Attention Deficit Hyperactivity Disorder:
Overview with Implications for Residential Treatment and
Therapeutic Schools

Jay J. Jones
Fresno, California

Other Implications

No comprehensive presentation of "implications" is possible in a paper of this length. This topic itself is obviously so broad that endless statements about implications could be given, without comprehensively improving our understanding of this complex and difficult problem. However, several thoughts on implications will be presented.

Most impressive to this writer are the implications of the scope of this problem on residential treatment centers and therapeutic schools. Reflecting on statistics already presented elsewhere in this paper. Garfinkel & Wender (1989) estimate that 10% of children may be affected by problems associated with ADHD, and Cantwell (1989) estimates another 15% of children demonstrate conduct problems.

The significant overlap between these disorders implies a high percentage of children in normal schools that are affected. How #many times could we multiply this figure to arrive at an estimate of how many children in residential treatment and therapeutic schools are so affected? If we simply take for granted that the children who are being served in residential treatment and therapeutic schools represent the most severe and chronic of these cases, we could speculate that an astronomically high percentage of children being treated in these settings are affected by some serious combination of these disorders. What degree of a speculation would be reasonable--50%, 60%. 80%. These figures are not at all out of the question.

To extrapolate from these speculations, if our treatment systems are not designed to apply appropriate treatment, we may be missing the therapeutic boat entirely. Much treatment in these settings is strictly behavior-modification based--which is often limited to token economies and point systems, etc. Yet we have already cited opinion stating that a strictly behavior-mod program might be ineffective, or even harmful.

Many treatments focus exclusively on psychosocial causes and remedies. But if we are treating children who have neurological--or even quasi-neurological--problems, how are these psycho-social interventions going to benefit them in remediation of the central deficit.

Many programs in delinquency treatment are designed on the concept that children are merely "wilfully disobedient." However, if much of their problem comes from impulsivity, how are we going to do anything dramatically beneficial for these children, other than provide them with further discouragement, disapproval, and failure?

Residential treatment and therapeutic school programs must become enlightened as to the prevalence of this combination of disabilities in their populations. And we obviously need to research further, and screen these populations more effectively, so that we may determine the frank extent of these problems.

And finally, we must develop more appropriate therapeutic and educational technology to meet these challenges squarely. We must admit the difficulties inherent in ADHD--as we are able to see them--and we must acknowledge our failed attempts to adequately treat ADHD.

Last Modified: Thursday, October 02, 1997 9:34:45 PM