Stimulants (such as methylphenidate and dextroamphetamine) have been the widest and best studied of any group of medications for the behavioral and emotional problems faced by children. Taken as recommended, they are effective and safe for most children with ADHD. Side effects mostly occur early in treatment, tend to be mild and short-lived, and in most situations can be successfully managed through adjustments in the dose or schedule of medication.
Parents are often confused by the fact that stimulants are the most frequently prescribed medications for ADHD. Why use stimulants, they wonder, when their child seems already overactive and overstimulated? The reason is that such medications are thought to work by “stimulating” the brain to keep slightly more of the brain chemicals (neurotransmitters) available that help all of us focus our attention, control our impulses, organize and plan, and stick to routines. With effective stimulant medication treatment, children with ADHD are better able to manage academic work and social interaction, attend to behavior modification techniques, and follow rules. Far from making a child someone he is not, as the word drugs implies, stimulants act as medications that can help many children with ADHD be who they are—with more appropriate attention, impulse control, and activity level.
It is important to consider that while many parents view placing their children on stimulant medication as a last resort—after all other measures have been tried—research has shown that such other treatments are more likely to work if the child is also taking stimulants. By helping the child focus, stimulants lay the groundwork for him to be able to respond better to behavior management techniques, academic instruction, and other demands on his attention.
Stimulant medication can be prescribed in a variety of doses and schedules. Because there has been so much controversy about ADHD in the media, many parents ask for and many physicians prescribe, the lowest dose of stimulant medication that leads to any improvement. It is now known that the best results from medication treatment are achieved by the dose that shows the most improvement with the least side effects.
Children with ADHD who have additional medical conditions or reasons why taking stimulant medication is not advisable may be prescribed non-stimulant medications instead, such as atomoxetine, guanfacine, tricyclic antidepressants, or bupropion. Children who were originally prescribed stimulants but experienced excessive side effects, improved for only very short periods, or responded insufficiently may also switch to non-stimulants. These non-stimulant medications have been shown to have variable degrees of positive effects on the core symptoms of ADHD. In general, non-stimulants have not been studied as extensively as stimulants, although more research into non-stimulants has been conducted in recent years.
Behavior therapy is considered another proven first-line treatment for ADHD. Behavior therapy emphasizes ways in which adults can better manage and shape their child’s behavior by using sound behavior management principles and includes techniques for giving instructions and commands in a way that builds children’s self-control and self-esteem. Programs that teach behavior therapy focus on how to give clear commands, use time-outs effectively, create effective rewards systems, and otherwise structure a child’s environment in ways that work. Parents and teachers can learn to use these techniques effectively. This approach, which focuses on how adults can help children develop more appropriate and positive behaviors, has been shown to be effective, while child-focused approaches (such as traditional psychotherapy) have not.
Evidence for the effectiveness of behavior treatments in children with ADHD is derived from a variety of studies. The long-term positive effects of these treatments may be boosted when a chronic care model for child health has been implemented. Some of the more evidence-based behavioral treatments for children with ADHD (those with sound research behind them) follow.
Behavior therapy programs coordinating efforts at school as well as home may enhance the effects. School programs can provide classroom adaptations, such as preferred seating, reduced work assignments, and test modifications (location where tests are administered and time allotted for taking the test). Adolescents documented to have ADHD can also get permission to take college boards in an untimed manner by following appropriate documentation guidelines.
Other Components of a Treatment Plan
Other treatments, including psychotherapy and family or marital therapy, may provide valuable assistance to families who have problems that are not directly caused by but are related to and affect ADHD. The stress that a child’s behavior may place on the family can prevent them from carrying out a treatment plan unless such issues are addressed. When one parent or partner also has ADHD (a frequent occurrence because the condition runs in families), this can put even more stress on family functioning.
The fact that ADHD symptoms frequently manifest themselves in school settings, and children with ADHD may also have learning disabilities and other learning-related conditions, means that academic intervention can make a difference for your child even if it does not directly affect her ADHD symptoms. Children with clearly diagnosed learning disabilities qualify for special education services in school. In this situation, schools are federally mandated to develop Individualized Education Programs (IEPs) that detail exactly what services will be offered and how they will be delivered. The same is true for children who have behavioral needs too severe to be handled in a regular classroom.
Fortunately, students who have learning or behavioral needs related to their ADHD symptoms but do not have diagnosed learning disabilities or such severe behavioral needs can also receive services. While such programs, strategies, and considerations do not directly address the core symptoms of ADHD, they support the child with ADHD academically and behaviorally and, thus, help maintain their success and self-esteem.
Clearly, because each of the treatments discussed targets different results, it is most common to use several types of treatment at any given time. While most children’s treatment plans may begin with medication and behavior therapy, additional approaches, such as academic intervention, psychotherapy, and family therapy, may provide added support when they are indicated. When choosing from the menu of treatment options, you will need to consider whether
- You have the work schedule, time, confidence in the treatments, and energy necessary to adhere to them.
- They address one of your child’s most important 3 to 6 target outcomes.
- The therapies are available in your community, which isn’t always the case.
- Your family can realistically afford them, particularly since behavior therapy often isn’t covered by health insurance.
Consider how good a match each of these approaches is for your child, and whether the results can be satisfactorily monitored. How smoothly can each treatment be combined with the others that you plan to implement? How available are these techniques or programs in your community? How long are the benefits likely to last after the treatment has ended? Are there any possible negatives or side effects? How well do the positive effects translate to your child’s everyday life (are you still using the parenting techniques 3 days after the training session and are they helping with his behavior)? How well does the treatment method coincide with the values and goals of your family as a whole? Most importantly, how does your child feel about this type of treatment? Will he feel stigmatized by his friends or family because of it?
In the end, no matter how effective the other members of a treatment team believe a certain approach to be, it will most likely break down unless the child himself understands its purpose and is committed to making it work. For this reason, the litmus test for any mode of treatment should be whether it promotes your child’s self-confidence, improved self-management, and higher self-esteem. It may take more than one try to create this type of treatment plan, and you should expect to be constantly reshaping it, but the potential benefits are worth the effort.