Understanding Treatment Plans for ADHD

Dr. Harold Koplewicz, President of the Child Mind Institute, and Diane Debrover, Deputy Editor of Parents, discuss concerns about medicating children with attention deficit hyperactivity disorder.


-When Parents Magazine and the Child Mind Institute surveyed more than– more than 1,000 parents, 3/4 of the parents thought that AD medication is often used as a quick and easy fix for children. Are you seeing that happening? -I think it’s a real misfortune that myths stay alive for so long. And I think it has a lot to do with the fact that parents, in general, don’t believe that ADHD is a real disorder. But it is more than just inattention. We’re talking about children who have inattention, impulsivity, and hyperactivity that is significantly more than the average child their age, and it’s causing them to stress and dysfunction. And it’s going on for weeks, or months, or even longer. Today, the best treatment is medication. And it works in about 80 percent of the time, but it’s not a quick fix. It’s really a medicine that works for kids who have these symptoms, and it increases their attention span, and makes their life easier at school, at home, and with friends. But it’s just one of the tools we use to treat kids with ADHD. -It’s always hard to get anyone to take medication the way they’re supposed to take it. Do kids who are taking ADHD medication appreciate the fact that it’s helping them, and it motivated to take it everyday, or is it a struggle often for parents to get them to take it? -So, I think that it’s really a parent’s responsibility to make their kid take the medicine– no matter for strep throat, or for an allergy, or for ADHD. But I think it’s kind of amusing that what happens with children who have ADHD, is that frequently, they will tell you that they started taking the pill, and their teacher is nicer, or their mother isn’t yelling at them as much. And you always say to them, “Isn’t that odd? You take the pill, and yet everyone else’s behavior is changing.” So, I think that like most times, when you have something called an externalizing disorder, where you’re disruptive, and you’re causing trouble to the world, and you don’t realize you’re doing that. You think, the world is being mean to you, the teacher is being unfair, your parents are being too strict. And what’s interesting, it only takes years later where kids who are now in college or who now own the problem and say, “Look, without the medicine, I am so disorganized, I’m so inattentive. I miss class, I’m never on time for my assignments. It’s almost like not wearing my glasses if I have to read. I’m straining too much.” But when they’re kids, it’s really a parent’s responsibility, not theirs. -Does this mean that a child who has difficult behavior but doesn’t actually have ADHD might benefit from taking this medication? -No. Absolutely not. Difficult behavior doesn’t deserve a prescription. Difficult behavior deserves a diagnosis and an evaluation. I actually think most kids want to behave. Most kids want to please, most kids want to do well in school, they wanna do well at home, they wanna have lots of friends. And so, if a child is “difficult,” we really wanna figure out why that child is difficult, not give that child a prescription. -How does behavioral therapy play a role in the total treatment? -Well, I think being a parent of a child with ADHD really requires you to be a super parent. I mean, I think most parents, myself included, get away with very inconsistent parenting. We tell our children we’ll be right there, and it’s ten minutes. Or we tell our kids, “If you do that one more time, there’ll be a consequence,” and there is no consequence. And yet, children with ADHD really require consequences quickly, they need reinforcements, and positive reinforcements quickly. So, what behavioral therapy does is really train parents to be more consistent, to have better skills at when to avoid conflict, how to actively ignore things, how to praise appropriately and quickly, and how to intervene when things are dangerous and really harmful. And those kinds of techniques, like parent-child interaction therapy, could be very effective. They don’t get rid of hyperactivity, the kids are still to move around more, but it can make a parent a super parent. And while bad parenting doesn’t cause a psychiatric disorder, super parenting can make a psychiatric disorder much better.