More than meds: a multifaceted approach to ADHD

ADHD often interferes with a child’s ability to follow directions. This can be perceived as misbehavior or “not paying attention” and lead to problems at school.

Billy is sitting in a chair in his third grade classroom, but can’t seem to find a comfortable position. He fidgets and adjusts, creating enough noise in the process to distract the other children around him. Sensing the disruption his teacher asks him read out loud, but after several attempts, Billy admits he isn’t sure what page the rest of the class was reading from. Some of the other students laugh as his teacher points out their place in the story, visibly annoyed at his inability to remain focused…

Though fictional in nature, the frustration portrayed in this scene is all too real for many children and teachers. Attention Deficit Hyperactivity Disorder is one of the most common neurobehavioral disorders in children. Recent numbers show 4.5 million students age 5 to 17 have been diagnosed with some form of ADHD, where impulsivity, hyperactivity, inattentive behavior or a combination of all three, interferes with relationships at school or home.

While the number of reported ADHD cases has risen slightly over the past few years, there is little evidence to support sensationalized news stories labeling ADHD a growing epidemic. Michael Neessen, PsyD, co-director of Children’s Hospital Boston’s ADHD program, believes the public’s increased awareness (and media’s burgeoning obsession) with the condition has less to do with a higher prevalence of ADHD, and more to do with better understanding of its symptoms. He says today’s teachers and parents are simply more informed and are therefore better at picking up on ADHD’s warning signs, which are made all the more visible due to the fast-paced, technological climate we currently live in. “Kids today have larger home work loads, busier schedules and just a general increase in the demands placed on them,” he says. “It’s not that there are substantially more kids with ADHD out there, it’s that there is more awareness of what ADHD is and the current education climate calls more attention to their condition.”

Science has yet to determine the causes of ADHD, but a combination of genetics and environmental factors is suspected in most cases. Because ADHD often affects multiple aspects of a child’s behavior, a multi-tiered approach to treatment is usually the most successful. Medication and evidence-based treatments are important, but there are many other teaching and parenting methods adults can adopt to make life easier for the thousands of kids with ADHD.

“Using slightly altered parenting techniques and behavioral management is especially helpful for kids with ADHD,” Neessen says.

Outside of medication, here’s a look at some ways parents and teachers can help children with ADHD gain more control over their bodies and environment, and likely improve their grades, personal relationships and quality of life in the process.

Consistency. Children with ADHD are more likely to be confused by changes in routine and often have a hard time adapting to new surroundings or expectations. Variances in their expectations, or what is expected of them, can often trigger symptoms of their condition. “One of the hallmarks of kids with ADHD is inconsistency in their behavior,” says Neessen. “Creating more structure in their lives leads to improved consistency, which is vital to helping kids with ADHD function better in school or at home.”

Neessen says parents who are in agreement about their expectations for their child, as well as how they express and reinforce those expectations, provide the most consistent environments.  Once a successful behavioral/positive reinforcement model has been established, parents can act as advocates to educate teachers, relatives, sitters and any other authority figures in the child’s life about how to best implement it. When expected behavior and the reward system associated with that behavior is clearly defined by every adult the child’s life, it’s much easier for him or her excel in their daily functions.

Exercise. The belief that there’s a positive correlation between a well-exercised body and academic success has been around for some time, but evidence of this relationship as it relates to kids with ADHD isn’t particularly clear. “The empirical data on how exercise effects kids with ADHD is somewhat lacking,” Neessen says. “But many pediatricians will tell you that some amount of regular exercise is going to help positively regulate a child’s mood and attention.”

Exercise is important for all students, especially those with hyperactivity

Neessen says children with ADHD, especially those that display hyperactive tendencies, often benefit greatly from regular exercise, both to expend excess energy and improve brain function. “Getting outside and working their bodies allows these kids time to help regulate all the systems involved in attention,” he says.

Self-esteem. Self-esteem plays a very important role in a child’s social and academic development. A child with ADHD who has difficulties at school or with interpersonal relationships may have a lower sense of self-worth, which can exasperate his or her symptoms and create a vicious cycle. Modifying tasks or activities to better suit the strengths of a child with ADHD can do wonders for self-esteem and confidence.

“If you can help kids with ADHD break bigger tasks down into smaller pieces, it can give immediate reinforcement that they’re succeeding,” Neessen says. “The gratification of a job well done can help build confidence. In some cases that boost can be as important, if not more important, than the assignment itself.”