What you need besides medication for Attention Deficit Hyperactivity Disorder (ADHD)

If you use only medication to treat Attention Deficit Hyperactivity Disorder (ADHD) you’re likely to only get a partial response that does little to help your child or an adult with all of the effects of living with ADHD. ADHD is considered a developmental disorder, and many of it's most disabling effects are ones that are developmental in nature. Often children with Attention Deficit Hyperactivity Disorder (ADHD) did not learn skills (or learned them poorly) at the developmental moment that was best to learn them. Lets take being "orderly" as a simple example: putting things in order, organizing, having a clean bedroom, kitchen or workspace. Most of us learn this at a very early age, putting together blocks, putting items together by colour, size. Putting away toys in their proper places. At a young age these activities were fun, self reinforcing. Someone clapped their hands and said, "Great job!" The problem is, when you wait until the age of 12 rr 25 to take ADHD medication and try to teach yourself to be "organized," to set your daily schedule, to keep your desk clean, to organize your bedroom or kitchen.... no one is there to reinforce you, and these tasks are simply not self reinforcing. Your learning a new skill at a poorly chosen developmental time. Normally we learn new skills when they are easy. With ADHD you not only have difficulty with the skill, you often learn it when it's a painful task and hard. No wonder we need support, guidance and structure!

Psychotherapy, social skills training and even anger management training are not only important options to consider — they are mandatory in order to treat the long-term issues that go hand-in-hand with attention deficit disorder.

Once some of the behavior problems are under control with children we are better able to approach the situation and provide an intervention. Often, that's what the medication does, and it also offers us a chance to STOP, THINK and THEN take action. Something that without the medication, we can have a hard time to follow. (There are specific techniques to teach children and adults to STOP, THINK and then ACT without medication. Usually this is in response to external cues and stimuli. In my clinic's in Burnaby and Vancouver we spend a lot of time doing just that. Medication may not be the right choice, and if it isn't, we can work on these techniques. But evidence shows medication is the most effect measure we can take initially.)

Parenting training has been shown to be an effective and an important component of any treatment of ADHD in children. We offer a number of different parent training options including individual sessions, home visits to set up positive behaviour support systems, and books and video training that is supported by scientific evidence. Think of the TV show, Super Nanny — except that the therapist helps the parents learn how to best help their child with ADHD. And remember, on every episode of Super Nanny, Super Nanny needed to return more than once because these techniques are complex and you need feedback.

Psychotherapy for ADHD
We have research demonstrating the effectiveness of a wide range of psychotherapies for the treatment of ADHD in both children and adults. Some people use only psychotherapy instead of medication, as it is an approach that does not rely on taking stimulant medications. Others use psychotherapy as an adjunct to medication treatment. Cognitive Behaviour Therapy is the primary type of therapy for use with ADHD. You learn to understand how what's already in your mind (automatic thoughts) effects the outcome (feelings) and not the other way around. You learn to deal with irrational thoughts, how to think "scientifically," and how to deal with others.

Behavioral therapy is a critical part of the parent training program. It teaches specific techniques to deal directly with immediate issues...behaviours .... of concern. Primarily we use techniques that put an emphasis on positive behavioural support, reinforcing positive behaviours, and ignoring (NOT reinforcing) behaviours we want to see less of. Punishment and negative interactions have been shown to do little to effect the behaviour of children with ADHD.

Psycho-education, for both adults and children, is also a critical component of treatment. Issues of self esteem, depression and anxiety need to be addressed throughout the treatment process.

Social Skills Training for ADHD
Often children with ADHD are sent to "social skills training." This has it's good side, and it's bad. Most children learned social skills through watching others, then practicing them. For the person with ADHD these skills often didn't seem to work, and they developed new and often inappropriate ways to relate to others, get what they want and organize their environment. In a good social skills training classes we provide a safe environment in which to demonstrate and practice these skills, and then set up a graduated process of using these skills in the real world. Social skills training helps the child to learn and use these skills in a safe practice environment with the therapist (or parent). These skills include learning how to have conversations with others, learning to see others’ perspective, listening, asking questions, the importance of eye contact, what body language and gestures are telling you. Often we use a social skills inventory to get a good idea of what specific skills someone has, and what skills they need to learn.

Support Groups for ADHD
Mutual self-help support groups can be very beneficial for parents and individuals with ADHD themselves. A sense of regular connection to others in the same boat leads to openness, problem-sharing, and sharing of advice. Concerns, fears and irritations can be released in a compassionate environment where members can safely let off steam and know that they are not alone. As well as this type of support, the groups can invite experts to give lectures and answer specific questions. They can also help members to get referrals to reliable specialists.
Psych Central hosts two support groups online for people with attention deficit disorder: Psych Central ADHD support group and NeuroTalk’s ADHD support group. While I am happy to give information on these groups, I also have to warn you that often individual's in support groups spread false and misleading information. They join groups in order to spread this information. Sometimes this is in the form of rumours and scare tactics about medications, sometimes it's in the form of misleading information on treatments they "know" work but which have no scientific basis. Be careful, and always go to your medical doctor for advice. There really are no simple diets, vitamins or supplements that fix ADHD. And fish oil tablets are NOT a cure. Go talk to "reliable" sources.

This blog is not offered as medical advice or as a means of diagnosing or treating ADHD or any other disorder. Don't go on line and take an ADHD "test." The diagnosis is complex, and it involves not just looking for symptoms of ADHD, but also ruling out other disorders that might look just like ADHD. So avoid these on line "tests" which are nothing more than a collection of symptoms. You need to see a licensed or registered professional for that. Medical doctors can diagnose ADHD, but the diagnosis is complex and often they will make a referral to a Registered Psychologist. You can obtain a referral from the British Columbia Psychological Association for a psychologist near you.

My web page lists a number of resources you can make use of yourself in dealing with Attention Deficit Hyperactivity Disorder (ADHD). Please visit it at www.adhdhelp.ca or one of my other sites at either Psychology Today, AAMFT, PSYRIS or my professional site.

Attention Deficit Hyperactivity Disorder (ADHD) assessment and treatment services are offered for individuals, couples, families, children and adolescents in the Burnaby, Vancouver, Coquitlam, Port Moody, New Westminster and Maple Ridge areas of the lower mainland. This includes neuro-developmental assessments, psycho-education and cognitive behaviour therapy. I also provide diagnostic assessments for autism and Asperger's Disorder in my Burnaby office.

Dr. Jim Roche
Registered Psychologist, British Columbia 01610