Treating ADHD

Treating ADHD
ADHD can't be cured, but it can be successfully managed. In most cases, ADHD is best treated with a combination of medication and behavior therapy. Any good treatment plan will require close follow-up and monitoring, and it's important for parents to actively participate in their child's treatment plan.

Medications
Several different types of medications may be used to treat ADHD:
Stimulants are the best-known treatments — they've been used for more than 50 years in the treatment of ADHD. Some require several doses per day, each lasting about 4 hours; some last up to 12 hours. Possible side effects include decreased appetite, stomachache, irritability, and insomnia. There's currently no evidence of long-term side effects.

Nonstimulants were approved for treating ADHD in 2003. These appear to have fewer side effects than stimulants and can last up to 24 hours.

Antidepressants are sometimes a treatment option; however, in 2004 the U.S. Food and Drug Administration (FDA) issued a warning that these drugs may lead to a rare increased risk of suicide in children and teens. If an antidepressant is recommended for your child, be sure to discuss these risks with your doctor.

Medications can affect kids differently, and a child may respond well to one but not another. When determining the correct treatment, the doctor might try various medications in various doses, especially if your child is being treated for ADHD along with another disorder.


Behavioral Therapy
Research has shown that medications used to help curb impulsive behavior and attention difficulties are more effective when combined with behavioral therapy.


Here are examples of behavioral therapy that may help a child with ADHD:

• Create a routine. Try to follow the same schedule every day, from wake-up time to bedtime. Post the schedule in a prominent place, so your child can see what's expected throughout the day and when it's time for homework, play, and chores.

• Get organized. Put schoolbags, clothing, and toys in the same place every day so your child will be less likely to lose them.

• Avoid distractions. Turn off the TV, radio, and computer games, especially when your child is doing homework.

• Limit choices. Offer a choice between two things so that your child isn't overwhelmed and overstimulated.

• Change your interactions with your child. Instead of long-winded explanations and cajoling, use clear, brief directions to remind your child of responsibilities.

• Use goals and rewards. Use a chart to list goals and track positive behaviors, then reward your child's efforts. Be sure the goals are realistic.

• Discipline effectively. Instead of yelling or spanking, use timeouts or removal of privileges as consequences for inappropriate behavior. Younger kids may simply need to be distracted or ignored until they display better behavior.

• Help your child discover a talent. All kids need to experience success to feel good about themselves. Finding out what your child does well such as sports, art, or music. This can boost social skills and self-esteem.

Helping ADHD Kids

ADHD is a common behavioral disorder that affects an estimated 8% to 10% of school-age children. Boys are about three times more likely than girls to be diagnosed with it, though it's not yet understood why.


Kids with ADHD act without thinking, are hyperactive, and have trouble focusing. They may understand what's expected of them but have trouble following through because they can't sit still, pay attention, or attend to details. Of course, all kids (especially younger ones) act this way at times, particularly when they're anxious or excited. But the difference with ADHD is that symptoms are present over a longer period of time and occur in different settings. They impair a child's ability to function socially, academically, and at home.


Accept That ADHD Is a Genuine Disorder
In order to help an ADHD kid, you must first believe that ADHD is a genuine brain disorder that results in unintended behaviors and consequences. Understand that ADHD is neither a reflection of a child's character nor of his intelligence or upbringing. Adults who believe that ADHD is a made-up diagnosis may think the child's behavior is willful and caused by a lack of discipline or poor parenting. These adults are going to handle their interactions with an ADHD child very differently than those who recognize the disorder's impact. It takes a mature, patient, calm adult leader to manage an ADHD child in a group setting.

Focus on Positive Channeling
Focus on strengths and provide opportunities for learning. ADHD kids are energizing. They are often passionate, enthusiastic, and active children. Take the time to catch the ADHD child doing good things, and compliment her. While the standard punishment model of discipline may be appropriate for some kids, it generally backfires with the ADHD child. Channeling her behavior in a positive manner reduces the odds that misbehavior will occur.

Adjust Your Expectations
The ADHD child is approximately two to three years behind his/her peers in emotional maturity. This can be confusing for adults, especially if the ADHD child is physically large for his chronological age but behaves several years younger, socially and emotionally. Adjust your expectations accordingly.

Give One-Step Directions
Many kids with ADHD have trouble following multi-step directions. They respond very well to predictability and structure, so they appreciate knowing the routine in advance of the situation.

ADHD is a disorder of self-control, ADHD kids may do and say things that they don't mean. It takes a strong adult to refrain from taking the bait and retaliating with punishments and reprimands. .

Correction Strategies

• Encourage rather than criticize.

• Tell them what you want them to do (not just what not to do).

• Refrain from accusations.

• Catch the child exhibiting positive behavior.

• Shape behavior through praise.

• Move closer to the ADHD child when you want his/her attention.

• Ask the ADHD child to do small errands/chores to redirect negative energy.

ADHD

What is ADHD?

