ADHD Beyond the Myths
FDU Enabling Children and Adults to Combat the Disorder
By Angelo Carfagna
When people discuss learning disabilities, Attention Deficit Hyperactivity Disorder (ADHD) often is mentioned but ADHD is not a learning disability. Its impact extends beyond the classroom and into all aspects of an individuals life.
According to the National Attention Deficit Disorder Association (ADDA), 4 to 6 percent of school-aged children have ADHD, which is best described as a neurological disorder. Contrary to some misconceptions, people do not outgrow ADHD. In fact, the disorder becomes more complex as a child grows and faces greater academic and social challenges. Often, individuals continue to show symptoms throughout adulthood, which is why FDU has developed two specialty clinics for this disorder: the Child and Adolescent ADHD Clinic and the Adult ADHD Clinic.
There are three main types of ADHD, says Linda Reddy, assistant professor of psychology and the director of FDUs Child and Adolescent ADHD Clinic: the inattentive type, the hyperactive/impulsive type and the combined type.
The inattentive type is defined by the American Psychiatric Association as an individual experiencing at least six of the following characteristics: fails to give close attention to detail or makes careless mistakes; has difficulty sustaining attention; does not appear to listen; struggles to follow through on instructions; has difficulty with organization; avoids or dislikes tasks requiring sustained mental effort; often loses things necessary for tasks; is easily distracted; and is forgetful in daily activities.
The hyperactive/impulsive type is defined as someone who experiences at least six of the following problems: fidgets with hands or feet or squirms in seat; has difficulty remaining seated; runs about or climbs excessively (in adults may be limited to subjective feelings of restlessness); has difficulty engaging in activities quietly; acts as if driven by a motor; talks excessively; blurts out answers before questions have been completed; has difficulty waiting in turn-taking situations; and interrupts or intrudes upon others.
In order to meet the diagnostic criteria, these behaviors must be excessive and long-term and must create a real handicap in at least two areas of a persons life, such as school, home, work or social settings. Many individuals with ADHD also exhibit other psychiatric disorders, such as specific learning disabilities and anxiety or depressive disorders.
Although the causes of ADHD remain unclear, there does seem to be some type of biological disposition, says Reddy. In fact, according to ADDA, there is a 25 to 35 percent probability that another family member has ADHD. Contrary to some myths, Reddy adds, ADHD is not caused by poor parenting, inadequate teaching, food additives and pollution in the environment.
Helping Children Cope
Symptoms usually arise in early childhood, and most children with ADHD are diagnosed by first or second grade, says Reddy, who specializes in research on children with disruptive behavior disorders including ADHD. She has co-edited the books, Innovative Mental Health Interventions for Children: Programs That Work and Inclusion Practice in Special Education: Research, Theory and Application.
Reddy founded FDUs child and adolescent clinic in 1998 to join the expansive range of offerings provided by FDUs Center for Psychological Services. Now acting director of the center, Reddy says, Unlike other universities that have small training clinics, the Center for Psychological Services serves hundreds of families each year and offers a broad array of adult, parent, child and school assessment and treatment services.
Reddy has developed a specialized program that provides both cognitive/behavioral assessment and treatment for children with ADHD and their families. The clinic uses a multimodal treatment approach that offers problem-focused interventions and support services for children, families and schools. The program is staffed by licensed psychologists, certified school psychologists and doctoral students in the school and clinical psychology programs at FDU. All services are strictly confidential and offered on a sliding-scale fee basis.
At the clinic, child- and parent-group training programs are run concurrently. Reddy says the child-group training is designed to enhance social skills, self-control and anger/stress management. She adds that the parent-group training has five goals: 1) broaden parents understanding of the childs disorder; 2) identify their childs strengths and challenges; 3) teach parents the effective use of behavioral techniques in the home and public places; 4) build healthy family interactions; and 5) improve parental anger/stress management.
