It’s estimated that as many as 2.5 million children diagnosed with ADHD are taking medication to control their impulsivity, hyperactivity, and inattentiveness. Medications used to treat ADHD — usually central nervous system stimulants (CNS) — are often the first line of attack for treating the disorder. Clinical estimates suggest 70 to 80 percent of the children with ADHD “respond” to medical treatment. (However, in our clinical experience, that number is closer to 50 percent.) If you are considering placing your child on medication, give some thought to medical titration and family therapy as well.

PROPER DOSAGE IMPORTANT
Titration is the process by which the proper therapeutic dosage of a drug is determined. It’s important to note that the effects of medication on the behavior of individual children with ADHD are not standard. The dosage that might be right for one child might not be right for another. During titration, your doctor will prescribe a certain dosage of the drug for a week or two. The only way to determine the proper levels of the medicine for your child is to carefully observe him while he is taking the medicine.

Since CNS drugs are water soluble and fast acting, you should expect to see immediate improvement in your child’s behavior. Changes in behavior will occur within an hour to a few hours. Make note of both the cessation of ADHD symptoms as well as any changes in your child’s appetite, sleep patterns, and academic performance. In addition, you’ll want to ask your doctor about the side effects of each medication.

During titration, create a list of the ADHD symptoms your child exhibits and rate them every day. Also rate your child’s academic performance and any side effects he may exhibit. You can rate each effect from 1 to 10: 1 being no improvement, to 10 being 100 percent improvement. To make a rating form, create a grid with the days of the week listed across the top and each behavioral characteristic you are interested in tracking listed along the left side.

When you return to the doctor, take this form with you and discuss your observations. It’s very important that you continue to collect data and write it down each day during the titration phase. One or two weeks is a long time to remember everything that has happened without a written record.

The process of titration is extremely important for both you and your child. With the proper dosage and type of medicine, you may find you have a brand- new child.

Include Family Therapy

Although medication may be effective for treating the symptoms of ADHD, it does nothing to repair relationships. The best available evidence suggests that multimodal treatment is more effective than medication alone in treating a child with ADHD. Multimodal means your child and family are assisted by a variety of treatments. For example, your child may be taking medication but will also need an effective behavior management system in place.

In addition, some people find it helpful to attend family therapy sessions. To find a quality family therapist, make sure this individual has both the training (course work, degrees, licenses, and/or certifications) and experience working with families and children learning to cope with ADHD. Your therapist should set goals and objectives for each session and he or she should give you assignments to work on as a family. A good therapist will also require you to take data and turn it back in on a weekly or bi-weekly basis.

The diagnosis of ADHD can be difficult. However, there is hope for both you and your child. With medicinal treatments, family therapy, and behavioral intervention, strides can be made. Most important is deciding how to proceed once you’ve received the diagnosis. Be sure to select the therapeutic route that is best for your child and family.

Other Coping Strategies
The ADHD diagnosis can bring both heartache and relief. While relief may seem odd at the time of a such a devastating diagnosis, parents often say they’re relieved because they believe help is now in sight. But what form will that take? As parents, we know there is more we can do than simply medicate our children. That’s why it’s important to receive good information on a multimodal treatment plan that includes behavioral interventions and/or the legal support for your child.

Here are three coping strategies that will help you manage you ADHD child.

Structure Your Child’s Environment
Many children with ADHD appear lost and confused when transitioning from one activity to the next. They’re often easily distracted during these times of change. Research indicates that children with ADHD have problems discriminating the passage of time. For example, what seems like a few minutes to us can seem like an eternity to a child with ADHD. So it’s important that you make a schedule for your child and keep it. Schedules can vary in size, shape, and specificity but nonetheless, it’s important one be in place.

Make a daily activity schedule or a detailed, individualized activity schedule (get ready for school schedule, dinner routine schedule, brush teeth schedule, etc.). Secondly, use a timer to help your child gauge the passage of time. This should be individualized for each child and may vary from an “all done” timer to a countdown timer. The third key is rewarding your child sooner and more often with small rewards. This is better than rewarding later and less often with more sizeable rewards. In other words, catch your child being good and use specific praise. For example, “Johnny, great job coming to the table the first time I asked.”

Finally, practice sequencing activities with your child. In other words, break down a task, like making a sandwich, into smaller tasks. This will provide your child with supervised opportunities to break down a long assignment into a sequence of short, interrelated activities. With practice, your child will begin to break down activities on his own.

Use Behavioral Prompts

Behavioral prompts help remind students about expectations for their behavior at home, in the classroom, and in public places. Three prompts that may be particularly helpful are visual cues, proximity control, and hand gestures. Visual cues should be simple, nonintrusive cues to remind the child to remain on task. For example, point at your watch while looking him in the eye. Proximity control is simply moving closer to your child when giving instructions or during ongoing activities. Your physical proximity to him will help your child focus and pay attention to what you are saying.

Lastly, hand gestures are signals you can use to communicate privately. For example, raising your hand with all five fingers spread out may indicate there are five minutes left before your child must leave the house or go to bed. Practice each of these cues with your child and be consistent with the implementation of the prompts.

Give Clear Instructions

Effective instructions help us all successfully navigate through life. This is especially true for children with ADHD. If your instructions aren’t followed properly, it’s often because of the way they were delivered. Here are some general rules of thumb when giving instructions to your child

• Give them in a direct manner (tell, don’t ask).
• Give them in the positive (what to DO, not stop doing).
• Give as one instruction at a time.
• Be specific (not vague).
• Make it age-appropriate (preschoolers can accomplish one or two-step directions).
• Give your instructions in a normal tone of voice.
• Be polite and respectful (use please and thank you).

Here’s a good example of how to give instruction: “Lily, please walk in the hallway.” Unfortunately, we more often say, “Lily, STOP! You know what to do!” This makes the instruction unclear to the child with ADHD.

Know Your Legal Rights

Families receive legal support from two federal laws: Individuals with Disabilities Act (IDEA) and Section 504. Both protect children with ADHD, primarily by requiring modifications and accommodations in the classroom that all schools must provide to deliver a free and appropriate education in the least restrictive environment.
When a child with ADHD qualifies under IDEA, the child receives an individualized education program (IEP).

The IEP is a written document that includes specific goals for the child based on his or her current level of performance. Some children with ADHD will qualify for services under IDEA while others may not; This depends on the degree of impairment. Children who do not qualify under IDEA are covered under Section 504 and will receive a Section 504 plan (similar to an IEP).
For more information, go to: help4adhd.org/en/education/rights/idea.
David Bicard and Laura Baylot Casey are assistant professors of special education at the Universtiy of Memphis and board certified Applied Behavior Analysts (BCBA).

Tags: BCBA, David F. Bicard, NCSP, Ph.D., ]Laura Baylot Casey

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