Treatment of A.D.H.D.
Grant L. Martin, Ph.D.

If you find out your child has ADHD, don't be in too big a rush to run out and make all sorts of changes. First, take some time to process your own feelings and reactions. Let God know how you feel and talk to some trusted friends or family members. There is “a time to weep and a time to laugh, a time to mourn and a time to dance” (Ecclesiastes 3:4). There is every reason to have hope, but before you can start helping your child, you need a little time to come to peace with your own questions and reactions.

Remember that there are no quick fixes for attention disorders. In spite of claims to the contrary, special diets, electronic gadgets, or singular environmental alterations have not been proven to be helpful with significant numbers of ADHD children. The good news, however, is that there are many strategies and procedures that can improve your child’s behavior, self-esteem and overall quality of life. Here are five categories of interventions, each with some specific suggestions:

Understanding and parenting an ADHD child

Effectively parenting an ADHD child begins by increasing your understanding of ADHD. Books, tapes, seminars, support groups, and professional educators and mental health professionals are sources of information to help you broaden your awareness of how ADHD impacts your child’s behavior. Here are 12 specific tips for successfully parenting your ADHD child:

  • Provide consistency and structure. Above all, ADHD children need clear structure, definite descriptions of what they are being asked to do, specific consequences for their behavior, and consistent enforcement of these principles. They need an organized environment where the demands are clearly identified ahead of time. Surprises and the unexpected mean trouble. Try to keep daily events like bedtime, meals, and homework on a definite schedule. Be firm about limits and enforce them consistently. Limit the amount of TV since that brings even more distracting stimuli. Lots of rewards and praise for successful and appropriate behavior are also especially important.
  • Be sensitive to your child. Most children will be confused, discouraged, or upset when they learn their ADHD diagnosis. They might think there is something terribly wrong with their bodies or brains. Or they may want to use their diagnosis as an excuse, saying, “I can't help myself. I have ADHD.” Just like you, they will need time to adjust to the diagnosis. Your child needs a lot of special understanding and encouragement at this time. Although most children feel relieved, because now they know why they have struggled so much, they will also need hope for their future.
  • Explain ADHD simply. One of your most difficult tasks is to explain ADHD to your child. Without an explanation he will conclude he is either “bad,” “dumb,” or “inferior.” He needs to know that you realize he has a difficult time sitting still, stifling interruptions, and keeping his mind on a job; he needs to know his academic problems are not his fault. Tell him you know he is doing the best he can, but that he has a problem which makes it hard for him to concentrate and get his work done.
  • Phrase your explanation in word pictures your child can understand. Tell him that every person is unique and that we all have strengths and weaknesses. Some people have vision problems so that they can't see very well. These people wear glasses to allow them to view their world more clearly. Other kids have teeth that need straightening. They wear braces and retainers to correct their teeth so they can eat correctly, play the horn, or whistle.
  • Let your child know he is not the only one with this problem. There are lots of others in his school who also have attention deficit. If someone else in his extended family has the same problem, share this fact also. Let him know there are many parents, teachers, and very successful people who have attention problems.
  • Focus on what your child can do, not on his or her limitations. Your child may have difficulty concentrating while reading to himself, but does much better when listening to someone read aloud. Rather than force silent reading, which leads to frustration, let your child learn new information by reading to him, listening to a book on tape, or watching a videotape.
  • Remember the big picture. Schoolwork is important, but a child's emotional and social adjustment and love for God are more important. Be thankful for all the things that are going well in these parts of your child's life.
  • Teach and show by your life that mistakes don't equal failure. An ADHD child may tend to see his or her mistakes as huge failures. You can model, through good-humored acceptance of your own mistakes, that errors can be useful and can lead to new solutions. Mistakes and problems are not the end of the world.
  • Communicate that this is a team effort. Yes, your child has to take responsibility for doing his or her chores, completing homework, and putting out his or her best effort. However, your child is not in this alone. Everyone will work together to make school and home life as successful as possible.
  • Pray together and work on projects as a family. Emphasize family traditions, stories, and legacies to help keep the problem of attention deficit in perspective. In the larger scheme of things, family, faith, and loving relationships are truly what is important.
  • Do not compare your child with his or her brothers and sisters or classmates. Accept your ADHD child as s/he is. Be the best cheerleader your child will ever see!
  • Take care of yourself. Most ADHD children are high-maintenance kids. The constant advocacy, attention to details, remediation efforts and patience needed for a child with attention disorders can easily wear you down. There will be days when you are at your wit's end and you will feel like giving up and trading in the family minivan for a one-way ticket to New Zealand! Find time for yourself. Talk with a friend and maintain your sense of humor. Laughter is good for the soul. Your home needs to be safe, supportive, and fun. Do all you can to become that kind of parent and your child can learn to feel great about himself in spite of his attention problem!

