 |
 |
Management of AD/HD Parent Education. As outlined above, becoming informed about the true facts of AD/HD and avoiding the misunderstandings and misinformation is a critical part of overall management. Parents must be able to distinguish between fact and fiction and between good and bad advice. This is a never-ending process – there is an enormous amount of information available about AD/HD and the co-existing conditions. The field continues to develop rapidly on an ongoing basis. Behavioural Management. Behavioural management has been shown in controlled studies to be an effective treatment available for AD/HD. Behavioural modification therapies include social skills training, behavioural therapy and parent training. Details of these are available on other LANC handouts. Such strategies can also be useful at school and information is available for teachers. At home it is often difficult for parents as well as others to view a child’s apparently wilful misbehaviour as being due to a valid medical disorder. It is important to emphasis that AD/HD is not an excuse – rather an explanation. Having a ‘disability perspective’ is often helpful. Protecting and enhancing self-esteem is always essential and it is important as much as possible to try to avoid being overly-critical and to emphasise the child’s ‘islets of competence’. A supportive and empathetic communication style is helpful. Recognising that structure is critical for children with AD/HD with daily routines, consistency and organisation being present. Behavioural management strategies are very helpful and help parents feel better prepared to deal with the daily challenges of parenting a child with AD/HD. Educational Strategies. It is important that as a parent you develop a good rapport with the school. Generally schools are recognising AD/HD as a valid condition and this is very helpful. In situations where this is not the case attempts should be made to introduce an evidence-based approach to the school. The LANC has a School’s Liaison Officer who would be able to assist with this. It is important that as a parent you become an information source on AD/HD so that you are able to work with the school in your child’s best interests. Not only is feedback from the school essential in helping to guide effective management, but an understanding of schooling strategies, behavioural management and the reasons why a child with AD/HD, especially if there are complications, may act in a certain way at school, must be understood. For example ongoing detentions for a child who is always late or who does not turn in his homework can be counter-productive. Much better would be to arrange accommodations to enable the child to perform adequately in these areas with a resulting improvement in self-esteem. The LANC has a separate advice leaflet for schools. Counselling. Although this has not been shown to treat the core symptoms of AD/HD, it may help the child better understand the disorder and its impact on those around him/her. It can be particularly helpful if there are issues relating to self-esteem or social skills, or overall family issues. Siblings frequently suffer also because of the other child’s AD/HD and may need help in their own right. Medication. Details of medication are discussed in the accompanying medication handout. In essence, medication is frequently suggested as part of a multi-modal management plan in a child with significant AD/HD. This is based on a wide range of international data that shows clear improvement in core symptoms and complications when AD/HD is effectively managed as part of an overall treatment plan. In addition there is very strong evidence that the basis of most children’s AD/HD is an underlying neurobiological or brain chemistry difference. The use of medication should be seen as providing a window of opportunity to put a floor into the situation and stabilise it so that educational, behavioural and other strategies can be more effective. The media have tended to grossly over-emphasise the side effects of these medications and only rarely point out the reasons why medication is considered in an individual child. It is therefore critical that parents place side effects in perspective, look at the relatively low incidence of short term side effects with these medications, the paucity of evidence of long term side effects, and the fact that at least 90% of children with significant AD/HD can be effectively helped with the use of medication. It is also important to recognise that AD/HD is rarely a static condition, its difficulties frequently persist and often magnify with time. The long term for many children with AD/HD can be quite serious in terms of the risk of psychiatric disorder, antisocial behaviour, long term underachievement as well as problems with relationships, jobs and academic underachievement. The decision to medicate is never one that is taken lightly and should always be done, as at the LANC, after a comprehensive assessment to assess whether or not the child has AD/HD. Ongoing monitoring is also essential and your child will be seen on a regular basis at the LANC. Communication between appointments is always available by phone, e-mail or letter. The clinic’s ethos is to aim to empower patients as much as possible so that they can be informed and proactive partners in their child’s management. In doing this, however, they must not the limitations and be trained to recognise when they need to seek help from the LANC. The child may well benefit from medication for several years. Whilst some children outgrow the need for medication and their symptoms improve with time, in the majority clinical experience shows that medication is generally helpful on an ongoing basis throughout school years – especially until the child has passed GCSEs. Depending on other environmental supports then available, the child’s intelligence, the adolescent may possibly outgrow the need for medication, however, in others the need for medication persists into adulthood. It is always important at that stage to try to encourage your child to become good at topics that interest him/her as many children with AD/HD are able to over-focus in such areas. The medications most commonly used to treat AD/HD are as follows: The various methylphenidate preparations – Ritalin, which has a short-acting effect lasting about four hours, and various long-acting preparations such as Slow Release Ritalin, Equasym XL or Concerta XL. Other preparations used are Dexedrine, or Strattera. Strattera has recently obtained a UK product licence and its place in the overall management of AD/HD is still under scrutiny. It appears to have an advantage in its length of action and its general calming of behaviour. Other medications may be considered for possible use, usually later, by your child’s Consultant. Such medications may include Clonidine, which can be helpful with impulsive or oppositional behaviour or tics; Risperidone, for impulsive aggression and occasionally antidepressants may be used. However, such medications should only be used by experienced Consultants, such as at the LANC, and you would be fully informed if such medications are being considered. Other Complications. For other specific comorbidities, or complications, such as specific learning difficulties, speech and language problems, coordination problems etc., specific further assessments or therapies may be suggested. For example LANC has an Occupational Therapist who is able to assess and help children with coordination problems and at times can visit the classroom to observe the child in class. The clinic is also able to access specific help for learning difficulties and speech and language problems. Whatever combination of treatments is eventually decided on, in conjunction with yourself, it is crucial that the child’s progress is monitored. This will involve monitoring of their own views on their progress, as well as the view of their teachers and parents. However, remember that all children with AD/HD – and no doubt your own child – have very marked strengths as well as the difficulties of their AD/HD. It is important that the effective management of your child’s AD/HD effectively addresses these difficulties, whilst enabling his/her very real strengths to show through. Also remember that AD/HD is frequently genetic and that quite often one or other, or both, parents might have AD/HD. An awareness of this sometimes does not happen until the child is diagnosed, but it can be very useful, both in helping the parent’s life, and also that of the family as a whole. Some resources that you might find helpful are detailed below: Kewley GD (1999) Attention Deficit Hyperactivity Disorder: Recognition, Reality and Resolution. Reprinted by David Fulton Publishers 2001 Green C, Chee K (1997) Understanding AD/HD London: Vermilion Press Barkley, RA. (1998) Taking Charge of AD/HD: The complete authoritative guide for parents New York, Guilford Press |
| Copyright ©2007 Learning Assessment & Neuro Care Centre. All Rights Reserved. |