Dr. Robert R. Erk, Ed.D., is the Director of the Center for the Professional Study of Attention Deficit Hyperactivity Disorder.Dr. Erk is an Associate Professor of Counselor Education and Educational Psychology in the Department of Educational Studies at the University of Tennessee at Martin, TN 38238.Dr. Erk teaches graduate coursework in the school and mental health counseling tracks, is a past president of the Southern Association for Counselor Education and Supervision, serves as the American School Counselor Association Coordinator for Children With AD/HD Professional Interest Network, is a Licensed Professional Counselor and Marital and Family Therapist in Tennessee, and is the parent of a child diagnosed with AD/HD.
The Center strives to provide resources or information on AD/HD for professional counselors, teachers, and parents, conducts inservices and workshops on AD/HD at the state, regional, and national levels, and maintains a research and publication agenda on the disorder.
A SYSTEMS ORIENTED APPROACH TO AD/HD:
FAMILIES, SCHOOLS, AND COMMUNITIES WORKING TOGETHER
This should not be unexpected: an array of interventions or a multidimensional approach to treatment has long been advocated in the management of this disorder (Barkley, 1990, 1995; Erk
, 199, 1997, 2000). Second, the BEH or psychosocial treatment approach "alone" did produce some effects despite being limited.The amount of gain here probably should have occurred because the study seemed heavily weighted toward the BEH or psychosocial treatment approach.However, Barkley (2000) questioned if such an extensive BEH program could be justified (e. g., now or ever) in homes and schools (e. g., due to its extensive scale).Relevant to the gains made in this approach, Barkley (2000) speculated that the modest differences found between the BEH and CC groups in the MTA Study might be more due to information and therapist attention; these could have accounted for the small differences (e. g., in favor of the HEB group).For example, numerous parent education and behavioral training programs for parents with children diagnosed with AD/HD are already in existence and might obtain much the same results when properly employed.The BEH approach to treatment "means" parents are willingly becoming involved in parent education and training on the AD/HD, and they are learning and actively practicing a range of behavioral interventions designed to benefit the family and the child.
Moreover, this finding would appear to be related to reductions in negative and ineffective parenting practices in the home (e. g., reciprocal or parent-child interactions; Erk
, 1997).Therefore, the home and school environments benefited reciprocally from the COMB treatment. Fifth, when comorbid symptomatology (e. g., ODD, CD) and functional skills (e. g., academic and social skills) were considered, the group differences among all the treatment groups were smaller.For example, only the COMB treatment was consistently superior to CC when the comorbid conditions were identified.It should be remembered that comorbid symptomatology can be a major disrupter to any treatment that is being utilized; what this finding from the study reinforces is the need for careful assessment of comorbid conditions and that these conditions deserve as much attention (e. g., treatment) as the AD/HD itself.Unfortunately for the child, if the comorbid conditions remain undiagnosed and untreated, the comorbid conditions will often be mistakenly identified as the primary problems.This can lead to the AD/HD remaining at the "core" of the person's difficulties while the disorder can continue as undiagnosed and untreated (Erk, 1997, 2000). Sixth, COMB significantly outperformed MED-MGT with a small-to-moderate effect size (Hinshaw et al., 2000).This should not be entirely a surprising result; MED-MGT alone is not considered a prudent approach when it is to be used in isolation.Barkley (1990, 1995) recommended that parents should not invest in a MED-MGT only treatment plan.This is because with a MED-MGT only plan, the child is obviously deprived of opportunities to learn or acquire an improved behavioral repertoire (e. g., social and academic skills, enhanced and self-esteem). Seventh, and last, although overall findings were consistent for boys versus girls, for children with and without prior medication treatment, and subjects with and without disruptive comorbidity, two baseline variables (e. g., comorbidity with anxiety disorder and socioeconomic status) had the effect of moderating some treatment outcomes. A major limitation of the MTA Study may be the exclusive use of the AD/HD Combined Subtype; it was presumed that hyperactivity, impulsivity and inattention components are incorporated into the Combined Subtype.
, R. R. (1995).The Conundrum of Attention Deficit Disorder.Journal of Mental Health Counseling
, 17, 131-145. Erk
, R. R. (1995).A Diagnosis of Attention Deficit Disorder: What Does It Mean For School Counselors?The School Counselor , 42, 292-299. Erk
, R. R. (1995).The Evolution of Attention Deficit Terminology.Elementary School Guidance and Counseling
, 29, 243-248. Erk
, R. R. (1997).Multidimensional Treatment of Attention Deficit Disorder: A Family Oriented Approach, Journal of Mental Health Counseling
, 19, 3-22. Erk
, R. R. (1999).Attention deficit hyperactivity disorders
: Counselors, laws, and implications for practice.Professional School Counseling, 2, 318-326. Erk
, R. R. (2000).Five frameworks for increasing understanding and effective treatment of attention-deficit/hyperactivity disorder: Predominantely inattentive type.Journal of Counseling and Development
, 78, 389-399.
Friedman, R. J., & Doyal, G. T. (1992).Management of Children and Adolescents With Attention Deficit Hyperactivity Disorder.Austin, TX: Pro-Ed.
Hallowell, E. M., & Ratey, J. J. (1994).Driven to Distraction: Recognizing and Coping With Attention Deficit Disorder from Childhood through Adulthood.New York: Touchstone.
Hinshaw, S. P. et al., (2000).Family processes and treatment outcome in the MTA: Negative/ineffective parenting practices in relation to multimodal treatment.Journal of Abnormal Child Psychology
, 28, 555-564.
Hosie, T. W., & Erk, R. R. (1993, January).American Counseling Association
Reading Program: Attention Deficit Disorder.American Counseling Association
Guidepost, 35, 15-18.