While uncommon in adult corrections, the pharmacological treatment of attention deficit hyperactivity disorder (ADHD) is very common in juvenile justice settings. Unlike adults, minors are bound by compulsory school attendance statutes, and so juvenile justice facilities must provide an appropriate education. Many residents need to have their ADHD treated to fully benefit from the education and treatment offered them. With 46 percent of the youths in Virginia's juvenile correctional centers displaying significant symptoms of ADHD, (1) the task of safely and effectively treating them in a correctional setting can be daunting. Great care must be taken to ensure that residents with ADHD receive the correct pharmacological and therapeutic interventions delivered in a manner that will be safe both in the facility and upon their release.
Moving Toward Treatment
Effective treatment of ADHD begins with an appropriate diagnosis. Unfortunately, many clinicians are drawn to the primary symptom of the individual's difficulty concentrating. Difficulty concentrating is not the only symptom of ADHD; likewise, ADHD is not the only disorder that has problems with attention as a symptom. While ADHD may be the simple diagnostic answer, and while stimulants may be the easy therapeutic answer, multiple other diagnoses must be considered prior to the implementation of an effective treatment plan. Some of these include generalized anxiety disorder, post-traumatic stress disorder, major depression and manic episodes, all of which have either difficulty concentrating or distractibility also listed as a symptom. (2)
In a juvenile justice setting, where serious mental disorders and trauma are more common than in the general population, chances of a confounding disorder are likely. Given that someone with difficulty concentrating caused not by ADHD, but by one of the aforementioned disorders, may not respond well to frequent doses of psychostimulants, diagnostic accuracy is crucial. In these scenarios, clinicians must ascertain information critical to differential diagnoses, such as the symptom's duration of over six months, onset prior to age 12, and display of symptoms across settings. (3) Beginning to answer these questions can often help identify when the presenting symptoms have a source other than ADHD.
Once the diagnosis of ADHD is established firmly, the right treatment plan can be used to control symptoms, including inattention, hyperactivity and impulsivity, as well as to set and meet specific goals in a timely manner. When done correctly, treating ADHD will help the child follow rules and improve relationships with people of authority as well as with their peers. Treatment, however, isn't one-size-fits-all. It's best to customize the patient's treatment plan to meet the unique and specific needs of the child or adolescent. Treatment for ADHD may include medication (i.e., stimulants, nonstimulants and antidepressants) and behavior therapy that teaches children to set and meet goals while controlling their impulsivity and distractibility. Once decided upon, the proposed treatment's potential benefits must be weighed against potential side effects and negative drug interactions that might...