Other Management Options

Speech and Language Interventions

AS 30% of children with ADHD also have or have had speech and language problems, help is often necessary.  The speech and language difficulties vary from stammering, hesitation and stuttering, through to speech delay, speech clarity problems, difficulties with verbal expression and problems in language use.  Any or all of these problems can further aggravate self-esteem and social skills problems, and sympathetic and effective management is crucial.  This may be by support from the teacher, from a specialist speech and language therapist, or by group involvement.

Occupational Therapy Intervention

Children who have associated co-ordination problems, especially when these persist despite medication, may benefit from an occupational therapist, especially for help with their fine and gross motor skills. Such help can be useful in improving their self-esteem. In particular, subtle language problems, misinterpretation of jokes or double meanings can affect learning and social competence. Verbal reasoning, analysis of content, fluent understanding and social intuition are all dependent on having efficient language skills.

Behavioural Management Interventions

Behavioural management strategies, as outlined here and in Chapter 11, are very important to contain and help counteract the ADHD symptoms and complications. Too often this is confused with psychoanalytical psychotherapy and other psychological strategies. Psychoanalysis, especially if the therapist appears to blame the parents, can not only be ineffective but quite demoralising and counter-productive. Although it may often have a role in treating other complications, such as depression and relationship difficulties, it is not effective in treating the core ADHD symptoms. Traditional psychoanalysis frequently misinterprets ADHD symptoms. For example, the forgetfulness of ADHD may be misinterpreted as being negative or aggressive in a relationship. Impulsiveness and shirt-term memory problems may be misinterpreted as wilful behaviour and many other ADHD symptoms can be seen in quite different and inappropriate light. Distinguishing between psychoanalytical and behavioural modification strategies is therefore helpful. The most helpful counsellors for children with ADHD seem to be those with their own strong, innate personality characteristics, with experience of life and who are able to absorb the ADHD knowledge into their own philosophy and practice.

Specific Counselling

In certain situations, either marital, family or individual counselling to try and resolve any problems can be very helpful. Such counselling should always allow for the possibility of unrecognised parental ADHD.

Dietary Manipulation

While dietary manipulation and adjustment can be helpful sometimes with non-specific behavioural problems and with hyperactivity, there is little evidence to support their use as mainstream treatments for children with ADHD. Various diets, including the Feingold Diet, low sugar diets low in preservatives, amines, and colourings, have been tried in different forms over the years. There is little proof in scientific studies that such diets are helpful for most children with ADHD. However, there are anecdotal comments from parents of normal children, that some children’s behaviour is helped. Some mothers, of young children especially, find that avoidance of certain foods may reduce the child’s high energy levels, but not the impulsiveness or the poor concentration. Future research may identify a small sub-group of children in whom diet is of some help.

Despite the lack of firm scientific evidence, dietary manipulation has held a prominent place historically in the management of hyperactive children in the UK. Adjusting diet appeals to parents, perhaps because it is non-medical. In the past, parents of children with persistent severe problems, which have not been helped by dietary manipulation, have not generally been informed that the use of medication is an option.

Coach / Mentor

A coach or mentor needs to be a person who believes in the child with ADHD, has some understanding of the condition, and is able to meet either in person or by phone on a regular, at least weekly, basis, to encourage and to help with planning and progress generally.

Because children with ADHD tend very much to think in the ‘here and now’ and not plan ahead, one of the key roles of the coach is to structure, think ahead, organise and foreshadow forthcoming events, and to help think the child’s way through them – to remember PE kit and directions for football games etc. The coach can also be very helpful in reminding, encouraging and helping the child stay focused and on task.

During ‘down’ periods, encouragement can be very useful and help can be given in avoiding procrastination, providing help with organisation and trying to minimise negative, destructive thinking.  All this helps encourage the child’s self-esteem and promotes social skills.

We would suggest a regular, at least weekly, meeting at a regular time slot, for between 15-30 minutes.  There needs to be an agenda and this is often best done with the use of a notebook where items discussed are noted, and these can then be reviewed at the forthcoming meeting.  The previous week needs to be looked at and analysed as to where problems occurred, what might have been done to help, and generally encouragement given.  The next week is then planned ahead, potential pitfalls identified, and as much praise and support and planning done as possible.

The LANC works with many ADHD coaches throughout the country and finds them an extremely valuable resource.

Useful Resources: