ADD / ADHD Treatment

The ADD Coach Academy is pleased to present information About ADD/ADHD Treatment for your educational growth. We know education is the first essential step in the process of learning how to manage the individual challenges of ADHD. We also know that ADD coaching builds hope by educating clients about their own AD/HD.

Many individuals with ADHD come to coaching quite discouraged because “the medications didn’t solve their problems.” Unfortunately, many of these people don’t often make it to coaching until there’s a crisis of a potential lost job, failing business, looming academic failure or a broken relationship . At this point there is so much pressure to "fix things" that the coach has to find ways to take the pressure off.

They usually know very little about their own ADHD and only have a general idea of what ADHD is from their physician, articles they have briefly read, or information from some of the many recommended books. And even if the doctor is well educated and informed in the ADHD field, they still focus primarily on diagnosis and medications, leaving a big space for coaches to educate and lend support toward self-management strategies.

When these pressure-packed kinds of situations present , it takes a skilled coach to work with the client to convert that pressure into a session of understanding and acceptance so that the individual knows the coach is there to take the pressure off, help them find their unique self, and begin the process of self discovery & awareness that will eventually move them forward to new heights of fulfillment and happiness.

ADHD Treatment

*Taken from testimony by Dr. Richard Nakamura, September 26,2002, who was then Acting Director of the National Institute of Mental Health, to the Committee on Government Reform, United States House of Representatives. The following portions are extracted from the text of that testimony:

*Mental Health: A Report of the Surgeon General 2 contains an informative, thoroughly researched chapter on ADHD and includes recommendations for treatment. " The practice parameters state, 'the cornerstones of treatment are support and education of parents, appropriate school placement, and pharmacology.' These practice parameters evolved out of research relating to two major types of treatment: pharmacological treatment and psychosocial treatment, particularly behavioral modification, as well as multimodal treatment, the combination of psychosocial and pharmacological treatments."

Most often, the first treatment used should be psychosocial, including behavioral therapy, social skills training, support groups and parent and educator skills training. Psycho stimulant medications, including methylphenidate, are the most widely researched and commonly prescribed treatments for ADHD. Numerous studies have established the safety and efficacy of stimulants and psychosocial treatments for alleviating the symptoms of ADHD. NIMH research has indicated that the two most effective treatment modalities for elementary schoolchildren with ADHD are a closely monitored medication treatment and a treatment that combines medication with intensive behavioral interventions. In the NIMH Multimodal Treatment Study for Children with ADHD (MTA), which included nearly 600 elementary school children across multiple sites, nine out of ten children improved substantially on one of these treatments.

Failure to provide appropriate treatment for certain disorders—including ADHD--also poses a risk to brain integrity and function. The brain is a very flexible--or "plastic"--organ that needs certain stimulation in order to mature properly—to make the correct connections. In the same way that covering one eye [and eliminating visual stimulation] during a critical phase of development leads to life-long visual impairment, failure to receive and properly process cognitive and emotional stimuli during critical periods when the brain is undergoing rapid growth and maturation may result in damage with lifelong consequences. Therefore, a child who cannot pay attention, and who cannot learn, is at risk of having his or her brain and development adversely affected; and many children with ADHD develop learning delays and academic failures that lead to early school drop out. Children with ADHD who are untreated may be at increased risk for some medical and social problems such as reckless driving, drug and alcohol abuse, smoking, academic failure, difficulty in making relationships, and trouble with the law.

I would like to be sure that we focus carefully on two questions that deserve answers: 1) Are diagnoses being made effectively and are appropriately diagnosed children receiving properly selected treatments that will help them gain an upward trajectory in life? Too many children with ADHD are being ignored and remain at high risk for other lifelong problems, including depression and substance abuse. 2) While it is also well known that many children are being given medications for a variety of disorders, it is clear that not all of those children ought to be taking medications. Are some of our children, particularly active boys, being over diagnosed with ADHD and thus are receiving psycho stimulants unnecessarily? Little evidence of over diagnosis of ADHD or over prescription of stimulant medications has been verified in research. Indeed, fewer children (2 to 3 percent of school-aged children) are being treated for ADHD than suffer from it. Treatment rates are much lower for girls, minorities, and children receiving care through public service systems. Medical and public awareness of the problem of ADHD has grown considerably so that people, who were under diagnosed in the past, are being identified and treated. Most researchers believe that much of the increased use of stimulants reflects this better diagnosis and more effective treatment of a prevalent disorder.

