FACES | Family Advocacy Creating Education and Services | INFORMATION

ADD/ADHD SERIES — PART 3

March 2009

ADD & ADHD Treatment

Professional Help for Children and Adults

Left untreated, ADD and ADHD can cause many problems. Children may fall behind in school and clash with parents and peers. Adults may suffer from relationship, career, and financial difficulties. But treatment can help both children and adults minimize the symptoms of ADD and ADHD, develop effective coping skills, and work through problems at home, work, and school. Treatment options include behavior therapy, medication, support groups, social skills training, educational support, and professional coaching.

Getting help for ADD/ADHD

If you or your child suffers from the symptoms of ADD or ADHD, don’t wait to seek treatment. There are many effective treatments available that can help people with ADD/ADHD improve their ability to pay attention, control impulsive behavior, and curb hyperactivity. Treatment for ADD/ADHD can also improve performance at school or on the job, improve the quality of relationships, and decrease stress and frustration.

The first step in getting help for ADD/ADHD is finding a physician or therapist who specializes in its treatment. To find treatment providers and information about your treatment options, you may want to contact:

Find an ADD/ADHD specialist

Search the CHADD Professional Directory for treatment professionals and organizations offering help for children and adults with ADD/ADHD.

Your primary care physician or your child’s pediatrician
Your insurance company
Officials at your child’s school
Local hospitals or clinics
A local parent support group

During the course of treatment, most professionals who specialize in ADD/ADHD will educate you and your child about the condition so that you can better understand ADD behaviors.

ADHD Specialists	What they can do to help
Child and adolescent psychiatrists	diagnose ADD/ADHD prescribe medications
Psychologists	diagnose ADD/ADHD provide talk therapy help people with ADD/ADHD explore their feelings
Cognitive-behavioral therapists	set up behavior modification programs at school, work, and home establish concrete goals for behavior and achievement help families and teachers maintain rewards and consequences
Educational specialists	teach techniques for succeeding in school help children obtain accommodations from schools advise families about assistive technology
Behavioral coaches	help adults find practical solutions to everyday problems teach organizational and time management techniques help adults tackle procrastination and motivational problems

Developing an ADD/ADHD treatment plan

Once the treatment team is in place, the next step is putting together a personalized treatment plan that addresses you or your child’s specific needs. Family involvement in treatment improves the chances of success, which is why it’s so important to work closely with the treatment team.

The most effective treatment for ADD/ADHD tackles the problem on multiple fronts. This comprehensive treatment strategy is known as the multimodal approach. Elements of the multimodal approach include:

Education about ADHD (for both the person with ADHD and the parents, spouse, or other family members)
Behavioral intervention strategies
Parent training
A specialized educational program
Medication, when necessary

Behavioral therapy for ADD/ADHD

Behavioral therapy, also known as behavior modification, has been shown to be a very successful treatment for children with ADD/ADHD. It is especially beneficial as a co-treatment for children who take medications for ADHD and may even allow you to reduce the dosage of the medication.

Behavioral therapy involves reinforcing desired behaviors through rewards and praise. It also involves decreasing problem behaviors by setting limits and consequences. For example, one intervention might be that a teacher rewards a child who has ADHD for taking small steps toward raising a hand before talking in class, even if the child still blurts out a comment. The theory is that rewarding the struggle toward change encourages the full new behavior.

According to the American Academy of Pediatrics, there are three basic principles to any behavior therapy approach:

Set specific goals. Set clear goals for your child such as staying focused on homework for a certain time or sharing toys with friends.
Provide rewards and consequences. Give your child a specified reward (positive reinforcement) when he or she shows the desired behavior. Give your child a consequence (unwanted result or punishment) when he or she fails to meet a goal.
Keep using the rewards and consequences. Using the rewards and consequences consistently for a long time will shape your child's behavior in a positive way.

