Importance of Behavior Therapy for Children who have ADHD

 

OVERVIEW OF LEARNING DISABILITIES

Hardman who is cited in Kauchak states that almost 1 out of 10 students has some type of exceptionality that requires extra help in the classroom. An exceptionality as defined in Introduction to Teaching by Don Kauchak and Paul Eggen is a “learning or emotional need that results in their requiring special help to succeed and reach their full potential.” English2Another way to describe exceptionality is by calling this term a learning disability. There are over 10 different learning disabilities that each affect the bearer of the disability in different ways. In this post I will only be focusing on the most common learning disability, attention deficit hyperactivity disorder, or ADHD for short. 

WHAT IS ADHD?

 ADHD is defined as a chronic condition marked by persistent inattention, hyperactivity, and sometimes impulsivity. A few behavioral solutions are available to the parents of children who have ADHD. The first and safest option parents have is putting their child through behavior therapy. Many parents do not put their child through behavior therapy because according to the Center for Disease Control and Prevention’s (CDC) statement in the Washington Post, behavior therapy “can take more time, effort and resources than medicine.” However, the CDC encourages behavior therapy as the first step when treating children with ADHD because the results will be longer lasting than the use of medication. Click here to read my post specifically about this article

The second behavioral solution for parents of children with ADHD is to give their children medication that will calm them down and help them focus. Medication can be very beneficial to children who have ADHD. According to the CDC, medication helps treat ADHD symptoms in about 75% of the children who have ADHD. Medication cuts down on hyperactivity, interrupting, and fidgeting, but there is a downside to medication. The downside to the medication option is that many patients taking medication may experience side effects. 

Another downside to medication is that once a child stops taking medication or forgets to take the pill one morning, that child is back to square one.  The child will still retain the same behavior from before he took the medication, whereas with correct behavioral therapy, the child reaps the benefits from therapy even when not on medication. I believe that medication for children with ADHD should be the last option and only given out to children who have already attended behavior therapy.

DOWNSIDES TO TAKING MEDICATION

Most of the time the use of medication for children who have ADHD can be very beneficial, especially in children who have sizable symptoms, but it is crucial to not overlook the side effects and downsides to medicating your child. It is very important when deciding whether or not to put your child on medication to fully understand the possible side effects that medication can have on your child. Roy Boorady, MD, a child and adolescent psychiatrist lays out many of the side effects of children taking medication for ADHD in his article Side Effects of ADHD Medication. The side effects that Boorady focuses on in his article are sleep problems, eating issues, mood changes, and depression.

Many children who take medication for their ADHD have a hard time going to sleep at night. This is because many times the medication that children are taking is too strong and it keeps the brain stimulated for too long. If your child has a hard time getting a good night of sleep, they will have trouble the next day in class staying focused because they are too tired, effectively counteracting the use of medication. Another side effect that many children on ADHD medication experience is the loss of appetite. When taking extended release medication, a very common type of medication for ADHD, the drug peaks after about four hours after it has been taken. Doctors normally suggest taking medication in the morning before going to school, so many times children are not hungry when it’s time for lunch. This is a very real issue because if your child is not eating and getting enough nutrients, your child can experience delayed growth or even develop other medical problems.

MENTAL HEATH PROBLEMS

Many times taking medication for ADHD can also affect your child’s mental health. One very serious side effect that affects the mental health of many children after taking ADHD medication is the rebound or come-down.

Some parents describe something we call the “rebound effect.” After the medication wears off, their child becomes very irritable and aggressive. Sometimes parents tell me, “Every day at 4:30, I know it’s going to happen.”

After the medication wears off, many children become aggressive towards their parents making it so that the child does not act like his normal self. This rebound effect is due the medication leaving the receptors in the brain too quickly. Another side effect that affects the mental health of children on ADHD medication is the risk of developing mood swings. When the dose is too high for a child, often he or she may begin to look sedated or zombie-like but this can be fixed with a lower dosage, but many times even when the dosage is correct some kids will still get moody and irritable on medication. Not only can medication cause moody and irritable behavior, but children taking ADHD medication also have a high risk for developing depression. Boorady states, “Of course we have to keep in mind that kids who have ADHD can also develop depression. In fact they are  higher risk for developing major depressive disorder than other kids.” Depression is a very serious issue that should not be taken lightly when considering whether or not to give your child medication for their ADHD.

ALTERNATIVES TO MEDICATION

It is not fair to subject your child to side effects such as mood swings, eating issues, and sleeping problems as well as very serious medical problems such as depression without first exploring the other options. One alternative to giving your child mediation right away is the implementation of behavioral therapy. Behavioral therapy is defined as a series of Englishtechniques to improve parenting skills and a child’s behavior. Click here to see Dr. Kimberly Williams speak about how to use behavior therapy to help your child.

A few examples of behavior therapy are presented in A Review of Non-Medication Interventions to Improve the Academic Performance of Children and Youth With ADHD.  The first type of behavioral therapy that appears in this journal is consequence-based therapy,  meaning taking something away from the child such as desert or video games if the child acts up.

Both token reinforcement and response cost were highly effective in increasing the rate of responding, work completion, and overall accuracy of academic responding. In most cases, the effect sizes for these consequence-based interventions were large

The second type of behavioral therapy presented in this journal is self-regulation therapy. This means that the child with ADHD is in charge of monitoring themselves. This type of behavior therapy was also found to be very successful in changing the behavior of children with ADHD for the better.

