In summary, assessment involves not only determining if a child has ADHD, but also determining the type of ADHD, the likely causes and measures the amount of the symptoms. This information will be useful in determining what treatments to give and how to measure treatment success. If the treatment is successful, the number and/or intensity of the ADHD symptoms will become less. The following sections of this pamphlet deal with various treatments to consider for a comprehensive approach toward ADHD treatment.

Psychotherapy. Counseling or psychotherapy is a very important part to ADHD treatment. Psychotherapy is useful to teach children new skills to cope with and overcome the problems that arise with having ADHD. The goals of psychotherapy may include but are not limited to the following: increase attention span, increase self-esteem, effective parenting skills, effective communication, and decrease impulsive and aggressive behaviors, and excessive motor activities. There are several forms of psychotherapy that are beneficial and often crucial to the treatment of ADHD.

Behavior Modification. Probably the most beneficial form of psychotherapy for ADHD children is behavior modification. Done correctly, it can make a big difference. Behavior therapy involves targeting a desired behavior to change (increase or decrease), defining this behavior in measurable terms, counting how many times the behavior happens before any effort to correct it is done, making a plan to correct the behavior, following this plan, and then gathering more measures to make sure that the plan works. If the plan is good, the behavior will decrease or increase depending on what is desired. If the plan is not working, it can be adjusted or it can be thrown out and a new plan used instead. With behavior modification, parents play a major role in measuring the behaviors and working the plan.

Dr. David B. Stein developed a complete treatment program using prinicples of behavior modification applied by parents of children with ADHD symptoms. In a published journal article he demonstred the programs effectivness on 35 children diagnoses with ADHD. After a few short weeks of his treatment, all participants were symptom free and continued to be symptom free at their follow-up a year later. His program does not use medication, eeg biofeedback, nor supplements. The program is entirely based on behavior modification.

Parents should learn principles of behavior modification to help them better parent their ADHD children. Ask your therapist for more information about behavior modification. THIS IS VERY IMPORTANT.

Counseling. Counseling can help with the 'internal' effects of ADHD. This includes feelings of low self worth, depression, anger management and a variety of other concerns common to children with ADHD. A form of counseling called "self-talk" is a technique used to help reduce the tendency of an ADHD child to act without thinking. It also is used to increase a child's ability to remain on task at school. Other counseling techniques help children feel better about themselves. When children feel good about themselves, they are more likely to follow the advise of parents and professionals.

Play therapy. For young children, play therapy can be very useful. A therapist may use play therapy to measure children's skills, measure the amount of impulsiveness, or assess possible internal conflicts or struggles. Play therapy can also be used to help overcome conflicts caused by having ADHD. What is more important, therapists will often use play to establish a good relationship with children that encourages them to participate and return to therapy.

Exercises. Many exercises have been developed to strengthen attention, short term memory and other skills often lacking in children with ADHD problems. For example, relaxation exercises are often used to teach the child how be calm and cope with life's problems. The Memory Game is used to help ADHD children to remember verbal commands while self-monitoring helps them remain "on task" when completing their school work. (Consult with your therapist on using these exercises.)

To get the most benefit from an exercise, choose one that you feel your child could use most. Practice the exercise for at least six of the seven days of the week. Usually most exercises will be mastered within a two month period. Every child is different and may master the exercise faster or slower. After the child has mastered the skill and is using it without your supervision, you can practice a different exercise. Again choose the next exercise that you feel will achieve the most benefit. With time and neglect of practice, children will sometimes lose skills they have learned earlier. Thus your child may need to review a previously learned skill by practicing the exercise again until it is re-mastered.

Support Groups. It's difficult to parent ADHD children. Special parenting skills need to be developed that match their special needs. Family therapy, parenting classes and support groups are the most effective forms of treatment for ADHD children whose symptoms were caused by earlier parental permissiveness, domestic violence and dysfunctional homes. Symptoms can be greatly reduced by parents learning how to discipline effectively and be consistent. ADHD children need a structured yet nurturing environment. Most parents need help in learning how to provide their children with a balanced environment. Some parents can provide nurture but lack the ability to provide structure or vice versa.

