Comprehensive Treatment of Childhood ADHD

By John M. Grohol, Psy.D.

Child Interventions

Children can be their own best keepers, especially when it comes to how older children and teens learn most from — their peers (friends). The measure of the severity of a child’s ADHD can be seen in how impaired their relationships are with their friends. ADHD children with no close friends are a sign of severe ADHD that, if left untreated, predicts negative adult relationships. Friends can help an ADHD child immensely.

Child interventions take a behavioral and developmental treatment approach. They tend to focus on teaching academic, recreational, and social/behavioral competencies, decreasing aggression, increasing compliance, developing close friendships, improving relationships with adults, and building self-efficacy in the ADHD child.

Child ADHD interventions can include intensive treatments such as summer treatment programs (9
hours daily for 8 weeks), and/or school-year, after-school, and Saturday (6 hours) sessions. Such programs can also help with relapse prevention (e.g., through integration with school and parent treatments, which can all be linked together through a home/school report card system).

Medication for Childhood ADHD

Since not all children will respond to behavioral interventions, medications may also be considered in the treatment of childhood attention deficit disorder (ADHD). Behavioral interventions, like those listed previously, may not always be sufficient for some children. Parents and teachers can also sometimes not implement the program correctly, or keep it up over the long-term (after the therapist’s contact has ended).

At such times, the prescription of an appropriate psychostimulant medication may be appropriate as medications often offer more immediate short-term benefits (allowing the child to be able to better focus on the behavioral interventions). Such short-term benefits include decreased classroom disruptions, improvement in teacher ratings of the child’s ADHD behavior, improvement in compliance with adult requests, improvement in peer interactions, and increase in on-task behavior and academic productivity.

However, medications rarely should be used as the first treatment implemented. Twice as many parents will refuse any additional type of treatment for their ADHD child when a medication is prescribed first (and is ineffective), than when a parent first tries their child on a behavioral approach. Research has also shown that most parents prefer a behavioral approach (or a combined behavior and medication approach) over medications alone. A combined treatment approach also has shown that children can gain as much value from medications at significantly lower doses. Since ADHD medications have been linked to stunted childhood growth (height and weight), lower doses are generally preferred.

The need for a medication prescription should be determined following initiation of behavioral treatments, and its timing will generally depend on severity of the ADHD and responsiveness of the child to the behavioral interventions.

An individualized, school-based medication trial should be conducted with your child to determine need and minimal dose needed to complement the behavioral intervention. The physician or psychiatrist should cycle through methylphenidate and amphetamine-based medications (such as Adderall, Ritalin or Concerta) before trying other drug classes with your child. Your doctor should begin by prescribing the minimal dose needed, and only increase if symptoms don’t decrease over time (1 to 2 weeks). Consider the long-acting versions of a medication if dosing schedule doesn’t allow for multiple doses administered throughout the day.

Keep in mind that ADHD medications generally only work for as long as they are taken, hence the reason a combined approach that involves both behavioral interventions and medications is nearly always preferred. Medications are not effective for all children, and there is uniform lack of research evidence for their long-term use (more than 2 years). Medication compliance has generally been shown to be poor the longer a child is on a medication, and medication alone will likely have little effect on academic achievement, family problems or problems with relationships with their friends.

This article based upon a presentation by Dr. William E. Pelham Jr., October 2008.

 

APA Reference
Grohol, J. (2009). Comprehensive Treatment of Childhood ADHD. Psych Central. Retrieved on September 20, 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.