Conventional treatment

Most experts now agree that the most effective treatment for hyperactivity is medication, such as methylphenidate (Ritalin), dextroamphetamine sulfate (Dexedrine), pemoline (Cylert), or one of several antidepressant medications. These medications may produce nuisance side effects and sometimes problems that are more serious, but the great benefits they provide may be worth the risks. Obviously, the question of benefits versus risks is difficult.

Family counseling can also be helpful for a child with attention deficit disorder; especially in teaching parents which behaviors are attributable to the disorder and which are not. The thrust is to help the family structure the child's activities, learn to identify the child's special skills or gifts, and provide consequences to use for inappropriate behavior.

Much is made of educational treatment. In fact, the American Academy of Pediatrics Committee on Children with Disabilities has stated that behavioral and educational treatment should be tried before medication. However, only one state and Washington, DC provide for academic and behavioral assistance for hyperactive children. Although some teachers are very good with these children, many teachers have little training in dealing with them. Too often, children are incorrectly labeled as emotionally and behaviorally disturbed and are unnecessarily transferred to special settings.

Physical Education (PE) offers an opportunity for therapy, but it is seldom exploited properly. Hyperactive children typically have a rough time in PE because of their poor listening skills, distractibility, and impulsiveness. PE teachers should receive in-service training in the proper management of these children, as should playground monitors and school bus drivers.

For the present, however, most pediatricians cannot count on successful educational modifications and must rely on family therapy and medication. Sports participation can serve as an important adjunct to these modalities.

Choosing an activity

To integrate recreation and sports into treatment, the activities must be planned thoughtfully. Parents are familiar with "individual education plans," based on careful consideration about which sports or recreation programs are suitable.

Through short interviews with children and parents, a pediatrician usually may help the family select activities most likely to bring success. The pediatrician attempts to find out why certain athletic and recreational activities have failed in the past. How does the child spend free time? What activity does the child usually do when asked what he or she would like to do? What assets do the parents see in the child in the way of eye-hand coordination, running skills, speed, endurance, and strength? How mature is the child physically and emotionally? If the pediatrician knows about local opportunities for sports and recreation, he or she can greatly assist the parents in choosing an activity or activities to fit the child. For children with motor coordination problems or other special problems, the pediatrician might want to consult an adaptive PE instructor for advice about the best activity.

It is important for parents to talk to the coach or recreation leader about their child's skills and problems before a program begins, but parents worry that this will create a negative attitude in the coach or teacher. On the contrary, most coaches want and need to know about potential problems in advance. If not made aware of the problem, the coach probably will interpret some of the child's behaviors as deliberate and possibly directed at the coach, which will leave a particularly bad impression.

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