CENTER FOR THE PROFESSIONAL STUDY OF

ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD)

Dr. Robert R. Erk, Ed.D., is the Director of the Center for the Professional Study of Attention Deficit Hyperactivity Disorder. Dr. Erk is an Associate Professor of Counselor Education and Educational Psychology in the Department of Educational Studies at the University of Tennessee at Martin, TN 38238. Dr. Erk teaches graduate coursework in the school and mental health counseling tracks, is a past president of the Southern Association for Counselor Education and Supervision, serves as the American School Counselor Association Coordinator for Children With ADHD Professional Interest Network, is a Licensed Professional Counselor and Marital and Family Therapist in Tennessee, and is the parent of a child diagnosed with ADHD.

The Center strives to provide resources or information on ADHD for professional counselors, teachers, and parents, conducts inservices and workshops on ADHD at the state, regional, and national levels, and maintains a research and publication agenda on the disorder.

A SYSTEMS ORIENTED A PPROACH TO ADHD:

FAMILIES, SCHOOLS, AND COMMUNITIES WORKING TOGETHER

The Center is dedicated to advocating and promoting a Systems Oriented Approach To ADHD: Families, Schools, and Communities Working Together. A systems oriented approach to ADHD can be broadly defined as--the development of the child with ADHD and their ability to function more effectively in their home, in their school, and in their community--can often be related to the education and training on ADHD that has been conducted or occurred in the major systems that are connected to the affected child's life. The major systems considered here are the following:

THE FAMILY SYSTEM. For example, the parents and siblings comprise the family system; the family system may also be composed of extended or blended family members. It is important for parents (or all family members) to increase their knowledge and understanding of the ADHD, realize that the disorder has often brought about high stress levels for its members, and that the problem behaviors can be managed more effectively. Importantly, the family needs to understand that the unity of the parents and siblings in fully accepting the child with ADHD and working collaboratively to foster a supportive and healthy family environment is crucial. This includes the parents' taking responsibility for seeking and supporting appropriate treatment interventions or regimens for the ADHD.

THE SCHOOL SYSTEM. For example, the school officials, teachers, classmates, and peers comprise the school system. In many instances, by not being educated or trained on the symptoms and problematic behaviors that are often connected to the disorder, school personnel or educators may inadvertently exacerbate the symptoms or problematic behaviors of the child with ADHD. Unfortunately, classmates or peers at school often relentlessly tease, taunt, devalue, and socially shun many children with ADHD. For children with ADHD, these social-emotional experiences with classmates or peers can be indelible in their memories. Therefore, schools are the place of choice for also educating students about the ADHD symptoms and the problem behaviors they may observe.

THE SCHOOL TO FAMILY SYSTEM. For example, the school personnel or educators, parents, and siblings comprise the school to family system. The school and family system need to become clinical allies or form a therapeutic alliance for the identification and behavioral management of the child with ADHD. Moreover, school systems may be subject to complying with the provisions of the federal acts such as the Individuals With Disabilities Education Act (IDEA), Section 504 of the Vocational Rehabilitation Act, and the Americans With Disabilities Act (ADA). These federal acts can apply to students diagnosed with ADHD from elementary school through the college years. Schools are becoming increasingly aware of their legal obligation to appropriately serve children and adolescents with ADHD. For example, these federal acts have often served as an impetus and pointed out the need to increase the inservice education and training for educators on ADHD children. School systems may need to increase their vigilance for identifying and supplying appropriate interventions, accommodations or variations in classroom instruction and testing practices for ADHD children. At school, the counselor may consent to serve as a resource person or a case manager for appropriate services or treatment for the child with ADHD. By forming a school to home partnership and coordinating together the interventions or treatment plan, the likelihood that the ADHD child can perform more satisfactorily is optimized.

