What treatments Are Available?
For decades, medications have been used to treat the symptoms
of ADHD. Three medications in the class of drugs known as stimulants
seem to be the most effective in both children and adults. These
are methylphenidate (Ritalin), dextroamphetamine (Dexedrine or
Dextrostat), and pemoline (Cylert). For many people, these medicines
dramatically reduce their hyperactivity and improve their ability
to focus, work, and learn. The medications may also improve physical
coordination, such as handwriting and ability in sports. Recent
research by NIMH suggests that these medicines may also help children
with an accompanying conduct disorder to control their impulsive,
Ritalin helped Henry focus on and complete tasks for the first
time. Dexedrine helped Mark to sit quietly, focus his attention,
and participate in class so he could learn. He also became less
impulsive and aggressive. Along with these changes in his behavior,
Mark began to make and keep friends.
Unfortunately, when people see such immediate improvement, they
often think medication is all that's needed. But these medicines
don't cure the disorder, they only temporarily control the symptoms.
Although the drugs help people pay better attention and complete
their work, they can't increase knowledge or improve academic
skills. The drugs alone can't help people feel better about themselves
or cope with problems. These require other kinds of treatment
For lasting improvement, numerous clinicians recommend that
medications should be used along with treatments that aid in these
other areas. There are no quick cures. Many experts believe that
the most significant, long-lasting gains appear when medication
is combined with behavioral therapy, emotional counseling, and
practical support. Some studies suggest that the combination of
medicine and therapy may be more effective than drugs alone. A
large study is currently being conducted on this.
Use of Stimulant Drugs
Stimulant drugs, such as Ritalin, Cylert, and Dexedrine, when
used with medical supervision, are usually considered quite safe.
Although they can be addictive to teenagers and adults if misused,
these medications are not addictive in children. They seldom make
children "high" or jittery. Nor do they sedate the child. Rather,
the stimulants help children control their hyperactivity, inattention,
and other behaviors.
Different doctors use the medications in slightly different
ways. Cylert is available in one form, which naturally lasts 5
to 10 hours. Ritalin and Dexedrine come in short-term tablets
that last about 3 hours, as well as longer-term preparations that
last through the school day. The short-term dose is often more
practical for children who need medication only during the school
day or for special situations, like attending church or a prom,
or studying for an important exam. The sustained-release dosage
frees the child from the inconvenience or embarrassment of going
to the office or school nurse every day for a pill. The doctor
can help decide which preparation to use, and whether a child
needs to take the medicine during school hours only or in the
evenings and on weekends, too.
Nine out of 10 children improve on one of the three stimulant
drugs. So if one doesn't help, the others should be tried. Usually
a medication should be tried for a week to see if it helps. If
necessary, however, the doctor will also try adjusting the dosage
before switching to a different drug.
Other types of medication may be used if stimulants don't work
or if the ADHD occurs with another disorder. Antidepressants and
other medications may be used to help control accompanying depression
or anxiety. In some cases, antihistamines may be tried. Clonidine,
a drug normally used to treat hypertension, may be helpful in
people with both ADHD and Tourette's syndrome. Although stimulants
tend to be more effective, clonidine may be tried when stimulants
don't work or can't be used. Clonidine can be administered either
by pill or by skin patch and has different side effects than stimulants.
The doctor works closely with each patient to find the most appropriate
Sometimes, a child's ADHD symptoms seem to worsen, leading parents
to wonder why. They can be assured that a drug that helps rarely
stops working. However, they should work with the doctor to check
that the child is getting the right dosage. Parents should also
make sure that the child is actually getting the prescribed daily
dosage at home or at school--iit's easy to forget. They also need
to know that new or exaggerated behaviors may also crop up when
a child is under stress. The challenges that all children face,
like changing schools or entering puberty, may be even more stressful
for a child with ADHD.
Some doctors recommend that children be taken off a medication
now and then to see if the child still needs it. They recommend
temporarily stopping the drug during school breaks and summer
vacations, when focused attention and calm behavior are usually
not as crucial. These "drug holidays" work well if the child can
still participate at camp or other activities without medication.
Children on medications should have regular checkups. Parents
should also talk regularly with the child's teachers and doctor
about how the child is doing. This is especially important when
a medication is first started, re-started, or when the dosage
The Medication Debate
As useful as these drugs are, Ritalin and the other stimulants
have sparked a great deal of controversy. Most doctors feel the
potential side effects should be carefully weighed against the
benefits before prescribing the drugs. While on these medications,
some children may lose weight, have less appetite, and temporarily
grow more slowly. Others may have problems falling asleep. Some
doctors believe that stimulants may also make the symptoms of
Tourette's syndrome worse, although recent research suggests this
may not be true. Other doctors say if they carefully watch the
child's height, weight, and overall development, the benefits
of medication far outweigh the potential side effects. Side effects
that do occur can often be handled by reducing the dosage.
