Treatment of Attention-Deficit Hyperactivity Disorder (ADHD)

by Joseph M. Carver, Ph.D.

(Page 5 of 6)

Treatment of ADHD often involves a multidisciplinary approach and includes physicians, therapists, educators, and families. Children and adults with mild ADHD may require minimal professional intervention while severe ADHD may require multiple medications and professional interventions.

Medication Medication for Attention-Deficit Hyperactivity Disorder (ADHD) has been the treatment of choice for many years. Three groups of medications have been utilized: stimulants, antidepressants, and tranquilizers. Stimulants have the best track record, working very well in 65 - 75 percent of cases. Children with the inattentive type of ADHD frequently require a low dose to obtain a favorable response. Antidepressants can be of help, especially when bed-wetting is also part of the ADHD symptom picture. Tranquilizers have been used although typically in special cases, as when the ADHD features are related to neurological damage or head trauma.

Counseling for ADHD Counseling can help both the ADHD child and his family understand and cope with the disorder. Cognitive approaches often assist the ADHD student with developing coping skills and decreasing impulsivity. Counseling often focuses on self-control, respecting others, and decreasing negative self-concept that often accompanies ADHD.

Home/Classroom Management Techniques A variety of home and classroom management techniques are found in ADHD research and literature. Recommendations abound and several are listed in this paper. Clinical experience also provides "tricks of the trade" that are shared via the internet or in literature. Perhaps one of the best discovered by this author deals with the "withdrawals" experienced by some ADHD children after school, as the Ritalin medication leaves the system and the child becomes grouchy and hypersensitive. One pediatrician recommends a 12 oz. Mountain Dew which serves to "flatten out" the angle of the withdrawal. Thousands of internet sites are devoted to Attention-Deficit Hyperactivity Disorder (ADHD) and offer these and other suggestions for family and school management.

Discipline and Home Management Recommendations
The following two sections offer a program of discipline helpful in Attention-Deficit Hyperactivity Disorder (ADHD) children as well as a list of home management suggestions. The "Highway Patrol Approach" has been outlined by this author while the home management suggestions have been available in the public domain for many years.

The Highway Patrol Approach to Discipline

The Highway Patrol Approach uses the discipline and correction methods of the adult world with children. The Highway Patrol Approach is strictly business, not emotional or reactive, and corrects behavior through punishment (the fine) and bringing attention to the incorrect behavior. If you are speeding on the highway and are pulled over by the Highway Patrol, after viewing your license and registration, the conversation goes something like this:

Highway Patrol: "Mr. Jones you were clocked going 65 in a 55 mile per hour zone." He has just told you the incorrect behavior.

Highway Patrol: "The fine for speeding in this state is $85.00. Please sign this ticket." The officer has informed you of the punishment for that offense.

Highway Patrol: "Have a nice day." The officer remains polite and businesslike. He does not ask why you were speeding. He does not try to make you understand the reason for speeding laws in that state. He does not insult you with "How can you be so stupid!" or "Where did you get this junker of an automobile?"

The Highway Patrol Approach thus involves three steps:

Step 1: Identify the offense or incorrect behavior.

Step 2: Inform the offender of the punishment/fine.

Step 3: Remain polite and business-like.

When used with children, the Highway Patrol Approach is effective in reducing anger, hostility, and incorrect behavior. The fine for speeding won't bankrupt anyone, will sting the pocketbook, but is not unbearable - nor is it easy to ignore. This approach has been found the most effective in maintaining adult behavior.

When we use this same approach with children, it decreases the anxiety and anger often associated with parental discipline in both the children and the parents. By identifying the incorrect behavior, providing an appropriate fine or punishment, and maintaining a calm, business-like interaction, we decrease the misbehavior while continuing our good relationship with the child. An example:

Parent: "Jimmy, you shoved your brother and you know we don't allow shoving and hitting in this family. I want you to go to your room for 15 minutes. When your time is up you can join the rest of us and watch television. We'll see you in 15 minutes."

Variations in the Highway Patrol Approach That Create Misbehavior
The Highway Patrol Approach, like parental discipline, could be altered in a way that accidentally creates increased bad behavior. Some variations in parental behavior:

Excessive Fines The punishment/fine must always focus on correction - not excessive punishment. If you are audited by the Internal Revenue Service (IRS), their opening line goes something like "This is not a punishment. This audit is simply to insure compliance."

If a new law passes in your state that makes the fine for speeding $10,000.00 - the majority of adults would lie, try to evade arrest, or do anything in their power to avoid getting that ticket for speeding. Nobody tries to avoid an $85.00 fine unless they have an outstanding warrant for another crime.

