ADHD series part III: an ADHD treatment regimen that works
According to Alan Wachtal, MD- “ADHD left untreated can be among the most debilitating disorders to live with.”
In fact, research shows that untreated ADHD can be one of the most impairing disorders for employed adults.
Too many parents leave themselves and their children untreated.
This post outlines the different professional options to treat ADHD and provides effective parenting tips to to help manage ADHD symptoms.
Children who go undiagnosed and untreated are more likely to struggle through school, both academically and socially. These same struggles will continue into adulthood, making college, a career, close relationships more challenging than they need to be. Receiving an accurate ADHD diagnosis and treatment regimen is critical.
ADHD is a disorder that affects the brain’s ability to pay attention, stay focused, stay organized and focus on tasks until they are completed. (I know, I know- every wife has secretly diagnosed their husband ☺)
Currently, there is no permanent “cure” for ADHD. However there are countless combinations of therapies and medications that help most people manage their ADHD symptoms.
The great news is that thousands of adults live with ADHD and lead successful, productive lives.
Creating a comprehensive treatment program
A comprehensive treatment program that covers school and home is critical and should include these five areas:
1. Strength-based parenting
2. Effective Praise
3. An accurate diagnosis
4. Psychological, behavioral and educational techniques
5. Medication management
1. Strength-based parenting
The concept of Strength-based parenting is founded in the principles of Social Learning Theory and Positive Reinforcement. Simply put, our task as parents is to “Find the good in our children more often than the bad.”
Although our children make “bad choices” or do “bad things”, this does not make them “bad children”. Instead, it makes them “good children making bad choices”.
As parents, we are quick to find the mistakes and poor choices our children make each and every day. We have a professional license to punish right?
As parents, it’s our job to shape and mold our children into the leaders of the future. We begin shaping and molding with our children’s strengths.
For example I am working with a young man who really enjoys puzzles. This same young man also desperately wants to be independent. He hates being told to wake up, go to school, do his chores, do his homework etc. and argues each time he is told to do anything.
The constant arguing created a difficult strain on the relationship and uncomfortable feeling of ‘walking on egg shells’ in the home.
Two weeks ago, we decided as a team to use a strength based approach of creating a daily schedule with large magnet puzzle pieces. Each piece of the puzzle equals a task he is required to do through out the day.
We wrote the title of the task in small caps on each puzzle piece, laminated them and put them on the fridge. This young man works on his “daily puzzle” each day before and after school on his own. By 7:00 pm if his puzzle is completed, then he earns an extra 30 min of video game time.
The young boy loves the puzzle, loves the independence, and the home has now stabilized with much less arguing. His parents appreciate his positive attitude and the new atmosphere in their home.
By focusing our treatment plan on these two strengths, the young man feels encouraged and is willing to work through his problems in the home. If we are always on the look out for the positive behaviors and acknowledge them, our children feel loved and appreciated.
As the negative behaviors come up and we need to correct them, our children know we are correcting them out of love.
2. Effective Praise
Using Effective Praise is effective because it gives children hope and a reason to change. Effective Praise is more powerful in getting your child to change behavior than criticizing or punishment.
“He did things to please me, because I was invested in him. In three weeks he was a totally different child.”-Eric
3. Accurate diagnosis
Several symptoms of ADHD are shared with other disorders such as Oppositional Defiant Disorder, Anxiety, Reactive Attachment and several others. It is not uncommon for a child to be inaccurately diagnosed at first by a school counselor, teacher or even parents.
It is vital to a child’s success that they receive an accurate diagnosis, not simply an educated guess by the neighbor “who is good with kids”.
Just like you wouldn’t go to a therapist for car problems, don’t look somewhere else for a mental health diagnosis. An accurate diagnosis may include an assessment from a psychologist, psychiatrist, an evaluation from a school counselor or therapist, and interviews with teachers and parents.
Our children deserve a complete assessment and evaluation if there is a suspicion or signs of ADHD. An accurate diagnosis will not only provide you with the education to make informed decisions, but will also help you connect to the appropriate resources, services and professionals to your child’s ADHD symptoms.
Having an accurate diagnosis of ADHD will also provide you with ideas and guidance in creating the right learning and working environment.
This sounds like common sense, but neuroscience research shows that an ADHD brain functions best through visual instruction i.e. charts, schedules, reminders, pictures and calendars. Basically, the more visual a learning environment is and the more learning or working visual scenarios we create for our children (and less auditory), the more success our children will have.
We’ll discuss the fascinating research regarding neuroscience and visual instruction in a later post. (Yes-I said fascinating-i’m a nerd.)
