Imagine that you’re the parent of six-year-old Brandon. You receive a call from Brandon’s teacher asking you to come in for a parent-teacher conference. During the meeting, you are told that Brandon doesn’t listen to directions, cannot wait to take his turn, won’t share toys with others, and often shows off just to get attention. Other kids are starting to avoid him because he is too rough.
The teacher asks you if Brandon has ever been checked for Attention Deficit Hyperactivity Disorder—ADHD. You’ve always known that Brandon is a handful, but you thought he was just “being a boy.”
Now you remember things you have heard or seen on the news—-maybe that ADHD is commonly treated with drugs such as Ritalin, but also the worrisome claims that ADHD is just a label used to justify drugging kids who are simply energetic and lively. You decide to get some expert advice. Who can you trust to be an expert in ADHD?
One answer is the new HALP (Hyperactivity, Attention and Learning Problems) Clinic at UCSF. HALP is the first new program to be launched as part of The Children’s Center, a major initiative of UCSF’s Langley Porter Psychiatric Hospital and Clinics.
“We are delighted to be able to provide this service to the Bay Area. ADHD and related problems are among the most common mental disorders of children and continue to be a major problem for many adolescents. Designing the optimal intervention for each child takes time and expertise, but the results are worth it, ” said Glen Elliott, MD, PhD, director of The Children’s Center.
The unique aspect of the HALP program is its comprehensiveness. The multidisciplinary staff includes child and adolescent psychiatrists, clinical child psychologists, and pediatricians working together as a team. A medical screening includes a physical exam and neurological screening to determine whether other physical problems might be related to a child’s attention difficulties. If so, referrals to other specialties can be provided.
“Our diagnostic evaluations are extremely thorough,” said Linda Pfiffner, PhD, the director of HALP. “It’s so important to get a developmental history of the child and to have input from parents and teachers in order to get a complete picture.” The diagnostic work-up covers major problems and disorders that can affect a child’s ability to function well at home or school.
Typically, the team of mental health professionals meets with the family to conduct medical screening, diagnostic interviewing, psychological and neuropsychological testing. The team also collects extensive information about the child at home and in the classroom.
“It’s important to go beyond simply diagnosing ADHD to determine what type of ADHD it is, what other learning or emotional problems may be present, and what kind of treatment recommendations are reasonable,” Pfiffner said. HALP’s approach to treating ADHD includes medication when appropriate, but it doesn’t stop there. “Medications can work wonders for some, but most of our kids with ADHD do best with a combination of medication and psychosocial treatments,” she said. “Then there is a substantial group who either don’t benefit from medication, or who don’t need it if other treatments are provided.”
Pfiffner’s research focuses on non-pharmacological treatments for ADHD. She was recently awarded a grant from the National Institute of Mental Health to develop a skills-based treatment program specially designed for children with the Predominantly Inattentive Type of ADHD.
“With the support of UCSF’s Research Evaluation and Allocation Committee, we first tried out this new treatment right down the street at Jefferson Elementary School,” Pfiffner said. The results were impressive-inattention symptoms were cut in half in the treated group. “The NIMH funding will allow us to take the program to several other elementary schools in San Francisco as part of a larger trial,” she said.
To help with the special needs of pre-schoolers, Samuel L. Judice, MD, was recently recruited from Yale University. Judice contributed a chapter on “Treating Preschoolers with Medication,” for the book Pediatric Psychopharmacology. His current research focuses on medications for ADHD that are not classified as stimulants. “Stimulants like Ritalin and amphetamine preparations are invaluable,” said Judice, “but we need other alternatives, especially for very young children.”
Rounding out the HALP faculty is Keith McBurnett, PhD, who was recruited from the University of Chicago. McBurnett’s research includes aggression, oppositional and defiant behavior, and the special needs of adolescents and adults with ADHD. McBurnett and Elliott recently completed a clinical trial of medication for adolescents with ADHD.
“There certainly will be opportunities for Bay Area families to participate in other clinical trials for ADHD in the future,” said McBurnett. “The best way to learn about new trials at UCSF is the web site on UCSF’s home page: www.ucsf.edu.” A newly developed site for the Children’s Center will be posted later this fall.
Millions of children in the United States have ADHD, leading to problems at school, for example, not, not working up to potential, not completing and turning in assigned work, or not consistently following rules and directions. At home, children may not complete routine daily activities such as homework or chores regularly or independently. Some have problems with defiant behavior; others are primarily disorganized and inattentive. Many have low self-esteem, and often these children have trouble making or keeping quality friendships.
## To contact the HALP Clinic:
* By phone: 415-476-7365
* By mail: Linda Pfiffner, Director, HALP
* UCSF LPPI, Box 0984-CAS, 401 Parnassus Avenue, San Francisco, CA 94143
## Pfiffner provided a list of HALP programs available for families affected by ADHD:
* Superparenting 101: a course to help parents learn techniques to help children with attention or behavioral problems. The approach combines traditional parent training with specialized therapeutic skills training. Parents learn effective communication strategies, how and when to use rewards and how to discipline effectively.
* Social Skills Training: a fun course that helps children learn skills and tips on making and keeping friends, handling disappointments and getting along better with family and friends at school and in their neighborhoods. The course combines learning new skills with repeated practice and teaches ways to put new skills to work in everyday life. Parents attend the course at the same time as their children. The parent course covers everything taught in the child’s course, emphasizing the same language and rewards for the home setting; this way, progress can be maintained at home after the courses are completed.
* Life Skills Training: a course to help children get better organized and take responsibility for the day’s tasks, like getting ready for the day, being on time, managing homework assignments, and establishing good habits and routines. This course is sometimes combined with the Social Skills Training course.
* HALP clinicians can visit a child’s school for classroom observation, Independent Education Plan staffing, teacher training or to design a behavioral program with the child’s teacher to help with academic productivity.
* Medication: The HALP Clinic philosophy on medication is to provide the most current factual information to the parents and then allow the family to decide what is best for their child. The staff provides information about what medications do and don’t do, including all known potential benefits and risks. For families who want to try medication, the HALP clinic offers individualized medication assessments and careful monitoring of how well a child does on different doses of medicine for ADHD. For children with more complicated medication needs, the HALP staff works closely with the Complex Diagnosis and Medication Clinic also located at The Children’s Center at Langley Porter Hospital and Clinics.
* The HALP clinic takes a proactive approach, working with behavioral interventions first. Programs are tailored for each family to take into account the many stressors often facing parents of children with ADHD including their own symptoms of ADHD, depression and marital problems.