TREATMENT OF adhd

Behavioral Treatment of ADHD

The American Academy of Pediatrics recommends starting ADHD treatment with behavioral therapy. This therapy focuses on reinforcing positive behaviors and reducing negative ones by teaching attentional focus, and impulse control strategies. It often involves parents and teachers, providing structure, setting clear expectations, and using consistent consequences and rewards to support the child’s development.

Cognitive Behavioral Therapy (CBT), which may be especially beneficial for adolescents with ADHD, helps change negative thought patterns and teaches time and task management skills. It can also address coexisting issues such as anxiety or depression.

Psycho-education helps families understand ADHD better, enhancing self-help skills and improving health choices. Support groups and counseling offer opportunities to share experiences and learn coping strategies.



Due to the neurochemical nature of ADHD, behavioral therapy alone is almost always insufficient, and medication is most often necessary. In Little Rock, there is a shortage of psychological services, leading to long waiting periods for therapy appointments. Consequently, depending on symptom severity, parental preferences, and available resources, we may prioritize medication management. 

Educational Treatment of ADHD

In addition to behavioral treatment, many children with ADHD also require professional educational interventions. These interventions can be provided through an Individualized Education Program (IEP) or through a Section 504 Plan. Both help support a child's specific learning needs within the school environment and are mandated by law. IEP and 504 Plans are different in scope and purpose. We will describe both.

-IEP

The Individuals with Disabilities Education Act (IDEA), established in 1975 and amended in 1990, ensures that students with disabilities receive a free and appropriate public education. An Individualized Education Program (IEP) is a personalized educational plan for students qualifying under IDEA's 14 disability categories, including ADHD, which must significantly impact a child's educational performance for the IEP to be implemented.

Creating an IEP involves collaboration among educators, parents, and specialists, starting with an assessment of the child’s academic and functional skills to understand how ADHD affects their progress. The IEP includes measurable goals for improving attention span, organizational skills, and managing impulsivity. For example, a reading specialist may assist with challenges like poor reading comprehension.

The plan outlines necessary special education services, such as resource room support, specialized instruction, tutoring, and behavior intervention. Accommodations may include extended test times, seating adjustments, reduced homework loads, and the use of technology like audiobooks or speech-to-text software. Seating a child at the front of the class can help minimize distractions.

Many IEPs also include a Behavior Intervention Plan to manage behavioral challenges associated with ADHD. Regular monitoring and reviews allow for necessary adjustments to the IEP.

-Section 504

Section 504 accommodations ensure students with disabilities, such as ADHD, have equal access to general education under the Rehabilitation Act of 1973. These accommodations—like extended test time, preferential seating, and technology aids—remove barriers and provide equitable academic opportunities.



Unlike an Individualized Education Program (IEP) designed for students with significant academic challenges needing special education services, a Section 504 Plan supports higher-achieving ADHD students who need specific accommodations for academic success. To qualify, a student must show that their ADHD substantially limits major life activities like learning or concentrating.

A 504 Plan is developed by a team of teachers, counselors, administrators, and parents, sometimes including the student. It specifies the accommodations needed for success in a mainstream classroom.

For standardized tests like the ACT, students may qualify for accommodations such as National Extended Time. Schools must request these accommodations well in advance, submitting details from the existing 504 Plan and relevant medical evaluations. It's crucial to initiate this process early, as accommodations cannot be arranged through external parties. A simple letter from organizations like All For Kids will not result in extra time on the ACT. Instead, request a Section 504 Plan from the school ahead of time.

Lifestyle Modifications for ADHD

It is important to create a consistent daily schedule for your child with ADHD which can aid in better time management and organization. Maintaining a balanced diet and being physically active have been shown to help manage symptoms of ADHD. Some psychiatrists recommend martial arts for their ADHD combined type patients.

Ensuring sufficient and quality sleep is crucial, as sleep problems are common in those with ADHD. See our section on sleep.

Pharmacologic Treatment of ADHD

Because ADHD is caused by a neuro-transmitter (dopamine) imbalance, medications are generally needed for this condition. The treatment is usually a stimulant medication, although non-stimulant medications are also available.

When considering the pharmacologic treatment of ADHD, it can be helpful to use an analogy to differentiate between the various medications and their effects on the brain and a child's behavior. For our analogy, we will chose three vehicles: a bicycle, a 4 cylinder Honda Accord and a 4-wheel drive V8 full-sized pickup truck. All these vehicles can get you to your destination, but with varying levels of power and speed.

The Bicycle:  Atomoxetine (Strattera), Viloxazine (Qelbree), clonidine, and guanfacine are non-stimulant medications that can be compared to transportation by a bicycle. Just as bicycles offer a steady and controlled means of transportation, these non-stimulant medications provide a more gradual and conservative approach to managing ADHD. Unlike stimulants, they work by increasing norepinephrine levels in the nerves of the brain, leading to improvements in attention and a reduction in hyperactivity and impulsivity. Similar to how bicycles offer consistent, slower-paced travel, these medications generally take longer to produce noticeable effects, often resulting in fewer side effects than stimulant medications used to treat ADHD. These medications are good choices for children with the inattentive form of ADHD and children who can't tolerate stronger stimulant medications.

The Honda Accord:  Methylphenidate (e.g., Ritalin, Focalin, Quillivant, Daytrana Patch, Metadate CD, Concerta, Azstarys), can be likened to a 4-cylinder Honda Accord. Much like a reliable sedan, methylphenidate offers good efficacy (effectiveness) and is generally well-tolerated. It works by quickly increasing dopamine levels in the brain, which enhances focus and attention in people with ADHD. Methylphenidate is a dopamine reuptake inhibitor. That means that it is milder in its action on dopamine levels, keeping the naturally released dopamine in the synaptic cleft of the nerve for a longer period of time without increasing the amount of dopamine released by the nerve. However, it is still a strong Schedule II stimulant medication delivering powerful results. Driving an Accord provides good handling and moderate power—traits that reflect how methylphenidate smoothly and effectively manages symptoms day-to-day, making it a preferred choice for most children with ADHD.

The 4-Wheel Drive Truck:  Finally, amphetamines (e.g., Adderall, Dyanavel, Adzenys, Dextroamphetamine, Vyvanse) can be likened to a 4-wheel drive V8 full-sized pickup truck. These medications deliver powerful stimulation and robust effects. Amphetamines enhance the release and prevent the reuptake of norepinephrine and dopamine, offering strong and often longer-lasting effects, depending on the medication chosen. Like taking the wheel of a pickup with a V8 engine, these medications provide significant power and capability, making them suitable for managing more severe ADHD symptoms or for individuals needing prolonged or robust symptom control. However, they require consideration of stronger side effects and potential misuse or even abuse.



The vehicle analogy helps illustrate how these medications vary in strength, onset, effectiveness, and side effects, allowing parents to have a voice in choosing the most appropriate “vehicle” for managing ADHD.