Teaching self-control and social behavior

Once you have the basic parenting principles down, it’s time to help your child develop better social skills and self control. While most children can sit through a meal without a major incident, an ADHD child will wiggle, rock, and squirm his way from appetizer to desert. And while most children can consciously focus their attention and resist the urge to move around, your ADHD youngster must learn how to do this. Let him know that he can still choose his behavior. It’s just a little harder for him than for his siblings or friends. And he will need your help to do it.

ADHD children need very specific, step-by-step instructions on how to control their actions. It will help if you can enlist the aid of your child’s teachers, school bus drivers, and recess monitors. Instruction in self-control in one situation will not carry over to a new setting unless the child’s caretakers are very involved in the effort. Learn how to communicate your child’s problem to others in simple, practical terms and ask them to help you set limits and teach your child self control. You can also use games and activities like Statue and Beat the Clock to help your child learn to ignore distractions and develop impulse control. (For more details on these activities, see Dr. Martin’s book What You Need to Know About Attention-Deficit/Hyperactivity Disorder — Facts, Myths, and Treatment.)

Since the majority of ADHD children have experienced some social problems, immaturity or aggression, you will probably also need to help your child develop better social skills. Two of the major goals of social skills training are that ADHD children will become more knowledgeable about appropriate and inappropriate social behavior, and that they will learn how to behave in socially sensitive ways with their peers and classmates. Many schools and clinics provide social skill training that can be a great help to ADHD children. These programs usually help children learn (1) how to enter or begin a social interaction, (2) conversational skills, (3) conflict resolution and problem solving, and (4) anger management.

Seeking medical support

More children receive medication to manage ADHD than any other childhood disorder. And more research has been conducted on the effects of stimulant medications on the functioning of children with ADHD than any other treatment modality for any childhood disorder. Unfortunately, a great deal of misinformation has been perpetuated by the sensationalist, popular press. This extensive research, however, helps us to be fairly definitive about the benefits and liabilities of medication.

In general, we can say medication intervention is a significant help to ADHD children. Between 70-80 percent of children with ADHD respond positively to medication. Attention span, impulsivity and on-task behaviors improve, especially in structured environments. Some children also demonstrate improvements in frustration tolerance, compliance and even handwriting. Relationships with parents, peers and teachers may also improve. Medication will not make your child behave perfectly, nor will it make him smarter. What it can do is reduce many of your child’s attention difficulties so that he can tackle his problems more successfully.

Recently, the National Institute of Mental Health released the Multimodal Treatment Study of Children with Attention Deficit Hyperactivity Disorder (MTA). This study is the longest and most thorough study ever completed comparing treatments for ADHD. The study found that medication in combination with intensive behavioral therapy was significantly superior to all other types of treatment.

Although medication alone was found to be more effective than intensive behavioral treatment alone, the combination of the two was necessary to produce a variety of improvements, and also led to the use of somewhat lower dosages of medication. Also, for the improvement of social skills and anger management, behavioral treatment was found to be very beneficial and necessary. Medication alone, in other words, does not help a child make friends or know how to resolve conflict in appropriate ways.

