Support Through Medication
Medication can be a support for people with ADHD. Although most parents and teachers of children with ADHD find medication helpful, it cannot take away all the symptoms of ADHD. Medication may help children to be less hyperactive, more attentive, and better organized than they would be without medication, but it is unlikely to enable them to function on the social and organizational levels of children without ADHD. Neither do stimulants help the central auditory processing deficits common among children with ADHD (Tillery, Katz & Keller, 2000).
Some parents are afraid to give their children stimulants because they have heard that stimulants are like street drugs. Although stimulants are sometimes abused, the therapeutic use of stimulants differs from the street use of stimulants. “Getting high” requires large dose increases of stimulants, or it requires quick absorption of stimulants through intravenous or nasal routes. When taken orally at prescribed doses, methylphenidate does not cause a “high” because it takes too long to reach the brain. In order to be used as a street drug, it would have to be crushed and snorted or injected (Gottlieb, 2001). When used therapeutically, stimulants are not a risk factor for substance abuse (Castellanos, 1997).
Although outward signs of hyperactivity often decrease as children enter adolescence, inner restlessness is likely to persist. Disorganization and inattention to detail follow many people with ADHD throughout life. Some adults with ADHD find medication useful as they interact with a world full of organized, punctual, and detail oriented people.
Types of Medication
Stimulants decrease hyperactivity in about 80-90% of children with ADHD. Stimulants are currently the treatment of choice for both adults and children with ADHD unless they have a condition that makes treatment with stimulants unwise.
Methylphenidate (Ritalin) is the stimulant most commonly prescribed for ADHD. It is available in tablets that last about four hours each, in sustained release tablets that last 6-8 hours, and in a new form called Concerta that lasts 10-12 hours.
Other stimulants commonly used for ADHD include Adderall, Dexedrine, Dexedrine SR.. Adderall lasts about the same amount of time as sustained release methylphenidate, and it is thought by some doctors to have a smoother and steadier effect.
A medicine that is neither a stimulant nor an antidepressant was released in early 2003 after short-term studies with 4000 people. The brand name for this medicine is Strattera. Its formulation is known as atomoxetine [formerly known as tomoxetine]. It is being promoted as benefiting people with ADHD who do not do well on stimulants. So far, tests have indicated that Strattera is moderately effective in reducing symptoms of ADHD while improving sociability. Strattera has some of the same side effects as stimulants prescribed for ADHD (including decreased appetite). In addition, some people claim they have irritability and mood swings as an unpleasant side effect. Strattera does not appear to increase insomnia – in fact, some people report being sleepy as a side effect of Strattera. Long term studies have not yet been published.
Psychological Supports
Although medication alone has been shown to be more effective than psychological interventions alone (Treatment of Attention-Deficit/Hyperactivity Disorder, 1999), most clinicians feel that psychological interventions should accompany medication. These interventions often involve behavior management, cognitive-behavior strategies, or attention-training techniques.
Behavior techniques can sometimes help children stay on task and can improve their organizational skills. Behavioral techniques commonly used for children with ADHD include systems of rewards (such as point systems), contingent attention, time out, functional analysis, and positive behavior supports. (For more information see Fast Facts on Developmental Disabilities: Challenging Behavior online at http://www.MODDRC.com or call 800- 444-0821.)
Behavior techniques applied by parents and teachers are helpful. However, behavior techniques probably are most effective when applied in specialized summer camps or other controlled settings by highly trained people (U.S. Department of Health and Human Services, 1999). Some behavior treatments may be able to target areas in the brain and affect brain function (Castellanos, 1997).
Cognitive-behavior interventions teach children to observe their own behavior and to use problem-solving approaches to alter it.
Attention-training techniques originally evolved as a treatment for people with head injuries. It was later found that similar techniques were useful for children with ADHD.
Other psychological interventions include social skills training, interventions to build self-esteem, or interventions that address coexisting issues such as anxiety or depression.
Alternative Interventions
Dietary:
Various herbs, vitamin/mineral/fatty acid supplements, and special diets eliminating certain foods (wheat, gluten, sugar, food additives) have been suggested as treatments for ADHD. The National Institutes of Health Consensus Development Conference Statement on ADHD states that “some of the dietary elimination strategies showed intriguing results suggesting the need for future research” (2000, p. 184).