It's natural for parents to be concerned about whether taking
a medicine is in their child's best interests. Parents need to
be clear about the benefits and potential risks of using these
drugs. The child's pediatrician or psychiatrist can provide advice
and answer questions.
Another debate is whether Ritalin and other stimulant drugs
are prescribed unnecessarily for too many children. Remember that
many things, including anxiety, depression, allergies, seizures,
or problems with the home or school environment can make children
seem overactive, impulsive, or inattentive. Critics argue that
many children who do not have a true attention disorder are medicated
as a way to control their disruptive behaviors.
Medication and Self-Esteem
When a child's schoolwork and behavior improve soon after starting
medication, the child, parents, and teachers tend to applaud the
drug for causing the sudden change. But these changes are actually
the child's own strengths and natural abilities coming out from
behind a cloud. Giving credit to the medication can make the child
feel incompetent. The medication only makes these changes possible.
The child must supply the effort and ability. To help children
feel good about themselves, parents and teachers need to praise
the child, not the drug.
It's also important to help children and teenagers feel comfortable
about a medication they must take every day. They may feel that
because they take medicine they are different from their classmates
or that therežs something seriously wrong with them. CH.A.D.D.
(which stands for Children and Adults with Attention Deficit Disorders),
a leading organization for people with attention disorders, suggests
several ways that parents and teachers can help children view
the medication in a positive way:
Compare the pills to eyeglasses, braces, and allergy medications
used by other children in their class. Explain that their medicine
is simply a tool to help them focus and pay attention.
Point out that they're lucky their problem can be helped. Encourage
them to identify ways the medicine makes it easier to do things
that are important to them, like make friends, succeed at school,
Myths About Stimulant Medication
Myth: Stimulants can lead to drug addiction later
Fact: Stimulants help many children focus and be more
successful at school, home, and play. Avoiding negative experiences
now may actually help prevent addictions and other emotional
Myth: Responding well to a stimulant drug proves a person
Fact: Stimulants allow many people to focus and pay
better attention, whether or not they have ADHD. The improvement
is just more noticeable in people with ADHD.
Myth:Medication should be stopped when the child reaches
Fact: Not so! About 80 percent of those who needed medication
as children still need it as teenagers. Fifty percent need medication
Treatments To Help People With ADHD and Their Families Learn
Life can be hard for children with ADHD. They're the ones who
are so often in trouble at school, can't finish a game, and lose
friends. They may spend agonizing hours each night struggling
to keep their mind on their homework, then forget to bring it
It's not easy coping with these frustrations day after day.
Some children release their frustration by acting contrary, starting
fights, or destroying property. Some turn the frustration into
body ailments, like the child who gets a stomachache each day
before school. Others hold their needs and fears inside, so that
no one sees how badly they feel.
It's also difficult having a sister, brother, or classmate who
gets angry, grabs your toys, and loses your things. Children who
live with or share a classroom with a child who has ADHD get frustrated,
too. They may feel neglected as their parents or teachers try
to cope with the hyperactive child. They may resent their brother
or sister never finishing chores, or being pushed around by a
classmate. They want to love their sibling and get along with
their classmate, but sometimes it's so hard!
It's especially hard being the parent of a child who is full
of uncontrolled activity, leaves messes, throws tantrums, and
doesn't listen or follow instructions. Parents often feel powerless
and at a loss. The usual methods of discipline, like reasoning
and scolding, don't work with this child, because the child doesn't
really choose to act in these ways. It's just that their self-control
comes and goes. Out of sheer frustration, parents sometimes find
themselves spanking, ridiculing, or screaming at the child, even
though they know it's not appropriate. Their response leaves everyone
more upset than before. Then they blame themselves for not being
better parents. Once children are diagnosed and receiving treatment,
some of the emotional upset within the family may fade.
Medication can help to control some of the behavior
problems that may have lead to family turmoil. But more often,
there are other aspects of the problem that medication can't touch.
Even though ADHD primarily affects a person's behavior, having
the disorder has broad emotional repercussions. For some children,
being scolded is the only attention they ever get. They have few
experiences that build their sense of worth and competence. If
they're hyperactive, they're often told they're bad and punished
for being disruptive. If they are too disorganized and unfocused
to complete tasks, others may call them lazy. If they impulsively
grab toys, butt in, or shove classmates, they may lose friends.
And if they have a related conduct disorder, they may get in trouble
at school or with the law. Facing the daily frustrations that
can come with having ADHD can make people fear that they are strange,
abnormal, or stupid.