The primary benefits of the combined use of medication and therapy are improvement of the core problems of ADHD — hyperactivity, impulsivity, and inattentiveness. Attention span seems to improve and there is a reduction of disruptive, inappropriate and impulsive behavior. Compliance with authority of figures is increased, and children’s peer relations may also improve, primarily through reduction in aggression. If the dosage is carefully monitored and adjusted, medication has been found to enhance academic performance. Medication by itself will not rectify learning disabilities. If a child has visual or auditory processing deficits, for example, medication will probably not change the learning problem. But it may well help your child pay better attention, so that he can better apply his educational instructions.

The most important finding to emerge from the vast amounts of research about ADHD is that no one treatment approach is successful alone. Neither medical, behavioral, psychological nor educational intervention is adequate by itself. We must be conscious of treating the whole child or adolescent.

Some parents feel guilty about having their child take medication because they mistakenly think they are tranquilizing him. This is simply not true. Medication actually helps stimulate the parts of the brain that are needed to concentrate. The decrease in external movement does not mean he has been tranquilized. It means he is able to focus more effectively.

All medical decisions, of course, need to be based on the comparison of the benefits and alternative treatments available, and any possible side effects. Although your physician can give you more details, here are a few of the possible side effects of medication.

The primary side effects noted for stimulant medication are insomnia, anorexia or loss of appetite, weight loss and irritability. Most of these appear at the beginning of treatment and only last for about a few weeks.

Appetite suppression is another possible side effect. Your child may be less hungry for a time. This affect may be less noticeable if the drugs are taken with or after meals, as the effects wear off before the next meal. Adjusting the dosage can usually alleviate this symptom over a week or two.

Other mild, but less common side effects, can include sadness, depression, fearfulness, social withdrawal, sleepiness, headaches, nail biting, and stomach upset. These symptoms will usually resolve spontaneously with a decrease in dosage. Some of these symptoms are mild and can be considered acceptable side effects in light of clinical improvement. You and your child’s physician will need to make the decision regarding the advantages of decreased distractibility versus side effects such as nail biting. Alternatively, a trial of a different medication can be initiated.

There are no reported cases of addiction or serious drug dependence to date with these medications. Studies have also examined the question of whether children on these drugs are more likely to abuse other substances as teenagers, compared to children not taking stimulant medications. Recent studies document a decreased risk of later substance abuse if ADHD children are treated for their condition.

Another possible long-term side effect that has been considered has been the suppression of height and weight gain. Presently, it is believed that suppression in growth is a relatively transient side effect of the first year or so of treatment and has no significant effect on eventual adult height and weight for most children. However, suppression of growth is a problem for a very small percentage of children. It is wise for your physician to monitor your child’s growth while they are receiving stimulant medications.

In ending this section, remember that medication is never the sole treatment program for ADHD. What you do after the start of medication, and the other therapy and training he receives along with the medication will determine the lasting benefits. Medication is a very important aspect of a balanced treatment, but it cannot do it all.

Ensuring appropriate educational assistance

It’s no wonder an ADHD student has problems with school. Nowhere else is your child required to concentrate so long in the face of so many powerful distracters. Students must learn class routines, conform to teachers’ rules and inhibit their impulses to do otherwise. And they must control their body movements, maintain an appropriate level of arousal and delay gratification until report cards are issued. You can see why the ADHD child experiences so much frustration and failure at school. This also explains why it is often the classroom teacher who raises questions that bring about referrals for an evaluation for ADHD.

Unfortunately, while the teacher knows your child has a problem, he or she may not realize the problem is ADHD and may not know what to do about it. Consequently, it may be up to you to initiate a thorough assessment and treatment plan, including seeing that some modifications are made in your child’s learning environment.