Neurofeedback is an alternative treatment that involves learning to alter the rhythm of brain activity with the help of an EEG machine. Supporters claim that it is as effective as stimulant medication, and that results are sustained over time. However, most studies to date have been small and have not included controls (Sterman, 2000).
Other treatments:
Other alternative treatments include biofeedback, chiropractic skull manipulation, and Attention Restoration Theory. The latter states that people are able to focus their attention better after contact with nature. Supporters say that ADHD symptoms are alleviated after children have played outside in natural “green” settings, and that the more time they spend in “green” settings, the less severe attention deficit is (Taylor, 2001).
Large scale, independent, and well-controlled studies are not available for alternative therapies. Some of these treatments may help specific people with symptoms of hyperactivity or inattention, but they have not yet been shown to be effective for the general population of people with ADHD.
Educational Supports
504 Accommodation Plans and
Individual Educational Plans:
Sometimes it is difficult to obtain special educational services for children with ADHD. The Individuals with Disabilities Act (IDEA) was written before much clinical information on ADHD was available, so ADHD was not addressed specifically in the law. Because of this confusion, the U. S. Department of Education issued memoranda clarifying state and local responsibilities in this area.
A memorandum issued in 1991 stated that children with ADHD should be classified as eligible for services under the “other health-impaired” category of the IDEA when “ADD is a chronic or acute health problem that results in limited alertness, which adversely affects educational performance.” (U.S. Department of Education, 1991, p.3). However, children with ADHD are not eligible to receive special education services simply because they have been diagnosed with ADHD. In order to receive special education, educational performance must be adversely affected by ADHD.
Students may also receive services and accommodations under Section 504 of the Rehabilitation Act of 1973. This law prohibits discrimination on the basis of disability. Schools are required to provide students with disabilities “free appropriate education.” A 504 Plan may include classroom or homework accommodations. It may also include special study or social skill classes.
If the child is found eligible for a 504 Plan or for an Individual Educational Plan, the parents and school personnel work together to form a plan that meets the child’s needs. (See Fast Facts on Developmental Disabilities: Individual Educational Plans. It is available from the Missouri Developmental Disabilities Resource Center www.MODDRC.com or call 800-444-0821.)
If the child is found ineligible, the following are options:
Ask whether the child has been evaluated under Section 504 criteria. (Some children not eligible under IDEA are eligible under Section 504 criteria).
Contact the state Parent Training and Information Center. (The Parent Training and Information centers in Missouri and Kansas are listed in this article under the heading “Resources.”)
Become involved in a local ADHD support group and learn how others in the area have navigated their way through the system.
Contact the state Protection and Advocacy Agency (Missouri Protection and Advocacy is listed in this article under “Resources.”)
Tips for Parents
When assigning tasks or giving instructions, remember that children with ADHD have trouble processing and remembering instructions given orally. They may need simple one step instructions repeated several times. Older children may benefit from written instructions they can refer to step by step.
Children with ADHD live in the present. They reflect little on the past, and are not interested in consequences. Warnings about what may happen if they persist in their present actions hold little meaning for most children with ADHD. They usually do not care about rewards or punishments in the (perhaps unimaginable) future. They respond to instant feedback and tangible rewards in the present.
Children with ADHD seek immediate gratification. Some are able to use a point system most profitably with tangible tokens (play money or other items they can touch and hoard.) It also helps to have reward items prominently displayed.
Homework often becomes a struggle for parents and their children with ADHD. If possible, encourage children to complete the regular assigned homework. Some students enjoy estimating how long an assignment will take, setting the timer, and then racing against the timer. Others prefer small rewards or rest breaks when each assignment is completed. If homework becomes too much of a challenge, it may become necessary to request smaller assignments or other accommodations.
Many children with ADHD are unusually creative. Sometimes the special abilities of children with ADHD who are gifted go unnoticed, because the focus is on their needs. This is particularly true when children have learning disabilities or behavior disorders along with ADHD.
Children with ADHD should be encouraged to pursue individual interests. However, children should not be pressured to meet unrealistic goals. Some children with ADHD feel the need to avoid stress and complexity in their lives. They may be happier to have fewer organized activities and responsibilities, and more “down time” when they can just relax and unwind.
Children with ADHD may need help with self-esteem, and may need extra encouragement, praise, and affection. They are often out of step with the rest of the world, resulting in many reprimands and disappointments. It helps them to feel that their parents accept them even when they make mistakes and experience failure. Parents who decide to enjoy their children as they are can gradually encourage more of the traits they value.
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