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ADHD Treatment Options

Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common neurodevelopmental conditions. The United States Center for Disease Control has recently indicated that approximately ten percent of the school age population has been diagnosed with ADHD (CDC, 2010).ADHD

Typical symptoms that are exhibited in a child with ADHD include:

  • a lack of attention to details
  • difficulty following instructions
  • poor impulse control
  • hyperactivity
  • issues with regard to self-regulation

Research On ADHD Treatment:

The National Institute of Mental Health (NIMH) conducted the largest on-going research studies (MTA: Multimodal Treatment of Attention Deficit Hyperactivity Study) examining the efficacy of various treatment modalities for ADHD. This study consisted of over six hundred children who were diagnosed with ADHD.

Each child was assigned randomly to one of four treatment groups:

  • intensive medication management alone
  • intensive behavioral treatment alone
  • a combination of both
  • or routine community care which served as a control group

Outcomes Of The ADHD Study:

What the study found was that combination behavioral treatment and medication management were significantly superior to behavioral treatment alone in reducing symptoms of ADHD (Dec 1999, Archives of General Psychiatry). The results also highlighted that these improvements in functioning (with combination behavioral and medication therapy) lasted for upwards of 14 months. A final important finding from the study indicated that combination treatment (behavioral therapy and medication) was superior in treating other areas of daily functioning such as anxiety/depression, academic achievement, social skills, and family interactions in comparison to medication or behavior therapy alone.

ADHD treatment Options:

As the above study indicates, pharmacological intervention is oftentimes the first treatment of choice for a child with a diagnosis of ADHD. However, medication alone is not the only solution as was evident in the study. Behavior therapy, which focuses on teaching children appropriate self regulation skills by modifying the environment so that appropriate on-task behaviors are reinforced while negative, off-task behaviors are extinguished, is a vital component of a treatment plan. Many times parents do not want to go with medication as a primary treatment and would rather try behavioral therapy or working with a social worker to help develop socialization skills.

Many children with ADHD exhibit issues with their daily social functioning. It is important to realize that these social deficits are not because of a lack of inherent social skills but because of the impact that issues with attention to the social world and impulsivity have on their daily social interactions. The focus of the intervention then needs to be on how to change the child’s daily environment so that he or she is set up for success. Many times this will include modifications in the classroom setting to help improve on-task behaviors and self regulation. Another intervention that is often needed for a child with a diagnosis of ADHD is parent and teacher education. It is important to work with parents and teachers so that they can have a better grasp as to why they are observing particular behaviors.

In summary, the empirical research has indicated that a combination of pharmacological intervention and behavioral treatment is the number one intervention for a child with a diagnosis of ADHD. However, there are other options that are less invasive such as behavioral therapy in isolation, parent/teacher education, and/or social work support to help improve daily social interactions.

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The Importance of Teaching Self-Advocacy Skills to Children with ADHD

Attention Deficit Hyperactivity Disorder is a neurological condition associated with under activation of the frontal lobe. This area of the brain is also associated  boy with ADHDwith the executive functioning skills such as organization, time management; planning, impulse control, cognitive flexibility, and ability to self monitor one’s work. Children with ADHD without a doubt demonstrate poor executive functioning. These children have difficulty initiating action on tasks, organizing materials appropriately, managing time effectively, etc. These are all skills that can be developed and improved; however, they are also areas that need be accommodated in order for the child to perform to his or her ultimate potential. Many articles and blogs (link to my past blogs on EF) have been published regarding teaching executive functioning skills. There is also ample work out that there that provides accommodations that teachers may utilize in the classroom setting. We can teach the child the skills, we can accommodate the child; however, if the child is not a self advocate than it is all for naught.

 Step 1 To Teaching Children To Advocate For Themselves:

The first stage to begin to develop self advocacy skills is for the child to be able to recognize that he or she exhibits weaknesses or deficits with particular skill sets. Explain to the child (in child friendly terms) what it means to lack organization skills, have difficulty planning, and struggle with time management. Use daily examples from the child’s life (e.g. how long did homework take last night? How long should have it taken?). Once the child identifies that there is a problem he or she can then work on solving the problem.

Step 1 To Teaching Children To Advocate For Themselves:

The next step is to target one task at a time. Work with the child to create a list of areas that can be improved (e.g. morning routine, homework, organizing his/her room). Once the list is created, have the child number them in order from the biggest problem to the smallest problem. Self advocacy skills are developed by the child being able to develop the solution to the problems through Socratic dialogue with parent and not by parent simply providing a list of what needs to be done (e.g., what do you have to do first? …., well, that is one step, but is there something that needs to go before that?). This process is time consuming and will create headaches for many parents on a daily basis. However, if you ultimately want the child to develop the skill set, he or she must develop the solutions. After the first problematic behavior is tackled, the parents and child should then target the second one on the list in a similar manner. There are many strategies and devices (use of timers, checklists, etc) that are way too exhaustive to be explained in this blog that are wonderful tools to help with task completion; however, the first step is for the child to identify that he or she needs help.

The ultimate goal of childhood is to develop independence and skills necessary to live in society. One of the most important skills to develop is self-advocacy; to be able to identify that one has a problem and also to know when to seek others out for help and guidance.

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New Guidelines for ADHD Diagnosis

Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common neurodevelopmetnal disorders.  Current data suggest that the prevalence rates in school age children is between eight to ten percent.  This is a disorder which is characterized by significant inattention and/or hyperactivity-impulsivity.

New Guidelines For an ADHD Diagnosis:

ADHD is a buzz topic that has been highly discussed in the media this past week (here in the Chicago Tribune and in The Wall Street Journal).

The American Academy of Pediatrics published new guidelines regardinboy with adhdg the initial diagnosis of the condition. According to these new guidelines, children can now be officially diagnosed with the disorder when they are as young as four years old.  Prior to these new guidelines (which were just published this month) a child was unable to be diagnosed with the condition under he or she was six years old.

What benefit does an early diagnosis pose?  Quite a bit of benefit for families who have a child with the condition.  These children are now able to receive accommodations and interventions within the home and school domains to ensure social and academic success.

There have been plenty of past policy statements that document the best practice for treating ADHD.  Now these young children will be able to receive treatments that they might otherwise have been missing out on.  The American Academy of Pediatrics published a best practice paper for the intervention of ADHD in 2001.  In a nutshell, the paper states that the two primary interventions for ADHD include the use of stimulant medication and behavioral therapy.  Donna Palumbo, a neuropsychologist from New York, wrote a chapter in a pediatric neuropsychology textbook in 2007 “Pediatric Neuropsychological Intervention“, that updated the AAP practice guidelines to include parent training and social skills training in addition to the already mentioned stimulant medication and behavior therapy.

What are your thoughts on children getting diagnosed as young as 4 years old for ADHD?

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