Saturday, November 29, 2014

Current strategies in the management of ADHD symptoms


Current strategies in the management of ADHD symptoms and behavior focus on parent skills education, behavioral management, environmental modifications, psychotherapy and psychoeducational programs.1 Most agree that these interventions should precede and or coincide with pharmacological interventions. These interventions are highly dependent on age. Behavior management and token rewards work well in younger children and education is more applicable to adolescents and adults. There are few clinical studies that have been designed to assess specific behavioral strategies, but the consensus of current opinion will be reviewed here.

Most individuals are more likely to overcome their weakness what they understand what they are and how they manifest. The National Institute of Health (NIH) recommends that individuals with ADHD, adjusting for age, should begin to learn more about ADHD and how is impacts their lives.2 A better understanding that nothing is “wrong” with them and they have to work harder in certain areas typically reduces the defensiveness and poor self-esteem that often accompanies children and adults with undiagnosed ADHD.3 This is best accomplished by ADHD education and some may require psychotherapy to cope with these feelings according to the National Institute of Health (NIH).4

Following professional assessment and diagnosis of ADHD, the greatest weaknesses identified should be discussed with the child, parent or adult being evaluated. The National Institute of Mental Health (NIMH) recommends that children and Adults with ADHD should be educated on how to recognize situations and conditions that place them at a disadvantage, based on their weaknesses.5 For example, it is better to study in a quiet location with minimal chance of auditory and visual distractions if a child is easily distracted. On the other hand, having a “study buddy” to review flash cards or quiz each other may help someone that has a limited attention span when directly studying from a textbook.

The University of Maryland School of Medicine recommends that younger children benefit from a structured, daily routine with consistent boundaries and establishing an attainable behavioral reward system.6 For a more successful school experience it is beneficial to prepare the teacher and share effective strategies. Ongoing communication with the teacher is essential.

The psychoeducational approach for adolescents and adults should be centered around establishing effective organizational  skills
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1.     A. Montoya a, F. Colom b, M. Ferrin. Is psychoeducation for parents and teachers of children and adolescents with ADHD efficacious? A systematic literature review.   European Psychiatry 26 (2011) 166–175
2.     http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder/index.shtml
3.     van den Hoofdakker BJ, van der Veen-Mulders L, Sytema S, Emmelkamp PM, Minderaa RB, Nauta MH. Effectiveness of behavioral parent training for children with ADHD in routine clinical practice: a randomized controlled study. J Am Acad Child Adolesc Psychiatry. 2007 Oct;46(10):1263-71.  http://www.ncbi.nlm.nih.gov/pubmed/17885567
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