Domestic violence is a cause of ADHD symptoms and aggression within children. Women's support groups offer long term help for mothers learning how to have a structured yet nurturing environment. In addition, the groups teach mothers how to help their children deal with their anger and aggressive behaviors. These groups can help the family overcome the many negative effects of domestic violence.

Biofeedback. Biofeedback is simply giving children information about their body (e.g., skin temperature, muscle tension, electrical activity, heart rate) and having them control their body in some way. Several forms of biofeedback are useful for ADHD children. Temperature biofeedback can be used to teach children relaxation and self control. Children can practice these self control exercises at home and at school.

Probably the most impressive form of Biofeedback is EEG Biofeedback where children are taught how to change their brain wave patterns. To briefly explain, theta brain waves happen with inattention and day dreaming. Beta waves happen when you are concentrating and remaining on task. EEG biofeedback trains children how to decrease theta waves and increase beta waves. Each biofeedback session takes about 30 minutes. After 40 sessions, many children have increased attention and less hyperactivity. Research studies suggests that EEG biofeedback can raise IQ scores as much as 15 points and raise grades in school. These improvements seem to be long lasting.

EEG biofeedback is an expensive treatment. Total treatment costs can range from $1,300 to $5,000. Clinics with high success rates combine nutritional supplements with EEG biofeedback. With EEG biofeedback, many children will no longer need medication. Other children will still need medication but show improvement in concentration and school work that would not have been possible without the EEG biofeedback.

Medication. Many professionals agree that medication should be used as a last resort. None of the other described techniques have as many possible harmful side effects as medication. However, of all the techniques presented in this pamphlet, medication provides the quickest and often the most dramatic change. It is the treatment of choice for children with a genetic cause of ADHD and whose behaviors are so far out of control that they are failing in school. For children who have experienced domestic violence, inconsistent home environments, have a learning disorder, and poor motivation for school work, medication may also help the child's ability to concentrate and remain on task.

Today there are a variety of medications used to treat ADHD symptoms. Probably the newest and most used medication today is Strattera. It acts similarly to the new antidepressants. It has the advantage of not being addicting. Prior to Strattera, the stimulant medications (e.g., Ritalin, Adderall, Concerta, Metadate, Dexedrine) were the most commonly used medications. They have the potential to be addicting if misused. Today these medications are still used with great frequency. Other non addicting prescription medication used to treat ADHD symptoms include Wellbutrin, Catapres and Tofranil. Only professionals trained in medicine can prescribe these medications. Your physician can help you decide which medication is right for your child.

There are conditions where medication should be used with great caution. For example, children who have ADHD symptoms that are really caused by the first symptoms of manic depressive disorder ( an illness of extreme mood swings) or a psychotic disorder (an illness where the child looses touch with reality) may have their symptoms worsened with stimulant medication. Likewise, children who have trouble concentrating because they are depressed, do not need stimulant medication. Other types medications may be more appropriate for these children.

There are conditions where medication should not be used. For example, some parents do not have time nor an interest to correctly discipline their children and use medication as a means of behavioral control while the child is at school. In these cases, the medication is not appropriate because it does not address the real cause of the problem. Treating a child with stimulants who has lead poisoning would also not be wise. After the lead toxicity is out of the body, and the body has had a chance to heal, the need for medication could then be determined. Therefore a thorough assessment is needed before medication is considered.

While most parents' goal should be treating their child effectively without medication, some children will need medication. To date, the science of alternative approaches to ADHD is not advanced enough to guarantee success with every ADHD child. Medication combined with other techniques will do much to deal with the devastating effects of severe ADHD symptoms.

