Attention Deficit Hyperactivity Disorder, ADHD, is a heterogeneous disorder. Symptoms and responses to treatments can vary greatly among individuals. With conflicting information on the Internet, confusion abounds. In this article, we will review the latest research and what every parent should know about how to discipline a child with ADHD.
Table of Contents
What Is ADHD and What Are The Effects
Attention Deficit Hyperactivity Disorder, formerly called Attention Deficit Disorder (ADD), is characterized by excessive inattention, hyperactivity and/or impulsivity. It is commonly diagnosed in school-aged children. This mental disorder can have lifelong impacts on individuals.
ADHD a complex disorder. Kids being hyperactive and distracted doesn’t necessarily mean that they have the disorder. Their symptoms have to meet a set of diagnostic criteria and guidelines outlined in the Diagnostic and Statistical Manual of Mental Disorders (currently DSM-5).
ADHD may affect all aspect of a child’s life. It can have impact on parents and siblings, disrupting family functioning and parents’ marital relationship. The adverse effects can also change throughout the patients’ lives1,2.
During elementary school years, a child with ADHD often experiences academic failures, rejection by peers, low self esteem, sleep deprivation, stressed parent-child relationships and family functioning disruptions. When children feel sad, they may show oppositional or aggressive behavior.
A mother of a child with ADHD are more likely to suffer from depression and consume more alcohol. Siblings often feel victimized by aggressive acts from their siblings. Many siblings also feel anxious, worried and sad because they are expected to care for and protect their ADHD brothers or sisters.
ADHD teenagers have more parent-teen conflicts and less friendships than other teenagers. They have a higher risk of dropping out, teenage pregnancy, delinquency, traffic violation such as speeding and being at fault in traffic accidents.
Previously thought to only affect children, ADHD can continue to affect patients into adulthood. As many as 60% of the affected individuals continue to show significant ADHD symptoms as adults.
Adults with ADHD are more likely to have interpersonal difficulties with employers and coworkers, and be dismissed from employment. They also often have difficulties in relationships. If unmedicated, they have significantly higher risks of drug abuse. ADHD adults also tend to rake up higher healthcare costs for themselves and their families.
ADHD Treatment and Discipline Strategies
Kids with ADHD are at a significant risk for later oppositional defiant disorder (ODD) and Conduct Disorder (CD). This is one of the biggest concerns for parents and the reason why many parents want to focus on learning how to discipline their kids.
Although how to discipline an ADHD child is a major concern, many ways in addition to discipline can be addressed as part of the treatment strategies.
Parenting interventions are the first line treatment options.
Behavioral Parent Training (BPT) has a long, successful history as a treatment across several childhood mental health disorders4. It has been used as a treatment and discipline method for ADHD kids for over 50 years5.
In BPT, parents receive training in how to discipline at home using behavioral modification principles such as positive reinforcement3 and natural consequences instead of harsh punishment. The goal is to improve parental understanding of behavioral discipline principles and a child’s compliance with parental commands.
Similar to parenting intervention, teachers receive training in classroom-based behavioral discipline strategies to improve a child’s problematic behaviors and academic performance.
Psychotherapies for a child with ADHD can include training in how to improve social skills, anger management and problem solving.
Stimulants have effectively treated many ADHD kids and is the most prevalent ADHD medical treatment. Clinical studies have found that therapeutic doses of stimulants can improve PFC functioning and efficiency, reducing symptoms6.
Parents need to make sure that their child with ADHD only takes the recommended dosage as directed by physicians. Over-consumption of stimulants can impair PFC functions and/or become overaroused.
For parents who have newly diagnosed adolescents, they should work with physicians before starting any medication treatment to assess for symptoms of substance abuse. If substance use is identified, the abuse has to be addressed before medication treatment can begin.
Stimulants are not for everyone. Some people cannot tolerate them. There may be negative side effects such as tics, aggressive impulses or drug abuse liability. For those individuals, non-stimulant is another option.
Non-stimulants usually take longer to work. A child may have to take them for a period of time before noticing improvement in symptoms.
Treatment Plan for a Child with ADHD
ADHD is an early onset disorder. The latest research shows that up to 60% of these kids continue to have symptoms into adulthood. For these people, it is a chronic condition that needs to be managed throughout life.
