ADHD Treatment Options
From parent training to medication, we break down the many kinds of treatment for children with ADHD.
ADHD, or attention deficit hyperactivity disorder, is marked by a variety of symptoms, including forgetfulness, high distractibility, restlessness, impulsivity, and inattention to detail. Different children with ADHD will exhibit different symptoms, so there is no blanket treatment for the disorder. Instead, many experts recommend a multi-step approach.
First, it's essential to have a handle on the situation. "Make sure you meet with a specialist in the area and get the right diagnosis," says Natalie Weder, M.D., a child and adolescent psychiatrist at the Child Mind Institute in New York City. This is particularly important because at least two thirds of kids diagnosed with ADHD have at least one other mental health or learning disorder in their lifetime, according to the American Academy of Child and Adolescent Psychiatry. You want to be certain that you are dealing with actual ADHD, not a learning disability or an anxiety disorder or depression.
Once you have a thorough diagnosis, treatment might proceed in steps. "You need to take a tiered approach, and the first step should be psycho-social intervention," says Robert Volpe, Ph.D., an associate professor in the Department of Counseling and Applied Educational Psychology in Bouve College of Health Sciences at Northeastern University. In other words, at the very least, you should start with behavioral management approaches that involve changes to the way you and your school interact with your child. "It's a low-cost, high-benefit solution," Dr. Volpe says.
Some examples: Preferential seating in the classroom, or putting your child in the "action zone," can help her maintain eye contact with the teacher and focus on what's going on. Taking frequent breaks during work--working for five minutes, perhaps, and moving around for two minutes--can make it easier for your child to complete tasks in class. And daily report cards, one of the most common behavioral strategies, can provide regular validation for improved behaviors. "This is where you target a few behaviors, such as interrupting, waiting your turn, and participating three times in class," Dr. Weder says. "And depending on how many checks you have in a day, you get a reward in the end." The key is to start with a behavior chart that is very simple. "If you make the chart very complicated and your child fails, you're reinforcing the fact that he can't do well," Dr. Weder says.
You also want to look into parent training, or programs that help you learn how to effectively manage a household that includes a child with ADHD. This might include changes to the way you discipline, organizational strategies, how to clearly communicate with your child, and how to respond to your child's behavior. A good behavioral pediatrician or child psychologist should be able to direct you to the right resources for these kinds of programs.
If your child's ADHD is moderate to severe, however, or if behavioral modifications aren't working, medication may be worth considering. But you need to have a plan for evaluating it at school or at home, Dr. Volpe says. One important question: What do you want the benefit to be? Are you looking to help your child be more successful academically, or are you simply trying to take his behavior down a notch at home? Have a discussion with your pediatrician about what kind of medication might accomplish that.
For ADHD, the most common medications prescribed are stimulants in short-acting, intermediate-acting, and long-acting varieties. Your doctor might suggest Adderall (amphetamine and destroamphetamine) or Ritalin (methylphenidate) for your child. One study found that stimulants were most effective in treating ADHD symptoms, as long as the dosage is tailored to the child. Some experts suggest starting with the lowest dose possible and working your way up. Common side effects include loss of appetite, trouble sleeping, and moodiness.
Talk to your child's teachers to see how the drugs are affecting your child's behavior in school, and consider having them complete behavior ratings and track academic performance to evaluate how the medication is working. Monitoring side effects is also important.
If stimulants don't help your child, or the side effects are too negative, nonstimulants such as Strattera (atomoxetine) and Intuniv (guanfacine) are available. If those don't work either, antidepressants might be prescribed. It may take several attempts to find the right medication and dosage for your child with the least side effects.
There are other things that might improve your child's ADHD symptoms or make them more manageable. For instance, exercise can help a hyperactive kid burn off excess energy. A consistent and soothing bedtime routine can help a restless child get more sleep. And regular meals and snacks can keep your child's blood sugar steady and help him focus.
In the end, you have to find the treatment that works for your child, and you want to investigate the options with a pediatrician who will monitor the results closely.
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