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Areas › Focus, starting, and ADHD › Treatment and medication
Consequences live in other people's responses, and a child who cannot yet hold a reward in mind across three days cannot supply them for themselves. So the adult provides what the child's own system cannot make: something that arrives quickly, is easy to notice, and follows the behaviour closely enough to be connected to it. This is why the plan is written for the parent or the teacher rather than the child, and why it asks more of the adults than of anybody else.
This explains how treatments work. Never start, stop or change a medication because of something you read here.
Be steadfast: your steadfastness comes only from God (Quran 16:127). Steadiness is being asked of the adult here, and the verse says where to look when it runs out.
النحل
وَٱصۡبِرۡ وَمَا صَبۡرُكَ إِلَّا بِٱللَّهِۚ وَلَا تَحۡزَنۡ عَلَيۡهِمۡ وَلَا تَكُ فِي ضَيۡقࣲ مِّمَّا يَمۡكُرُونَ
So [Prophet] be steadfast: your steadfastness comes only from God. Do not grieve over them; do not be distressed by their scheming
Qur’an 16:127read it in the library
Translation: M.A.S. Abdel Haleem, The Qur'an, Oxford University Press, 2004.
A randomised trial tested integrated CBT that addressed ADHD and substance use together against CBT focused on the substance use alone, in a group where the usual ADHD medication is not effective. It is a reminder that what people around a person do, deliberately and to a structure, is a real lever where medication cannot reach. The group studied is a particular one, so it supports the general principle rather than this specific technique.
van Emmerik-van Oortmerssen K, Vedel E, Kramer FJ, Blankers M, Dekker JJM, van den Brink W, Schoevers RA. (2019). Integrated cognitive behavioral therapy for ADHD in adult substance use disorder patients: Results of a randomized clinical trial.. Drug and alcohol dependence doi
Strength of evidence: one line of research. A single study, or a theoretical account.
A child who cannot hold a distant consequence in mind needs one supplied nearby, and only the adults can do that.
Coaching for adult ADHD comes down mostly to one thing: a standing appointment with somebody who will ask how it went. That sounds thin until you have tried keeping a plan alive entirely on your own.
Before anything else, the people around the child need to understand what ADHD actually is. Everything else works better once that has happened.
A great many people are diagnosed and then left with a starting dose nobody ever revisited, no reading, no group, nothing else at all. If things have stalled, the first thing to check is whether the treatment was ever actually finished.