Medical, Psychological, and Educational Treatment for Students with ADD/ADHD
Medical, psychological, and educational professionals must use a multi-modality approach in order to improve AD/HD students' social and academic skills. Collaboration among these three disciplines is the most effective way to treat AD/HD students. These disciplines will be introduced individually and suggestions for implementation of a variety of treatments will be made.
Medical Treatments
An effective way to assist AD/HD students is through the use of prescription medications. The two categories of medications prescribed are psycho-stimulants and tri-cyclic antidepressants. Stimulants are generally the preferred medical treatment since most children respond effectively to them. Stimulants include medications like Ritalin (methylphenidate), Dexedrine (dextroamphetamine), Cylert (permoline), and Adderall (a combination of amphetamine salts). These medications "decrease physical activity, and hence, decrease the activity component of total daily energy expenditure in children with AD/HD" (Butte, Treuth, Voigt, Llorente, & Heird, 1999, p. 1). Antidepressants include Norpramine (desipramine) and Elavil, which are generally used after stimulants have been unsuccessful with the child ("Attention Deficit," 1995).
There are many direct and indirect benefits from using prescription medications to aid children with AD/HD. Medication enables students to socialize better with both peers and family members. It decreases impulsivity and aggression, which are common traits of people with this disorder. It helps increase work output, school performance, attention span, and can also improve fine motor skills.
Alongside the benefits are some noteworthy side effects. Stimulants often cause a loss of appetite, which in turn results in minor weight loss as well as delayed growth. They may also cause insomnia, stomach and head aches, and in some cases, tics (Barkley, 1994). In certain children, stimulants heighten already existing obsessive-compulsive disorders. Because depression is also a common side effect, many children take antidepressants like Prozac, Paxil, or Zoloft in addition to the prescribed stimulants they are already using. These antidepressants must be taken carefully, because they are technically only approved for adult use by the Federal Drug Administration (Gibbs, 1998).
Dosage for AD/HD medication is determined by each individual child's needs. Parents are encouraged to keep a log in order to monitor their child's behavior and emotions in accordance with the timing and intensity of the medication. A child can be given medication in either immediate or slow release forms. Immediate-release forms take about thirty minutes to become effective and last between three to five hours. Medication is administered during breakfast, and again around or shortly after lunch. Slow-release forms of the medication sometimes take as long as two to four weeks to truly become effective. Their duration, once effective, is from six to ten hours. While most psycho-stimulants are used in either of these forms, Cylert can only be administered using slow-release dosages (Manos, Short, & Findlings, 1999). Even though these stimulants are not physically addicting, children should periodically be given brief medication vacations to determine if medication is still necessary and useful ("CHADD Fact Sheets," 1999).
Although specific dosages are determined by the individual child's needs, as with any prescription medication, overdose is possible. If the child seems lethargic, too serious, withdrawn, irritable, or glassy-eyed two to three hours after having taken the medication, there is a good chance that the child's dosage is too strong and adjustments need to be made ("Attention Deficit," 1995).
Even though stimulants do appear to help students with AD/HD, little is known as to how they work. It is likely that medications "increase the concentrations of certain brain chemicals (neurotransmitters) which improves the functioning of specific control areas of the brain that are under-active in ADD" ("Attention Deficit," 1995, p. 1). Studies show that stimulants appear to benefit at least 70-80% of the children who try this form of treatment ("CHADD Fact Sheets," 1999). For children who find stimulants ineffective, antidepressants are often useful and benefit approximately 80% of children who try them ("Methylphenidate Studies," 1996).
Prescription medications certainly are effective, however, pills are not a cure for ADD, nor do they teach children. In order to treat AD/HD patients, there must be coordinated efforts between medical, mental health, and educational professionals, as well as parents and the children themselves.
Psychological Implications/Interventions
Living with AD/HD is not only difficult for those with the diagnosis, but for family members as well. It is common that before the diagnosis is made, parents sometimes get frustrated with the child's unexplained behaviors that might be seen as lazy, forgetful, disorganized, or careless. Many children with AD/HD also deal with "peer rejection, low self-esteem, academic problems, and conflicts with family members and authority figures" (Frazier & Merrell, 1997). During the pre-diagnosis stage, parents tend to get angry with the child, and then fight with each other over the child's behavior; blaming themselves or each other. Once a diagnosis of AD/HD has been made, the child is frequently administered medication. As the child is learning to adjust to the medication, new behaviors often occur.
Students who have Attention Deficit Disorder often have many emotional problems. There are many reasons for this imbalance. An inability to maintain friendships is a result of poor social skills, "poor self-concept, rejection, and isolation from peers" (San Miguel, Forness, & Kavale, 1996, p.1). Counseling is the preferred technique to help the child and the family cope with this disability.
Parents sometimes go through a state of denial, believing that the medication itself will fix their child. Taking responsibility and a part in their interventions is often difficult for the parents. Support groups and advocate groups are helpful for the parents not only to deal with their child's disability, but also to inform them of their rights and the services that are available. Most communities offer a wide variety of support groups that are available through community mental health agencies. It is helpful for parents to understand that the child's disability is not their fault. However, learning to deal with the disorder is helpful. Sharing with other families and learning from their situations can help families put their own situations into perspective.
Educational Practices
Collaboration between the doctor, parents, child, and the teacher, is the only true way to meet the child's needs. Teachers need to monitor the child's behavior and reaction to medications. It is important that behavior modifications made at school be reinforced consistently by parents at home for success.
Two of the greatest challenges children with AD/HD face, are staying on task and maintaining attention (Rupley, 1998). Teachers can help this situation by making physical modifications within the classroom. For example, seating the student in close proximity to the teacher and away from distractions like the door, windows, and high traffic areas. Teachers can also seat the AD/HD student next to good role models, or use study carrels. Finally, allowing the student to stand or move around the room while completing class-work can also help the student to maintain focus, provided that he/she is not a distraction to others (Ostoits, 1999).
Another characteristic of an AD/HD student is disorganization. There are many strategies these children can be taught to lessen the occurrence of lost or forgotten homework and materials. Assignment books are useful tools for helping students plan ahead and schedule blocks of time for homework. Teaching them to plan ahead and break down large assignments into smaller units is strongly recommended (Yehle, 1998). Organizing materials for each subject is helpful. Colored folders are very useful for this task. Fanny packs or small bags are also useful to help students organize themselves and have classroom materials accessible when needed (Stormont-Spurgin, 1997).
The following teaching accommodations can easily be implemented to increase student success: provide visual and written instructions; avoid multiple commands; implement interactive, kinesthetic activities whenever possible; personalize situations and provide real-life examples; and divide assignments and instructions into smaller segments (Yehle, 1998). To check for understanding and maintain student focus, teachers should routinely ask questions and have students repeat instructions.
Various techniques using technology are beneficial to students with AD/HD and help maintain interest and focus. Myriads of excellent computer programs are available for all core subject areas, which are popular with these students, as they provide immediate feedback and interaction (Yehle, 1998). Many books on tape are also available for students with reading difficulties that range from poor "word attack" skills to simply "losing their place" in reading. Another useful tool is an overhead projector using different colored pens, which provides visual interest and variety, as well as keeps the teacher facing students.
To effectively treat AD/HD children, medical, psychological and educational interventions should be implemented in conjunction with each other. Although each can be somewhat effective on its own, collaboration is vital for long-term success. Medication, which is the most widely used form of treatment, can help, but it cannot replace other important factors such as changes in the child's environment, psychotherapy, and family counseling (Gibbs, 1998). Modifications are often needed in the above treatments, and constant communication between all involved parties is essential in order to promote student success.