The Proof is in the Jello
As the modern saying goes, “The proof is in the pudding.” But when it comes to talking about success working with troubled teens with ADHD, it might well be more accurate to say, “The proof is in the jello.”
Pudding tends to ooze or slowly slide, whereas jello wiggles, almost out of control, resisting all efforts to get it to stop and be still. Teens with ADHD are like that…seemingly perpetually wiggly. But are therapeutic schools as successful as they say they are when it comes to getting troubled teens to tame their wiggly nature?
Let’s take a look at the “jello,” before and after.
Attention-deficit/hyperactivity disorder (ADHD) is a psychobiological disorder that is described by attention deficit, hyperactivity, and reduced impulse control. A persistent pattern of this behavior interferes with normal daily functioning or development. Inattention manifests behaviorally in ADHD as wandering off task, lacking persistence, having difficulty sustaining focus and being disorganized. Hyperactivity refers to excessive motor activity (such as a child running about) when it is not appropriate, or excessive fidgeting, tapping, or talkativeness.1
What Does Research Tell Us?
Most research on therapeutic programs for ADHD focuses on the effects of medication, behavioral, cognitive, cognitive-behavioral, and neural treatments. And most literature on the success of treatments for ADHD concludes that the multi-modal approach is best for children and adolescents, as it combines developing self-control and self-regulation skills, understanding cognitive and cognitive-behavioral facts, practicing cognitive and behavioral play techniques, practicing functions management training, learning the technique of motor-perceptual rehearsal, undergoing verbal self-education training, training of stress coping skills, and adding in parent constructive training.1
Such studies showed that these treatments done in combination were more successful and had longer lasting effects on decreasing attention deficit, improving social skills, and diminishing behavioral problems related to ADHD, and even more so than a simple singular medication treatment or only behavioral therapy. When you add in the extra matter of problematic executive functioning (EFD), this collaborative approach is all the more effective, as together they address the development of working memory, planning skills, and progress monitoring.1
In research conducted on behalf of the Child and Adolescent Psychiatric Clinics of North America, the baseline immediacy for studying treatments for ADHD must be that treating children with ADHD during the school-age years is crucial. The short-term consequences of untreated ADHD symptoms and organizational impairments include poor scores on class tests, report cards and/or academic achievement tests. The short-term consequences of their social interaction problems include conflicted family relationships and few friendships, as well as frequent rejection or neglect from peer groups.2
And upon that premise, as the effectiveness of behavior management-type treatments is already well established for school-aged children and adolescents, such should be widely recommended to all families of children with ADHD. Combined behavior management treatments and stimulant medication have shown to be even more potent for achieving the best outcome possible.2
Another effective evidence-based treatment for ADHD involves working with parents (Family-Based Intervention) to teach them how to respond to their children with ADHD, in order to increase positive outcomes for their child both at home and at school. Overall, studies showed that Family-Based Intervention leads to improvements for children with ADHD in several areas, most notably, in the parents’ own ratings of their child’s problematic behaviors.3
Interventions in the classroom (Classroom Behavior Management) are also an empirically-supported treatment for ADHD. Similar to Family-Based practices, classroom interventions involve regular consultation with a teacher on the part of a behavior specialist, school psychologist, or similar professional. Teachers are educated about how ADHD impacts the child’s ability to focus, control impulsive behaviors, etc., and they are instructed on how to use specific behavioral techniques such as “specific positive feedback,” “planned ignoring,” “clear direction giving,” ”time out,” and the “daily report card.”3
While behavioral interventions in the classroom focus on time-on-task and minimizing disruptive behaviors, academic-oriented interventions focus on manipulating academic instruction or materials with the intent of improving behavioral and academic outcomes. Examples of such interventions include “variable assignment lengths,” “chunking assignments,” “high-interest modifications,” “varying instructional modalities,” “technology-assisted learning,” “basic skills enrichment,” and “peer tutoring.”3
Social skills interventions focus on the development and reinforcement of appropriate social skills such as communication, cooperation, participation, emotional regulation, emotional understanding, empathy, and enhanced levels of attention. A mental health expert, such as a licensed counselor or child psychologist, that has expertise in the field of ADHD and social skills, and can also include a school counselor, should be able to assist children and parents with participation in social skills interventions.3
Preliminary research also supports the use of regular physical activity for the treatment of ADHD. Research studies indicate that regular exercise improves behavior and information processing for children with ADHD. Some pediatricians are starting to recommend exercise in combination with or as an alternative to medication for the treatment of ADHD.3
Aside from non-pharmacological-based treatments for ADHD, medication treatment studies show stimulants have been found to reduce classroom disruptions and increase on-task behavior, compliance, and academic productivity. They have also been shown to decrease negative social behaviors such as inappropriate peer interactions, negative parent-child interaction, and aggression. However, the professional consensus is that medical treatments be done in combination with cognitive and behavioral approaches.3
Lastly, teens with behavioral issues in addition to ADHD thrive in boarding school-type programs. The organized lifestyle of boarding or residential schools with little or no surprises works best for kids with ADHD. Further, the individualized focus, within a highly structured living and learning environment, allows greater opportunity to communicate emotional issues. Each student enters the program with a personalized behavior modification plan. Because of this, trained professionals at an ADHD boarding school who work hard to create and maintain a controlled and predictable atmosphere can more easily focus their attention immediately when an individual acts out.4
1 “Effectiveness of Therapeutic Programs for Students with ADHD…,” Napalai Chaimaha, 2017.
2 “Behavior Management and School-Aged Children with ADHD,” Linda Pfiffner.
3 “6 Research-Based Interventions for the Treatment of ADHD in Children,” Rachel Wise, 2017.
4 “Is Boarding School for ADHD a Fit for My Child?” Michelle Garrigan-Durant, 2017.