ADHD: A Biological Disorder - Case Study Example

Interview with Professional This interviewed Susan Siegfried. She has an MA. in counseling psychology and a doctorate in clinical psychology. She is the clinical director of a mental health clinic in Minnesota. SPC Family Services deals predominantly with county cases in Minnesota. Dr. Siegfried does mostly assessment, diagnosis and the writing of treatment plans. The treatment plans are then given to the appropriate caregiver to be implemented. If it does not work she is called back. She also does the supervision for the clinic and for at least one doctoral intern each year. Dr. Siegfried states that about two-thirds of her assessment is with adolescents who are having repeated difficulties with the legal system, the school system or in the home. In addition, some of her assessment is with custody cases or repeat assessment on incarcerated individuals. She supervises assessment by her students for the self-referred cases. Causes of ADHD Dr. Siegfried explained that she was trained in the medical model and she believes that still colors the way she sees disorders. She believes ADHD is a biological disorder. In other words she says the child is born with it. More than that, she is not concerned with the etiology of the disorder because she really can not do anything about the fact that the child has the disorder. Her concern is with how the child and those around the child are dealing with the symptoms and how those symptoms have effected the way the child sees him/her self. She believes there is a lot of damage done to the child because others do not know what is wrong or how to deal with it. By the time she gets to the child, she has to deal with that damage and put in a plan to at least stop further damage and hopefully repair past damage. She does spend a lot of time helping parents understand that the disorder is not their fault; however, they do have a responsibility at this point in time that she is seeing themm to follow the program the child needs and failure to do their best with that is their fault. Assessment Dr. Siegfried does a battery of tests that changes slightly depending on the age of the child. Generally, she uses the Conner’s Child Assessment because it allows here to graph the responses of many care givers and school personell in one place to get a good picture of differences and similarities in behavior of the child in multiple locations and with multiple people. She also does the Weschler IQ that is appropriate for the child’s age. She wants to understand general ability, processing speed and strengths and weaknesses such as high performance score vs. low verbal score and with some of the individual tests as well. She looks for indications that show if she has to look further for a possible learning disability. She also uses the BASC which is the basic assessment system for children. She likes that instrument because it gives insight into personality issues as well as behavioral issues. In teens, she uses the MMPI-A. With both of these tests she is looking for axis I and in the later teens axis II disorders. She also interviews everyone she can that has a connection with the child. When it comes for testing for ADHD Dr. Siegfried has a strong warning. She says the assessor must stay completely open minded about the possible diagnosis until he/she sees evidence of that symptomology. She tells that she frequently arrives at a school to test a child and is greeted by teachers and administration alike saying things like, ‘we are so glad to see you’, ‘this kid is a real problem’. ‘We need to get his ADHD under control’. ‘How soon can you get him on meds?’ and so on. She estimates that about two-thirds of the time or more the child does not have ADHD. Most commonly she is finding anxiety disorders in many of these children. She says environment can create symptoms but it can not cause ADHD. Strategies to Manage Symptoms First, Dr. Siegfried states she is a strong believer in using medication if the child needs it. She believes the professional should use all the tools they have to help their patient. The red flag that she looks for in using medication is, does it make a noticeable change in behavior in multiple locations? If not, she continues to look at the situation, likely doing more assessment because it may be a wrong diagnosis or co-morbid disorders may have been missed. Dr. Siegfried is cognitive/behavioral in her general orientation, however, when it comes to ADHD she is completely behavioral. She states she is shocked at how few people really understand operant conditioning and how to do it, including professionals. She is frustrated that everyone in so into punishment. Any good behavioralist, she says, understands that the best way to extinguish a behavior is to take away the reward. Children and adults alike do what they do because they get something out of it. Almost always what they get out of the behavior is one of Maslow’s basic needs. If you figure out what they are getting and take it away from that behavior the individual will speed up the behavior for a very short period and with no reward they will stop. The key is not just to figure out what reward the child was getting but to make sure to provide the reward some other way in connection with appropriate behavior to get that reward. It is with that in mind that she writes her treatment plans. People hear what I say when I teach this but they have a very hard time doing it because the key is consistency. Consistancy is hard because the ADHD child in rarely in a vacuum so there so many things going on for the caregiver. She did talk about families that just do not have the capacity to understand this and for those families she write a strict family plan to follow that she knows they do not really understand why they are doing it but when they follow it things do improve. She has pretty good compliance because she generally comes into these families through the county who has the power to remove their children from the home. Dr. Siegfried’s Research with ADHD Dr. Siegfried worked as an in-home therapist for a long time. Before that, she was a high school teacher. She accidentally learned that when she came into these families referred by counties to do in home therapy that usually the children were doing poorly in school. Until she got that on track, the parents could not concentrate on anything else. She instinctively would sit the children down at a table and lay out their homework and because she wanted time with the parents she wrote a 3 to 5 step process the child could follow to get the assignment done. To her surprise, they usually did it and got a reasonable grade on it. They started to believe they could and often called her to get a process for another assignment. Eventually, she noticed that they would report that they had reused a process on a different assignment because it was like the one for which the process was originally written. She realized they were learning process. She now explains that frequently ADHD students are performance high and low verbal on IQ tests. School is mostly verbal. Information is provided verbally and the student returns the information in verbal form to prove they understood the information (homework). These students need to do it to understand it so they do not know how to get from the information received to the assignment. She found that writing a heuristic allows them to do the process without understanding, buy doing it they understand it. She taught this to skills workers and they went into homes and had great success with this idea. The success was so great that she got requests for her tutors from all across the country. Therefore, she put her idea online and it has been very well utilized since 1998. Now she has as many college students as high school or middle school students. Presently, since the new Weschler IQ provides processing speeds she is collecting data on processing in ADHD children. She believes processing can be taught so these students can have and easier time in problem solving not just in school but in life. This professionals certainly has the perspective of “how do we fix this or how do we make this better for the patient?’ It is clear she has the educational background to do that but she no longer seems concerned with exact etiology of things. That she can not change. She works hard to keep up with new research to always get better but that information just becomes one more bullet in her arsenal used to make better treatment plans. Clearly she enjoys what she does and she loves to tell success stories. Living in a small community she frequently see these ADHD children succeed as adults and as genetics would have it now she is treating some of their children for symptoms of ADHD. Read More