The Ingalls family is a middle-class family of four who live on a farm in Charleston, South Carolina. Charlie lives with his mother, father and older sister and has been having some issues in school that extend back all the way to first grade. His teachers noticed that he was having a difficult time staying seated during class and his grades began to decrease. His behavior at school resulted in his teachers calling home to express their concerns. His teachers learned that he was experiencing difficulties at home as well. He was very uninterested in doing any of his chores or homework and would rather be playing video games. His teachers have recommended that his parents look into putting Charlie on a medication, but his parents are not interested in medication for Charlie.
Currently, Charlie is in the fifth grade and he is still having difficulties at school. It has become a really big problem and is significantly affecting his education. His principal has reached out to Charlie's parents and is urging them to get help for Charlie outside of the school. They want to help their son and address his difficulties in school but are unsure of where to begin. I will discuss a diagnosis, developmental course, and intervention that could be beneficial for Charlie and his family in making their decision.
As Charlie grew up, he expressed several symptoms that are in line with Attention Deficit Hyperactivity Disorder (ADHD) – combined type. According to the DSM-5, a person has to show a pattern of both inattention and hyperactivity-impulsivity that interferes with their ability to function for at least 6 months to reach a diagnosis of ADHD (“Attention-Deficit/Hyperactivity Disorder”, 2017). There are certain criteria that an individual must meet in order to be diagnosed with any type of ADHD. An individual must experience several inattentive or hyperactive-impulsive symptoms before the age of 12, several inattentive or hyperactive-impulsive symptoms in two or more settings, their symptoms must interfere with their quality of functioning in life, and their symptoms cannot be due to any other type of psychological disorder (“Attention-Deficit/Hyperactivity Disorder”, 2017). For Charlie, he first began showing symptoms around seven years old. He also is having difficulties in both his home environment and his school environment, which is interfering with his social and academic functioning. He does not present any symptoms of any other psychological disorder, so a diagnosis of ADHD is likely for him as long as he meets the criteria for one of the types of the disorder.
The DSM-5 details the symptoms required to meet a diagnosis of inattentive type ADHD and it is required that an individual show at least six of the symptoms to meet the diagnosis criteria. The symptoms include failing to give close attention to detail, having difficulty sustaining attention in tasks, not seeming to listen when spoken directly to, not following through on instructions or schoolwork, having difficulty organizing ongoing tasks, avoiding, disliking or being reluctant to engage in tasks that require sustained mental effort, losing things necessary for a task, easily distracted, and often forgetful (“Attention-Deficit/Hyperactivity Disorder”, 2017). During Charlie’s childhood, he has expressed many of the symptoms listed above. For example, when Charlie is at school it is very difficult for him to follow through with the work he is given by the teacher and he will end up out of his seat because he can’t focus. Charlie is often easily distracted, as well, which causes him to be forgetful when completing activities such as taking out the trash or completing school work. Charlie exhibits at least six of these symptoms, possibly more, and his behavior meets the criteria for a diagnosis of inattention type ADHD.
The DSM-5 details the symptoms required to meet a diagnosis of hyperactivity-impulsive ADHD and, again, an individual is required to display six of the symptoms to gain a diagnosis. The symptoms include fidgeting or tapping hands, leaving your seat in situations where you should remain in your seat, running or climbing in situations when you shouldn’t, unable to play quietly, constantly on the go, talks excessively, shouts out answers before a question is completed, has difficulty waiting their turn, and interrupts or intrudes on others (“Attention-Deficit/Hyperactivity Disorder”, 2017). Throughout his childhood, Charlie also exhibited several of these symptoms. For example, Charlie has a very difficult time staying in his seat during class, even during projects that he is interested in. Also, Charlie often blurts out answers or questions before his teachers are finished asking questions to the class. Charlie also meets the criteria for hyperactivity-impulsive type ADHD diagnosis due to his regular behaviors in school and at home.
