ADHD Treatments and Coping Strategies

Detailed information on treatments and coping strategies for ADHD. Includes both children and adults with ADHD.

Attention Deficit Hyperactivity Disorder (ADHD, sometimes also known as AD/HD or ADD) is a diagnosis based on behavioral symptoms. The signs and symptoms of ADHD, and medications for ADHD are discussed in separate pages. This page focuses on the treatment of ADHD and the ways an individual and family members can cope with this sometimes vexing disorder.

What are the usual treatments for ADHD?

At the present time, it is generally believed that ADHD cannot be cured, and most people grow out of only some of the symptoms. There is also a minority view that ADD is caused by developmental trauma and can be successfully treated. The most commonly prescribed treatment is a combination of:

• behavioral intervention at home, in school, or in the workplace
• psychotherapy or coaching
• medication (discussed in-depth in the HealthyPlace.com ADHD medications section, which also includes a discussion of benefits and risks of medication)

Many people in the life of the person with ADHD may take part in this multi-modal treatment:

• the school or workplace
• the people who live with the person with ADHD, such as family, spouse, partner, or parents
• a psychiatrist or other medical practitioner who can prescribe drugs
• a psychologist, counselor, or coach
• most of all, the individual with ADHD who wishes to make changes in his or her life.

For most individuals with ADHD, this multi-modal treatment approach seems to work. However, some people do not respond well to the standard treatment, and some families object to the use of medications, particularly with young children. Some children object to the way the medication makes them feel.

How can an individual with ADHD cope?

Here are some suggestions for coping with ADHD. Start by viewing this condition as a difference rather than a disability and then set about to deal with the needs this difference creates.

1. Get a formal diagnosis. Choose a psychiatrist, neuropsychologist, or therapist who has knowledge and experience, including recent information about developmental trauma, which may influence the diagnosis. An exam should also rule out any other mental or physical problems that may be exacerbating or masking the ADHD.
2. Gather information about medications. If a medical practitioner recommends medications, do some research to decide if you and your family want to pursue this approach. If so, take medications as directed and notice any differences. Let your doctor know if there are any unpleasant or difficult side effects of medication so adjustments can be made. Once beginning medications, do not make changes without consulting your doctor.
3. Include therapy and/or coaching in treatment. Whether or not medications are incorporated, psychotherapy can help the individual and family deal with the feelings and tensions that accompany ADHD. Coaching can help with learning specific organizational and social skills.
4. Ask for help. Just as a blind person develops other senses more fully and learns to ask others for assistance when necessary, a person with ADHD must develop ways to compensate for a disability and learn to ask others for assistance. Ultimately, a person with ADHD will find that asking for reminders or help in organizing projects is a better solution than pretending to be able to handle everything, and then failing.

What is the role of psychotherapy in the treatment of ADHD?

Psychotherapists can help individuals with ADHD cope with the feelings of

• having ADHD
• living with people's responses to the ADHD behaviors.

Sometimes those feelings go back to childhood, when others criticized them for their inattentiveness, impulsivity, or hyperactivity. Constant criticism can lead to low self-esteem, and a person who has been feeling self-loathing for many years is likely to respond defensively to current interactions in unhelpful ways. The therapist will explore past and current feelings and work with the individual to forge new ways of interacting.

Sometimes the therapist works with the couples or families that include the person with ADHD so that everyone can examine and change their behaviors surrounding the ADHD symptoms.

What is behavioral intervention for ADHD?

Behavioral intervention is direct negative or positive reinforcement of desired behavioral changes. For example, one intervention might be that a teacher rewards a child with ADHD for taking small steps toward learning to raise a hand to be called on before talking in class, even if the child still blurts out a comment. The theory is that rewarding the struggle toward change encourages the full new behavior.

It is important to note that individuals with ADHD are notoriously variable in their symptoms. One day, the person may behave acceptably in one realm, and, the next day, may fall back into old, unacceptable patterns. This makes behavioral intervention difficult because it seems as if the training is not working. However, over time, reinforcement has been shown to improve behavior; a person with ADHD may simply have more off-days than other individuals.

What are some alternative treatments for ADHD?

Because ADHD is largely a behavioral condition affecting children, there are many concerns in both the diagnosis and particularly in the use of medication for treatment. Although there is often controversy when less traditional approaches to treatment of any condition are suggested, some promising alternative approaches for ADHD include:

• neurofeedback (EEG biofeedback, in which electrodes attached to the scalp provide brainwave pattern information, allowing the person to see the effects of relaxation, breathing, and focused attention, and learn to slow down or speed up brain waves)
• Interactive Metronome (IM) rhythmicity training (computerized system involving sound and movement patterns to assist with focused attention)
• EFT (Emotional Freedom Technique - involves the use of tapping on specific acupressure points while speaking certain affirmations - which seems to trigger changes in the neurological system)
• "outdoor green time" (nature seems to have a calming effect on people)
• Animal Assisted Therapy (petting and caring for animals helps some children become calmer and better self-regulated)
• small specialized classroom in a multi-dimensional program (going back to the beginning to fill in gaps in learning, including frequent periods of vigorous physical activity, constant opportunities for success, attention and acknowledgment for every accomplishment, adequate sleep and proper nutrition, etc.)

