PCIT for ADHD: A Parent Coaching Approach to Child Behavioral Therapy
If you are parenting a child with ADHD—or a child who seems to have ADHD-like symptoms—you may be feeling overwhelmed, overstimulated, and totally burned out. Maybe your child has a hard time slowing down enough to focus, has big feelings more often than their peers, or struggles to cooperate. You want your child to feel successful, but with so much struggle around daily tasks, it can be hard to know where to look for help.
Many parents in this situation wrestle with tough decisions: Should we seek a formal diagnosis? What kind of therapy is right for ADHD? Is medication necessary—or even helpful—for my child?
If you're searching for parenting techniques for ADHD or wondering how to help a child with ADHD without medication, you’re in the right place. PCIT (Parent-Child Interaction Therapy) is a powerful parent-child coaching approach that has impressive research evidence for improving emotional and behavioral problems that are common in kids with ADHD. It works by targeting core ADHD symptoms, emotion regulation, and behavioral responses through coaching clear parent communication and positive availability. And it supports you too.
ADHD Behavior Problems in Children
Whether you’re parenting a preschooler who climbs the furniture or a middle schooler who finds transitions challenging, behaviors linked with ADHD are often better explained by core biological differences in attention, regulation, and executive functioning.
Inattention, Hyperactivity, & Impulsivity – These core features of ADHD are used to provide a diagnosis, and can be present separately in kids with ADHD Inattentive Type or ADHD Hyperactive/Impulsive Type, or all together in a child with ADHD, Combined Type. These are the symptoms that tend to get kids in trouble at school or annoy adults. They make it harder for them to stay on-task and more likely to cope in ways that adults may not understand.
Executive Functioning — Most children with ADHD also struggle with at least one executive function. These are skills like planning, organizing, shifting gears, initiating new tasks, keeping multiple things in mind at once (working memory), problem solving, reasoning, and decision-making. Challenges in any one of these areas makes it even more difficult for a child to change their behavioral response in the moment and long term.
Emotion Regulation — Kids with ADHD are at higher risk for emotion regulation challenges. That means small frustrations (like a minor change in plans or expectations) can lead to big feelings that last a long time. Kids with ADHD can be particularly sensitive to perceived rejection or criticism from parents, teachers, or peers. They may become emotional and defiant when unable to engage in their favorite or “hyperfocus” activity. Sensory differences can trigger intense stress and anxiety — all of which complicate behavior even more.
Why ADHD Parenting Is Especially Hard
Parents of kids with ADHD are some of the most dedicated, but also can be the most emotionally exhausted. On top of finding the “right” supports for their child, they’re often also navigating their own challenges too—whether it’s their own ADHD, depression, or other neurodiversity. Conflict between caregivers is another stressor on ADHD parents, while they decide how to handle their child’s challenges and what to do next.
Parents of kids with ADHD are more likely to…
Let’s face it — it’s hard to stay patient and positive after yet another meltdown even though you tried a new skill that was “supposed” to work. You might feel constantly overstimulated and forget strategies you meant to try. Many parents feel guilt and wonder if they’re doing enough—or doing it “right.” That’s why any effective ADHD treatment needs to support parents as much as kids.
Early Intervention Matters for ADHD Outcomes
The Risks of Not Treating ADHD
Many symptoms of ADHD can be recognized early, in preschool-aged children. Left untreated, ADHD symptoms can affect everything from peer relationships, to family relationships, to self-esteem and anxiety. Kids may fall behind academically, get labeled as “troublemakers,” or withdraw socially. Research shows that untreated or under-treated ADHD in children leads to a much higher likelihood of developing serious behavioral problems, clinical depression, substance abuse, and legal conflicts in later childhood and adulthood.
First Line Treatment: Parent Training
Both the American Academy of Pediatrics and the CDC recommend parents complete training in behavior management as the first-line treatment for young children (ages 4-6) with ADHD symptoms—even before formalizing a diagnosis or turning to medication. For children ages 6-12 years old, they recommend the same parent training while families are considering medication. The CDC cautions against play therapy and talk therapy, as they have not been proven to improve ADHD behaviors or symptoms in young children.
Researchers have scoured literally hundreds of parenting programs available and determined that kids with ADHD have the best outcomes in programs that focus on the following:
helping parents model and coach effective emotion regulation for their children
training parents in consistent, constructive responses to challenging child behaviors
PCIT is a highly-effective parent training model that includes all the above features as well as live-coaching parent-child interactions to help parents apply the skills in real-time. Keep reading to learn more about the amazing research support PCIT has as a behavioral therapy for ADHD.
