Module 3 | Parada SEN

Module 3: Treatments and Classroom Strategies

In this module, we will explore some of the treatment options for ADHD as well as alternative treatments. You’ll learn about some of the more common side effects/risks and some of the questions to ask when discussing treatment options with your child’s healthcare provider.

We’ll also talk about some of the more common classroom management and learning strategies that may be used in your child’s school. You’ll learn how to discuss classroom and learning needs with your child’s teachers. We will also talk about what you can do to help your child learn good study skills and habits.

3.1 Treatment Options

3.2 Alternative treatments for ADHD

3.3 Effective Classroom Management Strategies

3.4 Effective Teaching Strategies for Children with ADHD

3.5 What You Can Do To Support Your Child’s Learning

3.1 Treatment Options

Before we talk about specific treatment options, it’s important to talk about choice. Your choice.

When a child is struggling with behaviour, especially disruptive behaviours, the pressure to 'do something' can be intense and overwhelming. Of course, you want to get the best available help for your child. It’s tempting to opt for what seems to be the 'simple' or 'quick fix' when you’re feeling the pressure. Resist that urge!

Regardless of what TV commercials or friends or anyone else may tell You, ADHD is not a ‘quick fix' kind of issue. Sure, there are interventions that can have positive effects fairly quickly but effective interventions require good assessment and treatment planning as well as a weighing of the viable options.

Every child is different. Good treatment planning is not a 'one and done' or 'one-size-fits-all' kind of endeavour. Ideally, it is a process that will change and evolve as your child’s needs change.

You, as the parent or guardian, have the right and responsibility to choose the intervention that is best for your child’s needs. It may be medication, it may be counselling, it may be an alternative therapy or some combination of those things. You may even choose to manage ADHD on your own.

The bottom line is that before you choose any intervention, you want to have a frank and open discussion with your healthcare provider, learn about each recommendation and the risks and benefits for your child.

Here are a few questions to ask your provider about any recommended interventions:

What are the benefits of this intervention?
What are the risks associated with this intervention?
Is this intervention backed by clinical research?
Is the intervention approved for someone my child’s age?
Is this a short-term or long-term intervention?
What can we expect in terms of behavior change?
How long after implementation would we expect to see an effect?
Who will provide this kind of service?
Is this intervention covered by my insurance?

As you can see, it is a lot to consider. Take your time. Ask all the questions you need to. Do your homework.

Once you have factual information, you can then make the best decision for your child.

So, with all this in mind, let’s take a look at some of treatments available for ADHD.

Traditional treatment options generally include:

Medication
Therapy (counselling, skills training)
Combination of medication and therapy

Medication

Medication for ADHD is one of those hot-button issues. Some parents and clinicians are 100% behind its use. At the other end are those who are 100% against the use of medication for children with ADHD. And, of course, there are a lot of folks in between with varying degrees of concern.

This discussion of medication is not an argument for or against its use to treat ADHD. That is a decision to make between you and your child’s healthcare provider.

There are a lot of myths surrounding the use of medication for ADHD in children. Some of the more common ones you might hear are:

It will turn them into ‘zombies’ or change their personalities
Medication is the ‘easy’ way out for parents
Drugging kids will make them addicts

Here are the facts:

Medications for ADHD, like any other kind of medication, can have side effects or not be the right medication for a person’s condition. As we will see in the side-effects discussion, mood changes can be associated with some medications. It doesn’t mean that medication can’t be helpful for you child. It may mean that a particular medication may not be the right one for your child.
Related to this myth is the fact that when ADHD symptoms are controlled, you may see a calmer, more focused child. If your child has been particularly active, the change can be noticeable and dramatic. If you feel something is wrong, by all means, discuss your concerns with your child’s healthcare provider at once.
Medication is not an ‘easy way out’ for parents or an excuse for lax parenting. The fact is, children with ADHD have trouble controlling their impulses. It is an issue of brain chemistry and not a result of lax parenting or not knowing right from wrong. In fact, research shows that parents of children with ADHD tend to be less permissive.
Research has found no evidence that people with ADHD who are treated with medication are any more likely to develop addictions than those not treated with medication. In fact, people with ADHD who are treated with stimulant medication have been found to have significantly lower rates of substance abuse than people with ADHD who don’t take those medications.

