Treatment of Attention Deficit/Hyperactivity Disorder
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Most ADHD therapy today involves a "biopsychosocial" approach - "bio" refers to medication, "psycho" refers to counseling and psychotherapy and "social" refers to instruction in self-management and training in social skills.
Medications
For decades, medications have been used to treat the symptoms of ADD. Medications in the class of drugs known as stimulants seem to be the most effective in both children and adults. These are methylphenidate (Ritalin, Methlyn), mixed salts of single entity amphetamine product (Adderall), and dextroamphetamine (Dexedrine or Dextrostat), and pemoline (Cylert). Cylert may cause serious liver damage.
For many people, these medicines dramatically reduce the hyperactivity and improve their ability to focus, work and learn. The medications may also improve physical coordination, such as handwriting and ability in sports.
Stimulants are not appropriate for every child with attention disorder. For instance, they are not intended for anyone with a primary psychiatric illness (such as schizophrenia, in which the person loses touch with reality) because they can worsen the disturbances. They can aggravate emotional problems, such as anxiety. They can bring out tics (involuntary movements) in a patient with a family history of tics.
Even a correctly administered stimulant can cause adverse effects, for no drug is completely without risk. The side effects most frequently reported are decreased appetite and insomnia. Less common are drowsiness, hypersensitivity, weight loss, headache, nausea, and blood pressure changes.
Whether a child should be given stimulants is a case-by-case decision in which the benefits are weighed against the risks. In the past, most stimulant treatments for ADHD were prescribed only for two to three years and only for children. But today, treatment may extend over longer periods and may be given to adolescents and adults. Stimulants clearly are not intendedto be the sole treatment.
Other medications prescribed for symptoms of ADHD include clonidine (Catapres) and tricyclic antidepressants.
Behavior Modification
Parents and children can be instructed in positive reinforcement techniques for rewarding desirable behavior and reducing negative behavior. Here are some strategies:
- Discipline can best be maintained by establishing a few consistent rules with immediate consequences whenever each rule is broken. Rules should be phrased positively in terms of what the child should do. Praise the child and reward him or her for good behavior.
- Structure a system of rewards for good behavior. This system encourages the child to work to earn privileges or rewards he or she wants by accumulating points for desired behaviors and removing points for undesirable behaviors.
- Make a written agreement (a contract) with the child in which the child agrees to do his or her homework every night or to demonstrate other desired behavior in return for a privilege.
- Provide a specified time-out location for when the child is out of control. This should not be seen as a place of punishment but as a "calm down" spot.
- Set up a study area away from distractions and establish a specific time each day to do homework.
- Have the teacher make a checklist of homework to be done.
- Put up a calendar of long-term assignments and other tasks.
- Avoid emotional reactions such as anger, sarcasm and ridicule.
By Wray Burns
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