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Treatment of ADHD | |
| What can I
do to help my child with ADHD? Treating ADHD requires a multi-modal approach. The goal of treatment is to help your child better deal with his or her environment. This will allow him or her to develop the self-confidence to become an adult who is able to adapt, adjust and cope with life’s circumstances. For many children with ADHD, medication, primarily psychostimulants, is an important part of treatment. Behavior management is also crucial, and some children may need individual and/or family counseling. Without specialized interventions, most children with ADHD find it very difficult to meet academic and behavioral expectations. A team effort, with parents, school officials and doctors working together, is the best way to help your child. How can I help my child at home? Parenting a child who has ADHD can be an exhausting and, at times, frustrating experience. Parents play a key role in managing ADHD and may benefit greatly from parent support groups. Children with ADHD may have trouble understanding important directions. They are usually in a constant state of activity. This can be a challenge to adults. You may need to change your home life a bit to help your child. Here are some things you can do to help: Organize your child’s life. Organize your schedule at home. Set up specific times for waking up, eating, playing, doing homework, doing chores, watching TV or playing video games and going to bed. Write the schedule on a blackboard or a piece of paper and hang it where your child will always see it. If your child can’t read yet, use drawings or symbols to show the activities of each day. Explain any changes in routine in advance. Make sure your child understands the changes. Be positive One of the most important things that you need to do is to be positive. Reward your child regularly for any good behavior—even little things such as getting dressed and closing doors quietly. Children with ADHD often spend most of their day hearing negative things and being told what they are doing wrong. They need to be praised for good behavior. They need to have more positive reinforcement than negative reinforcement. Children with ADHD often need their parents to identify their areas of strength. By focusing on these areas, children can develop the confidence and skills to tackle other, difficult situations. Parents of children who have ADHD must work on the task of not overreacting to their children's mistakes. Tell your child what you want rather than what you don’t want. Set up house rules. Make the rules simple, clear and short. Rules should be explained clearly. It’s important to explain what will happen when the rules are obeyed and when they are broken. Write down the rules and the results of not following them. Hang this list next to the schedule. The punishment for breaking rules should be fair, quick and consistent. If possible and reasonable, and if not resulting in a broken house rule, parents should try to ignore, as much as possible, negative behavior. Make sure your directions are understood. First, get your child’s attention. Look directly into his or her eyes. Then tell your child in a clear, calm voice specifically just what you want. Ask your child to repeat the directions back to you. It’s usually better to keep directions simple and short. For difficult tasks, give only 1 or 2 directions at a time. Then congratulate your child when he or she completes each step. Be consistent. Only promise what you will deliver. Do what you say you are going to do. Repeating directions and requests many times doesn’t work well. When your child breaks the rules, warn only once in a quiet voice. If the warning does not work, follow through with the punishment that you promised. Watch your children at play Make sure someone watches your child all the time. Because they are impulsive, children with ADHD need more adult supervision than other children their age. Make sure adults supervise your child all day. Watch your child around his or her friends. Making and keeping friends is a difficult task for children with ADHD. A variety of behavioral excesses and deficits common to these children get in the way of friendships. They may talk too much, dominate activities, intrude in others' games, or quit a game before it’s done. They may be unable to pay attention to what another child is saying, not respond when someone else tries to initiate an activity, or exhibit inappropriate behavior. Parents of a child with ADHD need to be concerned about their child's peer relations. Problems in this area can lead to loneliness, low self-esteem, depressed mood, and increased risk for anti-social behavior. Parents can help provide opportunities for their child to have positive interactions with peers. There are a number of concrete steps parents can take:
Help with school-related activities School mornings may be difficult for children with ADHD. Get ready the night before—lay out school clothes and get the book bag ready. Allow enough time for your child to get dressed and eat a good breakfast. If your child is really slow in the mornings, it’s important to make enough time to dress and eat. Set up a homework routine. Pick a regular place for doing homework. This place should be away from distractions such as other people, TV and video games. Break homework times into small parts and have breaks. For example, give your child a snack after school and then let him or her play for a few minutes. Then start homework time. Stop frequently for short “fun breaks” that allow your child to do something enjoyable. Give your child lots of encouragement, but let your child do the schoolwork. Focus on effort, not grades. Reward your child when he or she tries to finish schoolwork, not just for good grades. You can give extra rewards for earning better grades. Talk with your child’s teachers. Find out how your child is doing at school—in class, at