ADHD: What’s the Best Way to Help Your Child?

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About 2 million of the more than 6 million American children with ADHD were diagnosed as young children (ages 2 to 5), according to the Center for Disease Control (CDC ).

About 2 million of the more than 6 million American children with ADHD were diagnosed as young children (ages 2 to 5), according to the Center for Disease Control (CDC ). Treatment methods for the condition can vary. However, current guidelines from the American Academy of Pediatrics (AAP) clearly state that healthcare providers should first refer parents of young children for behavior therapy before prescribing medication. Behavior therapy teaches both children and parents how to better react to everyday situations, providing helpful tools and coping strategies.

That said, more young children are taking medicine for ADHD now than are receiving psychological services, according to the AAP.  Why? One of the reasons is cost.  “Behavior therapy is not free and not many insurance companies currently cover it,” says Ann M. Lagges, Ph.D., H.S.P.P., a psychologist specializing in Child and Adolescent Assessment and Treatment and Pediatric Psychology at Indiana University Health. “Plus, there are not enough providers who are trained in this area—for parents of young kids— especially in rural areas.”

Why is behavior therapy so important? “Our ability to diagnose ADHD can be challenging in children younger than five years of age. A kid that is high-energy and has impulse control issues, may be on the high end of normal, but we can’t diagnose ADHD at this point,” Lagges notes. Maturity is a big issue. Kids who may seem impulsive or over-the-top with energy, may be acting age-appropriate or may be immature (many 2 and 3 year olds fit the bill), but that’s not ADHD.  Instead behavior therapy—teaching children not to dart out in traffic or hit the child next to him when he’s angry—can be really helpful at this age, she says. In terms of finding a good behavior therapist, contact your pediatrician or even your child’s future elementary school. These outlets often have therapists they can recommend. Then, call your insurance company to find out who is covered under your health plan.

For kids older than six years of age, the AAP recommends medication as the first line of treatment and then adding behavior therapy if it’s available. The reason drugs are the first line of defense at this age group is because they are needed for school, when kids need to concentrate for more prolonged periods of time. A combined treatment plan—medication with therapy—is recommended because there may be related issues with ADHD. “Academic performance, social functioning, treatment of any co-occurring conditions, such as anxiety disorders—most kids with ADHD struggle in these areas and behavior therapy can provide skills for the parents and kids,” says Lagges.

She notes that one of the reasons it’s important for the parent to be involved in the therapy, is because the parent/child relationship improves. “All kids can be trying, but add ADHD and it becomes tough on parents because their child can’t stay focused,” she notes. Parents can begin to feel like every interaction is a conflict.

Therapy can also teach parents different strategies like giving kids single step instruction, says Lagges. “Instead of telling a child to clean up his room—which can be overwhelming for a child with ADHD—a parent learns to break it down. Please put your books away. After that, make your bed.” Instead of telling your child to get ready for school, parents can create a check list in pictures. The first picture is eating breakfast, then brushing teeth, then getting the lunchbox from the fridge. “ADHD kids can then follow this routine daily,” Lagges explains. “They won’t feel frustrated because they can’t stay focused and on task. If parents don’t attend therapy, they won’t know how to do this. Therapy can offer them helpful strategies for everyday situations.”

When it comes to medication, it can be common for some parents to hesitate. Lagges suggests that parents ask their doctor a lot of questions to make sure they feel comfortable with the drugs and dosing. It may also be important to remember that not medicating a child who needs can be a risk in itself. “If ADHD is not treated, kids may underachieve in school because they aren’t able to focus, they then may begin to dislike school and can be at risk for depression and anxiety,” she says.

While Lagges understands why parents may be cautious about putting their child on medication, she notes that “a lot of kids do absolutely fine and parents do notice a positive difference.” And remember, Lagges notes, you can talk to your provider about stopping meds any time.

The most important thing: “ADHD in kids is a common, treatable condition. Getting the right help is the key,” says Lagges.

-- By Judy Koutsky

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