Medication is one of the most widely-accepted forms of treatment for ADHD. What specific medications are available to your child may depend on where you are in the world. In general, some combination stimulant and non-stimulant type medications are approved for the treatment of ADHD in children.

What we will talk about in this section are some of the types of medications used to treat ADHD in children.

Stimulant Medications

Stimulant medications are probably the best known and most widely used types of medication for ADHD. As the name implies, they work by stimulating the brain to increase levels of the neurotransmitters dopamine and norepinephrine. These neurotransmitters, while not the only ones associated with ADHD, play key cognitive and affective roles in attention, focus, concentration, motivation and movement.

There are 3 main forms of stimulant medications:

Short-acting
Intermediate-acting
Long-acting

Each has its own advantages and disadvantages. Shorter acting forms give you some control over when your child has the medication in his system but you may have to give it more often.

Longer acting forms mean you don’t have to remember to take a dose as often and may reduce side effects a bit. However, the longer acting forms may create some sleep problems until the dosing and timing are regulated.

Quick Fact

These types of medication have been found to help about 70% of adults and 70% to 80% of children with ADHD.

When you think of stimulants, you think of being stimulated - more energy – right? NOT what you’d think of for a child with hyperactivity problems. When children with ADHD are moving (e.g., fidgeting, wiggling, chattering while doing their work, etc.), they are actually doing something called self-stimulating. They’re trying to satisfy that need. It’s one of the reasons they can’t pay attention to their math work (not stimulating) but can play a video game for hours (highly stimulating). Movement is stimulating. Doing is stimulating. So while it seems counterintuitive, stimulant medication acts on the neurotransmitters heling to reduce the need for self-stimulation so kids are better able to focus and be less hyperactive.

Of course with any medication comes the risk of side effects and stimulant medications are no exception. Some side effects are less bothersome while some can be quite concerning.Common side effects of stimulant medications include:

Headaches
Tummy upset
Elevated blood pressure
Trouble sleeping
Loss of appetite
Weight loss
Tics
Agitation

This is not an inclusive list and other symptoms could develop. Some of these side effects may resolve on their own after a few weeks. Others may indicate a need for a dosage or medication change but that is for your child’s provider to determine. If these or any other concerning side effects arise, ALWAYS call your child’s healthcare provider right away. Always err on the side of caution

Non-Stimulant Medications

Non-stimulant medications are generally used when someone, for whatever reason, cannot tolerate a stimulant medication. There may be an intolerance or a comorbid medical condition that precludes the use of stimulants.

Stimulant medication maybe just didn’t work well for that person. It may even be due to parental preference.

Sometimes, people do better on a combination of medications. Non-stimulants are also sometimes added to a medication regimen along with a stimulant medication to better control symptoms. Whatever the reason for its use, non-stimulant medications provide an alternative for treating ADHD symptoms.

There are 3 types of non-stimulant medication:

ADHD-specific medications
Blood pressure medications
Antidepressants

That list might surprise you seeing medications for blood pressure and depression listed. What researchers and providers have found is that these medications contain ingredients that have a positive effect on ADHD symptoms. Non-stimulants also have some advantages over stimulants:

They tend to not cause agitation
Less impact on sleep
Less effect on appetite
Less risk of abuse
Tend to last longer and wear off more gradually

Just because these medications do not contain stimulants doesn’t mean they are without risk. They are like any other medication and have their own side effects and risks.

Common side effects of non-stimulant medications include:

Drowsiness
Fatigue
Mood swings
Tummy trouble
Headache!

It is important to note that some medications used to treat ADHD may cause an increased risk of suicidal thinking or changes in heart rhythm or blood pressure (some blood pressure medicines). While not a common side effect, they have been reported.