Here are a few guidelines for making educational interventions with your child:

  • Be sure your child’s school staff accepts the legitimacy of ADHD.
  • See that your child is in a classroom that is structured and predictable, but not punitive or sterile. The ADHD student needs clear rules and consistent scheduling. Assignments should be clearly communicated, both to the child and to the parent. Instruction should be stimulating, clear, and uncomplicated.
  • Distractions should be minimal. This may mean seating your ADHD child close to the teacher and away from obvious distracters such as windows, active classmates, gerbil cages or pencil sharpeners.
  • Immediate and frequent feedback is required. Your child will periodically need to be given directions or instructions so that long periods of unproductive activity are minimized.
  • The ADHD student needs both verbal and tangible positive consequences for attention to tasks and completing assignments. Other meaningful positive and negative consequences will be needed to assist the student in learning appropriate classroom behavior.
  • Directions and instructions must be clear, concrete and concise. Give only a few directions at a time and use as much visual, auditory and hands on demonstration as possible.
  • The curriculum needs to be adjusted to allow the ADHD student to be successful. This is done by modifying the instruction methods to accommodate the child’s difficulty in paying attention and concentrating. Help with organizational skills is necessary. Some flexibility is needed to allow for the student’s low frustration tolerance. Assignments may need to be shortened. Computers can be used to compensate for poor handwriting ability. Assignments might be divided into smaller parts to help the student feel successful and to give more frequent opportunity for feedback.
  • It is crucial for the entire team of educators, mental health professionals, medical personnel, and parents to maintain regular communication. Everyone must work together toward the common goal of ensuring your student the best educational experience possible.
  • Maintain an advocate status with your child’s school. There are many other students to take up the school personnel’s time. Don’t wait for the six-week progress reports. Become very familiar with your child’s teacher and the classroom routine. Be courteous and tactful, but maintain a constant vigil on your child’s behalf.

Legal rights of ADHD students

The Federal Government has established several provisions that affect the education of children with Attention-Deficit Hyperactivity Disorder. One of these is the Individual’s with Disabilities Education Act (IDEA), and the other is Section 504 of the Rehabilitation Act of 1973. These laws require schools to make modifications or adaptations for students whose ADHD results in significant educational impairment. Qualifying children with ADHD must be placed in a regular classroom to the maximum extent appropriate to their educational needs, but they must also receive supplemental aids and services, if necessary.

Sustaining spiritual support

Not long ago a little boy with ADD asked his mother, “Mom, why can’t something be wrong with my arm and not my brain?” Later he added, “My broken arm will get better but you can’t fix my brain.”

You may have had the same kind of questions, along with, “Why my child?” or “Why would God allow this to happen?” I certainly don’t have the answers to these “why?” questions any more than I would claim to understand the mind and long range plans of God.

I do, however, believe ADHD children have potential to live very creative and fulfilled lives. There is every reason to be optimistic about their abilities to mature, yield fruit in season and prosper in whatever they do (Psalm 1:3).

Parenting is difficult with any child, and even more challenging for a child with special needs. That is why the spiritual resources of a Christian parent can make all the difference in the world. You don’t face this task with only your own strength and understanding. You have God’s promises of direction and power.

Pray regularly for your child. God has made some rather remarkable promises – He will answer our prayers (Mark 11:24); God has never failed to keep His promises (1 Kings 8:56). He does not lie. Remember these promises and claim them as you pray for and parent your ADHD child. God will not miraculously remove your child’s ADHD, but He will help you grow in patience, sensitivity and other parenting skills.

If part of God’s purpose is to help a parent develop patience and long-suffering, then blessing you with a child who has attention deficit is a guaranteed way to meet that goal! And, if parenting any child is worth a college education, then raising an ADD child should give you a Ph.D.! The task is continuous and the challenge is great. Put a solid spiritual foundation gives the Christian father and mother additional resources and a basis for hope even when some progress reports will be temporarily discouraging. God can provide encouragement and guidance for you and your child. And He can lead you and your child to rich, rewarding and successful lives.

“Trust in the Lord with all your heart and lean not on your own understanding; in all your ways acknowledge Him and He will make your paths straight” (Proverbs 3: 5-6). These verses capture the essence of every parent’s need.

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