As parents, you can set up a customized behavioral modification program for your child who has ADD/ADHD with the help of behavioral specialist, such as a cognitive-behavioral therapist. A cognitive-behavioral therapist focuses on practical solutions to everyday issues. This kind of therapist can set up a behavioral modification program of rewards and consequences for your child at home and at school and support you in shaping your child’s behavior.

Patience is key with behavioral therapy, since people with ADD/ADHD are notoriously variable in their symptoms. One day, your child may behave beautifully, and the next, fall back into old patterns. Sometimes it may seem as if the training is not working. However, over time, behavioral treatment does improve the symptoms of ADHD.

Social skills training

Social skills training is behavior therapy targeted at helping children interact more successfully with others. The therapist demonstrates appropriate behaviors and gives children practice within a group setting. Many people with ADD/ADHD are not skilled at reading social cues, which are communicated by facial expressions, tone of voice, and body language. A social skills group teaches children how to “read” others’ reactions and how to behave more acceptably. Make sure that your child’s social skills group also works on transferring these new skills to the real world. Much of the problem for children with ADD/ADHD, because they are so impulsive, is that they have trouble applying what they know about social skills to the real world.

For a social skills group near you, ask for a referral from your school psychologist or a local mental health clinic.

Parenting interventions and treatment for ADD/ADHD

Children with ADD/ADHD often have trouble translating what they’ve learned from one setting to another. For instance, they may have learned how to control impulsive outbursts at school, but impatiently interrupt others at home. In order to encourage positive change in all settings, children with ADD/ADHD need consistency. It is important that parents of children with ADD/ADHD learn how to apply behavioral therapy techniques at home.

Many behavioral therapy strategies and interventions are simply good parenting techniques. But applying these techniques consistently and appropriately isn’t easy. Behavioral parent training programs can help. These programs teach parents how to develop and implement effective behavior modification plans. They also educate parents on how to advocate for their children and get them the services they need.

To learn more about setting up your own behavioral modification program, see Parenting Children with ADD/ADHD.

School interventions and treatment for ADD/ADHD

School interventions are important in the treatment of ADD/ADHD in children. They ensure that the child has the support and assistance he or she needs to succeed at school.

An educational specialist can help a child with ADD/ADHD overcome the challenge of school. The educational specialist is a kind of coach for your child, focused on the school environment. He or she can help your child:

keep track of assignments
get books and papers from school to home, and vice versa
manage time so that homework gets done
take better notes
study more effectively
write better essays
organize his or her backpack and desk

An educational specialist will also have suggestions about assistive technology such as laptop computers and personal electronic planners. Some may also be able to advise about school accommodations, IEPs, and 504 plans. Ask your school for a referral or search in one of the two professional directories listed below.

Medication treatment of ADD/ADHD

Medications for ADD/ADHD can help alleviate the symptoms of distractibility, impulsivity, and hyperactivity. However, medication doesn’t cure ADD/ADHD. It can relieve symptoms while it’s being taken, but once medication stops, those symptoms come back. Also, ADD/ADHD medication works better for some than for others. Some people experience dramatic improvement while other experience only modest gains.

Because each person responds differently and unpredictably to medication for ADHD, its use should always be personalized to the individual and closely monitored by a doctor. When medication for ADD/ADHD is less carefully monitored, it is less effective and more risky.

Medication is most effective when combined with other therapies that address emotional and behavioral issues.

Is Medication Right for Me or My Child?

If you’re considering medication for ADD/ADHD, it’s important to know all the facts, including what medication can and can’t do, what side effects may occur, the safety concerns about stimulants, and what questions to ask your doctor.

Source: Helpguide.org

In the next article we will cover more on the facts about medication and other therapies.

Treatment and therapy for adult ADD/ADHD

Treatment for adults with ADD or ADHD, like treatment for kids, should involve a treatment team of professionals, along with the person’s family members and spouse. Professionals trained in ADD/ADHD can help you:

control impulsive behaviors
develop and keep a daily schedule
manage your time and money
get and stay organized
boost productivity at work, home, and school
manage stress and anger
communicate more clearly

In addition to the option of medication, adults with ADD/ADHD can also benefit from a number of other treatments, including behavioral coaching, individual therapy, self-help groups, vocational counseling, and educational assistance.

