The More You Know: ADHD
Attention-Deficit Hyperactivity Disorder, more commonly known as ADHD, is a performance issue rather than a knowledge issue. Point of performance scaffolding will help with task completion, success, and building confidence. Scaffolding can look like offering co-regulation of behavior at a point of performance while the child is learning regulatory behavior.
Parent education is one effective treatment modality for children under the age of 11 with ADHD. Parents are crucial in helping kids learn how to manage behavior and setting up home and school environments for success.
One form of parent education is friendship coaching, which essentially makes the parent a social skills coach for their child. Therapy or counseling works best in combination with medication. Therapy helps increase understanding and better prepares the family and individual for managing any unmedicated periods.
Being regularly engaged in therapy may also mean that less medication can be used with similar therapeutic effects. Kids and families need to understand how to manage symptoms throughout life. One third of people diagnosed with ADHD will have significant symptoms throughout life (Russell Barkley, PhD - Dedicated to ADHD Science+, 2023). More success is possible if new skills for managing symptoms are learned earlier.
Understanding – counseling the parent/teen/adult to help them fully understand what ADHD is and the impacts it can have. Reframing the perception of the disorder, reduces shame and feelings of inadequacy. This enables us to move through the other items on this list and best manage symptoms in order to increase a client’s quality of life.
Compassion and forgiveness.
Medication – most effective, most optimal outcomes come when combined with therapy .
Modification – of caregiver behavior to change a child's behavior. The adult changes how they respond to the child with ADHD, which can redirect the child’s behavior.
Accommodation – make changes to the physical environment, etc. to reduce impairment. For example, this could include creating a visual schedule or a reward chart.
Executive inhibition will typically present earlier in life than inattention, which typically manifests at school age. Executive inhibition includes verbal inhibition, motor inhibition, impulsive cognition, impulsive motivation, and emotional dysregulation.
Verbal Inhibition – speech and language (rapid speech, interruption, etc.)
Motor Inhibition – hyperactivity (this typically decreases with age and has no diagnostic value by adulthood. Restlessness decreases with age and becomes more internal.)
Impulsive Cognition – difficulty with suppressing task-irrelevant thoughts, rapid decision making.
Impulsive Motivation – prefers immediate gratification and a greater discount of delayed consequences.
Emotional Dysregulation – impulsive affect, poor top down emotional regulation. It is not irrational or a mood that lasts for weeks. It is often provoked. More emotional immaturity.
There are six types of attention and ADHD does not impact all of them, so “attention-deficit” can be a misnomer. ADHD impacts executive attention. People with ADHD struggle with attention toward the future. There is poor persistence toward goals, distractibility, deficient in task re-engagement, impaired working memory, and diminished self-monitoring.
While ADHD and its symptoms impact functioning and lead to impairment, it is important to note that it is not impossible to manage. Through medication and therapy or counseling, many people are able to effectively cope with the effects of ADHD in their daily lives at any point in their journey; from school age children to grown adults. We, as therapists, look to find the most effective strategies for our clients to counteract any and all impacts of ADHD symptoms on daily life.
Source:
Russell Barkley, PhD - Dedicated to ADHD Science+. (2023, May 20). ADHD Treatment of Children & Teens - Part I - Introduction [Video]. YouTube. https://www.youtube.com/watch?v=wgOpwfO1tNg