In my previous post, I wrote about several symptoms of ADHD and the importance of seeking professional help if you suspect that your child might have it. I likewise mentioned in general the various interventions used in dealing with its symptoms. Below, I will describe the various approaches and modalities that I am familiar with which are being used in helping a child with ADHD:
1. Counseling and therapyChildren with ADHD need to develop insight on why they may behave "differently" from others and to be taught strategies in regulating their behaviors. Often, I have encountered parents who are frustrated with their children who do not seem to "listen". They expect their children to behave (i.e. sit quietly, stop running around, etc.) after several warnings and though their children attempt to do so, they are often angered to find out that the "good behavior" is very temporary. Hence, they find themselves constantly scolding their children and/or nagging them. What they fail to understand is that children with ADHD have the urges and impulses to be active and that when they start fidgeting, or running around again, it is not completely because they are testing limits. They simply might not have no idea as to how to divert the excessive energy they have into something more acceptable and/or productive.
Sometimes, parents resort to threatening their children since they they feel that it seems to be the only effective way of keeping them in line. Children with ADHD on the other hand feels confused and helpless since though they feel they are trying to "behave", they still end up getting in trouble one way or another for any of the following reasons: constantly forgetting their assignments, failing to do their chores, being too rough or active, being too noisy or inattentive in class, etc. As they continually "disappoint" their significant others and authority figures (parents, teachers, caregivers etc) and get punished for this, it leads to a downward spiral of anger and confusion in both the parents and child. Eventually, other problems develop such as low self-esteem, low grades, negative attitude towards school and family etc.
Occupational Therapy, Counseling and use of Behavior Modication Techniques are helpful in helping children develop alternative ways of behaving and regulating their impulses. Similarly, family counseling can be beneficial in creating family interactions that are positive and supportive to each other, particularly to the child with ADHD. Parents are taught skills on how to enforce limits and help a child with ADHD develop a positive self-image. Furthermore, counseling goals for a child with ADHD could include: increasing frustration tolerance, teaching better planning and organizing skills, improving study habits, improving self-esteem, etc.
Among the advantages of this type of intervention are: a) Helps the family and the child with ADHD to develop awareness and insight on the symptoms of ADHD and its consequences. Child is imparted with life skills that are useful long-term; and b) No internal side effects on the body.
However, the positive effects and results are not not instant or immediate. Hence it is time-consuming and can be quite expensive. Furthermore, the results vary depending on the commitment of the child (family) to attend regular counseling and/or therapy, as well as on the skills of the therapist. In addition, counseling may not be very effective for children with severe symptoms of hyperactivity, inattention and impulsivity.
2. DrugsThere are several drugs that are being prescribed for children with ADHD. In the past, Ritalin was the most common drug that was used to help minimize the symptoms of ADHD particularly the hyperactivity, inattention and impulsivity. Now, new drugs have been developed which apparently have less side effects than Ritalin such as Strattera and Concerta, among others. Regardless of the type and brand of drugs that you would use, it is important to note that these drugs should be prescribed by a qualified health professional (developmental pediatrician or pediatrician) in order to determine the right dosage that is appropriate for your children.
For most of the cases, the effects of the drugs on a child's behavior are quite immediate and these behavioral changes are usually readily observed by the parents (i.e. less active, more focus in studying which is eventually translated to better grades, less impulsive, etc.). However, these positive effects are not long-lasting. Hence, as soon as the drugs wear off, the symptoms again manifest. This, as well as their side effects of long term-use are among their disadvantages, not to mention the high expenses if you do not have health insurance coverage.
3. Neurotherapy
An alternative to medication is neurotherapy. Some parents who do not wish to have their children medicated can opt for this intervention which involves brainwave biofeedback. Since ADHD is a considered to be a nuerologic disorder, particularly involving abnormal electrical brain activity, neurotherapy is used to re-train the abnormal brain waves. This procedure is not invasive and has long-term effects. Minimum number of sessions range from 20-40 depending on the severity of the symptoms. This approach has produced promising results with continuous feedback, coaching and practice.
Past researches (as well as personal experience working with children with ADHD) suggest that the most effective approach is usually the combination of one or two forms of intervention i.e. use counseling, behavior modification with medication or neurotherapy.