ADHD/ADD — Attention Deficit Hyperactivity Disorder

For over 20 years the Centers for Family Change has evaluated and treated children, adolescents and adults with ADHD (Attention Deficit Hyperactivity Disorder).

What Is ADHD?

• ADHD is a disorder of self-control or self-regulation.
• ADHD is characterized by significant difficulties with impulsive behavior, attention and hyperactivity.
• ADHD is a disorder people are born with, and not a result of parenting, environment or diet.
• ADHD is a disorder that makes life significantly more difficult.

(Click here for more information about ADHD: An Overview of ADHD)

How Do You Diagnose ADHD?

To be diagnosed with ADHD a child, adolescent or adult has to have:

• Multiple current symptoms of ADHD (6 symptoms per DSM IV criteria).
• Symptoms that are significantly interfering with functioning.
• A history of ADHD-like symptoms starting in childhood.
• No other disorder or problems that better explains current symptoms.

An Interview-Based Assessment Model:

The Centers for Family Change therapists utilize an interview-based assessment model to diagnose ADHD. Our model relies on in-depth clinical interviewing, supplemented by standardized rating scales. Our approach is based on the work of Russell Barkley, Ph.D. In complex cases, or when more than one problem may be present, psychological testing may be recommended to help with diagnosis.

Click here for more detailed information on assessing ADHD.

Treatment of ADHD

Our treatment model emphasizes a coordinated and multifaceted approach. We work with parents/families to help parents develop more effective ways of assisting their child or teen who is struggling with ADHD. We work with the child or adolescent on developing a better understanding of their disorder and on using strategies to better help themselves. We work with adults on ways they can better understand, manage and compensate for their ADHD symptoms. In addition, we coordinate our efforts with schools and with physicians.

Click here for more information on the treatment of ADHD in children & adolescents.

Click here for more information on the treatment of ADHD in adults.

Issues in Assessing ADHD

• Is there a test to determine if someone has ADHD?
  • There is no test that can determine whether someone has ADHD.
  • The best way to diagnose ADHD is to get a full picture of how an individual is functioning in different areas of his or her life. This can best be achieved through detailed interviewing.
• I have heard you need extensive psychological or neuropsychological testing?
  • This is not true. While testing can help diagnose many problems it is not the way to diagnose ADHD.
  • ADHD is not a disorder of not being able to do something, it is a disorder of not being able to do things (sustain attention, sit still, control responding) consistently. Thus, obtaining a full picture of how an individual is functioning in his or her life is a far better diagnostic method (and far less costly).
• What about new tests for ADHD that measure vigilance, attention etc.?
  • While there is some suggestion that some of these tests may be promising there is no evidence that on their own these tests are adequate tools for diagnosing ADHD.
  • Remember, to be diagnosed with ADHD one has to not only show sufficient current symptoms but have a history of symptoms dating back to childhood. These tests do not assess these issues. At best, they can be used to supplement an evaluation.

Special Issues in Assessing ADHD in Adolescents

Evaluating adolescents requires both an understanding of ADHD and of the issues and challenges of adolescence. Specifically, ADHD symptoms can take different forms in adolescence than in childhood. In addition, for some, adolescence can be a time of emotional volatility and risk taking. Careful evaluation is needed to identify the presence of ADHD symptoms and to insure that normal adolescent struggles are not confused with ADHD. Please see our article "Assessing ADHD in Adolescence" for a thorough discussion of these issues.

Assessing ADHD in Adults

Assessing ADHD in adults is a particularly complex task. First, ADHD in adulthood does not look like ADHD in childhood. Problems of impulsivity and inattentiveness are manifested in different ways. Second, to make a diagnosis, it is critical to establish early onset of ADHD. Thus, extended interviewing and review of available records is a critical part of the evaluation. Third, adults with ADHD are at risk for other problems, such as depression. Thus, the assessment needs to determine if other problems are present, and to differentiate ADHD from other disorders. Please see our article "Assessing ADHD in Adults" for a thorough discussion of these issues.

