Treatment for ADHD
When your child is diagnosed with attention deficit hyperactivity disorder, you face an ominous array of treatment choices. Finding the right strategy can be as frustrating as coping with the disorder.
You must arm yourself with information and make informed decisions. Most likely, you'll discover that a combination of treatments will serve you and your child best.
Medication: Yes or No?
Treatment often begins with the prescription of stimulants such as Ritalin, Adderall or Dexadrine. These drugs alter the level of brain chemicals known as "neurotransmitters," working to increase the child's attention span, while calming impulsive urges.
"They have been used for over 30 years, are effective 70 percent of the time and are considered very safe when used as prescribed," says psychotherapist Terry Matlen, who counsels children with ADHD in her private practice in Birmingham, Mich. However, Matlen recommends children be screened before taking stimulants to ensure the absence of heart disorders, which could be complicated by such drugs. And even in healthy children, side effects can occur.
"Side effects may include appetite suppression, insomnia and rebound [a feeling one gets when the medication wears off such as irritability, weepiness and an increase in ADHD symptoms]," Matlen says. For some children these side effects wear off once the body adjusts to the medication. But for others, the complications are chronic and require a change in dosage, she says.
"Concerta, which lasts 12 hours, and Dexedrine Spansule, which lasts 8 hours, are chosen often for preteens and teens, because only a single dose per day is needed -- no trips to the office at lunch and no missed doses," Matlen says.
By the time Eddy Hauser, a fifth-grader in Seattle, Wash., was diagnosed, his grades had plummeted, he had no friends and he had behavior problems during class time. Eddy now takes Adderall, a frontal lobe stimulant that has a smoother effect than Ritalin. "He takes a low dosage every six hours, so a single dose lasts him most of the school day," says Lee Hauser, his father. "He still tells terrible puns, plays computer games and reads voraciously."
Eddy experienced no personality change. However, he's no longer disruptive in class and now has many friends.
As depression often accompanies ADHD, your child may require a combination of stimulants and anti-depressants. The sedative effects of antidepressants and antihypertensives address insomnia, and are considered safe in low doses, Matlen says.
"Most professionals agree that medication should never be used as the sole treatment," says Jerome Schultz, Ph.D., clinical director and neuropsychologist at Lesley University in Cambridge, Mass. He recommends that parents also explore supportive therapy such as behavior modification.
"Behavior modification rewards or reinforces appropriate behavior while ignoring (or at least not reinforcing) troublesome behaviors," Schultz says.
The method works well in situations where the environment can be controlled, like a classroom or at the dinner table. However, it's more difficult to enforce work on playgrounds where children laugh at and encourage silliness.
"Everyone has the capacity to learn self-control," Schultz says. "Children with this disorder tend to rely on external controllers, because adults don't typically engage children in realistic goal setting."
But you can provide brief opportunities for your child to show self-control, he says. Games where a child must stand still to win helps him to understand the value of controlling himself. The time can gradually be extended once the initial skill has been mastered.
You can help improve your child's social skills by arranging short, structured activities with explicit rules, like a game of bowling or a trip to a favorite restaurant. "Afterwards [you can] discuss the experience, offering praise or suggestions for modifications for the future," Schultz says.
Teachers and parents can use charting to help a child set standards for his behavior. A chart taped in a prominent spot helps a child to see how he behaves.
"Reinforce swear-free periods, for example, by having him predict how long he can go without swearing," Schultz says. "Prediction involves the child and gives him a sense of control so he can monitor his own behavior."
You can reward progress with a treat after supper. Over time, you can switch to abstract rewards such as television or computer time. But do keep the goals realistic and reachable to ensure maximum success, Schultz says.
Self-monitoring also helps a child to examine, judge and modify his behavior, while focusing on the process rather than the product of an activity. Question your child about how he thought he handled a situation and offer suggestions for use next time. Watch a movie and ask how he thinks the character will handle a conflict or how he feels the character felt after a struggle. This helps your child to think through situations before they happen to him or her, Schultz says.
"Logical consequences work for a child who is not impulsive or who sees the connection between a bike left out in the rain and rust afterwards," Schultz says. But instead of waiting for the bike to rust, try an experimental approach. Ask "Remember what happened when that old iron pot we used for a dog dish was left outside? Your bike might do that too, so..."
Faced with strong medications, some parents opt for holistic or vitamin therapy. However, no clinical studies exist that prove these therapies work, says Matlen, "St. John's Wort, for instance, is known to have potentially serious side complications when combined with other medications," she says. And it's difficult to compare potency from one brand to another since the Food and Drug Administration neither screens nor monitors natural therapies.
If you consult a holistic practitioner or naturopath, you may be told to eliminate white flour, processed foods or certain dyes to isolate a food allergy. Serious food allergies can make a child look or behave hyperactive, but only a small number of children have food and dye allergies, Matlen says. "These children did not truly have ADHD to begin with. I wouldn't recommend any medication unless a doctor suggested it."
Consistency of Expectations
Decide what you want to focus on so the whole day isn't a battle, says Dana Currie, parent of a child with ADHD in Kitchener, Ontario. If grades slip or peer issues develop, ignore less important things like cleaning a bedroom. Post-it notes, schedules taped on the refrigerator and constant communication can help you and your child to cope.
"Let him know you value his efforts as well as his accomplishments," Currie says. "Set out clothes the night before, eat at the same time each day and make bedtime routine the same every night. Prepare him for transitions by telling him exactly what happens next."
Physically turn your child or tap him on the shoulder to ensure he hears your instructions. "When things occasionally spin out of control -- and they will -- maintain a neutral demeanor, remembering that making you angry is not his goal," Currie says.
A child with ADHD adores praise, but may not be able to accept it, Schultz says. "Because it means that you can criticize her as well. Ask for a self-evaluation and then, if she's right, agree with her," he says.
Enjoy your child's wonderful talents and imagination, and focus on the positive aspects of his or her life. The disorder is only one part of your child's life and, as most professionals agree, not the most important part.