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Changing the Game in ADHD Treatment: Why Medication Is Not the First, Only or Best Option

In this installment of their ongoing series on parenting, school psychologists Barrett and Vyas offer alternatives to medicine as treatment options for children diagnosed with ADHD.

Photo by Romina Velez on Unsplash

Attention deficit hyperactivity disorder (ADHD), which affects between 4 and 12 percent of school-age children, is one of the most common behavioral conditions. And after youngsters have been diagnosed with ADHD, families often want to know the best course of treatment so their children can be successful both in and out of school. Although parents and guardians are often told stimulants are the first line of treatment, many families have reservations about putting their children on such medications. This article focuses on helping families understand what ADHD is and offers suggestions for effective treatment options

What ADHD Is and What It Is Not

Children with ADHD have significant difficulty paying attention and/or display a high degree of hyperactivity and impulsivity.  Happening in more than one setting (e.g., at home and school) and before children are 12 years old, these behaviors also interfere with their everyday functioning. It is also important to remember that ADHD symptoms can look different at home versus school. In other words, when young people are interested in certain activities, receiving frequent rewards or have consistent external stimulation (e.g., watching television or playing with cell phones, iPads or other electronic devices), they typically can pay attention for longer periods of time.

Children with ADHD generallyhave one of three types: ADHD, predominantly inattentive presentation; ADHD, predominantly hyperactive/impulsive presentation; and ADHD, combined presentation. Common symptoms include:

  1. Being easily distracted
  2. Organization difficulties
  3. Disliking tasks that require sustained mental effort
  4. Having difficulty with regulating emotions
  5. Having difficulty with remaining seated when expected
  6. Talking excessively or blurting out answers

Although the process of diagnosing ADHD is beyond the scope of this article, one of the most important pieces of advice we can offer is for families to be sure the professionals who are evaluating their children are using a variety of sources and methods to make their decisions.  In other words, interviews with parents, caregivers and teachers; behavior rating scales completed by families and teachers; classroom observations; and individualized testing with children will lead to the most accurate decisions.  This process also ensures the reason for children’s behavioral difficulty is identified and the most appropriate interventions are provided.  For example, some students who are not paying attention actually have learning disabilities (e.g., difficulty with reading, writing or math) that lead to behavioral challenges.  A comprehensive assessment is strongly recommended so the most appropriate interventions can be provided to children.

It is also important for families to think about how much children’s behavior could be typical of others their age before considering an ADHD diagnosis, which for many parents and guardians is not always easy. Especially because constantly moving is common for toddlers, it is hard to know if such behavior is appropriate rather than being a sign of ADHD before the age of 4. As a result, ADHD is most often diagnosed during the elementary school years and teachers are the first to observe children having difficulty paying attention or controlling their impulses.

 What Is the Best Way to Treat ADHD?

It can be difficult for families to find the treatment approach that works best for them and their children. To paraphrase an old saying, some interventions work for some kids some of the time, but no interventions work for all kids all of the time. Check out the tips below as you are trying to help your child with ADHD.

  1. If you or your child’s teacher have concerns about your child’s level of inattention, consider setting up a daily report card (DRC).  Not only helpful for modifying behavior at school, a DRC also helps caregivers maintain regular contact with teachers. With a DRC, children are rewarded at home for appropriate behavior at school. Specifically, teachers complete a daily written report of a child’s performance on two or three personalized behavioral goals that should be specific and easy to observe (e.g., [child] will begin writing work with no more than two reminders). Children take the DRC home, where their parents/guardians provide rewards, privileges or negative consequences based upon their performance. Click here  for more information about DRCs.
  2. Concerns about inattention can also be discussed with your pediatrician.  Specifically, you can ask about having your child’s ferritin, iron and vitamin D levels checked. Because low amounts may be associated with ADHD, it is important to rule out medical causes of children’s behavioral difficulty to select the best course of treatment.
  3. Try a preservative-free and coloring-free diet, which is supported by the American Academy of Pediatrics. Sharing this very brief article  with your pediatrician could be a good place to start a productive discussion about the effects of food on behavior.
  4. New research supports that the order in which interventions are presented matters with regard to the use of stimulant medication and behavioral therapy. For example, a groundbreaking study showed that children with ADHD improve faster when they receive high-quality behavioral therapy before stimulant medication. If similar results are found with other studies, the current standard of prescribing stimulant medication as the first-line treatment could change.
  5. If you decide to have your children try a stimulant, it is important to note that because stimulants have an initial noticeable effect, people assume that the medication is needed. Please know, however, that regardless of whether individuals have ADHD, everyone will perform better while taking a stimulant.
  6. Because all caregivers can learn effective behavioral management techniques, find out about parenting strategy groups in your area that are designed to strengthen families’ skills in supporting their children’s behavioral needs. These groups may also include opportunities for children to learn social and other related skills in small groups with their peers.
  7. For families with children between the ages of 2 and 7 who feel their youngsters need more individualized support, parent-child interaction therapy (PCIT) may be worth considering. Focused on positive parent-child interactions and teaching effective child-management skills, PCIT involves parents being observed by a therapist in a playroom with their child and receiving in-the-moment coaching through a headset.

Treating ADHD is most effective when professionals partner with families to explain their options. These collaborative discussions help parents and guardians avoid medications and interventions that are ultimately not beneficial to their children’s happiness and health.

Desiree Vyas, Ph.D., NCSP, is a school psychologist and faculty member with Loudoun County (Virginia) Public Schools’ APA-accredited doctoral internship program in Health Service Psychology. Follow her on Twitter @DesireeVyas and Instagram @desiree_vyas.

Charles Barrett, Ph.D., NCSP, is lead school psychologist with Loudoun County Public Schools and an adjunct lecturer in the Graduate School of Education at Howard University.  Follow him on Twitter @_charlesbarrett and Instagram @charlesabarrett using #itsalwaysaboutthechildren.


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