Lesson 1: Lesson 1: What is ADHD?
Multi-ModalTreatment Programs:
A diagnosis of ADHD or ADD does not mean you automatically put your child on some kind of medication and hope all your problems will be resolved. While medication may be necessary to help these children "attend" long enough to be taught the skills necessary to function, it is only part of a holistic treatment program. In fact, good behavioral management skills and home organization can make a big difference. Behavioral management can help structure a child’s life and contingency programs can help motivate and keep him on track. So whenever we talk about treatments, we refer to a multi-modal approach. This includes medical, educational, psychological and behavioral management. Let’s look at each of these.
Medical Treatments: Medications are prescribed to treat the symptoms of ADHD, and are best used in conjunction with other forms of treatment. Before you make your decision about medication, here are some questions you might ask: What will this medication do for my child? What changes will I be able to observe? What are the short and long-term side effects? What can I expect if I choose not to use medication? How long will my child have to be on this medication? How do I know if this is the best medication for my child? Are there other conditions that my child has that might require medication, such as depression? Does my child have a learning disorder?
Don’t be afraid to ask your physician about the pros and cons of using medication. And don’t be afraid to get a second opinion. You are your child’s advocate and will need to make the final decision. If fears and uncertainties remain, ask if it would be possible to have a trial period of use to see what happens. Ask yourself if you would restrict insulin shots for a child who has diabetes if it were required to help the body function properly. Medication is often used only during school time. It is important to work out a schedule with your physician that can be monitored and regulated properly. Putting your child on medication doesn’t mean he has to stay on it forever. (Read Chapter 3, "The Power of the Pill", from Chaos to Calm.)
Medications are usually stimulants, which can improve attention while decreasing impulsiveness and hyperactivity, and are effective 50 to 90% of the time. They are basically designed to stimulate the lazy neurotransmitters in the brain. They do not take the place of behavioral management. But it might be necessary to use medication in order to help a child focus enough to learn the skills necessary to function in the world. Most frequently prescribed and probably most understood medications are Dextroamphetamine (Dexedrine), Methylphenidate (Ritalin) and Pemoline (Cylert), but new ones are becoming available all the time. Be sure to compare the ones recommended, the dosage required with the least side effects, the duration of action and side effects of each.
Educational Treatments. The more we learn and understand, the more we can become pro-active in our child’s raising. Our first reaction to ADHD may be doubt, suspicion and anger. "There’s nothing wrong with our child. We just need to try harder!" We all want to be good parents and want others to see us that way. Often, however, trying harder means using more force, which only intensifies the problem. A negative cycle begins: frustration; demands; anger; discouragement; defiance and opposition. Parents who try to "put up" with the situation may become tolerant to a degree, but end up becoming aggressive and coercive, insecure and inconsistent in their parenting and management skills.
Psychological Treatments. A family in turmoil or crisis may need the stabilizing force of therapy. Family counselors can help you recognize family dynamics and teach you coping strategies. Marriage counseling can help partners communicate their frustrations and concerns without attacking one another. Individual professional counseling for your child may be needed to help him sort through his hurt and anger. It is important to go to a psychologist trained in ADHD so the appropriate therapy can be utilized.
Behavioral Management. Many things can impact families and child raising: a child’s temperament; parent’s personality and parenting styles; level of effective parenting skills; inadequate attention, supervision, and time; parental permissiveness; parental inconsistency; stress factors in the home, between parents and in a child’s environment that trigger anxiety and worry, and is acted out in misbehavior; marital strife; financial worry; depression; normal stages of rebelliousness; and feelings of loss of power and hope.