As with ANY medication, always monitor your child’s reaction and discuss any concerns with your child’s provider right away.

Finding the medication regimen that works for your child takes time. It may take several adjustments or changes until optimal control of symptoms is achieved. You may not readily notice small changes that are taking place.

A good tool to use is a daily journal or medication diary. Each day, make a note of your child’s medication and dosage, the time taken, behavior or symptoms noted and when they occurred, side effects or other concerns, sleep, appetite, behaviour reports from school, etc.

Doing this will give you and your child’s provider a picture of what is happening over time. This kind of information is invaluable when working to find the best medication regimen for your child.

Behavior Therapy/Counselling

Children with ADHD have difficulty controlling their impulses and focusing on tasks. While medicine may help reduce the urge to act impulsively, it can’t teach children what to do instead. That’s where behavior therapy can help.

Behavior therapy helps kids to be more aware of their behaviors and learn strategies to control their actions. They learn what to do instead. Behavior therapy can also help kids learn to recognize when they’ve made good choices and compliment/reward themselves.

Parents also benefit from behavior therapy. You’ll learn new skills to manage behaviors and help your child learn and grow. Behavior therapy for parents has been shown to strengthen the parent-child bond and decrease problem behaviors.

So when should you consider behavior therapy? Sooner is better than later. Older children benefit from behavior therapy. Younger children may benefit even more.

The 2011 clinical practice guidelines from the American Academy of Pediatrics (AAP) recommend behaviour therapy as the first line of treatment for preschool-aged children (4–5 years of age) with ADHD. Why?

Behaviour therapy has been shown to work as well as medication for ADHD in young children.
Young children have more side effects from ADHD medications than older children.
Long-term effects of ADHD medications on young children have not been well-studied.

For children 6 and over, AAP guidelines recommend a combination of behavior therapies and medication.

What if you decide that medication and therapy are not what you want for your child? Are there

alternatives?

3.2 Alternative treatments for ADHD

Some parents prefer to look at alternative treatments for their child’s ADHD symptoms. Some of the more popular options include:

Specialized diets
Omega 3 supplementation
Neurofeedback
Memory training

Specialized Diets

Specialized diets for ADHD tend to be elimination type diets that restrict or eliminate certain foods or additives that are thought to contribute to ADHD. The most popular of these is the Feingold Diet.

The Feingold Diet eliminates artificial colorings, flavorings, and preservatives to decrease hyperactivity. It is thought that these substances exacerbate ADHD symptoms. So do diets like this work? Maybe.

Parents who have used an elimination diet often report some improvement in their child’s ADHD symptoms.

Research on elimination diets, especially those that eliminate artificial colorings, flavorings, and preservatives, has been mixed. There does seem to be some small but beneficial effect for about 10-30% of those on a diet like this. So, this type of diet may have some benefit for some children.

Omega 3 Supplementation

This intervention has become quite popular and shows some promise. In fact, the US Food and Drug Administration (FDA) has approved a ‘medical food' that contains omega-3 fatty acids specifically for the treatment of ADHD.

Why omega-3s? Studies have found that children with ADHD tend to have significantly lower levels of omega-3 fatty acids in their blood than typical children. When these children were given omega-3, they showed improvement in the severity of their ADHD symptoms as compared to children who were given a placebo.

Neurofeedback

Neurofeedback is based on the idea that changing brain-wave patterns can change behaviors.

People with ADHD have been found to have more theta waves (slow) and fewer beta waves (fast). It is thought that by increasing beta waves while decreasing the theta waves can improve ADHD symptoms. This is done by teaching people to recognize when their brain waves are in the desired wave pattern. Neurofeedback has shown some promise in the literature but results are mixed.

Memory Training

Memory training is based on the field of brain training. Brain training is the practice of ‘exercising’ certain areas of the brain to strengthen the functions associated with that area. People with ADHD struggle with working memory making it difficult to remember and use information in the short term. Cognitive training for ADHD involves using computer-based memory training programs to enhance the ability to remember, recall and use information.