4. Psychological, behavioral, and educational interventions
a) Cognitive-Behavioral Therapy (CBT)
Cognitive-Behavioral Therapy helps children develop healthy habits throughout the day to improve focus. Cognitive-Behavioral Therapy challenges our children’s negative thoughts like “I can’t do this” and “I’m different”. It also includes teaching coping skills that lead to improved organization, focus, and recognition of satisfaction in completing tasks.
Cognitive-Behavioral Therapy is a practical approach where a therapist will give children behavioral assignments to work on during the week. Assignments are monitored by parents and reviewed each week in therapy. Cognitive-Behavioral Therapy is a common, evidenced based approach and CBT mental health professionals can be found in most communities.
b) Behavioral Therapy (BT)
Behavioral Therapy teaches people with ADHD how to manage their time, organize personal space, and prioritizing all tasks through breaking down behaviors into small steps. For example, the task of coming home from school and doing study hour might be broken down like this:
1. Walk through the door
2. Put back pack on the table
3. Get a snack
4. Sit down at the table and start math worksheet
5. Work for 20 minutes
6. Take a break
7. Finish assignment
Behavioral-Therapy also teaches parents how to increase immediate consequences and rewards in the home to change behavior. Behavioral therapy is also a common, evidenced based approach and behavioral therapists and programs can be found in most communities.
c) Social Skills Therapy
Children with ADHD can be trained to understand and appropriately react to social behaviors and body language.
A social skills group is often an effective setting for teaching children how to communicate, follow conversations without interrupting, and paying attention to detail.
Social Skills Therapy can be taught in the home, school or therapist office. This technique is practical and very helpful but sometimes overlooked by parents who are more focused on improving behavior in the home.
d) Talk therapy
This treatment model is designed to help those who are struggling with the social and personal consequences of having ADHD. i.e. being seen as inferior, not smart, “scatter brained”, or falling behind in school or at work. Talk therapy is a common approach for older teenagers and adults to work through feelings of embarrassment and to overcome self-esteem and self-image issues.
This treatment is more likely to be helpful with older teenagers or adults because of their ability to self-reflecting, be introspective and self-critical. Typically young children struggle in talk therapy because they struggle with just talking and not actively participating in something. This approach is also difficult with young children because they may not be having self-critical thoughts, they just want to have fun! .
e) Training for parents
Being the parent of a child with ADHD takes more than patience — it takes training.
Smarter Parenting is here to help provide training in the areas of helping your children focus, helping you create a structured learning environment for your child, as well as continue to access and identify your children’s strengths on a daily basis.
It’s important to know how to encourage and guide your child, and be consistent in your communication. Check out the following links for chore charts, communication, and correction.
These skills will help you build a stronger relationship with your child, improve attitudes and family dynamics, and develop structure and consistency in your home.
f) Educational treatment program
Often times when a student’s behavior becomes an obstacle for the teacher or other students and impedes their learning, a qualified expert from the school district might be invited to professional assessment and make recommendations.
This professional may make professional recommendations that can at times be more hurtful to the child than helpful because the child’s program becomes “visible” to other children.
This sounds counter intuitive, but is definitely true with ADHD. A thorough risk/reward analysis should be done by your treatment team before integrating an intensive behavioral therapy program in their school classroom.
If your child is placed on a special educational treatment program, ask for it to be as socially invisible as possible. The program should not be radical in nature and make the child’s treatment plan clearly visible to other children and students. By not being socially invisible, children become targets of teasing and can be labeled as “troubled” or “weird”.
If your child is the only child in the class that is on a “special” program it’s also easy to feel singled out, which might lead to even larger problems than the initial behavioral one.
5. Medication management
Stay tuned to this blog series. In the next few weeks, a post will cover several prescribed ADHD medications and recommendations, and review the pro’s and con’s of treating ADHD with medication.
Tips for creating a stronger treatment plan
Treatment Plans must involve parents, families, and schools and must be effective across a broad range of environments, including home, school, and community. For example, your child’s behavior should be reinforced at home, school, baseball practice and grandma’s house if possible. The more places your children can generalize the appropriate behavior, the quicker they will learn to implement the desired behavior into their daily routines.
“Children with ADHD who fare the best are those who have effective parents, are correctly diagnosed, and receive a combination of psychological, behavioral, educational, and pharmacological interventions.”-Alan Wachtel, MD
ADHD treatment is definitely a multi-part approach. Be patient, try new things and have confidence that you will find the right formula for success!