2) The treating clinician, parents, and child, in collaboration with school personnel, should specify appropriate target outcomes to guide management.
The needs of each child with ADHD may be different. The recommendations suggest determining between three and six behaviors to initially work on improving. According to the guidelines, physicians should use the feedback received from parents, teachers and caregivers to establish areas that would most benefit the child. The initial treatment plan should target these specific areas. Treatment plans can then include specific actions that both parents and teachers can take to help the child improve in these areas. In addition, the treatment plan should include how the behaviors are measured and how “success” in these areas will be measured. These targets should become the basis for the initial treatment plan.
Examples:
- Improvements in relationships with parents, siblings, teachers, and peers
- Decreased disruptive behaviors
- Improved academic performance, particularly in volume of work, efficiency, completion, and accuracy
- Increased independence in self-care or homework
- Improved self-esteem
- Enhanced safety in the community, such as in crossing streets or riding bicycles.
3) The clinician should recommend stimulant medication and/or behavior therapy as appropriate to improve target outcomes in children with ADHD.
Medication works well for many children. Experts believe that 80% of children with ADHD respond favorably to stimulant medication treatment. However, medication is not right for every child. For some children with coexisting conditions, medication may not be a good choice. Family beliefs and circumstances may prevent medication being used. All of these factors should be considered when developing a treatment plan.
Although studies have shown that a combination of medication and behavior modification is the most effective treatment, many parents choose to use behavior modification without medication and are successful. In order for a treatment plan to have the best chance of success, doctors need to understand family dynamics and be respectful of parent’s choices.
