Research published in the June 2002 issue of the journal Medical Health Services Research says that sending difficult children to a boarding school may not be as effective as keeping the family together and providing a family preservation program.
Psychologist Linda A. Wilmshurst of Texas Woman's University compared children enrolled in a residential program with children who stayed at home. One year later, children who stayed at home were less anxious, less depressed and showed fewer symptoms of ADHD than those who had been enrolled in the 5 day a week residential program.
Residential treatment is typically the last resort for over-stressed families. For example, children in this study also had emotional and behavioral disorders (EBD), conduct disorders and oppositional behaviors that further complicated their ADHD symptoms. About one-third of the children in the study also had general anxiety, separation anxiety, or depression, or some combination of all three. Almost all of the participants came from low-income, single-parent families.
Almost two-thirds (63%) of the children who stayed with their families showed a reduction of clinical symptoms for ADHD, general anxiety and depression. Only 11% of the children who participated in the residential program showed similar improvement.
Wilmshurst theorizes that fear may have been a factor. "Removal from the home may have served to exacerbate existing levels of anxiety, resulting in excessive worry about their future, concern about past behavior, and a heightened awareness of the potential of removal again," she said. She also speculates that at least some of the difference may have been caused by interaction with other troubled children at the residential facility.
Wilmshurst believes that behavioral treatment was beneficial for several reasons, including the fact that children and parents spent more time together and were given practical help from trained therapists. Previous research supports the use of cognitive or behavioral methods in the treatment of ADHD. Wilmshurst refers to the work of Russell Barkley, Ph.D. and others in her article.
Families in the family preservation group received much more than the standard one hour per week of family counseling. For the study, therapists trained in family preservation offered treatment in the home and were available for the families 12 hours per day for a 12 week period. Treatment was targeted to specific problems. For example, if a parent was having difficulty managing a child at breakfast, the therapist would schedule a visit at that time to observe interactions and assist the parents in defining specific problem behaviors and suggesting alternatives. Unfortunately, such optimal treatment is not often the case in the real world.
Still, desperate parents may feel that sending their child to a residential facility is the only option they have, especially if there are other children in the family. Parents who are considering residential treatment should carefully weigh the pros and cons before enrolling the child in a program.