playtime, at lunchtime. Ask for daily or weekly progress notes from the teacher. These notes should include good things and not so good things. The ADHD child in school Problems occurring at school usually prove to be the catalyst for a diagnosis of ADHD. Behavioral difficulties may first become evident at school because the child is asked to maintain attention for long periods of time and sustain a persistent effort. Children with ADHD experience difficulties in many or all of the skills needed for academic success: starting tasks; completing tasks; making transitions; interacting with others; following through on directions; producing work consistently; and organizing multi-step tasks. If the child attends preschool, ADHD is often exhibited through excessive activity and an inability to stay with play activities for sustained periods. In elementary school, demands placed on the child to pay attention increase. Teachers may report the child is fidgety, often out of his seat, talkative and interrupting, usually looking about the classroom instead of at the teacher or chalkboard, bossy, and performing inconsistently. In middle and high school, these children-turned-adolescents frequently settle down, no longer appearing obviously hyperactive. Instead they may be fidgety, restless, often looking about, and loud. Their poor learning skills cause academic problems and under-developed social skills result in poor peer relations. Consider getting an extra set of schoolbooks for home. Find out the teacher’s lesson plans in advance, so you can work with your child at home. The structure and rules of the classroom are often hard for children with ADHD. Work with your child's teacher. By understanding your child's struggle, the teacher will be better able to help your child do better in school. Small group settings are easier for ADHD children to handle and should be used whenever possible. ADHD children tend to become easily distracted by those around them in large groups. They also are easily bored and need constant reinforcement in order to complete tasks. For this reason, private tutors often work well. Many ADHD children get much more done in 30 minutes or an hour with a tutor than during an entire day at school. It is important to remember that children with ADHD can do as well in school as their peers. ADHD does not mean a child is not smart. Children with ADHD may be disorganized and inattentive, but this is a result of the disorder, not their ability to learn. Once diagnosed and treated, children with ADHD can be helped to perform very well in school. If your child's family physician, teachers, and counselors work together and your child gets a lot of support from family and friends, your child can achieve academic success. Talk to your child's teachers and family physician about any special programs they might know of for ADHD children. Approximately 50% of children with ADHD can be taught in the regular classroom. Teachers must be trained to recognize the special needs of these students and to make any appropriate teaching and classroom modifications. The other 50% will require some degree of special education and related services. Of this 50%, about 35-40% will primarily be served in the regular classroom with additional support personnel and/or "pull-out" programs that provide special services outside of the classroom. The most severely affected, 10-15%, may require self-contained classrooms. Researchers have identified classroom characteristics that promote success for many children who have ADHD:
The research literature also suggests a number of teacher characteristics that will be helpful in teaching children with ADHD, including:
Self-monitoring techniques have also proven effective in the school setting. Self-monitoring of attention involves cueing the student so that he can determine how well he is attending to the task at hand. Cueing is often done by providing an audio tone, such as a random beep, though a timer can be used or the teacher can give the cue. The child then notes whether he was on or off-task on a simple recording sheet. Self-monitoring techniques have proven most effective when tied to rewards and accuracy checks. For more parenting skills, click here. What medicines are used to treat ADHD? Some medicines used to treat attention-deficit and hyperactivity disorder (ADHD) are called psychostimulants. Some of these drugs are methylphenidate (Ritalin®), dextroamphetamine (Dexedrine®), amphetamine and dextroamphetamine (Adderall®) and pemoline (Cylert®). Although these medicines have a stimulating effect in most people, they have a calming effect in children and adults with ADHD. Other types of medicine are also used to treat ADHD. These include clonidine (Catapres®), desipramine (Norpramin®) and buproprion (Wellbutrin®). Do the medicines for ADHD have side effects? The psychostimulants may cause a decreased appetite, a stomachache or a headache. The loss of appetite can cause weight loss in some people. This side effect seems to be more common in children. Some people who take psychostimulant medicines have insomnia (trouble sleeping). If your child needs to use one of these medications, here are some ways to avoid side effects (like a fast heartbeat, chest pain or vomiting): We will try to use the lowest possible dose that still controls the hyperactivity. Have your child take the medicine with food if it bothers his or her stomach. Children who lose weight while taking medicine for ADHD can have extra snacks during the day, such as peanut butter and crackers, granola bars or blueberry muffins. If a child is not hungry at dinnertime, save the meal for later. How should medicine for ADHD be taken? It’s important to take the medicine just the way your doctor says—not more often and not less often. Follow your doctor’s advice even if you think the medicine isn’t working. Be sure to talk with your doctor if you think the medicine isn’t working. Unless instructed otherwise, please