For your convenience, now you can download fact sheets, prepared by professionals, on ADHD assessment and treatment:
ADHD WA supports and encourages the use of multi-modal treatment for Attention Deficit Hyperactivity Disorder (ADHD).
What is Multi-modal Treatment?
This approach consists of two or more components or modes (hence multi-modal) to treat the symptoms of ADHD. In line with other best practice guidelines for ADHD, ADHD WA advocates a holistic approach to management which includes multimodal therapy and multi-disciplinary care for the management of the individual with ADHD.
Why is Multi-modal treatment used for ADHD?
ADHD is not a condition with a single dimension, therefore a single method of treatment is unlikely to address all of the issues which may confront the parents of a child or adolescent with ADHD or an adult with ADHD.
Factors which may be impacting on the child or adult and which therefore need to be considered in a treatment plan can include: age; gender; particular behaviour patterns at home, at school or at work; hyperactivity or inattentiveness; learning difficulties; problems with social interactions and relationships; cultural and economic considerations; location; strengths; and possibly co-morbid conditions. With so many factors to take into account, it is improbable that a single method of treatment will provide an effective remedy for the total situation.
Another factor to take into account is that some parents of a child with ADHD or adults with ADHD may prefer to use particular types of treatment while not wishing to avail themselves of other options.
Furthermore, certain habits and behaviour patterns become established over a number of years, particularly for parents of children with ADHD and for teenagers and adults who have ADHD. When people receive a diagnosis of ADHD and are looking to change their ways of functioning and perhaps thinking, professional assistance is needed along with support. This is an enlightening as well as difficult time. It helps ‘not to be going it alone!’
With so many factors to consider, the correct diagnosis becomes an important first step to a treatment plan. The identification for each individual of where their difficulties and strengths lie leads to an opportunity to select the best range of treatments and therapies to provide support and meet that particular child or adult’s needs.
There are some important principles to consider, whichever treatments are selected.
Firstly, the treatment needs to be evidence-based. Parents and adults must be given information from the clinician or specialist on the diagnosis and management plan, including any potential side effects of treatment in order to make fully informed decisions. It is paramount that everyone informs themselves from reliable sources through literature, clinicians or their support group about treatment options.
Secondly, the practitioner must be trained and registered with their professional association. The management and treatment of the symptoms of ADHD is an ongoing process which requires constant review.
Thirdly, an effective management plan needs to be centred for the child/person and give consideration to the family and/or the adult’s social context. This will usually include input from a range of clinicians and service providers as well as the client, all as active partners.
Fourthly, that there is rapport between the practitioner & client / patient. That is, the client/patient should feel understood, and be clear about what can be done to help them.
The following briefly outline some of the treatments, therapies and educational interventions which may contribute to a multi-modal treatment plan, listed in no particular order.
Nutrition and Diet
The role of diet in ADHD management is a complex and individual one; there is no “one size fits all”. Just as the impairment resulting from a diagnosis of ADHD can be wide ranging, even within the sub-types, or compounded with or without co-existing physical, learning or mental health issues.
At diagnosis; it is useful for a nutritional assessment to determine if the child has any underlying food issues that can impact on their attention, mood, irritability, energy levels, growth and development. These issues can include extreme food dislikes/fussiness, monotonous food choices, textural/taste sensitivities, food chemical intolerances, aromatic (smell) sensitivities and under or over-eating. Nutritional deficiencies and/or elimination test diets that arise from these issues need to be corrected and supervised by Accredited Practising Dietitians who are experts in paediatric nutrition and diet therapy. Clinical Psychologists can have expertise in eating disorders. Speech Therapists can aid in swallowing/textural difficulties.
On medication; sometimes, while different medications are being trialled and dosage adjusted to required needs there may be a change in appetite and desire for eating – this can be a frustrating time for parents but if eating occurs before medication takes affect or as it wears off in the evening then energy intake can be maintained. High protein energy supplementation may also assist at this time to maintain growth and development.
Previous diagnosis as a child
If the person has been diagnosed as a child then all of the above may still apply as they transition into adulthood. Maintaining optimal nutrition for life is important just as it is for the non-ADHD population. The prevention of diet related disease such as weight gain leading to Type 2 diabetes or heart disease also becomes an important issue.
