The treatment of the ADHD child can often be relatively straightforward. Because medication is of the greatest importance, treatment almost always requires the services of a physician. Nonmedical specialists, such as psychologists, educators, and social workers, may provide useful and sometimes absolutely necessary assistance, but they cannot assume primary responsibility for treatment. Since they are not trained to use and cannot prescribe medications, they are unable to supply the treatment that is both the best and sometimes the only one required.
This must be emphasized because too often the ADHD child or his family is referred to a psychologist, social worker, or school guidance counselor. Such referrals are made because of psychological maladjustment in the child, problems in the family, or failure in school. A very large fraction of ADHD children can be helped, often to a marked degree, by treatment with medication. In some children this may be the only treatment that is required. In others psychological and educational interventions may also be necessary.
It is often difficult beforehand to determine how much of a child’s trouble is caused by family difficulties and how much by his own temperament. Often, after a child has been treated with medications some of the problems may disappear while others will remain. ADHD is marketed to all of us as a biological disorder that causes children (and some adults) to exhibit a range of problematic behaviors: distractibility, hyperactivity, and difficulty listening, paying attention, and following directions; fidgeting is also part of the syndrome.
According to Novartis (formerly Ciba-Geigy), a large manufacturer of pharmaceuticals, the best “treatment” for this “disorder” is the prescription amphetamine, Ritalin. Although it is a stimulant, Ritalin is alleged to improve attention and reduce hyperactivity in “ADHD children” (Metcalf 1997). The company also markets to therapists, parents, and teachers an expensive series of books, videotapes, support groups, and classes to help them “manage” their “difficult children. ” If Huck were alive today, his teachers and care providers would, without a doubt, find themselves tempted by the promises of ADHD and Ritalin.
Understandably, many parents, teachers, and therapists who are constantly confronted with serious behavior problems and limited resources have responded with enthusiasm to the idea that ADHD is a biological disorder with a medical treatment. So much excitement has been generated that sales of Ritalin have grown by 700 percent since 1990, making it one of the most frequently prescribed medications in the United States. And ADHD has become a household term (Conne 1998). Like a steamroller, the ADHD-Ritalin machine forces its way through our families, schools, and clinics, flattening everything in its path.
The issue of stimulant medication often comes up during the intake assessment. Either the child is already taking medication or the parents are seriously considering putting their child on it (and want a referral to our child psychiatrist). Often the parents have not received this information and are grateful. Others prefer to have their child see the child psychiatrist for a medication evaluation. Many medications produce side effects. A side effect is an undesired by-product of the administration of medicine.
For example, aspirin sometimes produces irritation of the lining of the stomach and mild abdominal pain. Antihistamines, given for hay fever, sometimes cause sleepiness. The medications used in treating ADHD children will sometimes produce side effects. All medicines (including aspirin and penicillin) may produce allergic reactions. An allergic reaction occurs only in a small proportion of people who receive medication. Some medications are much more likely to produce allergies than others. The drugs most commonly used in treating ADHD children, the stimulant drugs, very rarely produce allergies.
Some medications that are used when the stimulant drugs do not seem to be the best treatment for an individual child are somewhat more likely to produce allergies. Parents should know the symptoms of allergies and should contact the doctor if they do occur. Although this rarely happens, if allergies are allowed to go on, they sometimes become worse. Some major symptoms are quite obvious: skin rash and hives. One other major symptom that many people are not aware of is a decrease in white blood cell count, which results in an increased susceptibility to infections.
When such an allergy occurs it is most common for a person to develop a sore throat and a high fever. Of course, most children who are not receiving medications of any sort occasionally get sore throats and high fevers, but a physician should immediately see a child who is receiving medication and develops such symptoms. In seeking out or prescribing medications for ADHD kids the following criteria must be met (Cushman 1995): • The family has a good understanding of Ritalin, particularly its side effects.
I discuss Ritalin’s limitations to counter many parents’ idea that the medication will solve everything. • The outcome measures for what the medication may accomplish are coconstructed by the family, the child, and the doctor. • The family is in control of when and if a trial of medication is started. Parents or children who do not choose the medication option should be complimented and not seen as resistant to treatment. • The psychiatrist uses common everyday language with the child. • The child’s concerns about the medication are taken into account, explored, and destigmatized.
• Possible side effects of the medication are constantly and vigilantly monitored. • The parents and the child can choose when and whether to take the child off the medication. The British Psychological Society report emphasizes the need to obtain as comprehensive a picture as possible of the child across different contexts (Armstrong 1995). These contexts include the neuro-biological as well as environmental factors such as life events, parental care, school experience, cultural background and individual psychological differences.
As Osenton and Chang (1999) state, ADHD can be viewed as both a heterogeneous and a pervasive category. This means that each child has a constellation of problems that is unique to themselves and thus ‘multiple domains’ of functioning come to be affected and must be taken into account. The BPS report further emphasizes that what matters is the quality of information obtained in order to plan intervention. Meaningful assessments must reflect the complexity of multiple causations of behavior and how these interact with factors in the environment.
Significantly, the EPS report concludes that assessment and planning is most successful when it involves the children themselves as active participants in the process. The need for a wide range of professionals to work collaboratively, both in the assessment phase and in preparing a treatment plan for the child and the family, represents the cornerstone of a multidisciplinary approach. However, the success of such multidisciplinary work depends on an acknowledgement of child development as the centerpiece of this collaborative approach.
Works Cited Armstrong, T. , The myth of the A. D. D. child, New York: Dutton, 1995. Conner, D. F. , Other medications in the treatment of child and adolescent ADHD, Guilford Press, New York, 1998. Cushman, P. , Constructing the self, constructing America. New York: Addison-Wesley, 1995. Metcalf, L. , Parenting towards solutions. West Nyack, NY: The Center for Applied Research in Education, 1997. Osenton, T. , & Chang, J. , “Solution-oriented classroom management: Application with young children. ” Journal of Systemic Therapies, 18(2), 1999.