Treatment of Children with ADHD

There are pros and cons to all ADHD treatments. But what is the most effective way to treat children with ADHD?

ADHD (Attention Deficit/Hyperactivity Disorder) in children can be a real problem - especially if the child involved is yours, if you are the child involved, or if you are the teacher, family member or physician of the child. ADHD is a recognized medical disorder for over a hundred years. But it is not a disorder without controversy. Some suggest that ADHD is not a real condition; others believe it is a real condition but it is over-diagnosed and over-treated. But one of the major points of controversy is whether to treat it with medications, counseling, behavioral approaches, or other alternative types of treatments.

In HealthyPlace.com, there are excellent sources of information regarding many of the controversies surrounding ADHD. In this blog, I will try to provide you with my point of view about the disorder.

Does ADHD Really Exist?

First, I believe ADHD is a real disorder (by the way, the accepted name for the disorder is ADHD - primarily inattentive type, primarily impulsive/hyperactive type, or mixed type - ie, ADHD with and without hyperactivity. More about the types of ADHD here.). It may be diagnosed as early as 6 years old and is characterized by three clusters of symptoms:

1. inattentiveness: failing to concentrate, focus or pay attention, not completing tasks, difficulty in organizing activities, losing things necessary to accomplish tasks, etc.
2. hyperactivity: not being able to be still when required (fidgeting or squirming) always being on the go, talking excessively, etc.
3. impulsivity: interrupting or intruding on others, not waiting turns, blurting out answers, etc.

There may be primarily symptoms of inattention, hyperactivity/impulsivity, or all three clusters present. (More on the symptoms of ADHD here.)

I believe the condition is both over and under-diagnosed. Often it is diagnosed by educators, school nurses, parents or busy physicians, and in some cases over-diagnosed. There are multiple reasons that children may be inattentive, or impulsive or hyperactive, eg. anxiety, home stress, medical conditions, psychological trauma, and others. It is often easy to make a diagnosis of ADHD without really considering other causes for the child's behavior. At the same time, a number of large studies of the population show that fewer than 1 in 10 children with the disorder are diagnosed or treated for it.

Treatment of ADHD

So what may be the result if ADHD is not treated? The short answer is that everyone may suffer as a result. The child may suffer grade wise, with decreased self esteem, have difficulty making or keeping friends, with severe behavioral or even legal problems, and may be a "set up" for getting into drugs or alcohol. The family suffers including not only the parents, but the other siblings of the patient. And the school room can be affected. The long-term consequences of untreated adhd can be quite profound and consequential.

So how do we most effectively treat children with ADHD? Is it with stimulant or non-stimulant medications, therapy, behavioral methods, nutritional supplements, diet, or punishment for bad behavior? Probably at least one of the methods on this list, except for punishment, work for some kids, but there is variation amongst kids, with a method working well on one, but not the next child.

A recent NIMH (National Institute of Mental Health) sponsored study (the MTA study) showed that, in the short term, medications seemed to work best in most kids with ADHD, but that counseling and behavioral techniques also had a place in the treatment. More recent follow-up on the kids in the MTA several years later calls some of the very positive short-term results for ADHD medications into question after 3 years or more of usage, but few medical experts question the benefit for most kids in the short run.

The scientific studies for the use of nutritional supplements and other alternative treatments of ADHD are less frequent and less well controlled, so their results are more controversial, but some children do benefit from the use of alternative approaches.

The choice of ADHD treatments should be left to parents (and somewhat to the desires of the child if able to make an informed decision), but the treatment of ADHD should be based on GOOD INFORMATION. The topic of our HealthyPlace TV show will be on the Pros and Cons of Medicating Your ADHD Child (read producer's blog post). I hope you'll join us on Tuesday, April 7 at 5:30p PT, 7:30 CT, 8:30 ET and contribute your viewpoint. You can watch the show live, or later "on-demand", right from our website.

Dr. Harry Croft is a Board-Certified Psychiatrist and Medical Director of HealthyPlace.com. Dr. Croft is also the co-host of the HealthyPlace TV Show.

next: Effects of Substance Abuse on Family Members
~ other mental health articles by Dr. Croft