Diagnosis as an adult
An adult who has been long term undiagnosed may have many factors that influence their nutrition – financial, social, spiritual, emotional, mental health and education.
A lack of skills in cooking or food budgeting issues and inconsistent healthy food selection can impact on nutritional status. Investigation for nutrient deficiencies can determine supplementation requirements. Gaining information and skills as well as seeking advice from Accredited Life Coaches can be useful.
Dietary advice from well meaning, unqualified or non-evidenced based sources can be counter- productive to an individual’s requirements. It can also be un-necessarily stressful or expensive for families and individuals. Dietitians Association Australia has a “Find a Dietitian” link on their website at http://daa.asn.au/
You’re an adult with ADHD / LD and you need to make a change. You want to switch jobs or stop chronic disorganization and lateness, which have been hurting your marriage. Or perhaps your child needs help with completing the piles of homework they get, now that they are in high school. The solution, in each case, may be to team up with a coach who understands learning differences.
Choosing a coach
The key, of course, is finding the right one. You should know what you want to change in your life and whether a particular coach can help you make the change. While a prospective coach should have experience working with clients and knowledge of the condition, the chemistry between the two of you determines success.
In some instances hiring a coach who doesn’t specialize in ADHD / LD, can be a mistake. They just don’t realize that strategies that work for clients without executive function issues and/or learning differences may not work for people with ADHD / LD, as their brains are wired differently.
It is easy to check a coach’s credentials. A certification program for ADHD coaches screens professionals for training and experience. Several organizations that certify life coaches have many members who specialize in working with ADHD. However, just because a coach is a graduate of a top program, or has multiple certifications, doesn’t guarantee they can help you. In this field experience and innate ability are just as important as formal training and diplomas.
Finding a Coach
A good starting point for finding a coach is ADHD WA. You can identify possible coaches in your area or long-distance coaches, whom you can work with on the phone. Another option is to log onto the websites of organizations that certify or list coaches. The International Coach Federation (ICF) certifies life coaches, but not specifically those trained in ADHD / LD. The Professional Association of ADHD Coaches (PAAC) and the ADD Coach Academy are also options for finding a coach, listing coaches who have additional training in ADHD.
When choosing to work with a coach you are in the drivers seat – be sure to ask questions and weigh up all the factors mentioned, before commencing a coaching agreement.
Medication - Stimulant medications are the best (they stimulate the under-active organizing part of the brain to fine-tune some erratic brain function). Two are available in Australia: Methylphenidate (brand name 'Ritalin') and Dexamphetamine. If one does not suit, the other should be tried. The medications can be taken just for school/work periods and not on holidays or weekends, or may need to be taken all the time. It is unclear as to who will grow out of it and who will not, and so extended periods off the medications (eg one month) should be trialed occasionally (eg Christmas holidays) to see if it is still necessary.
They work quickly (about 30 minutes) and last half a day (hence taken after breakfast and lunch). Longer acting (ie once daily) versions are available and they avoid lunch time dosing which is especially handy for school children. Types available include methylphenidate as 'Ritalin LA' or 'Concerta' and dexamphetamine as "Compounded" or "lisdexamphetamine/Vyvanse". (Note" Ritalin LA, Concerta and Vyvanse are more expensive if the ADHD was diagnosed over the age of 18).
Atomoxetine (‘Strattera’) is a new non-stimulant medication for ADHD which can be useful in that it does not have the on/off effect of stimulants and does not have some of the potential side effects (eg decreased appetite/sleep). However, it takes a few weeks to see if it is working (compared to a few days with the stimulants) – cheap if under 19 but more expensive for newly diagnosed adults.
Other medications can be used but are less effective compared with stimulants. Clonidine is useful for the hyperactivity/impulsivity problems and is often used with stimulant medication. Some antidepressants may be useful for their anti-ADHD effect, not for their antidepressant effect.
Currently in WA, only psychiatrists are able to start stimulant medication for adults (ie 18 and over). For children, both peadiatricians and child psychiatrists are authorised to start stimulant medications. Once children and adults are started on stimulants and are stable, GPs can sometimes share the prescribing, as a ‘co-prescriber’.