Attention-deficit hyperactivity disorder (ADHD) is the name of a group of behaviors found in many children and adults. People who have ADHD have trouble paying attention in school, at home or at work and they are much more active and/or impulsive than what is usual for their age. These behaviors contribute to significant problems in relationships, learning and behavior. For this reason, children who have ADHD are sometimes seen as being "difficult" or as having behavior problems. The research found out that ADHD is more common in boys than in girls.


What are the symptoms of ADHD?

The child with ADHD who is hyperactive/impulsive/inattentive will have 6 or more of the following symptoms:

• Appears not to listen
• Doesn't pay close attention to details
• Seems disorganized 
• Has difficulty following instructions
• Has difficulty keeping attention on work or play activities at school and at home
• Loses things needed for activities at school and at home
• Problems with interrupting or intruding 
• Can't stay in seat
• Talks too much
• Is always on the go
• Has trouble waiting his or her turn
• Has trouble with tasks that require planning ahead
• Forgets things
• Is easily distracted
• Blurts out answers before hearing the full question
• Fidgety or squirming
• Runs or climbs inappropriately
• Can't play quietly  
• Avoidance or dislike of tasks that require mental effort 

Diagnosis
There is no test that can determine the presence of ADHD. A diagnosis depends on a complete evaluation. Many children and adolescents diagnosed with ADHD are evaluated and treated by primary care doctors including pediatricians and family practitioners, but your child may also be referred to one of several different specialists (psychiatrists, psychologists, neurologists) especially when the diagnosis is in doubt, or if there are other concerns, such as Tourette syndrome, a learning disability, anxiety, or depression.

To be considered for a diagnosis of ADHD:

• a child must display behaviors from one of the three subtypes before age 7

• these behaviors must be more severe than in other kids the same age

• the behaviors must last for at least 6 months

• the behaviors must occur in and negatively affect at least two areas of a child's life (such as school, home, day-care settings, or friendships)

What causes ADHD?

ADHD is not caused by poor parenting though a disorganized home life and school environment can make symptoms worse

ADHD has biological origins that aren't yet clearly understood. No single cause has been identified, but researchers are exploring a number of possible genetic and environmental links. Studies have shown that many kids with ADHD have a close relative who also has the disorder.

Although experts are unsure whether this is a cause of the disorder, they have found that certain areas of the brain are about 5% to 10% smaller in size and activity in kids with ADHD. Chemical changes in the brain also have been found.

Recent research also links smoking and other substance abuse during pregnancy to later ADHD in a child. Exposure to environmental toxins, such as lead, can also be a factor. Other risk factors may include premature delivery, very low birth weight, and injuries to the brain at birth.

Things that don't cause ADHD:

-Bad parenting

-Too much sugar

-Too little sugar

-Aspartame (one brand name: NutraSweet)

-Food allergies or other allergies

-Lack of vitamins

-Fluorescent lights

However, some studies have even suggested a link between excessive early television watching and future attention problems. Parents should follow the American Academy of Pediatrics' (AAP) guidelines, which say that children under 2 years old should not have any "screen time" (TV, DVDs or videotapes, computers, or video games) and that kids 2 years and older should be limited to 1 to 2 hours per day, or less, of quality television


Coexisting Conditions

One of the difficulties in diagnosing ADHD is that it's often found in conjunction with other problems. These are called coexisting conditions, and about two thirds of kids with ADHD have one. The most common coexisting conditions are:

Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD).

At least 35% of kids with ADHD also have oppositional defiant disorder, which is characterized by stubbornness, outbursts of temper, and acts of defiance and rule breaking. Conduct disorder is similar but features more severe hostility and aggression. Kids who have conduct disorder are more likely to get in trouble with authority figures and, later, possibly with the law. Oppositional defiant disorder and conduct disorder are seen most commonly with the hyperactive and combined subtypes of ADHD.

Mood Disorders

About 18% of kids with ADHD, particularly the inattentive subtype, also experience depression. They may feel inadequate, isolated, frustrated by school failures and social problems, and have low self-esteem.

Anxiety Disorders

Anxiety disorders affect about 25% of kids with ADHD. Symptoms include excessive worry, fear, or panic, which can also lead to physical symptoms such as a racing heart, sweating, stomach pains, and diarrhea. Other forms of anxiety that can accompany ADHD are obsessive-compulsive disorder and Tourette syndrome, as well as motor or vocal tics (movements or sounds that are repeated over and over). A child who has symptoms of these other conditions should be evaluated by a specialist.

Learning Disabilities

About half of all kids with ADHD also have a specific learning disability. The most common learning problems are with reading (dyslexia) and handwriting. Although ADHD isn't categorized as a learning disability, its interference with concentration and attention can make it even more difficult for a child to perform well in school.



Will my child outgrow ADHD?

Symptoms of ADHD often get better as children grow older and learn to adjust. Hyperactivity usually stops in the late teenage years. But about half of children who have ADHD continue to be easily distracted, have mood swings, hot tempers and are unable to complete tasks. Children who have loving, supportive parents who work together with school staff, mental health workers and their doctor have the best chance of becoming well-adjusted adults.