It is crucial to select the right treatment approach with the help of a physician. But it also helps to be equipped with information on each treatment option.
Here is a summary of the treatments recommended by the AAP. Recommendations are based on patient’s age7.
For preschool-aged children (4-5 years of age)
For preschool-aged children, the first line of treatment is evidence-based parent-administered (and/or teacher-administered) behavior therapy. If behavior management intervention alone does not provide significant improvement in the child’s functioning, medication may be prescribed.
For elementary school-aged children (6–11 years of age)
For elementary school-aged kids, medication and/or behavior therapy is recommended, but a combination of the two is preferable. School environment, program or placement adjustment is also recommended.
For adolescents (12–18 years of age)
For adolescents, medication (with assent of the adolescent) and/or behavior therapy is recommended, but a combination of the two is preferable.
Barriers To Accurate Diagnosis
One of the reasons often raised by parents as barriers to diagnosis is the fear of mental illness stigma.
ADHD is a neurodevelopmental disorder affecting neurostransmitter circuits. We know that the brain circuits are more flexible in younger brains than in older ones (this flexibility is called the plasticity of the brain)8.
That means the earlier the disorder is diagnosed, the sooner interventions can be provided and the more likely they can interrupt the risk pathways leading to more advanced ADHD9,10.
On the flip side, because there are no ADHD blood tests that can diagnose the disorder, psychiatrists, psychologists and psychotherapists can only make judgement based on their own interpretation of parents’ description and understanding of the DSM-V diagnostic criteria. Therefore, there is also a risk of over-diagnosis11.
Latest Treatment Research And Controversies
Efficacy Of Non-Pharmacological Interventions
In 2013, Sonuga-Barke and colleagues published a meta-analysis casting a negative light on several types of psychological treatments, including cognitive training, neurofeedback and behavioral interventions.
Researchers found that the various non-pharmacological treatments showed positive effects only when the evaluators were aware of the treatment allocation. But when the evaluators rated blindly without knowing the treatment assignment, no statistically significant effects were found.
This finding is substantial because non-pharmacological treatments are usually recommended first before medications are introduced.
Mindfulness As A Treatment Option
One promising treatment option is combining mindfulness training with behavioral parenting training.
Some studies show that incorporating mindfulness training can significantly improve attentional processes in children and parenting skills in parents12,13.
Although more studies are needed to confirm the effectiveness in treating ADHD, practicing mindfulness in itself is worth doing because it provides many benefits such as improved self-regulation, positive emotions and general psychological well-being14.
The Diet Factor
Using diets to treat a child with ADHD has been a popular and appealing solution since the 1920s. These treatments are controversial because there is not enough empirical evidence supporting their effectiveness15,16. Conclusive results are difficult to obtain because of flaws in the study designs. In addition, children can have different sensitivity and intolerance to food17.
Common dietary interventions include additive-free diet (e.g. no artificial flavors and colors), sugar elimination diet, food allergies and sensitivities elimination diet and fatty acid supplementation diet18.
Only by trial-end-error can parents determine if a certain diet is right for their child. But it is important to do this under the guidance of nutritionists to make sure the diet is balanced and meets the needs of your growing child.
Pharmacological Treatment Safety
The first concern of using drugs to treat the disorder is safety.
Safety is a concern with all medications, not just ADHD medications. But since these drugs target the brain’s neurotransitter systems which are far more complex than other organs in our bodies, there is a greater risk of unforeseen problems.
Another concern is the negative side effects such as loss of appetite or developing tics. Abusing stimulants for non-treatment use is another major issue feared by parents.
Because of all these concerns, parents are recommended to start with non-pharmacological treatment before considering adding drugs to it.
However, if non-pharmacological treatment has not been effective or enough, parents have to weight the fear of these potential issues with the benefits gained from using medications. When ADHD goes untreated, the effects can have vast impact on the child’s learning, self-esteem, relationship and quality of life.
