Managing Childhood ADHD Without Drugs: Coursera ADHD Class Week 11

The last couple weeks of the Coursera class on ADHD focused on how to live with and manage ADHD symptoms without drugs. “Pills don’t teach skills” and whether parents of children with ADHD or adults with ADHD embrace the idea of medical therapy, drugs are not the only treatment approach for helping someone with ADHD thrive.

Students with ADHD need support both at home and within their school environment. In fact, the US Department of Education has put together a fairly comprehensive brochure on how to teach children with ADHD. After giving teachers some guidance on how to identify children with ADHD, it has three separate sections on how to help a child with ADHD be successful in the classroom. Although rumors abound about teachers that, subtly or not so subtly,  have told parents to put their kids on ADHD drugs, that isn’t one of the teaching strategies. Instead the pamphlet focuses on instruction techniques, effective behavioral interventions, and classroom accommodations. It suggests a student with ADHD should sit closer to the teacher and farther from distracting kids. Wow, who would have thought? I know some elementary school teachers are resistant to “special” seating “privileges” for students with ADHD, perhaps referencing this official brochure will help parents get the seemingly minor accommodations their children need. Multiple times the brochure makes the point that children without ADHD also thrive in classrooms that are structured to help children with ADHD. Basically, these are strategies that can help any teacher be more effective regardless of the makeup of their classroom in any given year.

At home, one of the most effective treatments for children with ADHD is teaching their parents better behavior management strategies. By acknowledging that their child has below age-level-norm organizational, self-control,  and coping skills, parents can structure the home environment with scaffolding supports to help the child succeed despite their ADHD symptoms. There are several different training programs for parents. Most have similar elements: stay calm and don’t get emotional, analyze what is working and what isn’t, rely on planning and praise to gain compliance, go to the child to give instructions — use eye contact and touch to get child’s attention before giving instructions, break large tasks into smaller ones, use labels, file cards, and other visual cues and organizers to make tasks less daunting, reduce time delays for consequences (positive and negative), and use warnings, “when-then”, token economies and time outs to guide behavior. Work with the child to create better habits and more effective behaviors. If the child is encouraged to help evaluate the results of the program, it can increase their commitment and desire to change.

One comprehensive parent behavioral training program covered in some detail was one developed by Russell Barkley. Dr. Barkley has written extensively about executive function, defiant children, and how to take charge of ADHD. Putting the effort into learning how to be a better parent for a child with ADHD is very worthwhile. Studies show that not only do children do better with more effective parenting, parental stress is also decreased and satisfaction is increased under these programs.

Adults with ADHD face slightly different challenges than kids with ADHD. Some of these challenges stem from the bad habits and/or negative thought patterns that can develop over a lifetime of living with ADHD. My next post, and the last in this series, will cover psychosocial treatments for adults with ADHD.

Drugs for ADHD: Coursera ADHD Class Weeks 9 & 10

Drugs are one of the most common, if not the most common, treatment for ADHD. They can help individuals be more productive, calm, and in control of themselves, at least while the drugs are active. ADHD drugs are similar to prescription eye glasses. They help an individual function while they are in use, but they do not cure the underlying condition.

The Coursera class on ADHD takes the standard medical line that if used as prescribed and not abused, ADHD drugs, in most cases, cause no significant or long-term ill effects. Dr. Rostain cites statistics that stimulants are not over-prescribed for ADHD and that untreated ADHD leads to much worse outcomes than medical treatment of ADHD. Most studies on drugs for ADHD last just months, not years. Given that many individuals with ADHD take drugs for 5 years or more, and start at a young age, it is troubling that there aren’t better long-range studies on their effects.

Dr. Rostain covers many myths about stimulant drugs for ADHD. One stood out to me. The myth is that these drugs do not improve academic achievement. He states that stimulant treatment of ADHD improves work productivity, classroom conduct and rule-following, peer interactions, grades, and leads to reduced punishment, fewer days absent, and makes repeating grades less likely. So yes, on stimulants a child with ADHD will appear to be a better student and will certainly be easier for the teacher to have in class. Dr. Rostain didn’t mention that some studies have shown that psychostimulants have not been shown to achieve long-term positive changes in peer relationships, social or academic skills, or school achievement. He also did not mention that there is evidence that stimulant treatment of ADHD in juveniles can damage their developing brains. Long-term use of ADHD can also create a loss of motivation. Students, especially college students, may feel that their success is due to the drugs and a shift of agency may create a dependence on the drugs and low self-esteem.

There are three basic types of drugs used to treat ADHD: stimulants, non-stimulants, and antidepressants. Each affects the signaling of neurons in the brain in a slightly different manner and the lectures on them were too detailed to easily summarize. The comprehensive “What we know” brochure on Managing Medication for Children and Adolescents with ADHD from the National Resource Center on AD|HD is a good place to start. The last couple pages have suggested readings and then a handy reference chart for the drugs which includes the generic names, the brand names, the duration of action for each drug, the form the drugs come in, the dosage ranges, and the common side effects.

Even though there is a great deal of evidence that drugs can help treat ADHD symptoms in the short-term, they still carry risks. Risks that your pediatrician or health services provider may not mention. The best approach if you are considering ADHD drugs for your child is to learn all you can about the various drug options and then carefully, with the help of your child, monitor both the short-term and the long-term effects of any drug you give your child. Pay attention to both the physical side effects, such as stomach aches and sleep problems, and the more subtle psychological effects that may include decreased drive and motivation. Ask yourself, are you trading their initiative and innate personality for a child that is easier to live with and more compliant?