cont. from

Getting reassurance

Part of the solution is simply acknowledging that the symptoms constitute a recognized psychiatric disorder. That is often reassuring for children and parents who have found the situation mystifying and maddening. Psychotherapy may help patients to identify and deflect the feelings that cause impulsive and aggressive reactions. (It is often best to ask children to talk not about themselves but about their reactions to other people's complaints.) Since children with ADD often have difficulty following social rules and understanding social situations, therapy must be didactic; for example, they may have to learn how to look at others who talk to them, listen to what they say, and wait their turn before answering. Some therapies work on the assumption that ADD patients have an inadequate sense of the past and future and must learn how to anticipate the consequences of their actions. Group therapy is often helpful, not only for mutual support and exchanges of advice, but because group meetings are a laboratory in which the situations most troublesome for these children can be recreated and they can see in others what they have not been able to see in themselves. Children with ADD need structure and routine. They should be helped to make schedules and break assignments down into small tasks to be performed one at a time. It may be necessary to ask them repeatedly what they have just done, how they might have acted differently, and why others react as they do. Especially when young, these children often respond well to strict application of clear and consistent rules. In school, they may be helped by close monitoring, quiet study areas, short study periods broken by activity (including permission to leave the classroom occasionally), and brief directions often repeated. They can be taught how to use flashcards, outlines, and underlining. Timed tests should be avoided as much as possible. Other children in the classroom may show more tolerance if the problem is explained to them in terms they can understand.

Establishing Routine and Structure
In a sense, establishing structure and routine is a form of behavior therapy - consistent schedules with rewards for acceptable behavior. Behavior therapy in a more formal sense may be useful to prevent a particular kind of aggressive or disruptive behavior that occurs in a few specific circumstances, but applying it to all the situations in which symptoms of ADD appear would be impractical - too time-consuming and demanding for anyone's patience and skill. Some behavior therapists have added cognitive techniques designed to change self-defeating thoughts, with inconclusive results.

Family Conflict
Family conflict is one of the most troublesome consequences of ADD. Especially when the symptoms have not yet been recognized and the diagnosis made, parents blame themselves, one another, and the child. As they become angrier and impose more punishment, the child becomes more defiant and alienated, and the parents still less willing to accept his excuses or believe in his promises. A father or mother with adult ADD sometimes compounds the problem. Constantly compared unfavorably with his brothers and sisters, the child with ADD may become the family scapegoat, blamed for everything that goes wrong. When ADD is diagnosed, parents may feel guilty about not understanding the situation sooner, while other children in the family may reject the diagnosis as an excuse for attention-getting misbehavior.

To avoid constant family warfare, parents must learn to distinguish behavior with a biological origin from reactions to the primary symptoms or responses to the reactions of others. They should become familiar with signs indicating imminent loss of self-control by a child with ADD. A routine with consistent rules must be established; these rules can be imposed on young children but must be negotiated with older ones and with adolescents. The family should have a clear division of responsibility, and the parents should present a united front. It often helps to write out complaints and to praise good behavior immediately. Role-playing may help a child with ADD to see how others see him. Family therapy or counseling, parent groups, and child management training are sometimes useful.

The effectiveness of treatment for ADD is difficult to judge. Patterns of change vary greatly and unpredictably with both drugs and psychotherapy, and there are uncertainties even in the standard measures of outcome; for example, some studies suggest that a child's own feelings about himself, observations of his behavior, and the judgments of other children about him do not change in the same ways or at the same time. Another problem is that the available studies are mostly short-term, although the issues are long term ones. Researchers may never know whether childhood drug treatment has lasting effects, since assigning children at random to a drug or a placebo is no longer considered acceptable. Treatment may become more precise and reliable when the diagnostic standards for ADD are refined and subtypes are differentiated through the study of genetics, family histories, responses to drugs, neuropsychological tests, and the associated learning disabilities and antisocial behavior.

next: Medical Treatment for ADHD

top . send to friend . adhd site map

Reviewed: 01/2006