Comprehensive Treatment of Childhood ADHD

By John M. Grohol, Psy.D.

While learning of the diagnosis of attention deficit disorder (ADHD) makes many parents feel relief, the real work begins in finding the right treatment approach for a child or teen diagnosed with ADHD.

If the diagnosis was made by a pediatrician or family physician, the first thing you should ask for is a referral to a mental health professional trained in the treatment of attention deficit disorder. This should happen before any treatment is prescribed, because, as you’ll learn, the order and focus of treatment is important. Although the inclination may be to start medication treatment immediately (with drugs such as Ritalin or Adderall), you should not give in to this feeling that you need “do something.”

Since the diagnosis of ADHD requires the child to have inattentive behavior in at least two settings — the home and school most often — the obvious interventions to change the child’s behavior involve those two settings. Comprehensive, effective treatment of childhood ADHD involves four different treatment strategies, used individually or combination:

  • Behavioral Parent Training
  • Behavioral School Intervention
  • Child Interventions
  • Medication

Parents shouldn’t expect instant changes in their child’s ADHD or behavior. Improvement and learning is a gradual process that takes time, especially with the behavioral interventions and training. However, research has shown that such interventions are longer-lasting, while the effects of medications will fade over time.

Behavioral Parent Training

Parental training benefits the child with attention deficit disorder because most parents simply don’t know what to do when dealing with an ADHD child. Even if a parent has raised other, non-ADHD children, learning how to best help a child or teenager with ADHD is a unique situation most simply have never had experience with.

Parents of ADHD children also usually have significant stress, and sometimes they may simply lack basic parenting skills. Some parents are often grappling with their own mental health issues, such as depression, anxiety, or bipolar disorder. ADHD children unintentionally contribute greatly to parental
stress and disturbed parent-child relationships. Learning good parenting skills can actually mediate most negative outcomes and therefore it makes sense to make it one of the main focuses of treatment.

Parent training usually takes on a focused, behavioral psychotherapy approach. The focus is on parenting skills, the child’s behavior, and family relationships. In parent training, parents learn skills and implement treatment with child, modifying interventions as necessary based upon how the child is doing. One of the key components of parent training is creating ADHD behavioral interventions for the home. These are easy to learn and implement and are a must for virtually any parent. Parents should also consider implementing the home daily report card (PDF).

Parent training is often done in a group-based, weekly session with therapist initially that lasts from 8 to 16 sessions. Most therapists will continue being in contact with the parents once the group sessions are done, as the parents need it (often for years). If a parent needs additional help throughout that time, most therapists will be glad to see the parents to help them through difficult childhood transitions (such as becoming a teenager).

Training can also involve discussion about maintenance of the program and relapse prevention, especially when the parent is under increased stress from relationship issues, work, etc.

Parent training is most often offered through a private psychotherapist trained in such interventions, but can also sometimes be found in schools, churches, primary care physicians and other common community outlets.

Behavioral School Intervention

Why are school interventions important in the treatment of a child or teen with ADHD? 33 percent of children with ADHD have academic problems every year and 48 percent have at least one year of special education. 12 percent of children with attention deficit disorder get held back a grade and nearly 10 percent of teens with ADHD will drop out of school if left untreated. Teenagers with ADHD will often score a full letter grade lower than other teens, even when controlling for academic skills.

School interventions are a behavioral approach where teachers are trained and implement treatment with the child, modifying interventions as necessary based upon the progress of the ADHD child. School interventions focus on classroom behavior, academic performance, and the relationships the child with his or her friends.

School interventions are typically available in most schools. Such intervention programs are administered most often by teachers, who’ve received specialized training in how to work with ADHD children. A core part of the school intervention is the school daily report card (PDF). The daily report card servers as a means of identifying, monitoring and changing the child’s classroom problems. It also acts as an avenue of regular communication between the parents and the teacher. It costs nothing, takes only a little bit of the teacher’s time, and is very motivating to the child (as long as the parent has selected the right rewards at the home for positive report card reports).

As with parental training, school intervention programs allow for maintenance and relapse prevention and will provide treatment for the child as long as necessary.

 

APA Reference
Grohol, J. (2009). Comprehensive Treatment of Childhood ADHD. Psych Central. Retrieved on October 31, 2014, from http://psychcentral.com/lib/comprehensive-treatment-of-childhood-adhd/0001747
Scientifically Reviewed
    Last reviewed: By John M. Grohol, Psy.D. on 30 Jan 2013
    Published on PsychCentral.com. All rights reserved.