ADHD Children, Counseling and Medication
WHY COUNSELING
SAMUEL R. CARON, Ph.D.
We all know that the treatment of choice for children with ADHD is a combination of medication and counseling. The medication increases brain activity and thus improves functioning. What I am going to discuss today are the purposes for the counseling component.
My first goal when I counsel ADHD families is to educate children and parents about ADHD. I use my 10 video lessons (http://www.adhd1.net/adhd-dvd.htm) to help me accomplish this. Understanding the disorder helps parents make informed decisions. It also aids them in better differentiating between misbehavior and ADHD related problems. It allows them to feel more comfortable with the medication when they understand the disorder and the purpose of the medication. It gives them the information they need to explain what is going on to skeptical relatives and friends.
Understanding ADHD
The children also need to understand the disorder. Understanding ADHD allows them to blame ADHD for historical inadequacies. This is probably better than their previous conclusions since so many children with ADHD decide that they are bad, stupid, crazy, lazy, uncontrollable, unlovable, etc. This education helps achieve a second counseling goal of improving the child’s self-esteem, which is so frequently damaged.
While encouraging the child to blame previous problem behaviors on ADHD, I simultaneously discourage them from continuing to use ADHD as an excuse. It is important that children take responsibility for their behaviors. On the other hand, we simultaneously want to make their environment more ADHD friendly so that they have a better chance of succeeding. Helping families develop ADHD friendly environments is a third goal of counseling.
Reward Programs
Setting up reward programs; improving family communication; constructing external reminders such as signs around the house; developing consistent family structures; reducing family arguing; practicing personal problem solving strategies; developing reasonable expectations; if necessary, reducing the amount of time spent daily on homework; having more family fun; helping parents to stop taking the problems personally; etc. are all ways to help make the environment more ADHD friendly.
Another counseling goal is to educate the children and parents about medication. It is easy to fall into the trap of thinking of the medication as a good pill or a smart pill. We discuss the fact that there is no medication that will make them smarter or keep them out of trouble. Although the medication does help improve concentration and reduce impulsivity, the children must try in order to improve. I want children to take responsibility for any improvements since this can also help improve self-esteem.
I think that some children resist the effects of the medication if they believe that we are trying to control them. That is why it is essential not to tap into their oppositionality with regards to medication.
Educate the Family
Another goal of the counseling is to educate siblings about ADHD. This can help them better understand the problems. We want the siblings to be our allies in treatment, and we do this by involving them in the treatment process.
A major counseling goal is to repair what is broken. ADHD can impair the relationships the child has with his parents, siblings, teachers, and peers. It is important to try to repair these. ADHD can also strain the relationship between the parents. It is essential that the parents are able to work together as a cooperative team in order to cope better with the problems.
Another goal of counseling is to determine whether other family members also need treatment. Every full sibling has a 40% chance of having the disorder. It is not unusual for the primary care taker to be depressed, and so this also needs to be explored. Parents might need marital therapy if the problems are affecting their marriage.
This article is not all-inclusive, but it does provide information about the importance of the counseling component.
Samuel R. Caron, Ph.D.
Dr. C & Elwood