Reddy added that the parent group provides parents a natural context to gain support, friendship and comfort from each other. As one parent of a child recently in the clinic says, perhaps the biggest plus is the realization that you are not alone. In meeting other parents who were trying to cope, we had a sounding board for our concerns and a place to learn helpful strategies.
Before a child is accepted into the clinic, a comprehensive assessment is required to determine a childs eligibility into the program and to group the children and families according to their specific needs.
Besides child- and parent-group training, parents and teachers are provided behavioral consultation services by school psychologists in the home and school. These consultations help parents and teachers work collaboratively in designing behavioral interventions for the child. As Reddy says, This outreach component is very important for maintaining and transferring treatment gains to the home and school. For ADHD children to be successful, their parents and teachers must develop a working partnership. It is a team effort.
Those with ADHD, she adds, most often display not merely an inability to pay attention, but most significantly an inability to plan effectively and follow directions. These kids are usually bright and have no trouble understanding directions. But they have problems taking what they know and using it in an organized and effective way. Basically, this is a doing disorder, not a knowing disorder.
But the impact often goes deeper. Many of the children in our program have been unsuccessful in school and unsuccessful making friends, Reddy says. In some cases, parents have reported they feel tremendously isolated because of their childs behavior. This is why it is essential to work with the parents as well as the teachers.
There are several steps teachers can take to assist students with ADHD, says Reddy. Its helpful for teachers to break tasks down into steps for the students, develop specific behavioral goals in the classroom, use reward systems, develop a proactive relationship with parents early in the school year, send daily school/home notes that focus on positive and negative behaviors and provide, if needed, extended periods of time for tests.
Stimulant medication (most commonly Ritalin) often is used to treat children with ADHD. While the clinic is not authorized to prescribe medication, it can refer patients to psychiatrists. Reddy says, Medication can be highly effective in helping children improve their concentration and attention to academic tasks; however, medication alone does not necessarily help childrens ability to make and maintain friendships, build healthy family interactions and work cooperatively in groups.
She adds that while there is no cure for ADHD, there are managing strategies that can increase individuals social, behavioral and academic functioning. Early intervention is the key to success, says Reddy, who points out that up to 30 percent of children with ADHD who do not receive treatment do not complete high school and are at a higher risk for substance abuse, negative encounters with police, automobile accidents and relationship problems.
In studies conducted thus far, Reddy has found that the clinics multimodal program has been effective in reducing aggression in the home and school. She also has discovered that parents stress levels significantly decrease after completing the program, and childrens abilities to socialize with peers and siblings significantly improve.
I would definitely recommend the program, says Rita OConnell, whose hyperactive son, Danny, was diagnosed with ADHD when he was 3 years old. After trying other programs and even medication, she turned to FDUs clinic. What Dr. Reddy taught us was how to help our children know their triggers and apply internal controls. She gave us the tools and the insight to help our child.
OConnell says the clinics emphasis on positive reinforcement and behavior modification strategies was particularly helpful. She especially found useful the token economy system, in which poker chips are given to reward certain behaviors and then can be traded in for books, video games, etc. In addition, children play games that build social skills and act out situations that commonly cause problems.
Today, Danny is in the first grade and is an honors student with no behavioral problems. OConnell continues to keep in touch with Reddy, who offers further advice on how to reinforce the clinics lessons. Reddy emphasizes that efforts at managing life with ADHD have to be maintained long after participation in one program. There is a great need for children with this disability to continue to be helped because as they get older, the social and academic demands become greater. Thats why we dont just provide management skills for the children but for parents and teachers as well.
The ADHD clinic also serves as a clinical and research training facility for graduate students in the school and clinical psychology programs. Tara Hall, MA00 (T-H), who is pursuing her PhD in clinical psychology and who has worked with the clinic since its establishment, says Reddy and FDU have filled an important need in the community. I did not see one child in the clinic who did not benefit from the program. And Ive received great feedback from parents. More and more people are coming to the clinic.
