Family- and child-centered interventions

Environmental interventions to treat attention deficit hyperactivity disorder (ADHD) include:

• psychoeducation
• parent training
• organizational management
• psychotherapy
• classroom-based behavior modification and social skills training

Many of these psychosocial interventions can help to alleviate some of the secondary symptoms and sequelae of the core ADHD symptoms, including oppositional defiant disorder (ODD), poor peer relationships, and school failure. They have no established efficacy in managing the core symptoms of ADHD.59

Psychoeducational interventions involve the parents, school personnel, and other significant adults in the child’s world. The psychoeducational process includes providing an understanding of the illness, its effects in different settings, and its course, prognosis, and treatment strategies. It involves ongoing support of the family and advocacy with schools, camps, and other organizations.60

Parent training uses a behavioral approach to help parents deal with oppositional symptoms and other problem behaviors. Parents are taught principles of positive reinforcement, the appropriate use of consequences, and how and when to use "time out." Such training often involves teachers in preparing a daily report card that provides feedback to parents on the child's performance at school. This daily report provides additional information to parents so that they can provide appropriate rewards and consequences. This behavioral work can be done with parents individually or in groups. In addition to psychoeducation and parent training, parent support groups can provide helpful resources, a sense of empowerment, and mutual support.

One of the more debilitating aspects of ADHD is its effect on a youngster’s social life. Children with ADHD often are stigmatized and teased by peers. Attempts at using interpersonal problem-solving skills therapy, cognitive training, or social skills therapy have had minimal impact on social behavior.61

School-based interventions

Children with ADHD often require accommodations in the classroom to optimize their learning environment and potential. Two pieces of federal legislation in the United States can help parents and professionals to advocate better for the special needs of these children.

The Individuals with Disabilities Education Act (IDEA) Amendments of 1997 (Public Law 105-17), constitute the fifth set of amendments to the Education for All Handicapped Children Act (Public Law 94-142). Many children with ADHD qualify for special education services under the “other health impairment” category within the IDEA.

The IDEA has several principles:

• free appropriate public education
• appropriate evaluation
• individualized education programming
• least restrictive environment
• parent and student participation in decision making
• procedural safeguards

Section 504 of the Rehabilitation Act of 1973 prohibits discrimination on the basis of handicap by recipients of federal funds. This civil rights law has the potential to be more liberal in obtaining services for children within the regular classroom.

Taken together, section 504 and IDEA are powerful weapons for parents and professionals working with children with ADHD, to maximize the possibility of academic success for these youngsters.

Adapted from: Hirsch GS and Koplewicz HS. Attention-deficit hyperactivity disorder. In: Devinsky O and Westbrook LE, eds. Epilepsy and Developmental Disabilities. Boston: Butterworth-Heinemann; 2001;187–204.
With permission from Elsevier (www.elsevier.com).
Reviewed and revised June 2004 by Steven C. Schachter, MD, epilepsy.com Editorial Board.