How can partners and spouses cope with living with a loved one who has ADHD?

ADHD is generally very challenging for the partner and family of the affected individual. It helps if all are committed to working through the difficulties of life with ADHD. In addition to, or instead of, medication, counseling or therapy can reframe troublesome interactions:

• the individual with ADHD will begin to see which behaviors irritate or anger the partner, and how those behaviors might be interpreted as unloving
• the individual that does not have ADHD can begin to change responses to the ADHD behaviors so that the individual with ADHD can receive calm feedback.

The therapeutic process will be most successful if:

• the therapist or counselor is experienced in dealing with ADHD or developmental trauma
• the therapist or counselor can work on two levels: the feeling level and the practical level
• the partners exercise their senses of humor.

In order to sustain positive feelings and to be patient during the therapeutic process, the individual who does not have ADHD may wish to attend a support group for partners of individuals with ADHD.

What are some strategies for parenting children with ADHD?

Parents of children with ADHD need to help their children to develop into their best selves. These parents also need to take care of themselves as they deal with the difficulties of ADHD on a daily basis.

A diagnosis is a good starting point. However, parents should be aware that the research on ADHD is evolving rapidly and both doctors and teachers may be relying on outdated information. Parents can develop a treatment plan that may include:

• parent education about ADHD (reading, watching videos, attending workshops, discussions with a therapist or coach)
• education for the child about ADHD at age-appropriate level, to develop ability to act as own advocate throughout life
• behavioral interventions at home and/or at school
• therapy or coaching
• medications
• alternative approaches to treatment.

Working to help a child change behaviors takes patience, attention to detail, and helping the child to compensate for ADHD. If one of the parents has ADHD, as is often the case, that parent will face even greater challenges to be a helpful parent to the child.

Some important guidelines for parenting children with ADHD are:

• Remember that your child's behavior is related to a disorder, and is not generally intentional.
• Manage your own frustration and anger so that you can be in a state to help your child to change daily patterns.
• Be patient with change: foster improvements and be calm about setbacks.
• Get help when you need it, either from your mate or from other substitute caretakers.
• Make a list of the positive traits of your child.
• Develop and repeat fun activities that allow your child to be at his or her best.
• Encourage athletic pursuits, if your child seems to benefit from such activities.
• Reinforce positive behavior quickly; follow through with negative consequences immediately.
• Expect only short periods of time sitting still.
• When giving instructions, stand or sit close to your child and keep the list of instructions very short.
• Be consistent.
• Provide structure.
• Be the advocate until your child can self-advocate.
• Believe in and support your child.

What can teachers do to help students with ADHD?

Teachers can educate themselves about ADHD and the accommodations they can provide for children with ADHD. In many cases, the teacher will want to work with parents to change the learning environment and monitor behaviors at home and at school. Some of the ways teachers can help a student with ADHD are:

• Help the student to remember homework assignments by giving written as well as auditory cues. Monitor the student's use of a daily planner to record homework assignments.
• Give the inattentive student a seat at the front of the room or away from distractions.
• Reward students as they try new and better behaviors in the classroom.
• Teach how to take notes.
• Teach in an interactive manner.
• Encourage the use of distinctive folders for different subjects. Suggest the use of one particular folder for papers leaving the classroom that must be returned, either signed by parents or completed by the student.
• Teach strategies for accomplishing long-term assignments.
• Provide duplicates of textbooks in the classroom so that the child can leave a set at home.
• For students who have difficulty writing neatly, allow the use of computers for written assignments, either in the classroom or at home.
• Develop a secret signal with students to indicate when they are diverging from accepted behavior.
• Allow extra time for exams if the child's attention wanders during tests.

next: ADHD Treatment Overview: Alternative Treatments
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Sources:

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(3) American Academy of Pediatrics. Clinical Practice Guideline: Treatment of the School-Aged Child With Attention- Deficit/Hyperactivity Disorder. Pediatrics 2001;108:1033-1044.

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(9) Linden M, Habib T, Radojevic V. A controlled study of the effects of EEG biofeedback on cognition and behavior of children with attention deficit disorder and learning disabilities. Biofeedback Self Regul. 1996 Mar;21(1):35-49.

(10) Lubar JF, Swartwood MO, Swartwood JN, O'Donnell PH. Evaluation of the effectiveness of EEG neurofeedback training for ADHD in a clinical setting as measured by changes in T.O.V.A. scores, behavioral ratings, and WISC-R performance. Biofeedback Self Regul. 1995 Mar;20(1):83-99.

(11) Heinrich H, Gevensleben H, Freisleder FJ, Moll GH, Rothenberger A. Training of slow cortical potentials in attention-deficit/hyperactivity disorder: evidence for positive behavioral and neurophysiological effects. Biol Psychiatry. 2004 Apr 1;55(7):772-5.

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