THE FAMILY TO COMMUNITY SYSTEM. For example, the parents and siblings along with the individuals in their community comprise the family to community system. Locale and its prevailing attitudes and sentiments are often the principal components of the community system. However, for the family with an ADHD child, the community system can refer more appropriately to the development of social interaction, social cohesion, moral support, and contains the potential for fostering a therapeutic resource or alliance. For example, it is crucial that our communities become better informed or educated on children with ADHD and their problematic behaviors, rather than focusing on and labeling the dysfunctional elements or parts of the child with ADHD. The family to community system is the place where the family lives, attends school, engages in recreational activities, has intimate ties, and it is the community that can act as a facilitator for fostering the development of positive mental health for many children with ADHD. Finally, it is the community that can strongly affect the course of events or the outcomes for families with an ADHD child.

CHANGING AND RECONSTITUTING SYSTEMS

From a systems oriented approach to ADHD, all of these systems can be perceived of as changing and reconstituting themselves by becoming more open to scientific, medical, and behavioral explanations for the disorder. For example, many persons who come into contact with an ADHD child do not know that the child's behavior is not willfully or deliberately planned to confront, undermine, or provoke their parents, teachers, or peers. Instead, becoming educated and understanding how this complex disorder can have life-long effects (e. g., academic, social-emotional, occupational) on the child with ADHD, and that the actions taken (e. g., positive or negative) in any one system can have reciprocal or circular effects. For example, the ADHD child's problematic behaviors or actions in any one system can in-turn influence the family, school, and community's reactions to the child. It should be remembered that these reciprocal actions and their consequences can often be imprinted into the life of the child or adolescent with ADHD.

CLOSING REMARKS

These systems can be viewed as forces working for either the good or to the detriment of the child with ADHD. There is an interconnectedness among the systems, the actions in one system or any part of it can affect the health or dysfunctionality of the child. The child with ADHD is an interacting and interactive member of these systems. They are powerful parts of the child's life and they frequently exert a strong influence over not only the child's behaviors, but certainly how their feelings, values, and attitudes evolve towards themselves and others.

A note of caution is probably in order, change in how these systems view and interact with ADHD children and adolescents will likely be gradual or long-term. By necessity there will need to be a heavy investment in education and training on the disorder.

MULTIDIMENSIONAL TREATMENT FOR ADHD

Through a systems oriented approach to ADHD and a multidimensional treatment plan the development of children and adolescents with ADHD can be enhanced. Perhaps the most important point of information to emerge from the last several years of research on ADHD is that no single intervention alone is probably going to be successful. The multidimensional treatment approach, moreover, needs to be long-term so as to optimize the child's development. The goal of multidimensional treatment should not be to find a cure. The goal is to provide interventions or strategies that can be important for managing this often chronic and disabling condition. The multidimensional treatment plan enables the professionals and parents to attack the ADHD from as many avenues as are feasible. Interventions or treatment typically includes some combination of the following:

PARENT EDUCATION. Education for parents and siblings on the ADHD symptoms and problem behaviors that are associated with the disorder is the necessary first-step. Parent education can be the benchmark upon which further progress for the family may be measured. For example, parent education can explain how the ADHD symptoms can frequently create in the home and at school, the myriad of problematic behaviors that are often considered disruptive or maladaptive to parents and teachers. Parent education can normally be accomplished in four to six well-planned one-hour sessions from a professional (or a parent support group) that is well-informed and experienced with the disorder. From parent education on ADHD, parents can be relieved of the guilt that they were somehow the cause of the disorder, they can acquire a better understanding of the disorder, and they can focus their efforts towards improving the quality of life for their ADHD child.

TEACHER EDUCATION. Educating teachers and school officials on the academic, behavioral, and personal-social problems that students with ADHD often exhibit provides them the information that they need to work more effectively with these children. As teachers and school officials become better educated about ADHD students, they can work collaboratively to maximize the interventions or strategies that are targeted at improving the academic, behavioral, and social functioning of these children. Through teacher education on the ADHD, issues such as educational negligence or malpractice with ADHD children can then be taken out of the equation. Increasingly, many state departments of education are urging local educational agencies or school districts to come into compliance with federal acts or statutes that can address the need for the identification and treatment of children with ADHD.

