Play it, Jen

Every good movie has a piano player somewhere in the background--
sometimes seen, usually unseen.
Seldom really noticed.
The feeling, the very soul of a scene, is created by that person tinkering at the keys.
It has been said, "All the world's a stage."
Well then...Play it, Jen.

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Location: Over Yonder, Missouri

I'm a California Native transplanted to the Missouri Ozarks. I've learned how to chase cows in high heels and load hay faster than you can say "Coco Chanel." These are some of our pictures and stories of living in a land with breath-taking beauty and adventure around every bend.

Wednesday, September 27, 2006

Treating ADHD Without Medication

"The treatment of attention-deficit/hyperactivity disorder (or ADHD) in children usually involves a combination of medication, education and behavioral intervention; however, it is not unusual for parents to want drug-free options. One proven method is behavioral therapy, or what is also referred to as “psychosocial treatment.” This approach requires an experienced therapist or educator to teach specific techniques geared toward the child and their parents, as well as the child’s teachers and extended family. While these methods are aimed at improving the child’s behaviors, they have also been known to improve the child’s symptoms and, therefore, some of the resulting problems. Unlike medication, this method takes more time, needs to have goals where achievements are measured in small steps, requires consistency throughout the day in whatever environment the child happens to be (school, home, friend’s house, others) and needs to be in force for the “long haul,” and not for just a few weeks. As you can tell, it is a method that requires the dedication of parents, extended family, teachers and the affected child.
When gearing up for this approach, it is important to identify which specific type of ADHD affects the child. For example, does he have the predominantly inattentive type? If so, he may be prone to many of the following symptoms:

Is forgetful of daily activities
Loses items on a regular basis
Doesn’t seem to listen
Has difficulty with organization
Can’t focus or maintain attention
Avoids tasks that require concentration
Often makes careless mistakes
Is easily distracted
Has difficulty with following instructions

If the child has the predominantly hyperactive/impulsive type, many of these behaviors will be evident:

Talks excessively
Is pretty noisy when engaging in activities
Is constantly on the go
Has difficulty waiting his turn
Doesn’t sit still
Blasts out answers before the question has been fully asked
Often interrupts others
Climbs chairs, desks or runs about more than the “average” child
Constantly moves his hands and feet when sitting

If he seems to have many characteristics from both of the above categories, he would then be diagnosed with ADHD, combined type.

In looking at the above symptoms, many parents may say, “My child does that.” However, in considering the diagnosis of ADHD, we are taking into consideration the following:

Does the child show the behaviors on a more frequent basis than most other children?
Do the behaviors create difficulty in at least two areas of their lives (home, school, social settings)?
Have the symptoms persisted for at least six months?

Once the specific symptoms affecting the child are identified, behavioral treatment is designed to teach new skills to all those involved with handling the results of those problems. For example, if the child keeps forgetting to brush her teeth, the behavioral treatment would be aimed at establishing a routine to help her accomplish this task. If the child acts like a bully to other children, approaches for more effective interactions are designed to help him learn to be friends with his peers. Other techniques used to help the parents assist their child include, but are not limited to:

Communicating expectations in spoken and written words (i.e., brush teeth, wait your turn, etc.)
Setting up routines (homework, playtime, meals with family, bedtime)
Choosing battles (ignore a little fidgeting and offer praise when he sits still)
Using the time-out method when unwanted behavior occurs
Using the “when and then” method for modifying unwanted behaviors; for example, “when” he climbs all over the clothing racks while shopping, “then” he will need to spend more time helping with chores at home
Using color charts at home to track progress of behavior (use his favorite color for good behavior, and his least favorite for bad)
Practicing good behaviors and pointing out unwanted behaviors before going to public places
Behavioral therapy works best when it is also utilized at school and during times of interaction with other children. This makes it vitally important for parents to work closely with their child, child’s teacher, mental health professional and local ADHD support group.

Untreated or under-treated ADHD can lead to wide-ranging problems beyond the symptoms of inattentiveness or hyperactivity and impulsivity. Some of these life-affecting problems include failure at school, depression, increased anxiety and social isolation. In my opinion, this is a strong reason to include behavioral therapy as part of any plan that attempts to treat ADHD."

Robert Danoff, D.O., M.S., is a family physician and program director of The Family Practice Residency, as well as the combined Family Practice/Emergency Medicine Residency programs at Frankford Hospitals, Jefferson Health System, Philadelphia, Pa. He is the medical correspondent for CN8, The Comcast Network, a regular contributor to Discovery Health Online and a contributing writer to The New York Times Special Features.


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