ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD)

Not all but most children with a diagnosis of ADHD require to take stimulant medication such as Ritalin depending on the impact on learning and daily activities at home or socially. Regardless of the severity of ADHD, behaviour therapies should be part of the ongoing treatment for ADHD even if there is an improvement after taking the medication. 

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However, it can be very hard and maybe impractical or unrealistic for children with ADHD (depending on the severity) to learn these behaviour strategies quickly without the help of stimulant medications particularly if the functional impact of ADHD on children is much more severe. On the other hand, if the severity of ADHD is mild and behaviour intervention is an important approach.

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As evidence suggested, stimulant medications such as Ritalin (Methylphenidate) work well in 80% to 90% of children. However, it only works if they continue taking it. Unless we as parents, teachers and doctors provide ongoing long-term behaviour intervention and strategies for our children, they may not be able to cope without taking the medications over the long run.

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With appropriate efforts, dedication, time and commitment, behaviour interventions/ therapies - Three-pronged - Parents, Child and Teachers approach could help children with ADHD.  Let's discuss what we can do to help in terms of behaviour intervention.

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BEHAVIOUR INTERVENTION (Three-Pronged Approach)

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The National Institute of Mental Health (NIMH) began a large treatment study for 14 months in 1992 called the Multi-modal Treatment Study of Children with ADHD (or the MTA study) showed that stimulant medication (such Ritalin) is most effective in treating the symptoms of ADHD either alone or in combination with behavioural therapies.

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Some children receiving the combination of medication and behavioural therapy were able to take lower doses of medicine.

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Behavioural therapy in the MTA (Multimodal Treatment of Attention Deficit Hyperactivity Disorder) study includes three approaches:

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1. PARENT LEAD TRAINING:

Helped parents learn about ADHD and ways to manage ADHD behaviours. This approach included techniques by which the parents can have positive interactions with their children while becoming more effective at getting their children to meet expectations for behaviour.

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A. Parenting Courses

Here is the list provides several parenting courses for you to learn and train in managing children with ADHD.

• Parenting Your ADHD Child 6-Week ONLINE Course - available to join when you want! 

​Upcoming Events – ADHD Support Australia

• Triple P Parenting course

​Happier, healthier, less stressed kids & families | Triple P (triplep-parenting.net.au)

• Tuning into Kids/Toddlers/Teens https://tuningintokids.org.au/parents/

• 1-2-3 Magic Emotional management (Parenting skills for parents of children 2-12 years)

• Parent-Child Interaction Therapy (PCIT) 

  • Up to 3yo - https://karitane.com.au/toddler-clinic​

  • Cassandra Bampton, Kimberley Lewis, Mrinalini Prasad and Anastasia Kladis (Registered Psychologist and PCIT Therapist)
    Departments of Communities and Justice, LINKS Trauma Healing Service
    Level 2, 2-6 Station Street Penrith NSW Australia 2750
    Phone: 0247227420 

• Incredible Years Parenting Program (Parenting skills for parents of children 2-5 years with Language Delays and/or Autism Spectrum Disorder) Parenting Programs • Practical Support • Learning Links

• Engaging Adolescent

Parenting Programs • Practical Support • Learning Links​

• Online Parenting Courses (multiple topics)

​Online Parenting Courses Australia - Parental Stress Centre

• Everyday Parenting: The ABCs of Child Rearing https://www.coursera.org/learn/everyday-parenting?action=enroll

• Parenting Courses

Parenting Courses | Parent Line NSW​

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Parental Resources

Thriving with ADHD - Parental Resources - Thriving with ADHD

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Free ADHD Course

• Free short eLearning courses – ADHD for Parents

Free short eLearning courses | OnLineTraining (oltinternational.net)

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• Parenting Your Child with ADHD

​parenting2015.pdf (chadd.org)

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Parenting Course in Other Languages for Culturally and linguistically diverse (CALD) Family Background

​Resources for Parents | Resourcing Parents (nsw.gov.au)

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B. Homework and How to Help Children At Home

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• Kids Health Information : ADHD – ways to help children at school and home (rch.org.au)

• Kids Health Information : Attention deficit hyperactivity disorder (ADHD) (rch.org.au)

• Managing ADHD in children & pre-teens | Raising Children Network

• ADHD Home Interventions.pdf (texaschildrenshealthplan.org)

• Homework Help for ADHD - CHADD

• Homework_Fact_Sheet_2016.pdf (chadd.org)

• “A Parent’s Guide to Conquering Homework” [Video Replay & Podcast #159] 

​Homework Problems for Kids with ADHD: Parents' Guide (additudemag.com)​​

• Parenting Your Child with ADHD

​parenting2015.pdf (chadd.org)

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C. Best ADHD App

The 11 Best ADHD Apps for 2022 (healthline.com)​

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2. CHILD-FOCUSED INTERVENTION:

By helping children and teens with ADHD to learn to develop social, academic, and problem-solving skills in a treatment program, these skill sets can be expanded to home, school and workplace settings.

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Executive Function in Children with ADHD

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Children with ADHD lag significantly behind in the development of their executive functions by approximately 30% or 3-6 years. 