For Hall, who will soon be a school psychologist, the program also has given her tremendous opportunity to gain professional training. I always wanted to work with children. Working at the clinic has reinforced for me the importance of having early intervention services for children who need help. Ive also been impressed by the resiliency of these children and their families.
Adults with ADHD
The success of the Child and Adolescent ADHD Clinic has led to the establishment of a clinic for adults, directed by Lana Tiersky, an assistant professor of psychology who joined the University in 1999. After the success of the childrens ADHD clinic, we thought it would be great to expand the services to adults, says Tiersky. There arent a lot of resources available for adults with ADHD.
Tierskys background made her a logical choice to head the clinic. She has a PhD in clinical psychology and has completed postdoctoral work at the Kessler Medical Rehabilitation Research and Education Corporation, West Orange, N.J., studying neuropsychology and patients with mild brain injury. Tiersky has specialized in working with people who suffer from cognitive disorders in which attention deficits occur.
Tiersky describes ADHD as a debilitating condition, which manifests itself in several ways. Adults with ADHD are often highly distractable, restless and poor at tasks that require advanced planning and organization. Other symptoms include poor memory, difficulties completing everyday jobs and emotional distress. As a result of these symptoms, an adult with ADHD may have family problems, be unable to work or be unable to enjoy their free time. Some cant hold jobs or move forward in their careers. Others have poor marital or social relationships.
In general, adds Tiersky, the research on adults with ADHD, particularly regarding the causes and treatment, is significantly lagging behind research on children with the disorder. For example, while research has shown that medication can help children, the potential benefits for adults are still being investigated.
Tiersky says that ADHD has become a popular topic and is the subject of many self-help books and Web sites, but theres a common misconception that anyone who has a problem organizing or completing tasks must have ADHD. As a result of some of the checklists available, a lot of people are forming their own diagnoses, many of them incorrect, and then consequently not getting the proper treatment.
Thats where FDUs Adult ADHD Clinic comes in. Opened last fall, the clinic provides both assessment and treatment services. Like the Child and Adolescent ADHD Clinic, it is staffed by doctoral-level graduate students and licensed doctoral faculty. Also like the childrens clinic, there is a sliding-scale fee based on the patients income or ability to pay. We want to serve those in the community who need our help.
The first step, says Tiersky, is making an accurate diagnosis. As with children, she says, its important to rule out the possibility that other disorders are responsible for the symptoms.
We provide a comprehensive evaluation, says Tiersky. The students and I work as a treatment team and make independent analyses. Then we confer and make a final determination and discuss treatment plans.
The treatment program includes psychotherapy that is designed to help with emotional and behavioral difficulties. We look at how the disorder affects the patients lives, their moods and their ability to communicate.
The second part of the treatment is cognitive rehabilitation, meaning therapy designed to improve attention, concentration and memory. For example, patients will learn how to manage memory problems with things like note-taking tips and how to manage their environments to enhance their mental performance.
Tiersky adds that most of the compensatory strategies are very simple, common sense lessons, such as reducing distractions at work and home, better organizational methods, etc. We focus on the pragmatics of how people learn. For example, someone with trouble concentrating might request holding meetings in a conference room rather than an office that is prone to interruptions.
Another component of the treatment is attention-building exercises. Were attempting to get them to improve their focus by listening to tapes, sort of like exercising a muscle to strengthen it. Even if this doesnt prove to have long-term benefits, clinically its still very effective because it helps patients identify how severe their problem is. But whether you can strengthen someones attentive capabilities when they have ADHD is not yet scientifically proven.
Tiersky is confident the clinic will help adults with ADHD and, through gathering data, contribute to the research and understanding about the disorder.
For more information about the Child and Adolescent ADHD Clinic, contact Linda Reddy, director, 201-692-2645, or e-mail Reddy@alpha.fdu.edu. For more information about the Adult ADHD Clinic, contact Lana Tiersky, director, 201-692-2645, or e-mail Tiersky@alpha.fdu.edu.