Designing a comprehensive ADHD treatment plan in South Florida (ADHD Treatment South Florida), as in any other locale, requires not only addressing the many complexities of this condition but also truly understanding the patient’s unique situation and needs.
Two core symptoms of ADHD are 1) Distractibility and 2) Impulsivity that significantly exceed the norms for age or developmental level. These problems may appear with or without a third basic element, Hyperactivity, which means having a very excessive activity level.
Roughly 3-5% of children and adolescents meet current diagnostic criteria for ADHD, around half will continue being affected as adults.
The condition is much more prevalent among males, particularly the hyperactive category. However, because girls are primarily “inattentive,” therefore, lacking the more disruptive, behaviors typical of boys with ADHD that result in them being “identified,” some females who could benefit from ADHD treatment may fall through the cracks and never be properly diagnosed. Concerns that ADHD is being over-diagnosed need to be balanced with those that so many who might potentially benefit from intervention are being overlooked. Not so long ago, the “treatment” tended to consist of learning from “hard knocks,” being told to “pull yourself up by your own bootstraps,” or being shunted to less desirable classes and vocations.
Alongside the above-mentioned symptoms, ADHD is often manifested in disorganization, difficulty remembering and completing tasks or following schedules, and aversion to activities requiring effortful thinking and sustaining concentration. Poor sleep and eating habits, “accident-proneness,” difficulty waiting their turn to speak, and a knack for saying just the wrong thing at the wrong time are also typical.
Children with ADHD often seem socially immature or just plain silly. Many of them do not seem to learn from bad experiences or negative consequences, especially about the value of learning to follow rules or respecting legitimate authority figures. In some cases, this may result from inadequate attention to social cues indicating “Stop!” compounded by failure to recognize the same or similar cues when they reoccur.
Yet, some of those with ADHD will be able to excessively focus (perseverate), even to the point of perfectionism, on preferred activities like playing video games or a sport, or in a preferred setting, like their best friend’s home. This can be very confusing, especially to their parents, who might logically think that if their son or daughter can concentrate, behave, or be highly motivated “when they want to,” they have no excuse for not being able to study effectively. Actually, this complexity of ADHD is a common source of parent-child conflicts and delaying getting the necessary evaluations and treatment. Adding to this difficulty is the fact that ADHD can be found in individuals with many strengths, including intelligence, talent, and creativity.
Another intricacy is that ADHD overlaps with many psychological and behavioral health conditions such as Anxiety, Oppositional-Defiant Disorder (Anger), Depression, Obsessive-Compulsive Disorder (OCD), and Bipolar Disorder. They are also more prone to having atypical movements, or tics, as well as various learning, information-processing disabilities, which taken together, may indicate “Executive Function Disorder (EFD).” Although technically speaking ADHD cannot be diagnosed together with Asperger’s Syndrome (Autism Spectrum Disorder), a significant subgroup of those with this condition have problems with attention, impulsivity, and over-activity.
Those with ADHD often grasp concepts but cannot translate them into test performance or demonstrate what they know “on paper.” ADHD increases risks for adolescent or young adult addictive problems and also for getting into problems with the law. Although well known to run in certain families, implying that there are genetic factors, the exact cause of ADHD is still being investigated. Life stresses like illness or divorce in their family often magnify the effects of ADHD.
No surprise, a key to success is early identification (hopefully by at least the early grades) followed by proper intervention. But this is easier than it sounds. ADHD is often hard to distinguish from high spirits, especially in young boys. Many other psychological or medical conditions- some already noted above- might look just like ADHD, but aren’t. This all raises the risk of “false positives” (diagnosing ADHD when it’s not present) and “false negatives” (failing to diagnose ADHD when it’s present).
Obtaining an expert psychoeducational evaluation, which integrates well-validated, age-referenced objective tests, school records, parent and educator observations and questionnaires, medical and developmental findings, and direct behavioral observation with clinical impressions is often the surest path toward an accurate diagnosis, identifying the person’s strengths and weaknesses, and clarifying recommendations.
Presently, the gold standard of “efficacious and specific evidence-based treatments” for ADHD is reached by:
1. Psychosocial interventions, which include individual behavior therapy (e.g. for mood regulation, self-control strategies, and interpersonal skills) targeted home and school behavioral plans, and parent training.
2. Medications, most commonly in the psychostimulant class, although some non-stimulant approaches seem to be emerging.
3. A combination of psychosocial treatments and medication. Although many experts recommend psychosocial intervention as the first-line strategy, in reality, it is often medication that is tried first or used as a stand-alone treatment. Why this pattern exists is related to many variables, including time, cost, insurance authorization policies, inadequate access to quality psychosocial treatments, and lack of practitioner expertise.
What about other kinds of promising ADHD treatments presently being studied? Attentional control training via mindful meditation practice, working memory training, and lifestyle and dietary changes may potentially be helpful to many with ADHD. Neurofeedback, which entails monitoring and applying information about one’s brain wave activity, is another ADHD treatment modality that finds support among some practitioners.
However, to date research about the effectiveness of neurofeedback has been mixed. While many patients report benefits, there is an unresolved question as to whether improvements are specifically related to the neurofeedback or better explained as a byproduct of non-specific factors, like relaxation or a placebo effect.
In addition to improving the symptoms and problems associated with ADHD, the long-term prognosis for success appears related to the affected person’s
1) having parents that not only understand their needs but get them the necessary help
2) doing well enough in school to have rewarding future options and
3) developing the capacity to form positive interpersonal relationships.
This is why psychosocial interventions are always considered to be an essential aspect of comprehensive ADHD treatment.
While sometimes a person with many strengths, or aptitude in a very viable skill (e.g. music or sports), can learn to compensate for ADHD or seem to “grow out of it,” by and large this is not the majority. Recently, there has been much more awareness of the extent of adults suffering from ADHD, or it’s residual effects, like not having been able to achieve in school or socialize to their optimal level earlier in life.
Conclusion: Proper diagnosis and a solid comprehensive approach including individual and home and school-based treatments, can greatly improve outcomes for those with ADHD (and those who care about them). Wishful thinking that a complicated condition like ADHD will improve it’s own volition will likely result in less possibility of success.
You can learn more about ADHD at www.chadd.org
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