Comprehensive Treatment for ADHD

By Alan Wachtel, MD with Eve Kessler, Esq.

At a Glance

Children with ADHD that are treated comprehensively have the most positive outcomes • A comprehensive plan involves medication in conjunction with educational, behavioral, and psychological interventions • Parent advocacy is critical to ensuring that the treatment plan is implemented properly

Children with ADHD who have the best outcomes are those who receive a combination of simultaneous interventions. While ADHD is not caused by poor parenting, or psychological, behavioral, emotional, or educational challenges, treating it successfully includes elements of all those components.

A comprehensive treatment strategy for ADHD involves:

  • Effective parenting and advocacy
  • A correct diagnosis
  • Properly implemented psychological, behavioral, and educational interventions
  • Medication managed by an experienced professional

Following is a guide to help you select the strategies and treatments best suited to your child.

Role of Medications

ADHD has a true biological basis. Brain scans show that when a person with ADHD uses certain medications, there are changes in how the brain functions. When medication works properly, the brain is “normalized,” becoming indistinguishable from the brain of someone without ADHD.

The goal of medications is to make a child with ADHD feel calm and focusednot to feel or think of himself as medicated.

There is no single “right” medication for everyone. Different medications work differently, have different delivery systems, and cause different side effects.

Medications may be stimulants or non-stimulants, short- or long-acting, and mood-positive or mood-negative.

Stimulants are generally the first line of attack because, over time, they have been found to work most effectively. People with attention deficits who take stimulant medications do not develop a tolerance for them: once the correct dose has been achieved, it will continue to work for years, unless there is a significant change in the patient’s weight.

Because there is no medication that is completely mood-neutral, it is important to minimize the “collateral damage” from taking medication. The key is to increase the amount of natural chemicals (Dopamine and Norepinephrine) that regulate attention while causing the fewest negative side-effects related to mood, appetite, and sleep. Therefore, each child with ADHD should be treated with the lowest dose of the most targeted medication that brings reliable results over time.

Educational Interventions

While medications are useful for attention and psychiatric disorders, they will not help children read, write, or understand math. For students whose ADHD impedes their ability to learn and function independently, and for those who have a co-existing psychological problem and/or specific learning disability, special education, related services, and therapeutic interventions are beneficial and may be required by federal law.

If your child has an Individualized Education Program (IEP) or a Section 504 Plan, your educational advocacy is essential. His program or plan must be monitored by his educational team each marking period and updated as frequently as necessary (at least yearly), and evaluations by experts must be performed on a triennial basis or more frequently, if necessary.

Your child must be taught—and master—the skills and strategies necessary for him to focus and function successfully and independently throughout the day and across curricula and environments.

Make sure all special education and related services, as well as any needed academic, functional, and social modifications and accommodations, are in place and are effective in the classroom, at recess, in the lunchroom, on the sports field, on the bus, and during extracurricular activities. If they are not, request a meeting to address your child’s strengths and concerns and to develop an appropriate educational program to be properly implemented.

Behavioral Interventions

If a student’s behavior impedes his learning or the learning of others, schools must have a qualified expert perform a functional behavioral assessment.

Behavioral therapies can be executed in ways that are more hurtful than helpful for a child, and a risk/benefit analysis must be done before a behavioral plan is developed and implemented. To be effective, no matter what the specific intervention —behavioral charts, checklists, bonus points, etc.—it must be positive, socially invisible, and have no stigma attached. If everyone in the class has a behavior chart and earns bonus points, there is no stigma attached when it is used for your child as well. However, if your child is the only one with the chart and points, the risk of his feeling singled out outweighs its value.

Psychological Interventions

For the large number of students with ADHD who have co-existing psychological and mood disorders, in addition to treating their attention, it is essential to target their anxiety, depression, or phobias with a combination of medications and therapies.

These interventions must involve parents, families, and schools and must be effective across a broad range of environments, including home, school, and community. For example, if your child holds it together in school only to fall apart when he comes home after school, the interventions being used are not working consistently and should be rethought.

This article is based on a presentation by Alan Wachtel, MD, sponsored by Smart Kids with Learning Disabilities. Dr. Wachtel is a psychiatrist and noted expert in the treatment of ADHD. He is the author of The Attention Deficit Answer Book: The Best Medications and Parenting Strategies for Your Child. Eve Kessler, Esq., an attorney with The Legal Aid Society, NYC, is President of SPED*NET Wilton, CT and a Contributing Editor of Smart Kids.

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