theADHDdoc.com - Your guide to medications and complementary and alternative treatments for ADD & ADHD.

Your guide to medications and complementary and alternative treatments for ADD & ADHD.

Strategies For Counselors

Keys for Successful Patient Care

1. ADHD is not like other psychiatric disorders. It was not caused by trauma, neglect, inadequate parenting, or social isolation. Applying therapeutic strategies based on existing models of psychopathology simply fails to produce resolution of the core symptoms of ADHD or promote improved social functioning.

2. Like other medical conditions that can affect attention, concentration, mood, and behavioral control (e.g. diabetes, hypoglycemia, anemia), the underlying medical causes of ADHD must be addressed as part of any effective treatment program. Prior to treating a patient for ADHD, make sure that they have been thoroughly evaluated for other medical conditions that can cause symptoms of inattention, restlessness, and impulsivity (e.g. anemia, hypoglycemia, diabetes, thyroid disorders, sleep apnea, dietary insufficiencies of zinc, magnesium). In pre-teens and teenagers it is highly advisable to insist on a screening for illegal psychoactives.

3. To date, certain types of stimulant medications (e.g. Ritalin-LA, Concerta, Metadate-CD, Adderall-XR), antihypertensive medications (e.g. clonidine and guanfacine), tricylclic antidepressants (e.g. Imipramine) and norepinephrine specific reuptake inhibitors (Strattera) have been demonstrated to be effective in treating the core symptoms of ADHD. The only type of non-pharmacological treatment that has been shown to produce significant improvement in the core symptoms of ADHD is EEG biofeedback. Without utilizing one of these types of treatments, there is no scientific evidence that your patient's symptoms of inattention, impulsivity or hyperactivity will improve.

4. If school is going well, life gets a lot easier for kids with ADHD. Consequently, make sure that your patients with ADHD are receiving accommodations and support as mandated by the Individual's with Disabilities Education Act (I.D.E.A.) and Section 504 of the Rehabilitation Act of 1973 (504 Plans).

5. I once heard it said that "pills don't build skills". From my perspective, Skill-building is at the core of effective counseling for patients with ADHD. Kids with this condition need to learn a number of skills including:

     how to engage in meaningful and enjoyable conversations with others,
     how to "pick out" important information when they listen and read,
     how to organize their possessions,
     how to work for what they want,
     how to control impulsive expressions of anger, sadness, and fear,
     how to express disappointment in an appropriate manner
     how to overcome fears and anxiety and
     how to solve social problems with others.

Play therapy may be useful in establishing rapport with a child whose disorder is caused by trauma or neglect. However, ongoing "play therapy" or "cognitive behavior therapy" is unsupported when applied to treating patients with ADHD. To be frank, kids with ADHD do not need an adult buddy to hang out with them and play chess or video games. These kids need parents, teachers, and therapists who will involve them in social skills groups (e.g. those modeled after the MTA groups developed by Dr.William Pelham) and encourage their parents to participate in parent training programs specifically developed for caretakers of children with ADHD (such as the program developed and evaluated at our clinic).

To learn more about parenting programs or social skills programs, check out the books and videos available at our online store.