According to the CDC, roughly 3-7% of children ages 4-17 are diagnosed with ADHD and this figure rises by 3-5% each year. It’s more common in boys than girls, tends to run in families, and does not resolve on its own if untreated. As a result, a large part of my practice involves the diagnosis and treatment of ADHD. I have written about the behavioral treatment of ADHD in an article (ADHD in Pediatric Epilepsy: A Review) that is currently being reviewed for publication.
Children with ADHD often also have learning disorders (e.g, Dyslexia) and behavioral problems (e.g., ODD – Oppositional Defiant Disorder), which makes the diagnostic process very important. Diagnosis involves gathering information from both parents and the school, either via behavioral scales and/or school observation. When there are suspected learning or processing issues, a neuropsychological evaluation is recommended.
The typical difficulties with ADHD are impulsivity, hyperactivity, and not paying attention. At school, these behaviors manifest as not staying seated, not completing assignments, losing focus during transitions, and negative peer interactions. At home, parents report defiance, difficulty getting to school, aggression, and bedtime problems. Not surprising, ADHD children (compared to their peers) tend to have difficulties with academics, peer relationships, and team sports. Over time, repeated school frustration and peer rejection can lead to low-self esteem and/or mood disorders.
The focus for any ADHD treatment plan should be reducing negative behaviors and increasing skills so the child can feel competent and successful with peers, in the classroom, at home, and on the sports playing field.
Once I make the proper diagnosis, the best (research supported) forms of treatment are:
1. Parent Training & Home Behavioral Plans – Over the course of several sessions, I teach parents how to change the structure at home, as well as how to initiate and reinforce positive behaviors. This includes giving directions, verbal praise, active ignoring, and consequences. We also create behavior-reward plans for specific issues (e.g., sleep). With education and practice, most parents feel significantly more skillful and empowered.
2. School Consultation, Classroom Management & Daily Report Card (DRC) – Teachers with ADHD children are often happy to receive outside support and guidance whereby I observe the child in the classroom and we work collaboratively to create a behavior plan. The most simple and effective plan is called a Daily Report Card (DRC) which outlines specific target behaviors for different time periods throughout the day. Progress is monitored daily and children receive in school and at home rewards.
3. Intensive Summer Programs – Research consistently shows that certain types of summer programs or camps can significantly reduce symptoms of ADHD. Such camps should have specialized staff; a behaviorally-oriented point/reward system; teach specific social skills; teach sport skills; address academic classroom behaviors; run all day long; and run for many weeks (3-7). B/c of the lack of such programs and strong research support, I created Big Apple Day Program in Mahattan – www.bigappledayprogram.com
4. Medication – Children with ADHD who do not respond to behavioral approaches alone may require medication. In such instances, I would refer the family to a child psychiatrist, child neurologist, or developmental pediatrician. Sometimes the combination of medication and therapy can work the best. The downside to medication (compared to therapy) are the possible side-effects. Also, unlike therapy which teaches long-lasting skills, medication loses its effectiveness once it is stopped.
5. Social skills groups – weekly behaviorally-oriented groups (5-10 children) with goals, points, rewards, and consquences can help teach pro-social behaviors and reduce other negative behaviors associated with ADHD. Though there is less support from research, these groups can be an effective treatment adjunct to home and school consultation.
Written by Joshua Rosenthal, PsyD