The Treatment of ADHD

Every family wants to determine what treatment will be most effective for their child. This question needs to be answered by each family in consultation with their health care professional. To help families make this important decision, the National Institute of Mental Health (NIMH) has funded many studies of treatments for ADHD and has conducted the most intensive study ever undertaken for evaluating the treatment of this disorder. This study is known as the Multimodal Treatment Study of Children with Attention Deficit Hyperactivity Disorder (MTA).12 The NIMH is now conducting a clinical trial for younger children ages 3 to 5.5 years (Treatment of ADHD in Preschool-Age Children).

The Multimodal Treatment Study of Children with Attention Deficit Hyperactivity Disorder.--- Research & Treatment sections

The MTA study included 579 (95-98 at each of 6 treatment sites) elementary school boys and girls with ADHD, who were randomly assigned to one of four treatment programs: (1) medication management alone; (2) behavioral treatment alone; (3) a combination of both; or (4) routine community care. In each of the study sites, three groups were treated for the first 14 months in a specified protocol and the fourth group was referred for community treatment of the parents' choosing. All of the children were reassessed regularly throughout the study period. An essential part of the program was the cooperation of the schools, including principals and teachers. Both teachers and parents rated the children on hyperactivity, impulsivity, and inattention, and symptoms of anxiety and depression, as well as social skills.

The children in two groups (medication management alone and the combination treatment) were seen monthly for one-half hour at each medication visit. During the treatment visits, the prescribing physician spoke with the parent, met with the child, and sought to determine any concerns that the family might have regarding the medication or the child's ADHD-related difficulties. The physicians, in addition, sought input from the teachers on a monthly basis. The physicians in the medication-only group did not provide behavioral therapy but did advise the parents when necessary concerning any problems the child might have.

In the behavior treatment-only group, families met up to 35 times with a behavior therapist, mostly in group sessions. These therapists also made repeated visits to schools to consult with children's teachers and to supervise a special aide assigned to each child in the group. In addition, children attended a special 8-week summer treatment program where they worked on academic, social, and sports skills, and where intensive behavioral therapy was delivered to assist children in improving their behavior.

Children in the combined therapy group received both treatments, that is, all the same assistance that the medication-only received, as well as all of the behavior therapy treatments.

In routine community care, the children saw the community-treatment doctor of their parents' choice one to two times per year for short periods of time. Also, the community-treatment doctor did not have any interaction with the teachers.

The results of the study indicated that long-term combination treatments and the medication-management alone were superior to intensive behavioral treatment and routine community treatment. And in some areas—anxiety, academic performance, oppositionality, parent-child relations, and social skills—the combined treatment was usually superior. Another advantage of combined treatment was that children could be successfully treated with lower doses of medicine, compared with the medication-only group.

Treatment of ADHD in an Adult.

Medications. As with children, if adults take a medication for ADHD, they often start with a stimulant medication. The stimulant medications affect the regulation of two neurotransmitters, norepinephrine and dopamine. The newest medication approved for ADHD by the FDA, atomoxetine (Strattera®), has been tested in controlled studies in both children and adults and has been found to be effective.19

Antidepressants are considered a second choice for treatment of adults with ADHD. The older antidepressants, the tricyclics, are sometimes used because they, like the stimulants, affect norepinephrine and dopamine. Venlafaxine (Effexor®), a newer antidepressant, is also used for its effect on norepinephrine. Bupropion (Wellbutrin®), an antidepressant with an indirect effect on the neurotransmitter dopamine, has been useful in clinical trials on the treatment of ADHD in both children and adults. It has the added attraction of being useful in reducing cigarette smoking.

In prescribing for an adult, special considerations are made. The adult may need less of the medication for his weight. A medication may have a longer "half-life" in an adult. The adult may take other medications for physical problems such as diabetes or high blood pressure. Often the adult is also taking a medication for anxiety or depression. All of these variables must be taken into account before a medication is prescribed.

Education and psychotherapy. Although medication gives needed support, the individual must succeed on his own. To help in this struggle, both "psycho education" and individual psychotherapy can be helpful. A professional coach can, among other things, help the ADHD adult learn how to organize his life by using "props"—a large calendar posted where it will be seen in the morning, date books, lists, reminder notes, and have a special place for keys, bills, and the paperwork of everyday life. Tasks can be organized into sections, so that completion of each part can give a sense of accomplishment. Above all, ADHD adults should learn as much as they can about their disorder.

Psychotherapy can be a useful adjunct to medication and education. First, just remembering to keep an appointment with the therapist is a step toward keeping to a routine. Therapy can help change a long-standing poor self-image by examining the experiences that produced it. The therapist can encourage the ADHD patient to adjust to changes brought into his life by treatment—the perceived loss of impulsivity and love of risk-taking, the new sensation of thinking before acting. As the patient begins to have small successes in his new ability to bring organization out of the complexities of his or her life, he or she can begin to appreciate the characteristics of ADHD that are positive—boundless energy, warmth, and enthusiasm.