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Executive functioning abilities are thought to develop sequentially, one skill building atop the next, starting at around age 2 and reaching full development at around age 30.

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Executive Functioning 101 Resource Hub

Executive Functioning 101 Hub | Life Skills Advocate

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Building the Brain's "Air Traffic Control" System: How Early Experiences Shape the Development of Executive Function (netdna-ssl.com)

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A. Executive Function - Ways to Enhancing and Practicing Skills with Children from Infancy to Adolescence (Harvard University)

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• Activities Guide: Enhancing & Practicing Executive Function Skills (harvard.edu)

• Enhancing-and-Practicing-Executive-Function-Skills-with-Children-from-Infancy-to-Adolescence-1.pdf (harvardcenter.wpenginepowered.com)

• Executive-Function-Activities-for-3-to-5-year-olds.pdf (harvardcenter.wpenginepowered.com)

• Executive-Function-Activities-for-5-to-7-year-olds.pdf (harvardcenter.wpenginepowered.com)

• Executive-Function-Activities-for-7-to-12-year-olds.pdf (harvardcenter.wpenginepowered.com)

• Activities-for-Adolescents.pdf (harvardcenter.wpenginepowered.com)

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How Teaching Executive Functioning Skills Can Reduce Challenging Behaviors

• Executive Functioning & Challenging Behavior | Life Skills Advocate

• How to Improve Executive Function Skills in ADHD Adults, Children (additudemag.com)

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B. Mindfulness Meditation training

"One landmark UCLA study found that people with ADHD who attended a mindfulness meditation session once a week for 2 1/2 hours, then completed a daily home meditation practise that gradually increased from 5 to 15 minutes over 8 weeks, were better able to stay focused on tasks"*

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Mindfulness training - How to Practice Mindfulness - Mindful​​

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C. Personal Organisation and Learning Skills Training

Learning Skills by CHADD (Children and Adults with Attention-Deficit/Hyperactivity Disorder)

https://chadd.org/stroud-umdadhdtools/

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D. How to manage Emotional Dysregulation

Emotional Regulation in Children | A Complete Guide (parentingforbrain.com)

Is your child Emotionally Dysregulated? - Bristol Child Parent Support

 

Irritability - Strategies to Help Your Child with Autism

SC_ATN Irritability Topic Flyer_083120_v7.pdf (autismspeaks.org)

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E. Psychologist

For Child-Focused Therapy, you should consider a psychologist-individual therapy particularly if there are associated mental health issues - such examples anxiety, depression, domestic violence, previous psychological trauma or exposure to chemicals during pregnancy (via the Mental Health Treatment Plan by your GP). 

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Often children engage better in Peer Learning, therefore Group therapy (coached by a Psychologist or Occupational therapist) for children with ADHD, particularly around social skills and anger management.

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3. School-Based Interventions:

Helped teachers meet children’s educational needs by helping them to learn the skills to manage children’s ADHD behaviours in the classroom (such as rewards, consequences, classroom seating, etc)

• De-escalation of Behaviour

https://www.ksdetasn.org/atbs/de-escalation-materials

 

If you are home-schooling, the strategies outlined in "Teaching and managing students that have ADHD" would help your child to learn much more effectively.

Teaching-and-Managing-Students_FINAL.pdf (adhdfoundation.org.uk)

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Teaching Emotional Regulation as a Behaviour Strategy

Emotional Regulation in SEND: Resources - Free Pritnable Resources (inclusiveteach.com)

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Reinforcement of Behaviors

Step 1: Identify target behavior (unc.edu)

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If you try all the behaviour interventions for a period of time and did not work for your child, it is not the end of the world. Please seek professional review, we are here to help.

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​​What about Medications in the Treatment of ADHD in Children?

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• Ritalin information Ritalin-and-Ritalin-LA-brochure.pdf (developmentalpaediatrics.com.au)

• Complete Guide to ADHD Medications - Child Mind Institute

  Complete Guide to ADHD Medications - Child Mind Institute

• Attention-Deficit/ Hyperactivity Disorder (ADHD): Parents’ Medication Guide (Short) ©2020 American Academy of Child and Adolescent Psychiatry 

  ADHD_Medication_Guide-web.pdf (aacap.org)​

• ADHD Parents Medication Guide – July 2013 (Long) American Academy of Child & Adolescent Psychiatry and American Psychiatric Association 

  ADHD Parents Medication Guide (psychiatry.org)

• ADHD: Should My Child Take Medicine for ADHD? | HealthLink BC

• Non-Stimulant Medication - Intuniv (Guanfacine) https://www.bhamcommunity.nhs.uk/EasySiteWeb/GatewayLink.aspx?alId=30895

• Clonidine (Catapres) Clonidine-for-various-conditions.pdf (medicinesforchildren.org.uk

• Outbursts_Parents_Medication_Guide-web.pdf (aacap.org)​

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Picture from Get the ADHD Treatment via Psychiatrist, Psychologist, Counselors at Meri Help

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Translated information

注意力不足過動症 - 维基百科，自由的百科全书 (wikipedia.org)

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Dr Winston Oo

Consultant Paediatrician