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ADHD Non-Pharmacologic Management
Aka: ADHD Non-Pharmacologic Management, ADHD Management, Attention Deficit Disorder Management
- See Also
- Attention Deficit Disorder in Children
- School Problem Evaluation
- Attention Deficit Disorder in Adults
- ADHD Diagnosis
- ADHD Differential Diagnosis
- ADHD Comorbid Conditions
- ADHD Medications
- Dextroamphetamine (Dexedrine, Dextrostat, Adderall) or Lisdexamfetamine (Vyvanse)
- Methylphenidate (Ritalin, Methylin, Concerta)
- Atomoxetine (Strattera)
-
General
- Medications are only a part of treatment plan
- General measures are a cornerstone of ADHD therapy
- First-line in children under age 6 years old
- Important adjunctive role that potentiates medications in age over 6 years old
- Behavioral therapy is a first-line measure, despite which only 50% receive it
- Visser (2016) MMWR Morb Mortal Wkly Rep 65(17): 443-50 [PubMed]
- Efficacy
- Behavioral, social, interpersonal and academic outcomes are similar for those on medication
- With or without behavioral intervention
- (1999) Arch Gen Psychiatry 56(12): 1073-86 [PubMed]
- Behavioral management has additional adjunctive benefits such as parent and teacher treatment satisfaction
- When behavioral management is used in combination with medications
- Molina (2009) J Am Acad Child Adolesc Psychiatry 48(5): 484-500 [PubMed]
- Management: General Measures
- Overall Most Effective Psychosocial Measures
- Parent Training in Behavior Management
- Specialists work with parents on home strategies
- Reinforce desired behaviors
- Discourage unwanted behaviors
- Classroom Interventions
- Proactive behavior strategies (e.g. reminders of class rules, daily report cards)
- References
- Shrestha (2020) Transl Pediatr 9(suppl 1):S114-24 [PubMed]
- Other effective measures
- Ensure adequate sleep
- Hiscock (2015) BMJ 350:h68 [PubMed]
- Regular Physical Activity
- Zang (2019) Medicine 98(46): e17980 [PubMed]
- Management: Establish Treatment Goals (Examples)
- Finish school written work in reasonable time period
- Recall recently read material
- Complete one project at a time
- Avoid procrastination and get organized
- Start needed but boring tasks without wasting time
- Management: Educational Interventions
- Special education
- Parents in U.S. Can request an eligibility evaluation for an individualized education plan (IEP)
- Children with ADHD are covered for accommodations at school
- Rehabilitation Act (section 504)
- Individuals with Disabilities Education Act
- Learning adjuncts
- Books on tape
- Computers
- Dictaphone
- Spell check
- Oral and non-timed examinations
- Educate the family and the school about ADHD
- See below
- Provide daily behavioral report cards to be shared with parents
- Classroom modification
- Frequent reminders of classroom rules
- Short, brief assignments with time for feedback
- Preferential seating
- Reduction of written tasks
- Support in organization and study skills
- Non-timed written tests and assignments
- Colored cued materials and techniques
- Reward positive behaviors with tokens (and charge tokens for disruptive behaviors)
- Management: Counseling for parents and adolescent patients
- Develop a sense of self esteem
- Behavior management (Cognitive training)
- Learning to "Stop and Think"
- Self monitoring skills
- Management: Family understanding (Coping)
- Learn difference between inability and non-compliance
- Offer routine environment in which to succeed
- Brevity
- Variety
- Structure
- List making skills
- Prepare for changes in routine
- Redirection and ignoring of disruptive child behaviors
- Reward good behaviors and accomplishments (e.g. tokens or points as positive reward)
- Become an informed advocate for your child
- Management: Treatments that show no specific benefit in ADD (Disproved, Avoid)
- Dietary intervention (no conclusive evidence)
- Mega-Vitamins and mineral supplements do not work (e.g. Fatty Acids, Vitamin B, Vitamin D, Ginkgo, St John's Wort)
- Anti-Motion Sickness medications do not work
- Chronic yeast infection treatments do not work
- EEG biofeedback does not work
- Applied kinesiology, chiropractic or manual manipulation show no specific benefit in ADD
- Optometric Vision training does not work
- Acupuncture, yoga, Mindfulness show no specific benefit in ADD
- References
- Barbaresi (1996) Mayo Clin Proc 71:463-71 [PubMed]
- Baumgaertel (1999) Pediatr Clin North Am 46:977-92 [PubMed]
- Chang (2020) Am Fam Physician 102(10):592-602 [PubMed]
- Felt (2014) Am Fam Physician 90(7): 456-64 [PubMed]