Studies have shown that computer-based cognitive training may be most helpful for children with attention and memory problems related to their ADHD.

3.3 Effective Classroom Management Strategies

Just as your child’s home routine and environment can affect ADHD symptoms and coping, the classroom environment can also influence symptoms. Managing behaviour in an open classroom can be challenging.

If your child has ADHD, it’s important to include your child’s teachers as part of the treatment and support team.

Keeping an open dialogue is vital to getting accurate feedback and for implementing strategies that work. If your child’s teacher doesn’t request a parent conference, ask for one!

Teachers can benefit from behavior training. There are a number of proven and effective behavior management strategies that can be successfully employed in the classroom:

Verbal reinforcement of appropriate behavior (praise)
Selectively ignoring inappropriate behaviors
Eliminating items that are distracting or tempting to fidget with
(eg. rubber bands, toys, desk clutter)
Provide calming items (also known as manipulatives) – these are items that can be used to provide sensory input for kids who need it in a quiet, non-disruptive way. (e.g., stress ball, sensory fidget toy)
Have a diversion plan – options for taking a break to avoid over-stimulation. This could include taking a break with a designated adult, running an errand or using a designated cool down space.
Helping supports – Designated people or actions to help a child avoid frustration and escalation. This might include a study buddy, a teacher or extra information or prompts.
Visual cues – pointing, visual schedules, cue cards
Behavior contracts to earn tangible rewards

Some additional strategies that teachers can use to help students with ADHD navigate their school day include:

Take brain breaks – take a walk, dance, play outside for a few minutes
Keep the lines of communication open with parents
Use a homework folder
Be alert for and sensitive to self-esteem issues
Minimize distractions in the classroom
Involve the school counselor in identifying strategies or providing support

These are a small sample of the numerous strategies that can be effectively employed in the classroom. These strategies help to manage your child’s needs while helping him/her to build new skills and experience success in the classroom. What works best will depend on your child’s particular needs.

Some teachers have a lot of experience with ADHD children while others do not. The National Resource Center on ADHD offers a number of informative resources for educators. You can find them here:

http://www.chadd.org/Understanding-ADHD/For-Professionals/For-Teachers.aspx

3.4 Effective Teaching Strategies for Children with ADHD

Children with ADHD struggle with skills like paying attention, completing tasks and memory. Learning and retaining new information can be challenging and lead to frustration.

Research suggests that strategies which proactively prepare and support the student have been demonstrated to improve attention, sometimes even surpassing the attentional performance beyond that of their peers. Teachers can help to make the learning experience more enjoyable and productive by employing specific strategies that anticipate and work with an ADHD child’s needs. Many of these strategies can benefit all students so they can be easily integrated into any classroom instructional plan.

Here are just some of the many instructional strategies for working with ADHD children:

Children with ADHD often struggle with change, transitions and organization. Clear instructions and expectations can help them be prepared for what’s coming up.

Set the stage – let students know what the plan is for the day or activity
Priming - Set clear expectations and what the reward for positive actions will be at the end of the activity
Identify the materials needed and allow time to get them
Offer seating away from distractions

Children with ADHD struggle with attention and memory. Prompts, modifications and support can help them to stay on task and experience success.

Provide structure and consistency during the lesson
Offer minimal choices. An either/or 'forced' choice option works well.
Use multiple ways of presenting material – audio or visual tools, songs, rhymes, visual posting and mnemonics, games – to provide multiple pathways of storing information
Employ chunking strategies – presenting material in small, manageable steps, shorten assignments
Offer follow up directions and reminders
Redirect attention as needed – for example, use visual cues or a learning buddy

Minimize the use of ‘timed’ tests and allow extra time as needed

Check in to be sure he/she is staying on task and understanding the work
Utilize small group and peer work with techniques such as ‘Think, Pair, Share’, ‘Square Share’ and other group activities
Harness the power of peer support to help check homework, stay on task, help with understanding a problem
Prepare for the transition to the next activity

As always, keep the lines of communication open with your child’s teacher. Together you can find what works for your child and what doesn’t. And don’t forget to ask your child. What we think as adults may not be what they think as children.