Another example of behavior therapy was presented to me by Rick Lavoie when he came to speak at Elon about teaching students with learning disabilities. Lavoie touched on the fact that teachers play a very important role in the development of students with learning disabilities. Lavoie stated whenever a student with special needs or a learning disability makes a social mistake that the teacher should comfort the student and conduct a social skill autopsy. Click here to read more about Rick Lavoie’s presentation and to learn more about social skill autopsies

According to Patrica Quinn, M.D., a doctor who has treated patients with ADHD for the past 25 years, behavior therapy can help with certain symptoms of ADHD that medication can not.

 A pill decreases common ADHD symptoms like impulsivity and distractibility, but it doesn’t change behavior. A child on medication might be disinclined to punch someone, because he’s less impulsive, but he doesn’t know what to do instead. Behavior therapy fills in the blanks, by giving a child positive alternative behaviors to use.

Behavior therapy teaches children with ADHD positive behavior instead of just pushing the bad behavior aside for a few hours like medication does. Another reason why children should go through behavior therapy before they go on medication is because many times after going through behavior therapy, the child will require a lower dose of medication then he normally would. William Pelham, Ph.D., states in Attitudemag

There’s clear evidence that a behavioral approach will work for the majority of children with ADHD, the benefit of using behavior therapy first is that, if a child also needs medication, he can often get by with a smaller dose.

In Side Effects of ADHD Medication, Boorady states that a smaller dose of medication means that your child will not experience as many side effects as he normally would with a higher dose. Pelham, director of the Center for Children and Families at the State University of New York is also an advocate for behavior therapy before putting children on medication for their ADHD. Pelham states that medication will almost always work at least in the short term for children with ADHD but Pelham suggests putting your child through behavior therapy first because that is the safer alternative.

If a child is put on medication before they are put through behavior therapy, it is uncommon for that child to be put through behavior therapy because the parents think it is not necessary because the medication is already working. Pelham conducted a four-year study at the University of Buffalo addressing the issue that is; parents not wanting to put their children through behavioral therapy after they have started medication.

Parents who see that medication is working are less motivated to follow through with behavior therapy. That would be fine if the data showed that medication alone helped the long-term trajectory of ADHD kids. It doesn’t.

This study shows that ADHD medication does not improve the cognitive ability of children who take medication after they stop taking the medication. According to Pelham, a child can take medication for 10 years, and the day the child stops taking medication, the benefits stop. Taking medication without going through behavior therapy at the same time is like putting a band-aid over a bullet hole.

It’s a lot harder to learn from scratch how to deal with a teenager who’s acting out than it is with a five-year-old who is acting out. The parent has lost five or ten years relying on medication and not dealing with problems that behavior therapy could have addressed. 

 

THE GOLDEN COMBINATION

If your child is on medication or is receiving behavior therapy but is still not progressing as much as they should be, consider putting your child on medication as well as putting your child through behavioral therapy. Using both methods to treat your child’s ADHD will be very beneficial because this will cancel out many of the downsides that each of these methods have on their own. Due to your child going through behavioral therapy, your child will not need as high of a dose that he normally would, minimizing the side effects created by the medication. Your child will be able to grow cognitively throughout the years while being on the same playing field as all of the other kids in the class. This would not be possible only taking medication or only going through behavioral therapy. The journal Nine Months of Multicomponent Behavioral Treatment for ADHD and Effectiveness of MTA Fading Procedures states

Later secondary analyses of the 14-month outcomes showed that by compositing several measures from both parents and teachers to increase reliability, it was possible to demonstrate a statistically significant though small (d = .26–.28) advantage of Comb over MedMgt

In this context “Comb” refers to the combination of medication and behavioral therapy and “MedMgt” refers to only medication. This peer reviewed scholarly article shows that the combination of medication as well as behavioral therapy is the best option when it comes to treating your child’s ADHD.

CONCLUSION

In conclusion, it is critical to know the side effects that putting your child on medication for their ADHD can have on them. Many times these side effects can change your child greatly, whether it be physically through loss of appetite or lack of sleep, or mentally through mood swings or the rebound after the medication wears off. It is important to note that medication can be a great thing and many children need to take to do well in school, but all children should attempt behavior therapy before they go on medication. There is no point in putting your child on medication before attempting behavior therapy because even if behavior therapy does not fully work for your child, the combination of both medication and behavior therapy works better than medication alone. If behavior therapy works for your child it will have long term affect on your child’s cognitive ability whereas medication will not. If behavior therapy does not work for your child there is no shame in medicating your child, it is just important for everyone to know that there are other alternative ways to treating ADHD besides medication.

WORKS CITED

Arnold, L. Eugene. “Nine Months of Multicomponent Behavioral Treatment for ADHD and Effectiveness of MTA Fading Procedures.” Proquest. Journal of Abnormal Child Psychology, Feb. 2004. Web. 2 May 2016.

Boorady, Roy, MD. “Side Effects of ADHD Medication.” Childmind.org. Child Mind Institute, n.d. Web. 27 Apr. 2016.

Cha, Ariana Eunjung. “CDC Warns That Americans May Be Overmedicating Youngest Children with ADHD.” Washington Post. The Washington Post, 3 May 2016. Web. 5 May 2016.

Kauchak, Donald P., and Paul D. Eggen. Introduction to Teaching: Becoming a Professional. New York: Pearson Learning Solutions, 2011. Print.

McCarthy, Laura Flynn. “Behavior Therapy for Children with ADHD: More Carrot, Less Stick.” Additudemag. Attitude Magazine, n.d. Web. 02 May 2016.

Trout, Alexandra L., et al. “A Review of Non-Medication Interventions to Improve the Academic Performance of Children and Youth with ADHD.” Remedial and Special Education 28.4 (2007): 207-26. ProQuest. Web. 02 May 2016.

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