Best Treatment Options for ADD or ADHD?

What are the best treatment options if your child is diagnosed with ADD or ADHD? 
 

Question:
Ellen Rome, M.D.
ABOUT THE EXPERT

Ellen Rome, M.D.

Dr. Ellen Rome is a board-certified pediatrician who was among the first in the U.S. to be board certified in adolescent medicine. She... Read more

The most commonly accepted treatment approach for attention deficit disorder or attention deficit hyperactivity disorder is a combined intervention of behavior therapy and medication. Behavior therapy is the mainstay for treatment in younger children with ADD/ADHD.

Optimally, parents, teachers and other caregivers need to work together to provide positive reinforcement for desired behaviors and extinguish or lessen the incidence of negative behaviors. Think in terms of ABCs: Antecedents, or what happens before a behavior; the Behavior itself; and the Consequences, or what happens immediately after. Changing the antecedents may mean putting a wiggly child in the front of the classroom, or next to a parent during the family dinner, to lessen distracting stimuli. Putting a hand on a shoulder or gently turning the child’s chin to face you before giving instructions can help the ADD child “tune in.” Rewards for acceptable behavior in a particular setting (for example, socially appropriate classroom behavior) should come immediately. Unacceptable behavior should be instantly followed by a time-out in a boring place (nonrewarding); “response cost,” such as the loss of TV/video game/other privilege for the older child; and at times “overcorrection,” or the addition of extra work, like having to scrub the floor or wash the baseboards.

Medications can be added in conjunction with or after behavioral interventions are in place. Pharmacotherapy helps a child use “effortful attention” to improve academic performance and classroom behavior when either are getting frustrating for the child. The goal is to add medicines before the child experiences school as a negative factor and before the child sees him- or herself as a failure. Many children, especially bright ones, compensate for their ADD behaviorally until the material expected to be mastered in school becomes more than their organizational skills can handle. It’s as if the ADD brain has information flowing in, ready to get filed in all of the drawers at once. This constant barrage of information is overwhelming to the child with ADD. It’s almost not an attention deficit, but instead an overwhelming flow of information that needs to be speedily processed. When the drawers are overflowing, or too many drawers are getting pulled out without easy retrieval of information, and all behavioral interventions are already being used consistently at home and at school, it’s time for medication. This is not an easy decision, as meds have their own side effects. Working with your pediatrician can help ensure use of the best medications for your child. The goal of medication treatment is to optimize performance so the child with ADD/ADHD can perform as close to his or her typical peers as possible. 

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