Staff

Therapists specializing in the assessment of ADHD:

Peter Perrotta, PhD
Katharine Grinnell-Noak, PsyD
Martha Cook, MSW, LCSW, LMFT
Michael Losoff, PhD
Rebecca DeNosaquo, PsyD
Carol Wahlstrom, RN, MS, LCPC
Jenny Kepler, MSW LCSW

Treatment of ADHD in Children & Adolescents

Treating children and adolescents with ADHD requires a multifaceted approach.

Working with parents/families

Children and adolescents with ADHD often need more structure and guidance. These children often have difficulties learning from mistakes and following rules, not because they do not understand consequences or rules, but because they are impulsive and do not stop to think about the implications of their actions.

Therefore, working with parents on ways to provide their children with more structure and guidance is critical in helping families where a child or teenager has ADHD. Younger children will often need more supervision to successfully complete tasks, more rewards to increase motivation and follow rules, and more support in coping with the demands of school. With older children and adolescents more parental oversight is often required to make sure that homework and chores are completed and rules are followed.

In our work with families, with a child or adolescent with ADHD, we often focus on helping parents identify and implement more effective ways to set and enforce rules, provide structure and support, and offer their children and adolescents guidance in managing ADHD. We also seek to involve the child or teen with ADHD, in this process. Our therapists are skilled in enlisting children and adolescents to work on finding more effective ways to resolve conflicts and better manage problems associated with their ADHD.

Increasing motivation and effort

One of the major concerns of parents with a child or teenager with ADHD is that the child or teen shows little or inconsistent motivation in school, fails to consistently do or complete school work, and shows limited interest in learning. This is a source of great frustration for many parents and a source of great concern, particularly for parents of adolescents as college looms in the future.

A variety of strategies can be useful in addressing these issues. These range from working with families on ways to garner more support from school personnel to the use of more structure and rewards to help motivate the student with ADHD. Finally, a key part of therapy is to prevent or alleviate power struggles that may arise over school work and inadvertently exacerbate problems.

Improving self-control and compliance

The other major complaint of parents of children and adolescents with ADHD is that their child or teenager fails to follow rules, is argumentative and defiant, and has poor self-control. These problems are clearly consequences of ADHD. However, they can take on a life of their own. In fact, there is good evidence that children and adolescents with ADHD are at increased risk for Oppositional Defiant and Conduct Disorders.

Working with families on ways to more effectively establish and enforce rules is often a key part of the treatment of children and adolescents with ADHD. Research has supported the use of positive consequences and parent training/behavior management strategies. Family therapy can provide a valuable forum where parents can learn more effective strategies to help their children and teens follow rules, where children and teenagers can practice and strengthen their ability to negotiate with parents in a respectful way, and where conflicts can be resolved and problem solving skills strengthened.

Working individually with children and adolescents with ADHD

We do not advocate individual therapy as the primary treatment for ADHD. ADHD is a disorder of self-control, of self-regulation. Individual therapy is based on the supposition that one can take what one has learned in therapy, and apply it in one’s day to day life. The nature of ADHD calls into question the value of individual therapy as a primary treatment approach for children and adolescents because ADHD is a disorder of self-control. Russell Barkley’s dictum, that “ADHD is a disorder of not doing what you know, not of not knowing what to do” clearly suggests that teaching skills is not likely to be of real benefit. However, children and adolescents with ADHD, can certainly benefit from individual therapy as a way of addressing and coping with the consequences of ADHD (social, emotional and behavioral problems that arise from ADHD) and as a way of better understanding themselves and the meaning of an ADHD diagnosis.

Medication Treatment

Research has consistently shown that medication based treatment is the treatment of choice for ADHD. There have been hundreds of studies which have consistently found medication based treatment to be the most effective treatment for ADHD. In 1999 the results of multi-site NIMH funded studied consistently found that medication treatment was by far the most effective intervention.