have your child take the medicine EVERY day. This is to help insure that the child will continue to behave in a proper manner, and get the positive reinforcement he or she needs. It’s best to take the morning dose of medication 30 to 45 minutes before school starts. Good times to take this medicine are before breakfast. Lunchtime doses can be given at school for some children. If your child can’t take this medicine at school, tell your doctor. Your doctor might choose a long-acting form of the medicine instead. The long-acting form of this medicine should not be crushed, broken or chewed before swallowing. The long-acting forms are usually taken only once a day, right before breakfast. It’s also important to know that some of the medicines used to treat ADHD are called “controlled” drugs. There are special rules about the way that controlled drugs can be prescribed, because these drugs could be used the wrong way. The prescriptions for controlled drugs, like methylphenidate, Adderall and dextroamphetamine, must be refilled at the drug store every month (they cannot be called in). When calling the office for a refill, please allow several days for it to be written. Also remember that you have to bring the prescription in the pharmacy within one week of when it was written. How long will these treatments last? People with ADHD should be checked regularly by their doctors. During these check ups, the doctor will want to hear what the parents have to say about a child with ADHD. The teacher’s comments about the child are also important. The doctor will want to check a person with ADHD after the medicine dose has been changed. The length of time a person takes the medicine depends on each person. Everyone is different. Some people only need a short treatment, for one to two years. Some people need treatment for years. In some people, ADHD may continue into adolescence and adulthood. Other treatment for ADHD Dietary intervention has long been claimed to be a useful treatment for an array of children's learning, behavior and attention problems. Advocates claim that removing food additives, such as preservatives and colorings, from the diet will improve most or all of a child's learning and attention problems. Numerous studies have debunked the notion of an additive-free diet as a treatment for ADHD. A large number of studies have examined the link between sugar and hyperactive behavior. A few of these studies have found some small effects of sugar on behavior though only a small percentage of children with ADHD seem to be vulnerable. I believe what is much more important is a well balanced diet. Most children are “carbohydrate addicts” who often have very little protein in their diet. By increasing the protein (meat, eggs, nuts, dried beans, tofu), especially in the morning and at lunch, increasing vegetables, and decreasing the carbohydrates (breads, potatoes, rice, pasta, sweets), many mood and behavior swings are greatly decreased. Many treatments advocated for children with ADHD have not been proven effective. Others have been proven ineffective or are completely inconsistent with current knowledge about ADHD. Parents should be wary of investing time, money and their child's interests in unproven, questionable treatments, such as EEG Biofeedback. EEG Biofeedback is the controversial therapy of the moment. Proponents of biofeedback believe that children with ADHD can be trained to increase the type of brain-wave activity associated with sustained attention. Up to 20 electrodes are attached to the child's head. Levels of electrical activity in various parts of the brain are measured and entered into a computer. The computer provides a signal, such as a light or tone. This "feedback" is supposed to teach the child to increase certain kinds of brain-wave activity and decrease other types. Training usually involves 40-80 sessions, each lasting 40 minutes or more. This "treatment" costs $3,000 to $6,000. The studies that suggest impressive results for EEG Biofeedback are seriously flawed. Sample sizes were small and appropriate control groups were not used to determine if any results are due to maturation or an "expectancy" effect. Although not proven ineffective, I recommend that any parent considering the use of biofeedback proceed with extreme caution. Another theory maintains that ADHD is caused by problems in the inner ear system. Advocates of this theory recommend an array of medications including anti-motion sickness medications and several vitamin-like substances. A success rate of more than 90% has been claimed for this treatment. However, this is anecdotal and has not been published in professional journals. No scientific support from well-controlled investigations has been offered. This theory is completely inconsistent with current knowledge of ADHD. Some have even linked ADHD to yeast. Candida albicans is a type of yeast that lives in the human body. At times candida can overgrow, causing, for example, a vaginal yeast infection known as Candidiasis. Those who support an ADHD - candida link believe that toxins produced by yeast overgrowth weaken the immune system. The body then becomes susceptible to ADHD and other disorders. Treatment consists of antifungal medication and a low-sugar diet, as sugar is believed to stimulate yeast growth. There is no evidence to support this theory and it is not consistent with current knowledge of ADHD. Another controversial theory suggests that ADHD is caused by a genetic abnormality resulting in increased requirements for vitamins and minerals. A treatment regimen -- debunked 20 years ago -- involves extremely high doses of vitamins. Others have suggested that ADHD is caused by the misalignment of two bones in the skull and promote the use of bodily manipulations to restore these bones to their proper position. |
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This site is for information only. It is not intended to replace consultation with your physician.