3.5 What You Can Do To Support Your Child’s Learning

Even though you’re not in the classroom with your child, there are things that you can do as a parent to support their learning at home.

Homework time can be the hardest time of the day for kids. They’re tired, they’ve been cooped up all day and the last thing they want to do is more work. Add a child’s inattention or hyperactivity to the mix and it can be a recipe for disaster. One small problem can turn into a monumental meltdown in seconds.

The good news is, with a little patience and a little planning, it doesn’t have to. The more you can remain calm, the more likely your child will too.

Before you do anything else, do this: don’t sweat the small stuff. Papers are going to get lost. Assignments are not going to always get written down. Books may not always make it into the book bag. It happens and it’s ok. You’ve got a plan.

Team Up with the Teacher

If you can’t talk face-to-face, at least maintain contact via phone or email.
Keep up on what’s happening. If the teacher doesn’t routinely send behavior reports home, it’s ok to ask.
If your child is struggling with a particular assignment, discuss alternative ways of getting the work done. It may be something as simple as smaller assignments or being able to scribe for your child.

Help Your Child Get Organized

Establish the habit of putting things like book bags, shoes and toys in their place
Use color-coding. Color-coordinate folders,
If your child’s teacher doesn’t use one, get a homework folder that your child can use to bring home assignments, worksheets, homework or other papers each day. Ideally, you want one that closes so that papers don’t fall out. Be sure to check it every day.
Help your child pack his/her book bag each night. Doing it together allows your child to build new skills while you can make sure essentials are being packed. It also allows you to clean out any unwanted surprises like leftover snacks.

Establish A Homework Routine

Set a time each day for homework. Homework should ideally be done right after school before kids get distracted with play time. Allow time for a quick snack if your child is hungry or thirsty.
Build some short brain breaks into homework time if needed. This means a few minutes to get up and stretch or get a drink of water and then back to work. This is not time for playing video games, texting or going outside to play.
Break the homework into smaller chunks if needed.
Be present. Your child may need help understanding the assignment or need prompting to stay on task.
Have a designated space for homework with minimal distractions. Make the homework space an electronics-free zone. Phones and tablets buzzing with messages are tempting and distracting.
Monitor the noise level. Some kids need quiet. Others do well with soft background music or white noise.
Check your child’s homework. When done, help your child put it in its place for the next day.

Praise, Praise, Praise

Praise is the most powerful reinforcement tool you have! Praise tells your child you see how hard they worked. It instills feelings of accomplishment and pride and bolsters self-confidence which is something children with ADHD struggle with sometimes.
Praise also feels good which makes it more likely the behavior will be repeated.
Catch them doing it right. Look for positive behaviors and praise them.
Praise ‘close enough’ behaviors when appropriate. A behavior doesn’t have to be perfect to be praised. If it is a particularly hard thing, offer praise for a great effort and encourage them to keep trying.

Reward Achievements

Use a behavior chart, sticker chart or even a reward app like iReward to visually track positive behaviors and goals. Focus on one or two small, manageable goals at a time.
Set small daily rewards (especially for younger children) for achieving daily goals. Your child is building new skills and that requires frequent reinforcement. (For example, 15 minutes of extra play time if homework is done.)
Set a weekly goal and reasonable reward. (For example, a trip to get ice cream if she had a week of positive behavior reports.)
If a child can already do something at 100%, the skill is already learned. A new goal should be just out of reach and a bit of a challenge. For example, the first week, a weekly goal might be 3/5 days achieved, depending on the child’s level of skill and the goal.

Above all, the most important way that you can help your child is to be an active, involved parent. Know what’s happening at school.

Talk to your child.

Talk to the teacher.

Be an advocate for your child.

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