“At first I was surprised to hear from other families how often kids switched their medication or tried new doses or schedules,” writes the father of a 9-year-old. “I guess my first reaction was, ‘Don’t the doctors know what they’re doing? Why can’t they get it right the first time?’ After we started the treatment process, though, I found it very reassuring that Tina’s pediatrician wanted our feedback on how the medication was working, and how we were doing with the behavior therapy. Tina experienced some irritability in between doses with her first prescription so we switched to a long-acting medication where she only had to take one dose per day. That worked a lot better, and then we figured out that working more in concert with her teacher on the behavior techniques improved the situation even more. As Tina started doing much better, she became more eager to participate in the plan. By the end of the first year I felt like we’d all worked as a team to put together the best program we could for her. It was great knowing we had all these people’s support and that as Tina’s life changed her treatment could change along with her.” - John, Tampa, FL
Follow-up visits should cover all of the ground since your last visit. This includes sharing your own observations of your child’s recent behaviors, ongoing problems, and new concerns and screening for any new coexisting conditions. You and your child should be given the opportunity to ask questions and should be informed about any major new research or other information pertaining to his condition or his treatment. The most recent rating scales, teachers’ observations, and other progress reports should be reviewed. Finally, your child’s target outcomes can be reviewed and, if your child is clearly not meeting the current goal for each one, his treatment can be reassessed.
If your child is not meeting his specific target outcomes, you, your child’s pediatrician, and your child should consider the following issues:
- Were the target outcomes realistic?
- Is more information needed about your child’s behavior?
- Is the diagnosis correct?
- Is another condition hindering treatment?
- Is the treatment plan being followed?
- Has the treatment failed?
- What coping strategies can you learn to deal with target behaviors that cannot be fully resolved through appropriate treatment?
No treatment for ADHD is likely to completely eliminate all of the symptoms of inattention, hyperactivity, and impulsivity and associated problems and conditions. Children who are being treated successfully may still have trouble with their friends or schoolwork. Still, you should see signs of progress relating to your child’s specific target outcomes or general behavior. If not, your child’s diagnosis and/or treatment should be revised.
A revised diagnosis is not a sign of failure in you, your child, or his pediatrician. It is merely a signal that your child’s treatment team has yet to create the optimal response to his symptoms.
Treatment of ADHD is in many cases largely a matter of continually monitoring and reshaping the plan, and you can expect treatment to change as your child adjusts to treatment, grows, and develops over time. As these changes are made, continue to make sure that any and all treatments are aimed at fostering good self-esteem and that your child understands them to the extent possible given his developmental level.
Follow-up visits should be geared in large part toward educating your child and empowering him to participate more and more in decision-making as he approaches adolescence. Adolescents who “own” their problems and treatment plans are much more likely to make progress. Those who feel that treatment changes are being “shoved down their throats” will naturally resist or abandon treatment and are at high risk for school failure, poor peer relationships, low self-esteem, substance abuse, and conduct problems.
Treatment for ADHD is generally considered to have failed only in cases when a child shows no response to appropriate trials and alterations in medication at maximum doses without side effects, when he cannot learn to control his behavior in spite of appropriate behavior therapy, or when a coexisting condition persistently interferes with the meeting of target outcomes. In each of these cases, the diagnosis would need to be carefully reconsidered and additional consultations might be appropriately called for.
In treating, monitoring, and following up on treatment for your child with ADHD, communication is key. As treatment continues in one form or another throughout your child’s early years, you will need to make sure that
- He understands and supports the goals and methods of his treatment.
- Other family members are equally informed and supportive.
- Teachers continue to work with him in effective ways and pass their observations on to him and you.
- Pediatricians and other medical personnel receive this feedback from you, his teachers, and others who spend time with your child.
- You and other members of the treatment team remain up to date on the legislation and medical, educational, and psychological issues that affect your child.
A child who knows as much as possible about ADHD will be better prepared as he faces challenges at home and school. A sibling who understands the steps involved in the treatment process may be more patient when you need to take time out for a parent training course. A pediatrician who is informed of any new family problems or stressors can make better decisions regarding treatment. Finally, educators who know that you and your child understand the nature of ADHD are often more eager to work together to manage it.
Attention-deficit/hyperactivity disorder is not yet curable, but it is certainly treatable. With
attention, dedication, and a long-term outlook, you and your family may be able to look
forward to continuing progress in the target areas you have defined.