Unfortunately, medication treatment is far from perfect. Medication does not cure ADHD. Moreover, most stimulant medications are time limited (even extended release medications). Thus, for part of the day people with ADHD are without the benefit of their medication (the exception to this being non-stimulant medications such as Strattera and Intuvin).

Moreover, medication is a management tool, not a cure for ADHD. For many, medication moderates or lessens symptoms, but does not completely eliminate ADHD symptoms. For some, the benefits of medication are limited, lessening symptoms only a mild to moderate degree. Finally, for a minority of individuals medication has limited benefits or the side effects are not tolerable. Thus, therapy is needed to help individuals and families cope with the challenges of ADHD.

Working with Schools

School is an area where many children and adolescents with ADHD struggle. Homework is often a major problem: the ADHD child or teen may “forget” to bring home or turn in homework, have difficulties staying on task when doing homework, and have significant difficulties organizing school materials, studying and working ahead. In addition, children and adolescents with ADHD may be more prone to disruptive behavior in school. Problems with self-control may also result in more difficulties with peers.

Centers for Family Change therapists take a two pronged approach in working with these issues. First, we work with families and children/adolescents on strategies to address school issues. This often includes setting up homework plans, to insure completion of homework, and working with parents to support rule following in school. Second, we will talk with school personnel and work to help schools develop more effective interventions to help students with ADHD.

When needed, our staff can provide letters to support the establishment of a 504 plan to make sure that plans to help a student with ADHD are established.

Nontraditional Treatments or “Buyer Beware”

As knowledge of ADHD has become increasingly wide spread more and more treatment options have proliferated. Historically, medication and behaviorally oriented therapies were the first treatments used for ADHD. Over the years a plethora of treatments have been offered to the public. These range from biofeedback treatments, to diet supplements, to memory and cognitive training programs. The problem with all of these non-traditional treatments is that there is no sound evidence to support their effectiveness. While proponents of some of these treatments cite studies to support their claims these are typically not methodological sound studies or there are only one or two studies, conducted by proponents of the model. Thus, the traditional warning of “buyer beware” needs to be associated with all of these approaches despite testimonials and claims of “promising results.”

Staff

All Centers for Family Change therapists provide treatment to children and adolescents with ADHD.

Resources

We have selected resources our staff have found to be particularly helpful. You can also access this listing in the Articles and Resources section of this site. For your convenience, we have listed below the two resources we recommend the most.

Barkley, R.A., Taking Charge of ADHD, Revised Edition, Guilford Press, N.Y., 2000.
This is an extremely well written and useful book for parents. It provides a clear understanding of ADHD as well as detailed information on assessing and managing ADHD in children.

www.chadd.org This is the website for Children and Adults with Attention Deficit/Hyperactivity Disorder (CHADD), a national advocacy and self-help group. This site offers much information about ADHD, updates on the latest research, advocacy information, and a variety of resources for individuals and families.

References

The model for understanding ADHD is derived from the work of Russell Barkley, Ph.D., primarily the following three works. Rather than repeatedly referencing them throughout this section, we are noting them here as the key influences for our understanding of ADHD.

Barkley, R.A., Attention-deficit Hyperactivity Disorder: A Handbook for diagnosis and treatment, 2nd ed., Guilford Press, N.Y., 1998.

Barkley, R.A., ADHD and the Nature of Self Control, Guilford Press, N.Y., 1997.

Barkley, R.A., Taking Charge of ADHD, Revised Edition, Guilford Press, N.Y. 2000.

Treating ADHD in Adults

A multifaceted approach to treatment is also called for with adults. Therapy and medication are both important interventions in helping adults more effectively cope with ADHD. Therapy can help adults better understand the meaning and implications of ADHD, learn more effective ways to cope with ADHD symptoms, and resolve family and marital tensions that may have resulted from untreated ADHD. Medication is the key intervention for lessening or alleviating the core ADHD symptoms.

