Child Psychiatry - ADHD
Treatment (Medical and Non-medical)
The medication treatment for ADHD can be roughly divided into two categories: stimulants and non-stimulants. Although their mechanisms are not exactly the same, both can increase the concentration of catecholamines in the brain, which improves the patient's memory, behavior, and emotional control abilities.
Behavioral treatment at home (Part 1): Constructing an ideal reward system
Behavioral treatment at home (Part 2): Handling negative behaviors
Behavioral treatment at home (Part 3): Addressing procrastination after receiving instructions
Tailoring ADHD Medical Treatment for Each Individual
When a child is diagnosed with ADHD, many parents feel overwhelmed and uncertain about how to proceed. Some worry that not being prescribed medication will put their child at a disadvantage, while others are hesitant due to the potential side effects of the medications.
The fact is, the treatment for ADHD varies from person to person. Doctors need to assess each patient's individual needs, consider any comorbidities, and then create a tailored treatment plan. The primary goal of these plans is to improve the child's learning abilities and reduce various behavioral issues at home and school.
Current research shows that medication for attention deficit has the most substantial evidence in treating ADHD, while various behavioral therapies can be effective for mild to moderate cases.
ADHD medications can be roughly divided into two categories: stimulants and non-stimulants. Although their mechanisms are not exactly the same, both can increase the concentration of catecholamines in the brain, which improves the patient's memory, behavior, and emotional control abilities.
Common stimulant medications include methylphenidate and amphetamines, which come in various formulations and differ in terms of duration of action. Doctors will prescribe medications based on the individual needs of the patient, ensuring that they can adapt well to the school environment and establish a solid foundation for learning.
Stimulant medications typically have an immediate effect on ADHD symptoms. However, their side effects can sometimes be discouraging. Common side effects include nausea, loss of appetite, insomnia, and agitation. Some parents may be concerned about the potential impact of these medications on their child's height, but numerous studies show that the final effect is only about 1 cm.
Non-stimulant medications include atomoxetine, clonidine, and imipramine. These medications generally have a lesser effect compared to stimulants, and their side effects may not necessarily be fewer. Doctors typically prescribe these medications when patients cannot tolerate the side effects of stimulant medications.
In conclusion, it's essential to recognize that each ADHD patient is unique, and the best course of treatment must be tailored to their specific needs. By working closely with healthcare professionals, parents can help ensure that their child receives the most effective treatment for managing their ADHD symptoms.
Choosing the Best ADHD Medication: 4 Key Factors to Consider
As parents, we want to provide our children with the best medication to help them adapt to life and learning while minimizing the impact of ADHD. Many parents are eager to choose the best medication, but in reality, there is no single "best" medication – only the one that is most suitable for their child. Here are four factors doctors consider when prescribing ADHD medications, which can also serve as a reference for parents:
Sometimes, children may not need to be focused and attentive throughout the entire day. Especially during the COVID-19 pandemic, many children attend online classes or only go to school for half a day. In such cases, longer-acting ADHD medications may not be necessary.
Here are the durations of some commonly used stimulant ADHD medications:
Methylphenidate HCl: 4 hours
Methylphenidate HCl Extended-release capsule: 8 hours
Methylphenidate Extended-release tablet: 12 hours
Lisdexamfetamine Dimesylate: 13 hours
Some children have difficulty swallowing pills. Fortunately, certain types of ADHD medications don't have to be swallowed whole. Parents can open the capsule and mix the granules inside with sugar syrup, fruit juice, or yogurt without affecting the medication's efficacy.
Here are ADHD medications available in capsule form that can be opened:
Methylphenidate HCl Extended-release capsule
Common stimulant ADHD medications are divided into two main categories: Methylphenidates and Amphetamines. While both types have a similar structure, their effects slightly differ. Since the effectiveness of medications varies among individuals, if one medication doesn't work well, doctors may try another from a different category.
Here are the classifications of commonly used stimulant ADHD medications:
Methylphenidate HCl: Methylphenidates
Methylphenidate HCl Extended-release capsule: Methylphenidates
Methylphenidate Extended-release tablet: Methylphenidates
Lisdexamfetamine Dimesylate: Amphetamines
The side effects of stimulant ADHD medications are generally similar, with slight differences depending on the specific drug and how its concentration changes in the patient's body.
Methylphenidate HCl: This short-acting medication lasts for 4 hours. Patients may feel tired when the medication wears off.
Methylphenidate HCl Extended-release capsule: This medication lasts for 8 hours, but its concentration in the body peaks twice (first and fifth hours). Between these peaks, patients may experience mood fluctuations, such as agitation. After 8 hours, patients may also feel tired.
Methylphenidate Extended-release tablet: This medication lasts for 12 hours and has two smoother peaks in concentration. Patients may experience fewer mood changes. However, they may feel tired after the 12-hour period.
Lisdexamfetamine Dimesylate: This medication lasts for 13 hours. Its concentration peaks 3.5 hours after administration, then gradually decreases but not as sharply as with other medications. As a result, patients may not feel as tired after the 13-hour period, compared to using other medications.
