Focus On Pediatrics-Nonmedical intervention best for ADHD

Parents need to know symptoms

Attention Deficit Hyperactive Disorder (ADHD) is a common term in today's society. Many children with behavior problems are labeled with the disorder. Therefore, it is important that parents know what symptoms to look for, when to seek professional help, and how to treat a child diagnosed with ADHD.

"To make a diagnosis, you need to have the proper symptoms, and to a degree that is inappropriate for your age or developmental level, and is impairing to your functioning," says Dan Coury, MD, chief of behavioral and developmental pediatrics at Children's Hospital in Columbus, OH. For example, the child loses toys and schoolbooks frequently, or fidgets and cannot concentrate in class.

The signs of ADHD are a pattern of overactive, impulsive, inattentive behavior where a child has trouble sustaining and staying on task whether the activity is play or work, explains Coury. There is no avoidance involved, such as not wanting to do household chores. The behavior is not a discipline problem, either. The child has trouble controlling his or her behavior and staying within limits.

Look for a pattern of behavior

It is important to note whether the child has developed a pattern of behavior, not one or two symptoms. Equally important is whether the behavior impairs the child. "If the child fidgets a lot in class and doesn't seem like he or she is listening, but gets good grades, then let the child be," advises Coury.

Children suspected of having ADHD should be evaluated by a health professional such as a psychologist, psychiatrist, or pediatrician. "That professional will ask questions regarding the specific symptoms and how significant the problem is," says Coury. Part of the assessment concerns the child's study habits, grades, and test scores. Children who can't concentrate often don't hear the lesson or assignment completely, and therefore do not do well on homework or tests.

When a child is diagnosed with ADHD, intensive nonmedical treatment options should be tried before medication is prescribed, advises Coury. The two nonmedical treatments include:

1. Behavior management.

It's important to first review parenting skills and see where improvements might be made. For example, parents may have been lax in setting limits and need to do so. Also, parents need to learn to give the child single instructions instead of multiple commands. For example, instead of telling children to pick up all the toys in their room, make the bed, put the books on the shelf, and put the dirty clothes in the hamper, the parent would give one command, such as making the bed. Once that task was complete, another instruction would be given. "Children with an attention problem will not hear the complete command or will go off to their room and forget some of the tasks or get distracted," explains Coury.

2. Change in the environment.

Parents and teachers need to assess the child's environment to see if there could be fewer distractions. For example, in the classroom, the child's desk could be in the front near the teacher so he or she could monitor whether the child was staying on task. Also, the desk should be away from the window or anything else that could be distracting.

If the behavioral management and environmental changes don't result in satisfactory improvement, then medication needs to be discussed. However, the nonmedical interventions should always precede prescriptions for medication. "A child with ADHD can't control his or her behavior; however, some children don't control their behavior because it hasn't been taught or it is not an expectation. If we do the behavior management first, then we know we have a child who has those expectations," says Coury.

From a medical standpoint, nothing harmful will happen to children with ADHD who are not diagnosed. However, from a psychological and emotional standpoint, it could cause some difficulties. The child's behavior may prevent him or her from making friends and fitting in socially. "As people get older, there is a tendency to get better; and as an adult, they don't need the medication," says Coury.

For more information on ADHD, contact:

Dan Coury, MD, Chief of Behavioral and Developmental Pediatrics, Children's Hospital, 700 Children's Dr., Columbus, OH 43205. Telephone: (614) 722-2438. Fax: (614) 722-4966. E-mail:

CHADD (Children and Adults with Attention-Deficit/ Hyperactivity Disorder), 8181 Professional Place, Suite 201, Landover, MD 20785. Telephone: (800) 233-4050 or (301) 306-7070. Fax: (301) 306-7090. Web site: