Each year, Kennedy Krieger Institute's Center for Development and Learning evaluates and treats several thousand children with ADHD. The evaluation includes a detailed medical, developmental and behavioral history of the child. "We verify concerns with a behavioral checklist completed by parents and the child's school," explains Paul Lipkin, M.D., director of the Center for Development and Learning. "After the evaluation, we look at issues regarding the child's attention, concentration, behavior and interactions, as well as his overall health and development."
In 2001, six-year-old twins, Terrel and Kerrel Williams, were brought to Kennedy Krieger to address their behavioral concerns. Nancy Grace, Ph.D., a psychologist at the Institute, indicated that the problem may be related to ADHD and treated the boys with behavioral intervention for several months. With this treatment, the twin's behaviors improved substantially, but they continued to act out in other ways that Dr. Grace believed could affect their school performance. After educating the twins' grandmother, Charlotte Williams, about the benefits of medication, the twins were prescribed a treatment regimen that helped significantly. "They don't act out as much as they used to," she says.
Treatment for ADHD consists of medication, behavior modifications, academic interventions, environmental restructuring and individual or family therapy. At the Center for Development and Learning, children are commonly treated with a combination of therapies.
"Medications have been used to treat ADHD for nearly 70 years. At Kennedy Krieger, we have a long history with their use and understand their effects and side effects," Dr. Lipkin says. "Medication can make a dramatic difference in the way a child functions at school, as well as the way in which he interacts with people in general. Families should keep this treatment option in mind and discuss it with their doctor."
There are several forms of medication, including antihypertensives, antidepressants and stimulants, such as Ritalin,® used to treat ADHD. Until five years ago, Ritalin® was the most commonly prescribed stimulant. Now, several new medications have replaced it. For instance, many physicians are recommending long-acting stimulants, such as Concerta® and Ritalin-LA,® which are effective up to eight hours a day.
In January, Dr. Lipkin and other providers at the Center for Development and Learning began using a new medication called Strattera® for children who have not benefited from stimulant medications. "Potential advantages of Strattera® are that it is not a controlled substance. Children can take it in a single morning dose, and it may have a 24-hour effect," he says.
While medications can help subside many symptoms of ADHD, experts recommend that children receive behavioral and academic intervention in conjunction with them. Terrel, who is in a small class at his school in Baltimore, benefits from one-on-one attention from his teacher. "Every child with ADHD requires a multi-modal treatment program, consisting of medication and educational intervention," explains Dr. Denckla, director of the Department of Developmental Cognitive Neurology at Kennedy Krieger. "The educational piece of treatment has to do with awareness of executive function and the role of executive function as a brain capability involved in being a student. It also entails strategic application of learning techniques."