With children, excessive punishment ("You're grounded for six months!!") almost forces children to lie and cover-up mistakes and offenses. If the punishment is short-and-sweet, designed only to "insure compliance" with the rules/regulations, the child feels no need to lie.

Unpredictable Fines Another law is passed in your state that allows the arresting officer to create his/her own fine - anything from giving you $5,000.00 to beating or shooting you on the spot. If arrested, unpredictable fines prompt the offender to manipulate - trying to get the lowest fine possible. When parental discipline is unpredictable, ignoring offenses sometimes while excessive punishment at other times, a very manipulative child is created. Unpredictable fines produce behaviors such as "sweet talking", crying spells, lying, attempts to influence ("I've got a relative that's in law enforcement!"), and even threats ("My next door neighbor is an attorney!"). Consistency in fines avoids manipulation in both law enforcement and parental discipline.

Canceled Fines If you are stopped for speeding and fined $85.00, then receive notice in the mail that your fine was canceled, you are more likely to continue speeding. If children are punished - then "bailed out" by the parents - they are likely to continue the incorrect behavior as they never suffer the consequences of their behavior. Children that are frequently rescued from the logical consequences of their misbehavior gain the feeling that rules don't apply to them. As time passes, their misbehavior often increases in severity to the point that a rescue isn't possible. The offender is then shocked that they will actually be punished. This situation is often found in teenagers who are frequently given probation or no punishment for offenses as a minor (under 18 years of age), then are shocked when sentenced to six months incarceration for an offense after turning 18 years of age.

Harassing Officer You are fined for speeding while driving to work on Monday. For the next four days, that same Highway Patrol officer stops your car to remind you that you are a speeder, lecturing you with each stop. You develop resentment and bitterness, feeling you are being harassed after already paying for the original offense. This also happens when we continue to remind our children of their mistakes, a situation which creates resentment.

Insulting Officer Almost all children and adults can accept their mistakes and punishment - if the punishment is appropriate for the crime/offense. However, imagine your reaction if you are stopped for speeding and during the process of giving you a ticket for speeding the Highway Patrolman offers comments such as "You're pretty stupid to be going this fast in this worthless automobile. You're probably the worst driver I've seen in months. Your parents obviously didn't raise you right! At this rate, you'll not have a license in six months. Did you get your license out of a gumball machine?"

In this situation, insults are more harmful than the actual punishment. When disciplining children, parents are often angry or upset, creating the temptation to "jab" at the child with insults. A child may learn from his or her mistake and accept an appropriate punishment, but insults continue to hurt long after the punishment is over. Insulting a child creates psychological damage that decreases their self-esteem. Imagine working at a business where your supervisor tells you how ignorant you are each time you make a mistake. You would lose your motivation to work, forget any plans for advancement or success, and develop resentment toward the supervisor and business. Children in trouble often offer comments like "My Dad thinks I'm stupid anyway. My Mom says I can't do anything right!" The idea is to correct - not insult.

The Angry Officer Imagine your reaction when pulled over for speeding, you look in the rear view mirror, and the officer is cursing, angry in appearance, and walking toward your automobile as though he's going to rip the door off your vehicle. Your anxiety level increases and when he asks questions your voice is mumbling, hesitant, and shaky. You are terrified that his anger may come in your direction and for that reason, you "clam up", fearful of making any type of response.

When disciplining children, it's important that we provide our discipline, structure, and interaction without anger and hostility. Being terrified of a parent is not a form of respect - it's a form of intimidation in which violence is respected, not the individual/parent. Discipline provided by an angry parent, often ranging in form from yelling and screaming to physical threats, sends a strong message to children that verbal and/or physical violence and aggression is acceptable - as long as there's a reason and you're upset. Parents who use the yell-and-scream method produce children who yell and scream. As time passes, everyone in the home yells and screams so much that the home is totally out of control by the time the children are teenagers. Those teenagers then mature to yell and scream at their sweethearts, spouses, and eventually their children.

Our best bet, don't discipline your children when you're angry or upset. Remember, it's business - not personal. In all interpersonal interactions, from disciplining children to a professional boxing match, the winner is the individual who maintains control - not the most aggressive or angry.

Summary: Both children and adults learn from mistakes. Corrective action should increase compliance with the established laws and rules of behavior - not harshly punish or intimidate the offender. As in the adult legal system, punishments are designed to fit the crime and discipline is conducted in a business manner. As children misbehave and make mistakes, our job as parents is to guide them in the correct direction. Guiding just about anything is done with a series of small corrections, not intense shoves or overcorrections.

About the Author

www.drjoecarver.com
This handout was written by Joseph M. Carver, Ph.D., a Clinical Psychologist. Dr. Carver is in private practice in Southern Ohio.