INDIVIDUAL COUNSELING. Professional counselors who work with ADHD children and adolescents should acknowledge at the onset that many of these children can be a formidable challenge. Often children with ADHD tend to be in a state of denial about their disorder and their problems. Moreover, many of these children can be oppositional in their attitudes, distrustful of authority figures, have low self-esteem, and see most of their difficulties or problems as being caused by others such as teachers, parents, and peers. Counselors who are remarkably patient and understanding, who can endure more relapses than progress in the beginning sessions or phases of counseling, and who can remain a positive force in the lives of these children often have the most success in forging a therapeutic relationship. Professional counselors should be aware that many children with ADHD can have coexisting conditions such as learning disabilities, oppositional defiant behavior, excessive anxiety, language usage problems, anger control problems, and can experience depression.

BEHAVIORAL MANAGEMENT TECHNIQUES. Educators and parents should consider that behavioral management techniques or strategies such as time-out, negative reinforcement, cost response measures for inappropriate behavior, contracting, earning rewards and special privileges for appropriate behavior, and cognitive behavioral training (e. g., self-instructional training) coupled with appropriate medical treatment seems to be the most effective treatment for many children with ADHD. In collaboration with the parents and the school, professionals, parents, and teachers can develop priorities for employing behavioral management techniques that target or address the child's problematic behaviors at school and in the home. It needs to be remembered that behavioral techniques or strategies often need to be varied, adjusted, or changed to meet the problematic behaviors or situations that ADHD children typically exhibit. It should also be remembered that there is a neurobiological basis for the ADHD. This suggests that ADHD children will often need more behavioral structure, more time to come into compliance, and more varied or unique reward systems to effectively promote change in their lives. Furthermore, in June, 1997 changes in IDEA were signed into law by President Clinton. One of the key changes, for example, that could be pertinent to schools and parents is the provision dealing with discipline. It is not usual for a child with ADHD to become involved at some point in their school career, in a disciplinary process that involves their behavior. In determining whether suspension or expulsion from school is allowable, the school or committee must consider: (a) the child's ability to understand or comprehend accurately what he or she did, and (b) their ability to control the behavior involved in the event or problem. The control part of this change can have important factors such as did the child have the opportunity to receive appropriate medication and interventions or treatment for the disorder.

SELF-ESTEEM EDUCATION. The major goal of parents, teachers, and counselors for many children with ADHD needs to be the restoration of their self-esteem. Without realizing it, many parents, teachers, and peers have often been excessively critical of the child, repeatedly complained about their misbehaviors, and unfortunately demeaned or belittled many of their efforts or struggles to improve themselves. For persons who come into contact with ADHD children, it should be remembered that they have endured many more frustrations and failure experiences in their young lives than other children. At every opportunity, parents and teachers should seek to create or take advantage of opportunities that can foster self-esteem and accomplishment in ADHD children.

SOCIAL SKILLS EDUCATION. There usually needs to be a strong instructional and training program on social skills education. Unfortunately due to their disorder, many ADHD children often have a limited or inadequate repertoire of social skills available to them. From the standpoint of many teachers and peers, poor or deficient personal-social skills stand-out almost immediately as the area most in need of improvement. For example, almost everything the child with ADHD does is viewed as socially different or inappropriate, they often feel that they are being excluded from active participation in their classrooms, and they often feel that their peers further exclude them from many social activities or games at recess. In many instances, the child with ADHD can also be disinvited by classmates or peers from attempting to play with them after school or on weekends. Instruction and real-life practice in acquiring an improved repertoire of social skills across settings (e. g., school, home) often needs to be a priority for many ADHD children.

