You can imagine the fuss two years ago when the American Academy of Paediatrics issued new guidelines suggesting that children as young as four (previously six) could be diagnosed with ADHD! That caused a furor and there were lots of protests because the inevitable result meant that medication for ADHD would be prescribed for preschoolers.
Those gloomy forecasts seem to have been borne out in the latest study carried out by The Cohen Children’s Medical Center in New York. They decided that they would survey about 3,000 specialists engaged in diagnosing ADHD and other behavioural disorders. They were particularly concerned about the preschoolers aged around four.
The results were startlingly at odds with what most medical authorities recommend for the treatment of ADHD in preschoolers which is that behavior therapy should be tried in the first instance. If that fails, the medications can be tried although sometimes a combination is recommended. But medication alone for preschoolers is not recommended.
The results of the survey were the following:-
- About 20% of the doctors were actually prescribing psychostimulants either alone or sometimes with behavior therapy.
- This is actually the opposite of what the AAP recommends because they say that behavior therapy should be the first option.
- The AAP recommends that Ritalin is prescribed where medication is suitable but about 30% of those specialists questioned very often were prescribing another drug or medication
- Behavior therapy was not popular at all because of the time, effort and expense involved
NICE in the UK takes a similar stance
The National Institute for Health and Clinical Excellence (NICE) in the UK has come out strongly by saying that children with ADHD who are under five years of age should not be given Ritalin or similar drugs.
It is estimated that there are about 400,000 children in the UK who have ADHD. Only about 10% of these children are treated and even then, there is far too much reliance on ADHD meds such as Ritalin.
Parents and behavior therapy
Basically, most specialists and researchers have found that there is an inbuilt prejudice against behavior therapy on the part of parents of children with ADHD. But to put it simply, we are only talking about effective parenting skills and I do not think that therapy is always necessary. But there is loads of research (especially that done by Dr. William Pelham at FloridaInternationalUniversity) which shows that the therapy will work much more effectively in the long term.
The MIND Institute research
Scientists and cognitive therapy experts at the above institute which is part of the University of California, Davis have shown that the typical brain of a child with ADHD does have problems in filtering out information which is totally unrelated to a learning task. This is just another reason why behavior and cognitive therapy will produce better results in the long run.
Parenting skills or therapy? – just look at the benefits!
Whatever we want to call it, there are many benefits of we take this approach.
- The child will never become dependent on the meds
- There is no risk of getting into substance abuse down the road
- The child will never be approached to sell his meds
- Parents benefit enormously from parent training or therapy
- Parents are less stressed
- There is less pressure on their relationships with spouses, partners and siblings
- The whole family can benefit
Simple examples of getting behavior under control
Here is a typical scenario where you tell your ADHD child to put his toys away. The instruction has fallen on deaf ears and he is till playing. The solution is not to get angry but merely try to understand that a big part of ADHD is that the brain flits from one thing to another so the child is not being deliberately difficult. He is just displaying a typical ADHD pattern of behavior.
Instead of flying into a rage, we might like to think of how we can actually help the child to do a few tasks and manage to stay focused so that he can finish them. No easy task when you have ADHD but if we set things up right, we can go a long way to making the whole scenario much less painful!
Setting up a routine for bedtime so that the child is told what to do at the various stages in getting ready for bed is one way of reducing stress and tension in the home. There are rewards along the way such as story telling or having a chat about the day’s events if certain things are done such as brushing teeth and changing into pyjamas and so on.
Where to get help
Depending on where you live, you can try the following places for parenting skills classes:-
- Your local church
- Community or rehabilitation center
- Your local chapter of CHADD (Children and Adults With Attention Deficit Disorder) in the USA
- ADDISS (The National Attention Deficit Disorder Information and Support Service) UK.
- Universities or research departments may run courses
- Local health authorities
- Your local hospital
- Your local National Health Service (NHS) in the UK
What you will learn
You will learn how to cope and help your child manage his or her ADHD. You will become an expert at keeping calm and also understand what are the triggers that fire the bad behavior. Above all, you will be aware of strategies that can defuse a situation and learn how to avoid risky problem areas.
As we have seen, these are the vital strategies we need to learn and whether we call them behavior therapy or parenting skills is of little importance. Whether the child will be on the ADHD meds or not is also secondary because we will be helping him to learn vital life skills. Above all, this is a great learning experience for both parents and children.
Robert Locke MBE is an award winning author and has written extensively on ADHD and related child health problems. You can visit this page on ADHD natural remedies to find out more.