Issue One

"These are the children that no one wants to play with," explains William E. Pelham, Jr., Ph.D, as we tour the facilities that make up the summer treatment program ("STP") for children with attention deficit hyperactivity disorder. But do all of them need to be put on medication, a dramatically increasing trend, or is there an alternative?

STP is a nationally-recognized program conducted by Pelham and colleagues at the University of Buffalo Psychology Department. There were 48 children enrolled in the summer program this year, 90 percent of them boys. The children come to the program on the referral from doctors, parents or teachers who believe that by participating in the intensive eight-week treatment program, they can learn to control their behavior. Children age 5 to 15 are placed in age-appropriate groups and stay together throughout the summer so they can be exposed to being part of a group. Being part of a group means making friends, interacting appropriately with adults and following the group-imposed rules and guidelines. The children are involved in schoolwork activity, arts, crafts and sports.

"It’s a summer camp," Pelham says, "with treatment thrown in." The program’s design relies heavily on behavior modification, a successful, time-honored way to correct problems. The premise of behavior modification is simple: Rewards for good behavior, consequences for bad behavior. All behaviors exhibited by the children at STP are meticulously recorded either on a clipboard or a large poster hanging in the classroom and hallways. The children receive daily report cards so they always know where they stand. The report also serves as a message that they are the ones who can control their own behavior, thus control the report card. The children receive a reward for a good report card and a consequence at home, decided before hand, for bad reports. In a camp-like atmosphere, implementing behavior-modification plans comes naturally and easily due to the activities involved with such a setting.

"Sports is a great way to teach children how to behave. In sports you have to wait your turn, and to play correctly is to play nicely. Sport activities require a person to be aware of appropriate social skills," Pelham says. "Some of the children have poor motor skills, and this activity can help improve that." Sports is also a way to improve self-esteem and self-efficacy, which in turn are thought to play a role in behavior.

The rules posted throughout the facilities are what most of us know as logical and basic. Be respectful, be kind, be courteous, don’t talk out of turn, keep your hands to yourself, don’t lie, don’t steal. These are rules we learned in kindergarten and what our parents have told us. To these children, they are concepts that have yet to be fully grasped.

"The reason these children have such a hard time with these rules is not," Pelham assured, "because the family has necessarily failed. We don’t know the cause of ADHD. We do know what doesn’t cause it, and that is families. Families do not cause ADHD. Of course, if a child grows up in an aggressive environment, it never helps."

Symptoms of attention deficit hyperactivity disorder include difficulties in attention, poor impulse control and an activity level that leads to serious impairment in daily life function. "You may need to tell your child 10 times to complete a chore," Pelham explains when I question him about my own child. "These children need to be told 25 or more times. ADHD should not be confused with normal childlike behavior."

Many parents believe that their child suffers from the disorder. Just as many believe that their child can’t possibly have it. Still others believe that the disorder simply does not exist. "The bottom line is not about whether you think your child has ADHD, but whether or not your child is functioning as he should," Pelham says. "Forget the diagnosis and ask, ‘Does this child have problems in important functioning areas and how can I change them?’"

It has been established that sugar does not cause ADHD, nor will a special diet treat the disorder. Asked if there might be a case where the teacher says the child has ADHD but Mom insists no, or perhaps the opposite, where it is Mom who believes the child suffers ADHD and the teacher says no, Pelham responded with a smile: "Quite possible. Somebody is reading wrong or in one of the settings there needs to be better management." Pelham further explains that in those cases the parent needs to be a detective. They need to look everywhere in that child’s life to find out where the problem lies. He suggests talking to the child’s pediatrician and his or her teacher, and then watching the child when with friends. "It might be simply a case where a teacher has poor classroom control. She thinks all the children are a problem. Or maybe the teacher has great classroom management, but at home it’s not as structured," he says.

Summer is a good time to give children the treatment because it is during the summer that most school-based programs decline or are eliminated altogether. When treatment that the child receives during the normal school year is interrupted, gains made then may be lost. Enrolling the child in the off-school season provides opportunity for better retention of lessons that have already been or need to be learned. Regression is less likely. Pelham cites many examples of how to keep the plan going year round. "We work with many teachers, showing them, teaching them how to handle children with these types of problems. It is part of the follow-up treatment." There is also a Saturday treatment program offered during the regular school year. "Year long treatment is the best," Pelham states.

"Many of these children are not on medication," Pelham says proudly. "And we’re showing success without it." That is not to say that all children should not be on medication, but a goal for many parents is to try to handle ADHD without it. Pelham is setting out to prove it can be done.

"We know that if you medicate a child for 10 years and they stop taking the medication, the behavior is the same without treatment. The symptoms return. Parents should be told this and told whether there are alternatives to medication. The bottom line is that medications can be very helpful but other treatments are almost always necessary. Parents have a choice: medication or behavior modification or both."

Pelham believes that behavior-modification treatment should be tried before medication. The decision for medications like Ritalin or Adderall should be taken very seriously and decided by experts–experts such as a pediatrician, a child psychologist or psychiatrist.

"You can live with ADHD; it is a life-long disorder. What is important is learning how to handle it," Pelham says. The summer camp treatment program is a program that hopes to arm the children with life-long skills needed to be successful, productive persons in society.

FOR MORE INFORMATION, CONTACT:

Attention Deficit Hyperactivity Disorder Program
Center for Children and Families
Department of Psychology
State University of New York at Buffalo

716-645-3697