Often, the cycle of frustration, blame, and anger has gone on
so long that it will take some time to undo. Both parents and
their children may need special help to develop techniques for
managing the patterns of behavior. In such cases, mental health
professionals can counsel the child and the family, helping them
to develop new skills, attitudes, and ways of relating to each
other. In individual counseling, the therapist helps children
or adults with ADHD learn to feel better about themselves. They
learn to recognize that having a disability does not reflect who
they are as a person. The therapist can also help people with
ADHD identify and build on their strengths, cope with daily problems,
and control their attention and aggression. In group counseling,
people learn that they are not alone in their frustration and
that others want to help. Sometimes only the individual with ADHD
needs counseling support. But in many cases, because the problem
affects the family as well as the person with ADHD, the entire
family may need help. The therapist assists the family in finding
better ways to handle the disruptive behaviors and promote change.
If the child is young, most of the therapist's work is with the
parents, teaching them techniques for coping with and improving
their child's behavior.
Several intervention approaches are available and different
therapists tend to prefer one approach or another. Knowing something
about the various types of interventions makes it easier for families
to choose a therapist that is right for their needs.
Psychotherapy works to help people with ADHD to like
and accept themselves despite their disorder. In psychotherapy,
patients talk with the therapist about upsetting thoughts and
feelings, explore self-defeating patterns of behavior, and learn
alternative ways to handle their emotions. As they talk, the therapist
tries to help them understand how they can change. However, people
dealing with ADHD usually want to gain control of their symptomatic
behaviors more directly. If so, more direct kinds of intervention
Cognitive-behavioral therapy helps people work on immediate
issues. Rather than helping people understand their feelings and
actions, it supports them directly in changing their behavior.
The support might be practical assistance, like helping Henry
learn to think through tasks and organize his work. Or the support
might be to encourage new behaviors by giving praise or rewards
each time the person acts in the desired way. A cognitive-behavioral
therapist might use such techniques to help a belligerent child
like Mark learn to control his fighting, or an impulsive teenager
like Lisa to think before she speaks.
Social skills training can also help children learn
new behaviors. In social skills training, the therapist discusses
and models appropriate behaviors like waiting for a turn, sharing
toys, asking for help, or responding to teasing, then gives children
a chance to practice. For example, a child might learn to "read"
other people's facial expression and tone of voice, in order to
respond more appropriately. Social skills training helped Lisa
learn to join in group activities, make appropriate comments,
and ask for help. A child like Mark might learn to see how his
behavior affects others and develop new ways to respond when angry
Support groups connect people who have common concerns.
Many adults with ADHD and parents of children with ADHD find it
useful to join a local or national support group. Many groups
deal with issues of children's disorders, and even ADHD specifically.
The national associations listed at the back of this booklet can
explain how to contact a local chapter. Members of support groups
share frustrations and successes, referrals to qualified specialists,
and information about what works, as well as their hopes for themselves
and their children. There is strength in numbers--aand sharing
experiences with others who have similar problems helps people
know that they aren't alone.
Parenting skills training, offered by therapists or
in special classes, gives parents tools and techniques for managing
their child's behavior. One such technique is the use of "time
out" when the child becomes too unruly or out of control. During
time outs, the child is removed from the agitating situation and
sits alone quietly for a short time to calm down. Parents may
also be taught to give the child "quality time" each day, in which
they share a pleasurable or relaxed activity. During this time
together, the parent looks for opportunities to notice and point
out what the child does well, and praise his or her strengths
An effective way to modify a child's behavior is through a system
of rewards and penalties. The parents (or teacher) identify a
few desirable behaviors that they want to encourage in the child--ssuch
as asking for a toy instead of grabbing it, or completing a simple
task. The child is told exactly what is expected in order to earn
the reward. The child receives the reward when he performs the
desired behavior and a mild penalty when he doesn't. A reward
can be small, perhaps a token that can be exchanged for special
privileges, but it should be something the child wants and is
eager to earn. The penalty might be removal of a token or a brief
"time out." The goal, over time, is to help children learn to
control their own behavior and to choose the more desired behavior.
The technique works well with all children, although children
with ADHD may need more frequent rewards.
In addition, parents may learn to structure situations in ways
that will allow their child to succeed. This may include allowing
only one or two playmates at a time, so that their child doesn't
get overstimulated. Or if their child has trouble completing tasks,
they may learn to help the child divide a large task into small
steps, then praise the child as each step is completed.
Parents may also learn to use stress management methods, such
as meditation, relaxation techniques, and exercise to increase
their own tolerance for frustration, so that they can respond
more calmly to their child's behavior.
Understandably, parents who are eager to help their children
want to explore every possible option. Many newly touted treatments
sound reasonable. Many even come with glowing reports. A few are
pure quackery. Some are even developed by reputable doctors or
specialists--bbut when tested scientifically, cannot be proven
Here are a few types of treatment that have not been scientifically
shown to be effective in treating the majority of children or
adults with ADHD:
- restricted diets
- allergy treatments
- medicines to correct problems in the inner ear
- chiropractic adjustment and bone re-alignment
- treatment for yeast infection
- eye training
- special colored glasses
A few success stories can't substitute for scientific evidence.
Until sound, scientific testing shows a treatment to be effective,
families risk spending time, money, and hope on fads and false
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