Archive for the 'The Total Transformation – Pediatrician’s Analysis' Category

The Total Transformation Review By Pediatrician

It’s been about eight months since I posted the first of my many reviews of different aspects of The Total Transformation Program by James Lehman. In fact, there are sixty of my own review entries available as of this writing.

I’m really excited to be bringing you someone’s else point of view on the Total Transformation Program by introducing another series of entries I just finished posting.

This analysis was completed and written by Dr. Patricia Quinn, a pediatrician who is the Director of the National Center for Girls and Women with ADHD. (Her analysis covers kids and teens of both genders.)

Dr. Quinn writes in easy to understand, everyday language so reading her review should be both enjoyable and informative.

Here are a few notes on the doctor’s analysis:

– Any links in the body of the reviews were added by me for readers’ convenience in accessing the Total Transformation website. There were no links in Dr. Quinn’s original analysis.

– Her analysis has been reproduced in its entirety. I have broken it up into 10 different blog entries for ease of reading.

– Blog entry titles were not part of the original. I broke up the paper in the same sections as she used in her original where she had broken it up into bold headed sections.

– Since this is a blog and entries appear in reverse chronological order, I had to be creative in actually posting the entries backwards in order for you to be able to read the paper correctly from beginning to end! When you read each entry down the page, that is the correct order – from introduction to reference list.

– It is reprinted with permission of Legacy Publishing.

Use the links below or on the side under the Categories section to begin accessing either set of reviews.

Dr. Patricia Quinn’s Total Transformation Review

My Total Transformation Review

Help For Behavior Disorders

Critical Analysis of the Total Transformation Program (TTP) of Legacy Publishing Helping Behavior Disordered Children and Teens

Patricia O. Quinn, MD, FAAP Director, National Center for Girls and Women with ADHD

Over the last decade, pediatricians have been diagnosing and treating increasing numbers of children with behavioral problems. These children with behavior disorders make up approximately 15 percent of the children seen by pediatricians, but these physicians do not always feel sufficiently trained to fill this new role.

They, as well as the families they serve, are in need of a structured program to aid in their work with behavior disordered children and teens. The Total Transformation® Program (TTP) by James Lehman, MSW, LCSW, is a program designed to address this need.

In an attempt to provide an objective assessment of the TTP, I will undertake to address several questions in three areas need/effectiveness/accessibility). These include:

• What is the need for a behavioral management program for children and teens
with ADHD and disruptive behaviors?

• How can the TTP meet the need of providing a behavior management program to
children and teens with ADHD and disruptive behavior disorders?

• What are the underlying premise and the goals of the TTP?

• What is the quality of the materials? Are they useful? Do they deliver what is

• What is the scientific evidence for the effectiveness of such a program?

• Lastly, what is the reputation of Legacy Publishing; and what is their ability to
deliver such a service?

Disruptive Behavior Disorders

What is the need for a behavioral management program for children and teens with ADHD and disruptive behaviors?

ADHD remains the behavioral problem most often diagnosed by pediatricians. Research has established that disruptive behavior disorders are commonly seen with ADHD.

From 30% to 50% of children with ADHD in a community sample, and 50% of children in a clinically referred sample, are likely to have another externalizing, disruptive behavior disorder. (Wilens et al., 2002; Busch et al., 2002)

In clinical practice, children with ADHD often have behavioral problems including ODD/CD. The presence of these externalizing behavior disorders significantly complicates the acute presentation of ADHD and is associated with more severe ADHD symptoms and overall impairment and a worse overall long-term prognosis.

Considering this negative prognosis, early identification and treatment of behavior and conduct problems in children and teens with ADHD cannot be overemphasized.

The American Academy of Pediatrics in their Guidelines for the Assessment and Treatment of ADHD, recommend that pediatricians assess for coexisting conditions in addition to ADHD symptomatology. They are then urged to begin treatment of diagnosed children with “stimulant medications and/or behavioral treatment” after “negotiating target outcomes.” (AAP, 2001)

Stimulant medications have long been known to be safe and effective in the treatment of ADHD and should be considered the first line of treatment for children and teens with ADHD and coexisting ODD/CD.

However, if ADHD symptoms respond but ODD/CD symptoms persist after medication intervention, psychosocial treatment should then be added to the treatment regime. If symptoms associated with ODD/CD are extreme at the time of diagnosis, multimodal treatment is often needed from the beginning.

The role of psychosocial interventions alone or in combination with medication for the treatment of ADHD have been studied extensively. The NIMH MTA study (MTA Cooperative Group, 1999; MTA Cooperative Group, 2004) and the Multimodal Psychosocial Treatment study (MPT, also known as the New York/Montreal study) (Klein et al., 2004) have examined the effects of pharmacological and behavioral treatments on ADHD symptoms when used alone or in multimodal treatment programs.

These large-scale, long-term, randomized clinical trials have greatly contributed to the field as to the efficacy of long-term medication treatment and the role of psychosocial
interventions in ADHD.

[Editor’s Note From Someone Elses’s Kids: The Total Transformation Program is a behavioral management program.]

Total Transformation Goals

What are the underlying premise and goals of the TTP?

The Total Transformation Program is a guided training program for parents that utilizes cognitive learning theory a behavioral management techniques to alter dysfunctional family interaction patterns.

The underlying premise of the TTP is that behaviorally disordered children and teens need to be empowered with skills to manage their daily functioning and social/behavioral interactions. TTP is an accountability based treatment program that empowers parents to deal with their child’s inappropriate responses.

It offers them a means to decode and understand their child’s behavior. It places parents in the training and coaching role and offers them a concrete plan that they can actualize in the home.