collected in the following decade. Six updated action statements recommended by the AAP Clinical Practice are presented along with documentation and research supporting their guidelines.

Challenges with capturing the ADHD diagnosis for children of preschool age are discussed, and early referrals for parents to participate in a parent-training program even before the diagnoses of ADHD is confirmed. The parent-training program must include helping parents develop age-appropriate developmental expectations and specific management skills for problem behaviors. (Note: these are all included as part of the Parent-Child Interaction Therapy curriculum.)

If the diagnosis is confirmed, the primary care clinician should prescribe evidence-based parent-and/or teacher-administered behavior therapy as the first line of treatment.

CDC Centers for Disease Control and Prevention; CDC 24/7 Saving Lives, Protecting People. May 31, 2017. “Behavior Therapy, including Training for Parents.” Retrieved from

This documents the CDC’s recommendations for treatment of Attention Deficit Hyperactivity Disorder (ADHD). This concludes that for children younger than 6 years old diagnosed with ADHD, behavior therapy is recommended as the first line of treatment, before medication is tried. Parent training in behavior therapy has the most evidence of being effective. Research evidence supports that teachers and early childhood caregivers can use behavior therapy in the classroom as well. The document listed Parent-Child Interaction Therapy (PCIT) as one of four programs for parents of young children with ADHD that reduced symptoms and disruptive behaviors ( Furthermore they state that the type of behavior training that is effective for young children, may also be effective for children with disruptive behavior through age 12. Links to resources and suggestions for teachers to support classroom success are provided.

Lin, Y.W. & Bratton, S.C., (2015). “A Meta-Analytic Review of Child-Centered Play Therapy Approaches.” Journal of Counseling & Development, Vol. 93, 45-58.

Using Meta-analysis, a quantitative and systematic method of integrating research findings from a collection of quantitative studies, the authors reviewed controlled outcome studies in Child-Centered Play Therapy from 1995-2010. They reviewed the outcome studies to determine the effectiveness of Child-Centered Play Therapy as well as the relationship between different therapy variables and the outcome of the therapy. Statistical support was found for the overall effectiveness of child-counseling interventions using Child-Centered Play Therapy methodology. The report compared child-centered play therapies with and without full parental involvement and confirmed statistically significant benefits of involving parents and caregivers compared to studies on child-centered therapies involving only the therapist. The authors concluded that counselors and therapists working with children should be encouraged to include parents and caregivers within the treatment process.

Child Welfare Information Gateway; Protecting Children and Strengthening Families Issue Brief (January 2013). “Parent-child interaction therapy with at-risk families.” Washington, DC: U.S. Department of Health and Human services, Children’s Bureau. Retrieved from

Reviews research demonstrating that as a result of Parent-Child Interaction Therapy (PCIT), parents learn more effective parenting techniques, the behavior problems of children decrease, and the quality of the parent-child relationship improves.

Bratton, S. C., Ray, D., Rhine, T. & Jones, L., (2005). “The Efficacy of Play Therapy With Children: A Meta-Analytic Review of Treatment Outcomes.” Professional Psychology: Research and Practice, Vol. 36, (4) 376-390.

According to the U.S. Surgeon General’s report on mental health the shortage of appropriate services for children is described as a major health crisis. The report estimated that 10% of all children suffer from emotional and behavioral problems severe enough to impair “normal” functioning, and less than half of them receive any treatment (U.S. Public Health Service, 2000). The report emphasized the importance of early intervention. The authors, research psychologists from University of North Texas and University of Central Florida, conducted a meta-analysis of 93 controlled outcome studies published between 1953-2000. They reviewed the overall efficacy of play-therapy to determine the factors that might impact its effectiveness. The report revealed that one of the greatest contributing factors to producing these favorable results was in fact, parent participation. Play therapy appeared equally effective across age, gender, and presenting issue.

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