8. What is the impact of ADHD on children and their families?
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 have trouble making friends. They may spend agonizing hours each night struggling to keep their mind on their homework and then forget to bring it to school. It is not easy coping with these frustrations day after day for children or their families. Family conflict can increase. In addition, problems with peers and friendships are often present in children with ADHD. In adolescence, these children are at increased risk for motor vehicle accidents, tobacco use, early pregnancy and lower educational attainment. When a child receives a diagnosis of ADHD, parents need to think carefully about treatment choices. And when they pursue treatment for their children, families face high out-of-pocket expenses because treatment for ADHD and other mental illnesses is often not covered by insurance policies. School programs to help children with problems often connected to ADHD (social skills and behavior training) are not available in many schools. In addition, not all children with ADHD qualify for special education services. All of this leads to children who do not receive proper and adequate treatment. To overcome these barriers, parents may want to look for school-based programs that have a team approach involving parents, teachers, school psychologists, other mental health specialists, and physicians.
9. How is ADHD treated?
• Nutritional treatments. Many parents have exhausted nutritional approaches, such as eliminating sugar from the diet, before they seek medical attention. However, there are no well-established nutritional interventions that have been consistently demonstrated to be effective for assisting the great majority of children with ADHD. A small body of research has suggested that some children may benefit from these interventions, but delaying the implementation of well-established, effective interventions is likely to be harmful for many children.
• Behavioral treatments. There are various forms of behavioral interventions used for children with ADHD, including psychotherapy, cognitive-behavioral therapy, social skills training, support groups and parent and educator skills training.
• Medication. Psychostimulant medications, including methylphenidate (Ritalin) and amphetamines (Dexedrine, Dextrostat and Adderall), are by far the most widely researched and commonly prescribed treatments for ADHD. Numerous short-term studies have established the safety and effectiveness of stimulants and psychosocial treatments for alleviating the symptoms of ADHD. National Institute of Mental Health (NIMH) research has indicated that the two most effective treatment modalities for elementary school children with ADHD are a closely monitored medication treatment and a treatment that combines medication with intensive behavioral interventions. In the NIMH Multimodal Treatment Study for Children with ADHD (MTA), which included nearly 600 elementary school children, nine out of ten children improved substantially on one of these treatments. Additionally, antidepressant medications may also be used as a second line of treatments for children who show poor response to stimulants, who have unacceptable side effects or who have coexisting conditions (such as tics, anxiety or mood disorders). Tricyclic antidepressants have shown clinical efficacy in 60 to 70 percent of children with ADHD. While the medications were extremely beneficial to most children, MTA findings indicated that medications alone may not necessarily be the best strategy for many children.