When Is Inpatient Care Needed for ADHD?

How can parents determine if inpatient care is a good option for ADHD (Attention Deficit Hyperactivity Disorder)?

Generally, inpatient care becomes an option when outpatient treatments have been unsuccessful, particularly in cases where ADHD is severe and accompanied by co-occurring conditions.

Using the 2022 National Survey of Children’s Health, these researchers found that 12.8% of adolescents diagnosed with ADHD had a severe case. That means these kids are more likely to have a co-occurring diagnosis, which makes treating the symptoms of simply ADHD being more difficult.

Many adolescents with severe ADHD also face co-occurring conditions. These often include:

Anxiety
Depression
Substance use
Behavioral conduct problems
Dyslexia
Developmental delays
Autism Spectrum Disorder

When Mark was first diagnosed with ADHD in kindergarten, he also received a diagnosis of Oppositional Defiance Disorder (a behavioral disorder, marked by hostility towards others). It took a team of school personnel to keep him on task and learning. Teachers and behavioral specialists used timers, visual cues, play breaks, environment changes and other techniques to help him complete assignments.

These strategies worked for several years, until Mark became older and more physically able to resist redirection. As Mark’s needs exceeded the capacity of traditional outpatient care, it became clear that an inpatient therapeutic program, equipped to manage his unique behavioral challenges, was the best option.

The benefits of inpatient care for ADHD.

While inpatient care can be costly, there are many benefits for the child suffering from ADHD. Some benefits include:

More monitoring/intensity. Inpatient programs provide 24/7 supervision, with more structure and daily treatment. This constant contact allows for continuous progress using new skills and behavior management practices.
More specialized treatment. Clinicians are able to observe and adjust treatments as necessary, and on real time. A treatment that is not working can be changed immediately instead of waiting for months.
A safe environment. When adolescents are struggling with aggressive behavior, impulsivity or self-harming behaviors, they can be closely monitored in a safe, controlled environment.
Monitoring and management of medication. Medications usually require fine-tuning. The inpatient setting allows clinicians to monitor symptoms and side effects carefully so any changes can be made quickly.
Family and caregiver involvement. Inpatient programs have skills and behavioral management training for family members, so that any progress made can continue at home.
Comprehensive treatment for co-occurring conditions. Treatments can incorporate other needed skills for anxiety, depression, learning disorders or other co-occurring conditions. Addressing these symptoms at the same time can improve overall outcome.
Transition to outpatient care. Patients are better prepared to continue outpatient care and prevent regression of symptoms after leaving an inpatient facility.

When to escalate to inpatient care for ADHD.

Inpatient care is a more appropriate option when a child with ADHD has complex behavioral needs. These needs are usually too difficult for parents and clinicians to address in weekly therapy or outpatient care.

Here are a few scenarios where a parent or clinician should escalate treatment to an inpatient:

Outpatient programs have failed to improve behavioral or academic outcomes.
When the child is self-harming.
When the child has suicidal ideation.
The child is using illegal substances.
Behavior become risky.
The behavior is endangering the child or others.
Anxiety, depression or other mood disorders are not improving.
The child is experiencing hallucinations or psychosis.
When medications are complex or side effects are severe.
When the family can no longer cope.
When the family feels like they’ve tried everything else recommended.

A 2019 review of 16 cross national studies found that the outcome for inpatient care for anxiety, depression and suicidal ideation showed improvements. When these disorders are addressed, clinicians, families and the one suffering from ADHD are better able to help manage the ADHD.

While ADHD in itself is not a reason for an intensive care situation, often it is not the only diagnosis with which your loved-one is struggling.

At Therapeutic Educational Consulting, we help guide, support and recommend for all kinds of therapeutic answers. Schedule with Rae Guyer, your therapeutic consultant for a no-cost discovery call.

Photo credit, SIPhotography