- 1.Harpin VA. The effect of ADHD on the life of an individual, their family, and community from preschool to adult life. Archives of Disease in Childhood. February 2005:i2-i7. doi:10.1136/adc.2004.059006
- 2.Loe IM, Feldman HM. Academic and Educational Outcomes of Children With ADHD. Journal of Pediatric Psychology. May 2007:643-654. doi:10.1093/jpepsy/jsl054
- 3.Webster-Stratton CH, Reid MJ, Beauchaine T. Combining Parent and Child Training for Young Children with ADHD. Journal of Clinical Child & Adolescent Psychology. February 2011:191-203. doi:10.1080/15374416.2011.546044
- 4.Feldman MA, Werner SE. Collateral effects of behavioral parent training on families of children with developmental disabilities and behavior disorders. Behav Intervent. 2002:75-83. doi:10.1002/bin.111
- 5.Fabiano GA. Father participation in behavioral parent training for ADHD: Review and recommendations for increasing inclusion and engagement. Journal of Family Psychology. 2007:683-693. doi:10.1037/0893-3188.8.131.523
- 6.SOLANTO MV, WENDER EH. Does Methylphenidate Constrict Cognitive Functioning? Journal of the American Academy of Child & Adolescent Psychiatry. November 1989:897-902. doi:10.1097/00004583-198911000-00014
- 7.ADHD: Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents. PEDIATRICS. October 2011:1007-1022. doi:10.1542/peds.2011-2654
- 8.Halperin JM, Bédard A-CV, Curchack-Lichtin JT. Preventive Interventions for ADHD: A Neurodevelopmental Perspective. Neurotherapeutics. June 2012:531-541. doi:10.1007/s13311-012-0123-z
- 9.DuPaul GJ, Kern L, Caskie GIL, Volpe RJ. Early Intervention for Young Children With Attention Deficit Hyperactivity Disorder: Prediction of Academic and Behavioral Outcomes. School Psychology Review. March 2015:3-20. doi:10.17105/spr44-1.3-20
- 10.Rappaport G, Ornoy A, Tenenbaum A. Is early intervention effective in preventing ADHD? Isr J Psychiatry Relat Sci. 1998;35(4):271-279. https://www.ncbi.nlm.nih.gov/pubmed/9988984.
- 11.Bruchmüller K, Margraf J, Schneider S. Is ADHD diagnosed in accord with diagnostic criteria? Overdiagnosis and influence of client gender on diagnosis. Journal of Consulting and Clinical Psychology. 2012:128-138. doi:10.1037/a0026582
- 12.Coatsworth JD, Duncan LG, Nix RL, et al. Integrating mindfulness with parent training: Effects of the mindfulness-enhanced strengthening families program. Developmental Psychology. 2015:26-35. doi:10.1037/a0038212
- 13.Cassone AR. Mindfulness Training as an Adjunct to Evidence-Based Treatment for ADHD Within Families. J Atten Disord. May 2013:147-157. doi:10.1177/1087054713488438
- 14.Brown K, Ryan R. The benefits of being present: mindfulness and its role in psychological well-being. J Pers Soc Psychol. 2003;84(4):822-848. https://www.ncbi.nlm.nih.gov/pubmed/12703651.
- 15.Cormier E, Elder J. Diet and child behavior problems: fact or fiction? Pediatr Nurs. 2007;33(2):138-143. https://www.ncbi.nlm.nih.gov/pubmed/17542236.
- 16.Heilskov Rytter MJ, Andersen LBB, Houmann T, et al. Diet in the treatment of ADHD in children—A systematic review of the literature. Nordic Journal of Psychiatry. June 2014:1-18. doi:10.3109/08039488.2014.921933
- 17.Sonuga-Barke EJS, Brandeis D, Cortese S, et al. Nonpharmacological Interventions for ADHD: Systematic Review and Meta-Analyses of Randomized Controlled Trials of Dietary and Psychological Treatments. AJP. March 2013:275-289. doi:10.1176/appi.ajp.2012.12070991
- 18.Pelsser LM, Frankena K, Toorman J, et al. Effects of a restricted elimination diet on the behaviour of children with attention-deficit hyperactivity disorder (INCA study): a randomised controlled trial. The Lancet. February 2011:494-503. doi:10.1016/s0140-6736(10)62227-1