PCIT for ADHD: Why It Works So Well
PCIT is a structured, science-backed therapy that’s been shown to improve behavior in kids since it was developed in the 1970’s. Lots of research supports the use of standard PCIT for improving ADHD-like symptoms like inattention, disruptive or aggressive behaviors, and emotion regulation — but more recent studies have confirmed that PCIT is particularly effective in kids with diagnosed ADHD from ages 4-12 years old. Newer therapy adaptations like PCIT-Toddlers and PCIT-ECo (Emotion Coaching) have developed emotion regulation strategies that help parents model strong coping skills while coaching their own kids’ emotional expression at the same time. These additional features have been proven effective for young children with ADHD.
Research Outcomes for Families Who Completed PCIT for ADHD
In addition to the decades of research that supports PCIT’s positive outcomes, below are just some of the results of studies specifically designed for children with ADHD:
In these studies, PCIT outperformed cognitive, relaxation, and mindfulness-based therapies for improvement in ADHD symptoms.
Emotion Coaching in PCIT: Parent-Child Regulation
Earlier, we reviewed how both children with ADHD and their parents have higher rates of emotion dysregulation. In real life, this looks like parents losing their cool after days, weeks, months, years of trying to figure out the best ways to help their child’s big feelings and ADHD behaviors. So increasing emotion regulation in both parents and children is a key target in improving family life for those with ADHD. Here are a few PCIT adaptations that incorporate emotion validation and coaching for both parents and kids.
Parent-Child Co-Regulation in PCIT-Toddlers
While ADHD isn’t diagnosed under the age of 4, many parents tell me that they noticed and sought help for ADHD-like behaviors as early as 18 months. PCIT-Toddlers is an adapted version of PCIT focused on children ages 0-3 years old (or older in children with developmental delays). This approach has been proven to improve secure attachment, improve child behavior and parenting skills, and can serve as a treatment or a prevention of disruptive behaviors in early childhood. Unique features of PCIT-Toddlers include education and live practice of parent emotion regulation skills (called Adult CARES), while the therapist offers supportive coaching to help keep you centered during your child’s most dysregulated moments. PCIT Toddlers also supports parents in emotionally validating their children’s big feelings and providing explicit training in parent-child co-regulation strategies.
Emotion Coaching in PCIT-ECo
PCIT-ECo was specifically developed and piloted with young children with ADHD, ages 3-7 years old. It follows a similar structure to standard PCIT, but has additional sessions to educate families about ADHD and ADHD behaviors, incorporates emotion validation and cognitive support for parents, and encourages parents to serve as an emotion coach for their child throughout each module. PCIT-ECo also introduces other ADHD-specific supports including parent-modeling of adaptive social problem-solving skills and empathy development in kids.
Other PCIT Adaptations
There are several other PCIT adaptations that include support if a child also has depression or anxiety in addition to ADHD. PCIT-ED (Emotional Development for childhood depression) and PCIT-CALM (for childhood anxiety) have both had positive research outcomes for children with ADHD.
Looking for a PCIT or ADHD Specialist Near You?
As a child psychologist and certified PCIT therapist, I love bringing a personalized approach to each family I serve. Whether your child has an ADHD diagnosis or just seems “more intense” than other kids, I offer support that meets you where you are in your parenting journey. In my boutique therapy practice, I intentionally limit my client caseload so that I have time to think and develop custom, outside-of-the-box resources to support the families I work with. So whether you’re a family with one or more neurodivergent caregivers or one with neurotypical parents, I am flexible and affirming. Let’s tailor PCIT to fit your values, cultural customs, and learning styles — and help you find harmony in your home, together.
I’ve successfully helped families:
Manage hyperfocus and emotional meltdowns
Navigate transitions and sensory overload
Reduce power struggles and defiant behavior
Build calmer, more connected relationships
You don’t need a formal diagnosis to get help for your child. You don’t even need to know what you’re dealing with yet. If you’re wondering, “How can I help my child with ADHD symptoms?”—this is a great place to start.
Therapy for ADHD and More in California & PSYPACT States
Dr. Sabrina Stutz, PhD, doesn’t just treat ADHD. Check out her other online therapy services for individual and family therapy, chronic illness and diabetes, and other parent-child behavioral therapies (like PCIT-Toddler, PC-CARE, and CARE Class). Interested in learning more about PCIT therapy? Read our blog series on what is PCIT and how PCIT online works in your home. Reach out today or request a consultation call to get started!