Helping Your ADHD Child Succeed in School

Written by Carol E. Watkins, MD

Focus on the important role of parents in helping ADHD children have a positive educational experience.

Introduction
Accepting the diagnosis
How medication fits in
Community support
Confidentiality and disclosure in the school setting
Advocating for your child's educational needs
Homework
Assistive technology
Social skills-an educational issue
Adolescent issues
Conclusion

Introduction

Ever since our country established a system of universal compulsory education, educators and clinicians have begun to notice students with ADHD-like symptoms. It has gone by many names and has been addressed in many different ways.

Accepting the ADHD Diagnosis

Many families go through a period of uncertainty during the time leading up to the eventual diagnosis. Sometimes, but not always, school problems trigger the ADHD diagnostic work up. The experience of "getting diagnosed" is powerful and can either be a blessed relief or a crushing blow. Many parents experience this as a loss and need to go through a process of mourning so that they can eventually accept their child as he or she is. The classic stages of mourning, denial, anger, grief and acceptance all apply here. Parents and teachers may have different perspectives on this phase of the process of acceptance. The professionals need to be patient with parents as they come to terms with their child's condition. They should not be too quick to pathologize parents who become emotional or angry in meetings. Some of the nicest, most conscientious parents may become angry and tearful in meetings. Parents and children may go through repeated episodes of mourning as they experience the effects of the ADHD in different settings and at different ages.

Parents need to listen carefully to teachers' observations. However, they must remember that teachers and schools do not make medical diagnoses. The classic symptoms of ADHD, inattention, impulsivity, and and sometimes hyperactivity, can be due to a variety of causes. A parent might request that a specialist observe the child in class or go to observe the class himself. Conferences with teachers and guidance counselors are useful ways of gathering and sharing information. Finally, a thorough diagnostic work up is crucial. It is not a good idea to diagnose and medicate a child based on a few checklists and a brief office visit. The psychiatrist or other clinician should take a complete individual and family history, interview the child, and review data from the school. The clinician should assess the child for the presence of depression, anxiety disorders and learning disabilities. These disorders are over represented in ADHD children. The clinician should discuss a comprehensive program for addressing the child's difficulties. Although there are a few children who seem "cured" when they are on the right medication regimen, most need other interventions too.

ADHD Medication

Medication is often an important part of the comprehensive treatment of an individual with ADHD. Ritalin is the most commonly prescribed medication for ADHD. It is important to remember that it is a short-acting drug and only lasts 2.5 to 4 hours. Often children are given a morning dose at 7AM before leaving home and do not get their second dose until Noon. If this is how your child's medication is scheduled, check to make sure that he is doing well in the two hours before lunch. Some children may experience a rebound effect as the medication wears off. If there is a problem during this period, talk to your child's doctor about adjusting the timing of the medication doses or switching to a different medication. Sometimes a small change in the timing of Ritalin dosing can make a big difference. Since teachers and some clinicians may not understand the short -acting nature of this medication, they may interpret the rebound irritability as deliberate acting out. When teachers note difficult behavior in a child on Ritalin, be sure to find out whether it is occurring at a specific time of day. There are now several good longer-acting forms of Ritalin and other stimulants. There are also other medications that can be helpful for ADHD if the stimulants are not sufficient. If the current regimen is not adequate, a comprehensive psychiatric evaluation may clarify the roles of both medication and other interventions.

Part of dealing with medication is dealing with the issue of stigma. Some children may think that only the "bad" kids go to the nurse to get stimulants. Other children enjoy their daily visits to the nurse. When students line up to see the nurse, the students sometimes figure out who is getting the Ritalin. For some sensitive children, this may be a reason to consider other medications. In other cases, some general classroom education about ADHD and medications may suffice.