In conclusion, there is no one-size-fits-all solution when it comes to ADHD medication. By considering these four factors, parents and doctors can work together to find the most suitable medication for each child, helping them manage their ADHD symptoms effectively.
Behavioral Treatment for ADHD Children at Home (Part 1): Creating an Ideal Reward System
In addition to medication, therapists can use behavioral treatment to address behavioral issues in children with ADHD. However, if parents know the right techniques, they can also implement behavioral treatment at home.
Some parents may be unsure about how to approach this, leading to a lack of improvement in their child's behavior and potentially increased defiance. Eventually, even well-intended advice may fall on deaf ears, and children may act in the opposite direction.
Before the situation worsens, parents should try establishing a reward system. It is essential to emphasize a reward system rather than a punishment system, as positive reinforcement can help reduce defiant behaviors. Here are some tips and examples for creating an effective reward system.
Key Points for a Reward System:
Keep it simple, focusing on one or two behaviors at a time.
Concentrate on rewarding positive behaviors instead of punishing negative ones.
Examples of Effective Reward Systems:
Purchase a small puzzle (approximately 10-30 pieces) and attach a magnet to the back of each piece. When your child demonstrates positive behavior, reward them with one puzzle piece. The child can display the pieces on the refrigerator or another magnetic surface, allowing them to show off their achievements. This serves as a social rather than purely materialistic reward. Once the puzzle is completed, they can also receive a more significant reward.
Community Reinforcement Initiative
Whenever your child receives praise from others while shopping, visiting stores, encountering neighbors, attending extracurricular activities, or any other situation, parents can buy an inexpensive small gift for their child. This helps them remember what they did right and reinforces the positive behavior.
In conclusion, implementing a reward system at home can be an effective way for parents to address their child's ADHD-related behavioral issues. By focusing on positive reinforcement and keeping the system simple, parents can support their child's growth and help them learn healthy habits that will serve them well in the long run.
Behavioral Treatment for ADHD at Home (Part 2): Handling Negative Behaviors
As mentioned in the previous article, behavioral treatment should focus on addressing and rewarding positive behaviors to avoid children becoming defiant. But what about negative behaviors? Should they be ignored and left unaddressed?
In fact, in many situations, it is possible to let children experience the consequences of their negative behaviors firsthand. This allows them to learn a lesson and reduces the chance of confrontation with parents.
However, sometimes negative behaviors can cause concern for caregivers, such as tantrums when the child wants to buy something. Here is an example scenario to illustrate how to handle negative behaviors.
Tantrums at the Store:
Scenario: You plan to take your child to a store to buy stationery. Based on past experiences, your child may throw a tantrum when entering the store, demanding to buy other toys displayed in the stationery store.
Handling Approach: Before entering the store, clearly communicate with your child about the shopping plan. Let them know whether you will be purchasing toys or other items, and set a limit on the number of items they can buy. Explain the potential consequences of negative behaviors, such as drawing unwanted attention from others. Parents can also help prepare their child for how to handle their emotions if they begin to lose control.
Experiencing Consequences: If the child behaves well and doesn't throw a tantrum, they can continue shopping with their parents in the future. On the other hand, if the child has a meltdown, they may lose the opportunity to go shopping next time. As the consequences were discussed beforehand, the child will remember the potential negative outcomes of their actions.
In conclusion, parents can handle their ADHD child's negative behaviors at home by allowing them to experience the consequences of their actions. Setting clear expectations and boundaries, and being consistent with the consequences, can help children learn from their experiences and develop healthier habits over time.
Behavioral Treatment for ADHD (Part 3): Handling Procrastination After Receiving Instructions
Sometimes, even when children hear their parents' instructions, they may not immediately stop what they are doing and attend to the task at hand. This can be frustrating for parents, who may repeatedly issue commands or raise their voice. However, such an approach can lead to resentment and deepen the child's rebellious behavior, ultimately affecting the parent-child relationship.
A more common and appropriate approach is to wait quietly and patiently, allowing the child to experience the consequences of not immediately responding to the instruction. For example, if a child is told to come to the table for dinner, they may begin to feel regret when they realize everyone else is enjoying their meal.
However, waiting patiently can be challenging for some parents, who may lose their temper and scold their child after just a few minutes. Here are some tips for parents to handle their child's procrastination after receiving instructions.
The Waiting Dice:
Children may not follow instructions immediately because they are too engrossed in their current activity or due to rebelliousness and defiance. Parents can establish an agreement with their child to use a dice to resolve the procrastination issue.
Whenever a child is reluctant to follow instructions, parents can ask them to roll the dice, using the resulting number to determine how much longer they can continue their current activity. For example, if the child does not want to go to bed, the parent can ask them to roll the dice to decide how many more minutes they can stay up.
Using the dice as a neutral third party can effectively reduce the power struggle between the child and the parent. It gives the child a sense of "letting fate decide" and reduces their opposition to authority figures.
In conclusion, parents can manage their ADHD child's procrastination after receiving instructions by using techniques like the waiting dice. By implementing creative solutions that avoid direct confrontation, parents can foster a healthier and more cooperative parent-child relationship.