TUESDAY, Nov. 4, 2003 (HealthDayNews) -- Medication is the mainstay treatment for the 9 percent of American school age children with attention deficit hyperactivity disorder (ADHD).
But it should be supplemented with good parenting skills and educational counseling by the child's doctor, according to experts speaking Tuesday at the American Academy of Pediatrics' National Conference and Exhibition in New Orleans.
ADHD is the most common childhood neurobehavioral disorder, according to the academy. Affected children have trouble concentrating and focusing. The disorder can hamper a child's learning, ability to regulate behavior, social skills, and self-esteem.
Medication such as Ritalin (methylphenidate) and Dexedrine (dextroamphetamine) can help improve symptoms of impulsivity and lack of concentration so the child can function better.
But drugs aren't the whole treatment story, says Dr. Esther Wender, professor of pediatrics at the University of Washington in Seattle, who talked to the pediatricians about the importance of educating parents of children with ADHD.
"In addition to writing a prescription, if that is needed, the doctor needs to provide a lot of counseling," she says.
Parents should expect their child's pediatrician to answer questions about the medications, which often have to be adjusted so the dose is correct, she says.
And parents need to ask questions, says Wender, such as: How might the dose be adjusted? What information does the doctor need from us to properly adjust it? How often will my child be reevaluated?
"Most of the time it is not enough to get one prescription and go with it without being evaluated," she says.
Immediately after medication is prescribed, there should be weekly follow-ups with the child's doctor for at least the first six weeks, she says. It can be by telephone.
Once parents are educated about the disorder, there is much they can do at home to help the child with ADHD.
"We encourage parents to increase structure and predictability in the home,'' says Dr. Karen Miller, assistant professor of pediatrics at the Center for Children with Special Needs, part of Tufts-New England Medical Center in Boston. She also spoke at the conference.
For instance, when a young child with ADHD is preparing to go to bed, things should happen in the same order so he or she knows what to expect, Miller says. Provide visual clues for proper behavior, Miller suggests. "Have a checklist for getting ready for bed. If the child completes the checklist, he or she gets an extra story, so you reinforce the behavior."
"Children with ADHD are disorganized," she says. "They are not always good at figuring out what to do next." Techniques such as checklists help, she says.
Reminding them of behavior rules can help, too. "If you go to the supermarket, for instance, with a child who has ADHD, review the rules of what you want them to do before entering," Miller says.
Parents might remind the child to stay in the cart, for instance, and to not talk loudly. "Remind them of the two or three rules, and then notice [when they follow them] and reinforce them," she says.
With teens, Miller says, the same principles work. Just adjust the reward. Instead of a second bedtime story, give additional computer time or telephone privileges.
Positive reinforcement is better than punishment, she says. In other words: "Catch them being good."
More information
For more information on ADHD, visit the American Academy of Pediatrics and Children and Adults with Attention-Deficit/Hyperactivity Disorder.
