When to consider medication for ADHD?
It is a frequent question asked by many parents, teachers and therapists; how do I help my child with ADHD? It is a legitimate question. The presentation can be the classic hyperactive, impulsive, inattentive child or just the inattentive child who gets lost in class and is disorganized. Parents may find themselves using words like “lazy” or “spacey” or “procrastinating” to describe their children. A parent might say, “I know he is smart but his grades don’t show it.” A teacher might think, “This student is a problem.” Living with or teaching a child with ADHD can be very challenging and difficult for all. Fortunately, my experience as a Board Certified Child and Adolescent Psychiatrist shows there are treatments available to help the child with ADHD.
There is very strong evidence that ADHD is a neurobiological disorder, a problem with the brain and its neurotransmitters. There is also very strong evidence that the primary cause of ADHD is genetic, due not to any single gene, but to combined effects of a number of genes. For some children, problems with ADHD show up very early in their development. As young children, they are difficult to manage, primarily because they have great difficulty following even the most basic of directions. Other children may not show symptoms of ADHD until later childhood or may have less extreme behavioral difficulties.
Interventions for children with ADHD should always start with a comprehensive assessment. The assessment of ADHD should document the presence, intensity and duration of ADHD symptoms. Generally, this includes obtaining direct observations from teachers and parents. This information helps document school-related, behavioral, and other social adjustment issues that often accompany ADHD. The assessment should also explore the presence of other emotional-behavioral problems that exist at home and school. Parent and teacher rating scales such as the Connors Rating Scales, the Child Behavior Checklist (CBCL) or the Behavior Assessment System for Children (BASC) are often used to measure ADHD related problems. The data gathered by these checklists, direct observations and reports can then be used to help determine whether the child shows significant signs of inattention, hyperactivity-impulsivity, or combined type (symptoms of both inattention and hyperactivity).
Most parents and teachers start by providing structure and guidance both at home and school. Direct instruction, along with positive behavioral feedback are critical aspects of any intervention plan. Since ADHD is recognized as a disability under the American’s with Disabilities Act (ADA), the child diagnosed with ADHD may qualify for a 504 plan that can provide specific classroom accommodations to help the child be successful in the classroom despite the disability. If academic achievement is uneven, psychological testing to rule out a formal learning disorder should be considered. About one third of kids with ADHD have a processing problem in reading, spelling, or math.
The good news about ADHD is that this disorder can, in most cases, be successfully treated. The American Academy of Pediatrics (AAP) and the American Academy of Child and Adolescent Psychiatry (AACP) have published guidelines for treatment of ADHD. There is a large body of scientific research showing the effectiveness of a combination of medication management and behavioral treatment strategies. Results from many of these studies suggest that carefully managed medication treatment and targeted behavioral interventions are the key ingredients.
Medications approved by the Food and Drug Administration (FDA) for the treatment of ADHD are the stimulant medications, methylphenidate and amphetamine, both of which are available in several different formulations and brands. Stimulant medications like Ritalin have been successfully used for the past 50 years and have been carefully researched in a number of controlled studies. While it is important to note that ADHD medication does not cure symptoms, a large percent of those individuals treated with medications significantly alleviate ADHD symptoms when the medication is active.
When considering whether or not to initiate a trial of medication, there are 3 things to think about.
- How much effort and energy is being put into helping your child be successful at school or home? Most parents (and teachers) invest a great deal of effort to help their child meet reasonable expectations, but the return on that investment is small. Grades remain poor due to inattention or it takes 4 hours to complete 2 hours worth of homework. It is a state of underachievement.
- What is the quality of your child’s social relationships? Kids with ADHD lag behind socially by about 2 years. They can have difficulty making and maintaining friendships. If the invites to birthday parties start to dissipate, think about quality of peer relationships.
- What is the quality of your relationship with your child who is diagnosed with ADHD? Parents sometimes experience a great deal of frustration and even hopelessness when parenting their child with ADHD. Perhaps there is a lot of tension or even anger in the home due to the challenges of parenting a child with ADHD? Maybe a trial of medication will improve the quality of interactions and ultimately, the relations ship with their child.
When combined with behavioral interventions, medication can improve behavior, academic performance, and interpersonal relationships. The interventions help improve the child’s self-control and concentration so that he or she is more likely to use skills to meet academic, social or behavioral expectations.