FAMILY COUNSELING. Family counseling is frequently recommended because the ADHD typically disables the family's communication patterns, is a root cause of family disagreements or arguments, and can lead to marital dysfunction, sibling dissension, and the social shunning of the family by others in their community. Many families need to come to the realization that the child cannot be separated from their disorder. Accepting and nurturing the child with ADHD from childhood, to adolescence, to adulthood despite the multiple frustrations can be the best form of therapy. For children with ADHD, the unity of the parents can be crucial to the future direction of their young lives.

In summary, a systems oriented approach to ADHD and multidimensional treatment for the disorder can compliment and reinforce each other. They share the priority of providing and sharing education on the disorder and fostering a safer psychological environment for providing treatment or services for ADHD children. It is within the family, school, and community systems that children with ADHD can learn how to live more successfully and have more fulfilling lives.

REFERENCES/SUGGESTED READINGS ON ADHD

American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders (4th ed.), Washington, DC: Author.

Barkley, R. A. (1990). Attention Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment. New York: Guilford Press.

Barkley, R. A. (1995). Taking Charge of ADHD: The Complete Authoritative Guide for Parents. New York: Guilford Press.

Copeland, E. D., & Love, V. L. (1991). Attention, Please!: A Comprehensive Guide to Parenting Children With Attention Disorders and Hyperactivity. Atlanta, GA: Southeastern Psychological Institute Press.

Erk, R. R. (1995). The Conundrum of Attention Deficit Disorder. Journal of Mental Health Counseling, 17, 131-145.

Erk, R. R. (1995). A Diagnosis of Attention Deficit Disorder: What Does It Mean For School Counselors? The School Counselor , 42, 292-299.

Erk, R. R. (1995). The Evolution of Attention Deficit Terminology.

Elementary School Guidance and Counseling, 29, 243-248.

Erk, R. R. (1997). Multidimensional Treatment of Attention Deficit Disorder: A Family Oriented Approach, Journal of Mental Health Counseling, 19, 3-22.

Friedman, R. J., & Doyal, G. T. (1992). Management of Children and Adolescents With Attention Deficit Hyperactivity Disorder. Austin, TX: Pro-Ed.

Hallowell, E. M., & Ratey, J. J. (1994). Driven to Distraction: Recognizing and Coping With Attention Deficit Disorder from Childhood through Adulthood. New York: Touchstone.

Hosie, T. W., & Erk, R. R. (1993, January). American Counseling Association Reading Program: Attention Deficit Disorder. American Counseling Association Guidepost, 35, 15-18.

Learner, J. W., Lowenthal, B. & Learner, S. R. (1995). Attention Deficit Disorders: Assessment and Teaching. Pacific Grove, CA: Brooks/Cole.

Nadeau, K. G. (1995). A Comprehensive Guide to Attention Deficit Disorder in Adults: Research, Diagnosis, and Treatment. New York: Brunner/Mazel.

Reif, S. F. (1993). How To Reach And Teach ADD/ADHD Children. West Nyack, NY: Center for Applied Research In Education

Shaywitz, S. E., & Shaywitz, B. A. (1992). Attention Deficit Disorder Comes of Age: Toward the Twenty-First Century. Austin, TX: Pro-Ed.

Disclaimer: The information contained on this web page is intended to be for informational purposes only. It is not intended as psychological or medical advice. Individuals who are diagnosed with ADHD should secure information and recommendations on ADHD from their treating professional. A systems oriented approach to ADHD with families, schools, and communities working together and multidimensional treatment for ADHD are the focus of this web page and its contents. The University of Tennessee at Martin is not responsible for the information or views expressed herein. Last updated November, 1997. Copyright 1997. All rights reserved. EMail: rerk@utm.edu

INTERESTING LINKS FOR MORE INFORMATION ON ADHD

  • CHADD
  • School Psychology Resources Online
  • Internet Mental Health
  • Mental Health Info Link
  • Dr. Bob's Mental Health Links
  • Infoseek
  • Internet Mental Health Resources
  • American Counseling Association
  • American School Counselor Association
    This is the time this file has been accessed.

    rerk@utm.edu