Education/Understanding ADHD’s Impact

It is critical that adults understand the implications and impact of ADHD on their work and personal lives. ADHD is not just a school problem for children. Similarly, it is not just a work problem for adults. Equally important, spouses/partners/family members need to understand that the adult with ADHD is not deliberately forgetting to do things, running late, or leaving tasks undone.

Strategies for Managing ADHD

There are a number of strategies that adults can use to help them better manage their lives. These range from traditional time management strategies and the use of organizational tools, to more innovative efforts to structure one’s life and stay on top of tasks, such as enlisting one’s spouse or partner as coach or resource person.

Medication

While research suggests that medication is equally effective for adults with ADHD as it is for children and adolescents, medication can be more complicated with adults. Cardiac and blood pressure issues may make the use of stimulant medications more complicated. Thus, careful evaluation and monitoring of medication treatment is critical.

Individual Therapy

ADHD cannot be “cured” by therapy. However, therapy is often useful for adults with ADHD. Therapy can provide a forum where adults come to terms with the impact and effect of ADHD on their lives, come to terms with the diagnosis and its implications for career and family life, and address feelings of inadequacy, anxiety or depression that may have resulted from struggling with ADHD.

Couples/Family Therapy

Helping one's spouse or partner, along with other family members, understand the impact of ADHD is often a key factor in helping adults with ADHD cope more effectively with their diagnosis. ADHD can disrupt family life, as the adult with ADHD may struggle to complete tasks and manage responsibilities. Therapy can assist couples and families in finding ways to more effectively manage ADHD symptoms and work through problems that may have occurred due to untreated ADHD.

Staff

Therapists specializing in the treatment of ADHD in Adults:

Peter Perrotta, PhD
Katharine Grinnell-Noak, PsyD
Martha Cook, MSW, LCSW, LMFT
Michael Losoff, PhD
Carol Wahlstrom, RN, MS, LCPC

Resources

There are increasingly more resources for adults with ADHD. Web resources include:

www.chadd.org Originally, a group for parents of children with ADHD, this organization has expanded to become a national advocacy and self-help group for persons of all ages. This site offers much information about ADHD, updates on the latest research, advocacy information, and a variety of resources for individuals and families.

Books on ADHD:

Russell A. Barkley, Taking Charge of Adult ADHD. Guilford Press, 2010.
A well written and accessible book, Taking Charge of Adult ADHD offers guidelines for assessing ADHD in adults, as well as a detailed discussion of treatment options (including medication based treatment). In addition, Barkley provides an overview of his model of adult ADHD and offers practical advice to adults to assist them in coping with their ADHD.

Russell A. Barkley, ADHD in Adults. Jones and Bartlett, 2009.
A concise discussion of ADHD in adults which provides an updated understanding of ADHD, as well as a discussion of assessment and treatment issues.

Russell A. Barkley, Kevin R. Murphy, and Mariellen Fischer, ADHD in Adults: What the Science Says, Guildford Press, 2007.
If you want a scientific book that offers the most extensive and research-based examination of ADHD in adults, then this is the book to get. However, a warning: this book is slow-going and research-based. It is written for professionals.

Kevin R. Murphy, Suzanne Le Vert. Out of the fog: treatment options and coping strategies for adult attention deficit disorder, Hyperion, 1995.
A personal favorite. Offers a concise discussion of ADHD in adults, including information on the disorder, its assessment and treatment. The second half of the book offers tips and strategies for managing ADHD in adulthood.

Edward M. Hallowell & John J. Ratey. Driven to Distraction: Recognizing and Coping with Attention Deficit Disorder, Touchstone, New York, 1994.
Less scientifically based, but still useful in understanding the impact of ADHD. Hallowell has also written two companion books, Delivered from Distraction and Answers to Distraction, which offer practical advice and recommendations for adults with ADHD.

Pera, G. Is It You, Me, or Adult A.D.D.? Stopping the Roller Coaster When Someone You Love Has Attention Deficit Disorder, Alarm Press, 2008.
A new self-help book that offers more up-to-date information than either Murphy or Hallowell. With a foreword by Russell Barkley.

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