What is Attention-Deficit/Hyperactivity Disorder or ADHD?
ADHD is a developmental and behavioral disorder characterized by the following three core symptoms:
- Inattention
- Hyperactivity
- Impulsivity
Diagnostically, there are three subtypes of ADHD:
- ADHD-Predominantly Inattentive Type
- ADHD-Predominantly Hyperactive-Impulsive Type
- ADHD-Combined Type.
Common symptoms of inattention include making careless mistakes in schoolwork
or chores, difficulty following instructions, misplacing belongings,
forgetfulness, difficulty organizing tasks and being easily distracted. Symptoms
of hyperactivity/impulsivity include difficulty remaining seated when
appropriate, excessive talking or movement, interrupting others and fidgeting.
If a child exhibits symptoms of ADHD, then is a diagnosis of ADHD appropriate?
Not necessarily. Diagnosis is reserved for children and adults who meet not only
symptom criteria, but also other diagnostic criteria outlined by the American
Psychiatric Association. Determining the presence of symptoms is only one part
of a comprehensive diagnostic evaluation. Furthermore, inattention and
impulsivity are symptoms of other medical or psychological conditions, such as
Bipolar Disorder.
Is there a test available that can diagnose ADHD unequivocally?
No. Despite evidence that ADHD has a neurological basis, there is no brain imaging
exam or any one psychological measure that can be used to diagnose ADHD. A
complete psychological evaluation is necessary to diagnose ADHD. Appropriate
diagnosis involves a detailed medical/family history, interviews with the
parents and the child, psychological testing and rating scales completed by
parents and teachers to identify behavioral and/or emotional symptoms.
Behavioral observation of the child during an office visit is not diagnostic,
as most children perform well during one-on-one situations. When making a
diagnosis of ADHD, mental health professionals consider the following questions:
- Are behaviors pervasive, present in more than one setting and before age
seven, and excessive given developmental age?
- Is there impairment in two or more areas of functioning (i.e., school,
home)?
- Are behaviors better accounted for by another medical or mental disorder?
Is medication the only effective treatment?
No. Although many stimulant medications (i.e., Ritalin®, Adderall, Concerta®) and some
non-stimulant medications (i.e., Wellbutrin®, Clonidine®, Effexor®) are effective
in helping some children manage the symptoms of ADHD, other treatment options
are available. A child's treatment plan may include educational accommodations,
behavioral management treatment and parent training or guidance.
The National Institute of Mental Health funded a study to compare the
effectiveness of medication management, behavioral treatment and a combined
treatment approach. The best known practices within each treatment approach were
selected for representation. Preliminary results indicate slight advantages of
the combined medication and behavioral treatment over single treatments in
certain areas of functioning (i.e., social skills, academics, parent-child relations).
The Summer Treatment Program offered through the Cleveland Clinic Children's
Hospital was selected as the behavioral arm of this nationally recognized
treatment study.
What is the Summer Treatment Program?
The Summer Treatment Program (STP) is a seven-week behavior modification program
that helps children, adolescents and their families learn to manage ADHD. The
STP is a well-established, well-documented treatment begun in 1980 by Dr.
William Pelham, a national leader in the area of childhood disorders. Published
reviews summarizing controlled studies of the STP and related research collected
over 15 years support its effectiveness. As an evidence-based program, the STP
uses only those interventions that have been demonstrated to work with ADHD children.
During the STP, are children involved with any academics?
As part of their daily activity, children between the ages of 6 and 11 engage in
three Learning Centers: Academic, Computer, and Art. During this time, children
practice skills that will allow them to become more successful in the classroom
environment (e.g., staying on task, following instructions, task completion).
Adolescents between the ages of 12 and 14 participate in 2 one-hour Academic
Learning Center periods. Teaching staff teach adolescents directed note taking
skills and strategies to pull the main ideas out of a lecture style classroom environment.
What is the child to counselor ratio, and who makes up the staff?
The program boasts a 2:1 child: counselor ratio. Five counselors, one graduate
student and four undergraduate students, supervise each group of 10-12 children.
Licensed teachers manage the academic and computer learning centers. Michael J.
Manos, PhD, clinical psychologist and clinical director, supervises all staff.
How are parents involved during the summer?
Parents are actively involved. Parents implement a Daily Reward System that is
individualized for each child. Parents are assisted with this process during
weekly parent training sessions, during which they also learn about appropriate
behavioral interventions that can be implemented at home. Current research and
strategies for school involvement are also discussed.
Is any follow-up treatment offered as part of the STP?
Parents are involved in monthly booster sessions, which meet throughout the school year.
Building on strategies covered during the summer, parents delve deeper into more
complex behavioral interventions, including effective school-based accommodations.
Does my child need to be diagnosed with ADHD in order to be accepted?
Yes. Children already diagnosed with ADHD do not need to be re-evaluated; however,
documentation of the diagnosis is required. Parents interested in a formal
diagnostic evaluation can schedule an appointment with the ACET Program
(216.445.7574). All children are screened for symptoms of ADHD during the
application process regardless of diagnosis in order to ensure appropriate
placement.
For more information on the psychological evaluations provided through ACET
or The Summer Treatment Program, visit the Center for Pediatric Behavioral
Health web site at www.clevelandclinic.org/childrenshospital.
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 10/11/2008…#8931
