When you hear "ABA," your mind might go straight to autism, even though we know that “behavior” applies to every organism that exists. But did you know, there’s a massive, underserved population out there that can also benefit from the same science of behavior: individuals with ADHD.
In one of our most attended Motivity CEU events, behavior analyst and educator Nicole explained why BCBA®s should be front and center in ADHD treatment. And it might just change how you view your practice.
Behavioral Treatment: The Gold Standard That Isn’t Being Delivered
Let’s start with the elephant in the room: The CDC and American Academy of Pediatrics both recommend behavioral treatment as a primary intervention for ADHD, particularly for children. Yet, few BCBA®s are actively providing that support. Why? Often, insurance restrictions are to blame. ABA is typically reimbursed for autism diagnoses, but ADHD is rarely covered, despite the clinical alignment. And so, many families are left with a prescription for medication and little else.
Nicole's perspective as both a practitioner and a parent illuminated the gaps in this approach. While medication can play a role, it often isn't enough. Kids are still melting down at home. Still struggling with social skills. Still not able to manage their time or emotions. And this is where low-dosage ABA, once or twice a week, can fill in the gaps and help kids build real-life skills.
ADHD Isn’t Just About Inattention
A core insight from Nicole's training is that ADHD isn't just about being "distracted." BCBA®s need to understand:
- Working memory deficits can mimic impulsivity.
- Rejection sensitivity dysphoria can look like oppositional behavior.
- Emotional dysregulation often gets mislabeled as "meltdowns" with no clear cause.
Knowing how to identify and address these less visible barriers is crucial to effective intervention. Nicole encourages clinicians to approach ADHD like detectives, gathering clues to understand each child’s neurological experience and designing support accordingly.
Why Our Reinforcement Systems Need an Update
One of the most compelling parts of the presentation tackled reinforcement. Traditional token boards and sticker charts? Often not enough. Kids with ADHD can become desensitized to reinforcement systems that rely too heavily on delayed deliveries. Or worse, they can become emotionally dependent on external validation, creating a long-term vulnerability to dopamine-seeking behavior.
Instead, Nicole shared systems that were:
- Performance-based (e.g., progress toward more complex behavior goals)
- Collaborative (designed with the child’s input)
- Emotionally aware (avoiding harsh error correction or punishment)
Even something as simple as a smiley-face chart co-created with a child can build momentum toward better habits. And that momentum is often what kids with ADHD need most.
Best Practices in Action: Pairing, Priming, and Planning
Nicole broke down her best practices using the four-term contingency:
- Motivating Operations: Build trust first. If a child doesn’t like you, they’re not learning from you. Period.
- Antecedents: Use priming. Preview what’s coming, prepare for what-if scenarios, and set clear expectations.
- Behaviors: Focus on shaping, not demanding. Start with small goals like tolerating emotional talk, and build toward regulation.
- Consequences: Reinforce early and often, but steer clear of power struggles. No child learns in a shame spiral.
Expanding Scope of Competence: One Hour at a Time
The beauty of ABA is its flexibility. You don’t always need 20 hours a week to make a difference. Sometimes, an hour a week of direct work, paired with thoughtful collaboration with caregivers and educators, can spark change.
As Nicole said, "There are so many other ways ABA could be implemented and utilized, and we're just not there yet as a field." Maybe it's time we got there.
Final Thoughts
There’s a generation of kids with ADHD who aren’t being served by talk therapy or medication alone. They need strategies. They need behavior change. They need you! And we need to meet them where they are: one intervention, one routine, one paired interaction at a time.
Looking to advance your clinical skills and earn CEU credits?
Check out the Motivity CEU Series webinar series on BehaviorLive.