Before taking medication, parents should know the pros and cons about prescription drugs. No medication is completely safe. While a stimulant (e.g., Ritalin, Cylert, Dexedrine, Adderal) medication may be relatively safe compared to other prescription drugs, some children will have severe reactions if the wrong diagnosis is made. For example, some children could develop muscle tics or twitches, jerking movements and increased sadness. If your child has any of these side effects from medication, contact your physician immediately. An overdose of stimulant medication could cause convulsions followed by coma, delirium, and high fever.

You may want to consider using medication to treat your ADHD child if alternative methods have either failed or are not affordable and you believe the medication will significantly improve your child's life. For example, if medication can keep a child from failing school, from getting into fights with other children, and behavior modification has failed, then medication should be attempted.

Once you decide to try medication, do not stop giving the medication too soon. At first, most children on stimulant medication will have some side effects such as lack of appetite, trouble falling asleep, headaches, irritability or increased blood pressure. Most of these side effects will go away within two weeks. Too often children are taken off medication too soon because parents become fearful of these side effects. Parents should try their physician's recommendations for at least six weeks before deciding whether to keep trying the medication or not. Keep in regular contact with your doctor to inform her or him of your child's progress with the medication and report all side effects. If you do decide to stop giving the medication, always inform your doctor of what you intend to do.

To find out if medicine is working or not, your child's symptoms should be measured before medication is given. Such measurements can be obtained through checklists completed by parents and school personnel, observations from trained personnel such as therapists or case managers, and measurements from computer programs (e.g., T.O.V.A., I.V.A). By continuing to measure your child's symptoms, the physician can monitor treatment success. This information provides parents with information to judge the worth of the medication.

Many parents mistakenly believe that medication should be enough to treat ADHD. They fail to realize that medication does not cure ADHD. It only reduces the symptoms of ADHD. For most children on medication, at first, they will improve in their school grades. However, research shows that over time, their grades decrease to their pre-medication levels. Medicine alone, even when it helps the child to move less and pay attention more, does not help improve school grades after six months, and does not improve a child's self-esteem. But medication, combined with psychotherapy and special parenting skills can help children increase their self- esteem, improve social skills, improve study habits, and learn new skills to deal with their ADHD symptoms.

Nutrition. Even though much controversy exists over nutrition, scientific research does suggest that nutrition can be very helpful in treating ADHD children. For children with food allergies that produce ADHD symptoms, the right diet can eliminate all ADHD symptoms and aggressive behaviors. Children with lead poisoning can use certain foods and nutritional supplements to remove the lead from their bodies faster.

If your child as an infant had to be switched to different formulas, or if your child has had numerous ear infections resulting in tubes being placed in the ears, allergies may be causing some of the ADHD symptoms. Dr. Block developed a method to treat ADHD symptoms through nutrition. These techniques are desribed in her book, No More ADHD: Ten Steps to help Improve Your Child's Attention and Behavior without Drugs!

There are some ADHD children who have multiple causes of ADHD symptoms. For example, many genetically caused ADHD children may also have allergic reactions to certain food. Many parents report that their ADHD child will act worse when eating chocolate or too much sugar. For the child with multiple causes of ADHD, elimination of chocolate and other foods that create allergic reactions will not completely remove symptoms of ADHD. Other treatment methods must be used as well.

Research suggests that most children will improve in IQ (an average of six points) and behaviors with appropriate nutrition. The first step in proper nutrition is to reduce the amount of junk foods. Parents should not allow their children to drink caffeine or eat too much sugar. As you decrease the junk food, you need to increase the nutritional foods. For the majority of ADHD children, diet alone is not likely to cure ADHD, however a healthy diet will improve symptoms. Some will show only minimal improvements with a good diet while others will show more dramatic changes. Another good book on this topic that is backed by extensive scientific research is Improve your Child's IQ and Behaviour by Stephen Schoenthaler (ISBN 0563-361-93X).

