Different Approaches to ADHD

Life transitions, such as changes in school and work, may be challenging for your patients/clients with ADHD. "Dealing with ADHD is never a static process," explains Dr Quinn. "Problems change over time, and patients need help dealing with them." This article examines a few approaches used to address these challenges.

Summer camps and summer treatment programs

Children and adolescents with ADHD may benefit from participating in summer camps designed for children with ADHD.1-3 In addition, summer treatment programs (STPs) provide a more structured curriculum.4 When speaking with patients and their caregivers about potentially participating in one, physicians should consider discussing the differences between these types of programs to help determine which might be a more appropriate fit for the child or teenager in question.

Summer camps, which aim to cultivate life, social, and academic skills, work toward helping children and adolescents develop these skills in traditional recreational settings, such as sports or high adventure camps.1-3 Summer treatment programs, in contrast, focus on introducing behavioral interventions, implementing rewards-and-consequences systems, and providing behavioral training sessions for parents.4

Accumulating evidence suggests that STPs may be beneficial for children and adolescents with ADHD.4-6 Sibley and colleagues reported positive results among 34 adolescents participating in an 8-week program.5 Participants attended full-day sessions designed to mimic a secondary-school setting. They were taught academic and organizational skills and also participated in life-skills and leadership training. At the conclusion of the program, all of the adolescents in the study were rated by their parents as being at least "somewhat improved" overall with respect to ADHD symptoms.5

Hantson and colleagues reported positive results among 33 children, aged 6 to 12 years, participating in a 2-week program. The children were exposed to 6 hours of therapeutic interventions each day, including an hour each of social-skills training, music therapy, play therapy, exercise therapy, and art therapy. Social skills were the primary focus during all therapies. During the same period, the parents also participated in four, 2-hour sessions consisting of psychoeducation and parent training. Both the participants and their parents reported that ADHD symptoms significantly improved.4

Health care professionals working with patients whose caregivers are thinking about enrolling them in a summer camp program or STP should advise the caregivers to begin the selection process early.7

Making the transition to college

For the person with ADHD who is going on to college, increased responsibility and independence can pose challenges.8 With this in mind, Meaux and colleagues conducted qualitative interviews with 15 college students who have ADHD to determine factors that helped and hindered the college transition.8

Their research uncovered three key themes. The first global theme was gaining insight about ADHD, which included descriptions of overt and/or covert behaviors that enhanced learning or knowledge about ADHD. Managing life was the second global theme and included descriptions of behaviors that affected self-management of ADHD. The third theme included how sources of support were or were not utilized. The results are provided below.8

Examples of factors that helped or hindered college students with ADHD8

	Gaining Insight About ADHD	Managing Life	Using Sources of Support
What Hindered?	Reluctance to openly discuss ADHD	Persistent ADHD symptoms	Lack of knowledge Missed opportunities
What Helped?	Learning from experience Seeking information Acknowledging Opening up	Being accountable Learning from consequences Setting alarms and reminders Engaging in self-talk Removing distractions Staying busy and scheduling	Parents Friends Teachers/tutors Academic support and disability services

Meaux JB, et al. J Psychiatr Ment Health Nurs. 2009;16(3):248-256. Copyright 2009 Blackwell Publishing. This material is adapted with permission of John Wiley & Sons, Ltd.

Given their findings, the authors believe it is critical for people with ADHD to develop insight into the disorder and self-management skills well in advance of their transition to college.8 "The results are not at all surprising," comments Dr Tuckman, "but sharing them with students and their parents may be very helpful."

"Students should also be encouraged to weigh the pros and cons of disclosing their disability to their respective colleges," adds Dr Quinn.

Choosing a college

"Choosing a college that is a good fit for the student is the first and perhaps most important step toward a successful college experience," notes Dr Tuckman. The National Resource Center on AD/HD has published an extensive list of questions the student may wish to ask regarding the college's support for students with ADHD. This list can be found in the "What We Know" information sheet #13, titled "Succeeding in College," which is available at help4adhd.org/about/wwk.9

Starting a first or new career

Adults with ADHD who are just entering the workforce or are seeking a career change have much to consider. Mao and colleagues suggest that individuals with this disorder select a career based on their interests, intellect, symptom severity, and the ability to manage symptoms.10

The National Resource Center on AD/HD recommends that any individual with ADHD who is making a career change perform a self-assessment of his or her interests, skills and aptitudes, personality, values, energy patterns, and workplace habits. More information about this self-assessment can be found in the "What We Know" information sheet #16, titled "Succeeding in the Workplace," available athelp4adhd.org/about/wwk.11

Life transitions may be challenging for people with ADHD. By providing patients and caregivers with relevant information and tools, you may help to make these transitions more manageable.

*Drs Quinn and Tuckman have been compensated by Shire for their contributions to the ADHD: A Shared Focus program.

References

1. National Resource Center on AD/HD. Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD). What We Know #7: Psychosocial Treatment for Children and Adolescents with AD/HD. Landover, MD: CHADD. 2004. help4adhd.org/documents/WWK7.pdf. Accessed June 8, 2012.

2. Dendy CZ. Teenagers With ADD and ADHD: A Guide for Parents and Professionals. 2nd ed. Bethesda, MD: Woodbine House, Inc.; 2006.

3. Hanlon P. ADHD summer camp: choosing the best program for your child. ADDitude. September 2011.additudemag.com/adhd/article/8414.html. Accessed June 8, 2012.

4. Hantson J, Wang PP, Grizenko-Vida M, et al. Effectiveness of a therapeutic summer camp for children with ADHD: phase I clinical intervention trial. J Atten Disord. 2011 Aug 19. [Epub ahead of print]

5. Sibley MH, Smith BH, Evans SW, Pelham WE, Gnagy EM. Treatment response to an intensive summer treatment program for adolescents with ADHD. J Atten Disord. 2012 Mar 16. [Epub ahead of print]

6. Pelham WE Jr, Fabiano GA. Evidence-based psychosocial treatments for attention-deficit/hyperactivity disorder. J Clin Child Adolesc Psychol. 2008;37(1):184-214.

7. Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD). Summer vacations. Landover, MD: CHADD. 2012. chadd.org/content/CHADD/efparents/socialskillsforchildren/ summervacations/default.htm. Accessed June 8, 2012.

8. Meaux JB, Green A, Broussard L. ADHD in the college student: a block in the road. J Psychiatr Ment Hlth Nurs. 2009;16(3):248-256.

9. National Resource Center on AD/HD. Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD). What We Know #13: Succeeding in College. Landover, MD: CHADD. 2003.help4adhd.org/documents/WWK13.pdf. Accessed May 4, 2012.

10. Mao AR, Brams M, Babcock T, Madhoo M. A physician's guide to helping patients with ADHD find success in the workplace. Postgrad Med. 2011;123(5):60-70.

11. National Resource Center on AD/HD. Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD). What We Know #16: Succeeding in the Workplace. Landover, MD: CHADD. 2003.help4adhd.org/documents/WWK16.pdf. Accessed May 4, 2012.