Therapy for adult ADD/ADHD

Therapy for adults with ADD/ADHD can be helpful for both the emotional issues related to the disorder and practical, day-to-day issues.

Talk therapy — Adults with ADD/ADHD often struggle with issues stemming from longstanding patterns of underachievement, failure, academic difficulties, job turnover, and relationship conflict. Individual talk therapy can help you deal with this emotional baggage, including low self-esteem, the feelings of embarrassment and shame you may have experienced as a child and teenager, and resentment at the nagging and criticism you receive from people close to you.
Marriage and family therapy — Marriage and family therapy addresses the problems ADD/ADHD can create in your relationships and family life, such as conflicts over money problems, forgotten commitments, responsibilities in the home, and impulsive decisions. Therapy can help you and your loved ones explore these issues and focus on constructive ways of dealing with them and communicating with each other. Therapy can also improve your relationship by educating your partner about ADD/ADHD.
Cognitive-behavioral therapy — Cognitive-behavioral therapy encourages you to identify and change the negative beliefs and behaviors that are causing problems in your life. Since many individuals with ADD/ADHD are demoralized from years of struggle and unmet expectations, one of the main goals of cognitive-behavioral therapy is to transform this negative outlook into a more hopeful, realistic view. Cognitive-behavioral therapy also focuses on the practical issues that often come with ADD, such as disorganization, work performance problems, and poor time management.

Behavioral coaching for adult ADD/ADHD

Behavioral coaching is not a replacement for therapy, but it can be a valuable supplement to an ADD/ADHD treatment plan. In contrast to therapists, who help people work through emotional problems, coaches focus solely on practical solutions to problems in everyday life. Behavioral coaches teach you strategies for organizing your home and work environment, structuring your day, and managing your money.

ADD coaches work with you on areas such as:

prioritizing
motivation
time management
procrastination

ADD coaches may come to your home or talk with you on the phone rather than meet with you in an office; many coach/client relationships are long-distance.

Tips for Managing Adult ADD/ADHD

Adults with ADD/ADHD can do a lot to help themselves. In effect, they can be their own behavioral coach. Self-Help for Adult ADD/ADHD offers strategies and tips for getting organized, managing your time, taking control of your finances, improving job performance, and boosting social skills.

Professional organizers

A professional organizer can be very helpful if you have difficulty organizing your belongings or your time. A professional organizer helps you:

reduce the stress that clutter creates
save time by organizing your belongings more efficiently
get organized and stay organized

A professional organizer comes to your home or workplace, looks at how you have things organized (or not organized), and then suggests changes. In addition to helping you to organize your paperwork and bill paying, a professional organizer has recommendations for memory and planning tools, filing systems, and more. A professional organizer also helps with time-management: your tasks, your to-do list, and your calendar.

Support groups for adult ADD/ADHD

A support group not only gives you the human encouragement you need to keep working on your issues, but also gives you frank feedback on how you come across to others. A support group for ADD/ADHD:

reduces the isolation of struggling with your disorder,
gives you a place to express your feelings to others who truly understand, and
lets you share strategies for success.

Usually a therapist or other mental health practitioner leads an ADD support group, making sure that you feel supported and that others listen to your feelings and reactions.

Helpguide’s Series on ADD/ADHD

ADD & ADHD in Children: Signs, Symptoms, and How to Get Help
Parenting a child with ADHD: Strategies for Family and Home Life
ADD & ADHD in the Classroom: Tips for Parents and Teachers
Diagnosing ADD & ADHD: Making the Diagnosis in Children and Adults
Adult ADD & ADHD: Recognizing the Signs, Symptoms, and Effects
Self Help for Adult ADD: Tips for Managing Symptoms and Getting Focused
ADD & ADHD Treatment: Professional Help for Children and Adults
ADD/ADHD Medications: Are Meds Right for You or Your Child?