Some people use nutritional products to help calm the symptoms of ADHD. Before trying any nutritional product, educate yourself as much as possible to understand how the supplements are proposed to work. When you decide which supplements to take, contact your physician to insure that the supplements will not interfere with any medical treatments that are being performed with your child. Be careful and not give your child too much of the nutritional supplement because some supplements can be toxic at too high of levels. Also monitor for side effects, just as you would with medication. For example, some children develop motor movements (i.e. motor tics)with Vitamin B6, just as they would with a stimulant medication. What may be helpful to one child with ADHD symptoms, may be detrimental to another. Learn all that you can about nutritional products before you use them. Most professionals agree that the majority of nutritional supplements are safer than medication.

Many nutritional products have the potential to make a difference in reducing ADHD symptoms. Today a common nutritional supplement is Focus Factor by Vital Basics (www.focusfactor.com). It contains a combination of vitamins and minerals belived to help idividuals with ADHD symptoms. Some parents and professionals feel that pycnogenol (an anti-oxidant from grape seeds and/or pine bark) help children concentrate better. When considering vitamins and minerals, a complete Vitamin B complex has been suggested as a good place to start along with "colloidal minerals". Depending upon which of his six types of ADD a person has, Dr. Amen recommends L-tyrosine, St. John's wort, 5-HTP, L-tryptophan, Inositol with L-tryrosine, GABA, ginko biloba, phosphatidyl serine, vitamin E, Piracetam, DL-phenylalanine, SAMe, and omega-3 fatty acids . Other nutritional products include Nature's Way "Attention Focus"; and "Barlean's Flax Oil". Both of these products contain no stimulants and can be purchased at most health food stores. Flax oil contains omega-3 fatty acids which is thought to be needed in most children with ADHD symptoms. Sound nutrition works well with behavior modification, exercises, and biofeedback. These techniques encourage brain cells to grow "dendrites" to other brain cells. As these dendrites grow, the child is able to overcome problems with attention, concentration, memory, etc. Vitamins and minerals supply the body with the raw materials to grow these needed dendrites. Vitamins and minerals also help the whole body to become more healthy and the mind to have a better attitude. Research has shown that giving children vitamins and minerals can decrease their aggressive behaviors by 50%. Another study, double blind control study, found that Vitamin B6 was more effective than the leading stimulant medication (methylphenidate or Ritalin)in reducing ADHD symptoms. Adding nutrition to your ADHD treatment plan is important.

Parenting Skills. Parenting children with ADHD can be difficult and frustrating. Because of frustration, some parents can cause damage to their ADHD children by yelling at them or putting them down. If parents yell at children when frustrated, they can injure their already fragile self-esteems. ADHD children often receive many negative statements by their teachers, peers, and outsiders. Parents need to learn how to help the child cope with ADHD and give them positive statements that build their self-esteem.

Another important concern is the way parents raise their ADHD children. Disciplining too harshly and not disciplining enough can both cause harm to ADHD children. Through being inconsistent and permissive, ADHD children become very manipulative and unpleasant to be around. ADHD children have special needs that require specialized parenting skills. These special skills include nurture and structure.

Nurture is the ability to give love to your child no matter what your child does. Some parents show love only when the child is behaving well. Nurturing your child also involves encouragement, understanding, and a strong emotional bond between parent and child. Structure involves being consistent, having set rules with consequences when rules are disobeyed, and having a routine around the house (e.g., consistent bedtimes, morning chores). It's rare that a parent will have both of these qualities naturally. What is more common is for a parent to be great at nurturing but poor at providing consistent structure or visa-versa. Parents need to work at developing both skills.

A good parenting program for parents with ADHD children is Dr. David B. Stein's Caregiver Skills Program. It is a comprehensive treatment program designed to address all ADHD symptoms within a few weeks. Another helpful parenting program is 123 Magic by Dr. Thomas W. Phelan (ISBN 096-338-6123). The book teaches parenting skills that work with ADHD children. Using these skills will help you not to yell at your children thus damaging their self-esteem. Most parents find the program very helpful.