If we take a look at Charlie’s development from birth through his childhood we can gain a better understanding of how Charlie came to be diagnosed with ADHD-combined type. ADHD is a very prevalent disorder that occurs in about 5% to 10% of children and adolescents (Eiraldi, Mautone, & Power, 2012). This disorder runs in many families and it is about 80% genetic. Not only is there a high genetic component to ADHD, but there are also several risk factors that can contribute to individual developing ADHD during childhood. During pregnancy factors such as maternal substance use, low birth weight, premature birth, and maternal stress can all contribute to the risk of development of the disorder (Cherkasova, Sulla, Dalena, Pondé, & Hechtman, 2013). After the birth of the child, there are still many risk factors through early childhood development that can contribute to an ADHD diagnosis. When a child enters preschool, the severity of the symptoms they are displaying and their ability to function can be great predictors of what their ability to function will be in the future (Cherkasova et al., 2013). This can continue on into their early school days, where it is important to note their ability to function socially because it can greatly predict the amount of impairment that they will experience as they grow older (Cherkasova et al., 2013). However, when in school this is a vital time for children to be diagnosed with ADHD. Teachers often see many kids in their classes that display symptoms of this disorder and parents often look to them for their opinions because of this experience. It has been found that teachers may be more likely to compare children with one another and this can lead to more diagnoses of ADHD that there actually are (Holland & Sayal, 2018).
Not only is it important to notice symptoms when a child is still school-aged, it is also important for a family to understand what problems their child can encounter if they do not treat their ADHD symptoms. Studies have found that individuals with ADHD-combined type show significantly more impairment in adulthood than other normally functioning adults when they have not gone through any type of treatment (Schmitz et al., 2002). Research has found that specific areas of functioning have been affected by this disorder when left untreated. When an individual meeting criterion for this disorder gets to adulthood, they present with decreased academic functioning, impairments in cognitive functioning, and broad deficits in executive functioning (Schmitz et al., 2002). If you know that your child is displaying symptoms of an ADHD disorder it is extremely important to get them treatment. If they go without treatment so many levels of their functioning will be impacted which could hurt their ability to take care of themselves or a family properly later in their life.
Charlie's family is struggling with the proper course to take that will help Charlie manage his symptoms and function well academically and socially. They don’t want to miss treating his symptoms and impair his functioning even further, but they aren’t sure what treatment will be best for him. I believe that the appropriate course for Charlie would be a combined type treatment that would include both medication and Cognitive-Behavioral Therapy.
The use of a combination of medication and therapy is very common for many different psychological disorders. Medication and therapy have both shown to be effective treatments for ADHD disorders on their own, but I think that it would be beneficial for Charlie to experience both medication and therapeutic measures. Research has shown that Cognitive Behavioral Therapy is a very effective therapy in treating ADHD and related disorders (Weiss et al., 2012). It is very effective in reducing symptoms of ADHD and moderately effects the amount of functioning that an individual presents with. Studies that use Cognitive-Behavioral Therapy to treat these disorders showed a 63% improvement in patients after treatment was completed (Weiss et al., 2012). In combination with medication, this therapy would be very beneficial to Charlie. The medication could help to reduce the symptoms that he is experiencing, while the tools he learns in therapy could help him learn to improve his executive functioning.
Using medication to treat ADHD disorders in children is something that many parents have a hard time with, including Charlie’s parents. However, medication has been shown to be one of the best treatment methods for controlling the symptoms of this disorder. Research has shown that children who take stimulant medication for ADHD symptoms show a reduction in the symptoms over time (Jensen, 1999). Medication is mainly used in the reduction of a child’s symptoms because of the disorder, it is not necessarily helping the child’s ability to function if they were to ever come off of the medication. This is why it is important to use a combined therapy method. Research shows that children who engage in both combined treatment and medication groups show significantly greater improvement than those who are in one or the other group (Jensen, 1999). For Charlie, I think that a combined therapy would be beneficial because of the severity of his symptoms and functioning. His symptoms have persisted for a very long time, which has impacted his ability to function. The best way for him to reduce his symptoms and improve his functioning would be to engage in both types of treatment.
Overall, Charlie is still a very young boy who is experiencing several symptoms of the ADHD-combined type that are impacting his ability to function normally. His parents and teachers are very concerned about his well-being and want to ensure that he does not continue to develop these symptoms and impair his functioning even further. It is important to get him in treatment as soon as possible because the longer his symptoms go untreated, the worse his functioning will be. I would recommend that Charlie's parents look into a combined therapy and medication treatment for Charlie. It is the best way to manage his symptoms while increasing his ability to function.