Attention Deficit Hyperactivity Disorder (ADHD) (cont.)

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What is the role of alternative therapies in ADHD?

CAM (complementary and alternative medicine) therapies are considered and/or tried in over half of patients with ADHD. Many times, these modalities are used covertly and it is important for the treating physician to inquire about CAM to encourage open communication and review risks vs. benefits of such an approach. CAM treatment modalities incorporating vision training, special diets and megavitamin therapy, herbal and mineral supplements, EEG biofeedback, and applied kinesiology have all been advocated. The benefits of these approaches, however, have not been confirmed in double-blind controlled research studies. Families should be aware that such programs might require a long-term financial commitment that may not have insurance reimbursement as an option. Recent research on the benefits of specific polyunsaturated fatty acid (EPA and DHA) supplementation has demonstrated a therapeutic benefit in several well-designed studies. Further research in this area will hopefully shed light on how these supplements work.

What are behavioral treatments for ADHD in children?

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In October 2011, the American Academy of Pediatrics (AAP), in their Clinical Practice Guideline, reaffirmed the 2001 recommendation that when treating target ADHD symptoms, "clinicians should recommend stimulant medication and/or behavior therapy, as appropriate." Several forms of behavioral intervention have been found to show little or no effectiveness in treating ADHD patients. These included individual or play therapy, long-term psychotherapy, psychoanalysis, sensory-integration training, and cognitive behavioral therapy. However, one form of a non-medication approach, behavioral therapy, has been demonstrated to be somewhat effective with ADHD children. The therapy sessions are conducted by a mental health professional (for example, a psychologist or social worker) and consist of parent and teacher training in child behavior management. The parents and teachers are taught to consider their child's behavior as a function of the disorder, rather than "bad behavior" or the result of failed parenting/teaching skills. The sessions then go on to teach the adults to pay attention to appropriate behavior, ignore minor inappropriate behavior, to give clear and concise directions, and to establish effective incentive programs, such as token or point reward systems. The adults manage misbehavior by applying immediate, specific, and consistent consequences (removal of privileges). Basically, the three principles of behavior therapy are

  1. set specific goals,
  2. provide rewards and consequences,
  3. and keep using the rewards and consequences for a long time.

Parents can help their child's behavior with specific goals such as: (1) maintaining a daily schedule, (2) keeping distractions to a minimum, (3) setting small and reasonable goals, (4) rewarding positive behavior, (5) using charts and checklists to keep a child "on task," and (6) finding activities in which the child will succeed (sports, hobbies).

Many feel that behavior therapy can be an appropriate first-level treatment in several scenarios:

  1. The milder ADHD patient
  2. For the preschool-aged child with ADHD-suspicious symptoms
  3. When the family prefers this approach vs. medication

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Attention Deficit Hyperactivity Disorder - Tests and Diagnosis Question: How was your attention deficit hyperactivity disorder diagnosed?
ADHD in Children - Symptoms Question: Please describe the symptoms of your child's ADHD. When did they first appear?
ADHD in Children - Behavioral Treatments Question: Describe the ADHD behavioral treatments that have been effective for your child or the child you care for.
ADHD in Children - Medications Question: If you've used medications to treat your child's ADHD, what's worked and what hasn't?
ADHD in Children - Personal Experience Question: Please share your personal experience with ADHD.