ADHD is a pervasive disorder, affecting all areas of function, the treatment plan must be farsighted, comprehensive and flexibility adapted overtime to changing needs. The commitment of patient and family to the plan must be cultivated. This implies that treatment must be not only effective, but also feasible, palatable and affordable for the particular patient. Therefore, treatment planning has to be individualized, with consideration for family preferences.
There are several ways to manage ADHD, let’s reflect on it.
Family Intervention with Children:
Different types of such programme are required with pre-adolescent children and adolescents. The programme consists of 9 weekly sessions and so spans about 2 to 3 months. It covers various aspects including:
(i) Psychoeducation
(ii) 4 factor model of parent child conflict
(iii) Help child develop prosocial behaviour
(iv) Social reinforcement during special play and independent play
(v) Enhancing parent child interaction
(vi) Giving effective commands
(vii) Use of reward system at home
(viii) Dealing with comorbid issues such as enuresis and enchopresis
Family Interventions with Adolescents:
Behavioural parent training, problem-solving and communication training, and structural family therapy have been found to be effective. Problem-solving and communication training is a highly directive treatment programme with 3 core components:
(i) Communication training
(ii) 5 step behavioural solving
- Defining the problem
- Suggesting/ introspecting possible solutions
- Evaluating solutions
- Implementing the solution
- Verifying the outcome
(iii) Cognitive restructuring – to modify family beliefs and negative attributions that underpin destructive interaction patterns. These beliefs may include themes of ruination, perfectionism, obedience, etc.
Behavioural interventions
• Modifying both school and home environment.
• Positive reinforcement – rewards or privileges for good behaviors. Ex: TV time after finishing school work.
• Time out – remove factors that reinforce problematic behaviours ex : if they start crying or throwing tantrum , sit alone in a corner for 5 minutes.
- Response cost- withdrawing privileges after unwanted behaviors.
Token economy – combination of positive reinforcement and response cost.
- Changes in sleep and diet. ( reducing sugar , change sleep patterns, including phyical activity).
Social Interventions
• Social skills training
• Anger management
• Supervised recreational activities.
• Parenting skills training
These are the certain ways to manage ADHD.
ADHD & MANAGEMENT
