JaynaGirl Website

How is AD/HD Treated?

Like many medical conditions, AD/HD is managed, not cured. There's no "quick fix" that resolves the symptoms of the disorder. Yet a lot can be done to help. Through effective management, some of the secondary problems that often arise out of untreated AD/HD may be avoided. In the majority of cases, AD/HD management will be a life-long endeavor. It may be helpful to think of AD/HD as a challenge that can be met. Recently, the National Institute of Mental Health (NIMH), in combination with the U.S. Department of Education's Office of Special Education Programs (OSEP), completed a long-term, multi-site study to determine which treatments had the greatest positive effect on reducing AD/HD symptoms. This study is known as the MTA study (The MTA Cooperative Group, 1999). MTA stands for multi-modal treatment study of children with AD/HD.

The recommended multi-modal treatment approach consists of four core interventions:

• patient, parent, and teacher education about the disorder;
• medication (usually from the class of drugs called stimulants);
• behavioral therapy; and
• other environmental supports, including an appropriate school program.

Each of these core interventions is described in more detail below. These approaches are your tool chest.

1-Parent, Child, and Teacher Education about the Disorder

Often, the first treatment step begins with learning what AD/HD is and what to do about it. This knowledge will help you understand that the way your child thinks, acts, and feels has a lot to do with circumstances outside his or her control. When we understand the nature of the challenge, we are better equipped to meet the challenge.

Understanding AD/HD also changes the way in which a child's behavior is viewed. When we know more about AD/HD, we come to understand that the child has troubles and is not the cause of those troubles.

There are accommodations that can help your son or daughter adapt reasonably well. It is critical to learn what these accommodations are and to work to see that they are put in place across different environments-school, home, community. Children with AD/HD need strong advocates. They also need to be taught self-advocacy skills if they are to successfully manage their symptoms throughout life. Self-advocacy should begin early in life. Help your child understand and identify his or her difficulties. Teach him or her how to ask for help and accommodations.

2-Medication

The MTA study found medication to be very effective in the management of AD/HD symptoms. Since AD/HD is a neuro-biochemically-based problem, it stands to reason that medication that gets to the core of the problem would be effective. The medication most often used is stimulant medication, especially methylphenidate. Most people know this medication as the drug Ritalin. There are other stimulant medications-Concerta, Metadate, Dexedrine, Cylert, and Adderall, an amphetamine compound.

These medications are believed to work by stimulating the action of the brain's neurotransmitters, especially dopamine. With the brain's systems working more efficiently, attention, memory, and executive functions, including inhibition, are improved. The result is better concentration, increased working memory capacity, greater recall, less hyperactivity, and more impulse control. Stimulant medications do not tend to help with symptoms of anxiety or depression (Barkley, DuPaul, & O'Connor, 1999).

The decision to place a child on medication may not be an easy one, especially given the controversy that surrounds the stimulants, specifically Ritalin. There have been many reports that medication is overprescribed for treatment of AD/HD. However, according to the American Medical Association's Council on Scientific Affairs (Goldman et al., 1998), "There is no widespread over-prescription of methylphenidate by physicians" (p. 1100). By following good diagnostic procedures, the chances of overprescribing this medication are significantly reduced. Some children cannot take stimulant medications. In these cases, the physician knows what other medications can be helpful in relieving AD/HD symptoms. Medication may not be the right approach for every child.

Always discuss any medication treatment thoroughly with your child's physician. He or she should explain the benefits and the drawbacks of medication to you and also to your child, if appropriate. When medication is first prescribed, the physician should start with a low dose and then gradually raise it until the symptoms improve. You will need to dispense the medication as prescribed and closely monitor its effects, including any side effects. With stimulants, most side effects are quite mild and go away over time. Since your child spends a large portion of his or her day at school, you will also need to be in contact with your child's teachers to determine positive effects and side effects. Communicate with the physician often, especially when medication is started. Call immediately with any problems or questions.

Also be aware that during adolescence many teens actively resist taking medication. If this happens, it's wise to discuss the situation with your child's doctor. While medication cannot be forced on an unwilling patient, the doctor may have some ideas of how to work with your son or daughter about any resistance to taking the medication.

Some parents are reluctant to place their child on medication for fear that doing so may lead to later substance abuse. Researchers have looked into this concern quite seriously. A recent study supports previous findings that stimulant medication treatment may actually prevent later substance abuse (Zametkin & Ernst, 1999). As with any medication, though, parents must carefully monitor its use to be sure that the medication is taken as prescribed.

3-Behavioral Therapy

As parents and teachers know, AD/HD can cause significant inappropriate behavior. Frequent complaints include failure to follow rules, listen to commands, complete tasks, delay gratification, or control impulse. In addition, some youth may be aggressive or anxious. These symptoms lead to their own set of problems, such as fighting or avoiding tasks. It is very easy for everyone involved-the child, the parents, and the teacher(s)-to be worn down into a pattern of negative, and sometimes hostile, interactions. This cycle, however, can be broken, and different, more positive interactions and behavior patterns can be developed. Knowing more about behavior and how to support behavior that is positive and appropriate is extremely useful information for any parent or teacher of a child with AD/HD.

Researchers have identified effective strategies that parents can use. The following brief explanation gives you an idea of the types of help your son or daughter needs, along with some examples. You can find a lot more help through reading, talking to other parents, and working with a clinician.

You must consider the age of your child and his or her ability before using any strategy. A good rule of thumb is to provide interventions until your son or daughter demonstrates that these are no longer needed. If you withdraw interventions and problems re-occur, put the interventions back in place.

Ways to Improve Life in General

Become Proactive. Knowledge is power. Gain knowledge about AD/HD so you understand why and how this disability affects your son or daughter at home, in school, in social situations, and how it affects your entire family.

Change Your Belief System. Before your son or daughter can change his or her self- concept, the adults in the child's life have to change the way they view him or her. Separate the child from the behavior, and then separate the child from the disability. We don't have &34;AD/HD children." We have children who have AD/HD.

De-stress. Find positive ways to soothe yourself. For example, exercise, meditate, take long walks. Less stress means better self-control. Look for the humor in things, and enjoy a good laugh.

Act, Don't React. Emotional responses such as blame and anger lessen when you stop, look, listen, and then respond. Thoughtful parenting is needed here.

Catch the Child Being Good. The home atmosphere and the child's sense of self-worth change when the air fills with words of praise and encouragement. Pay plenty of positive attention to your son or daughter. Reward and show appreciation when he or she does what is expected.