Research Paper on ADHD
Review of Literature
Attention deficit hyperactivity disorder is a mental disorder in children which includes a group of symptoms that comprises loss of attention, impulsive behavior and hyperactivity. These signs and symptoms are noticed in children between six and twelve years (Oord et al., 2012). The symptoms are pronounced in changing environments. Sleeping disorders and anxiety is also noted among children with ADHD (Oord et al., 2012). ADHD is defined as an abnormal mental condition in children which causes a significant impact on the education of a child (Barkley, 2006). Diagnosis of ADHD is mostly made through symptoms observation (Tatlow-Golden et al., 2016). Treatment entails pharmacological and non-pharmacological methods. These entire plans meet the criteria for treatment of attention deficit hyperactivity condition listed by the American psychologists association (Chronis et al., 2006). Pharmacological methods include stimulant and non-stimulant methods. Methylphenidate is the drug that has been the most practiced pharmacological approach. Non-pharmacological methods include behavioral therapies. These non-pharmacological behavioral therapies include Parent training, educational plans and training the patients on necessary social skills (Chronis et al., 2006). Parent training entails some reinforcement therapies such as positive and negative reinforcement policies. Rewarding positive behavior and punishing bad behavior has resulted in significant impact on ADHD patients (Lee, et al., 2012). Various classroom measures such as praise, timeouts during hyperactivity episodes, keeping daily scores by the teachers has also resulted in reduced symptoms in these patients (Chronis et al., 2006). Pharmacological treatment of the ADHD includes various methods: the use of stimulant drugs which include amphetamine and methylphenidate (Chronis et al., 2006). Methylphenidate has been the first line and the preferred choice for the treatment of attention deficit hyperactivity disorder. Some other drugs have listed though not approved for clinical use in attention deficit hyperactivity disorder (Vallerand et al., 2014). Long-acting stimulants have been preferred by most parents since the children could just take once without interfering with their school routines (Vallerand et al., 2014). The combination of the pharmacological stimulant therapy and behavioral therapy has shown to have an improved impact on the patients compared to the behavioral therapy alone or the standard community care (Oord, et al 2012). There has been a preference for either the combination method or behavioral therapy by parents and teachers, and its has a significant impact on the adherence to the therapeutic regimens has a substantial impact on the condition of the children (Vallerand et al., 2014).
Diagnosis of Attention Deficit Hyperactivity Disorder
Research done by (Tatlow-Golden et al., 2016) shows that the efficiency of ADHD diagnosis was compromised as doctors were not able to recognize all the symptoms due to inadequate training and intricate nature of ADHD. Diagnosis of other mental conditions such as mood disorder was more efficient (Tatlow-Golden et al., 2016). Many general practitioners diagnosed challenging and misguided behavior as attention deficit hyperactivity disorder though they diagnosed the primary symptoms of impulsiveness, inattention and hyperactivity right (Tatlow-Golden et al., 2016).
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According to research (Vallerand et al., 2014) regarding behavioral therapies for children with this condition; ADHD showed that there was an important niche in the administration process of these behavioral treatments. The administrators of these therapies lacked insight into some of the methods. It was considered a psychosocial intervention and hence was not a prioritized approach in the management of children who have attention deficit hyperactivity disorder (Vallerand et al., 2014). The significant value was emphasized on other methods such as the pharmacological method compared to the behavior modification methods (Vallerand et al., 2014). The observation in the research is similar to previous studies carried by Weiss (Vallerand et al., 2014).Weiss demonstrated the different emphasis received by the two methods (Weiss et al., 2008). The research also noted that there was lack of adequate training of physicians regarding the behavior modification therapy used in attention deficit hyperactivity disorder (Vallerand et al., 2014)The healthcare professionals assumed there was no need of the methods as behavior modification will be achieved by mental health education systems (Vallerand et al., 2014). Other professionals didn’t contribute to the use of the behavioral training methods to achieve symptom relief as there was no evidence to support that in the research (Vallerand et al., 2014). The gap in knowledge of the behavioral training therapies has significantly undermined the use of this method by healthcare professionals to achieve quality management of the patients (Vallerand et al., 2014)
Overlapping knowledge of evidence and non-evidence-based behavioral methods and failure to comprehend the difference has prevented the prioritization of the evidence-based practices and access to them (Vallerand et al., 2014). They also found out the level of specification and details of the behavioral guidelines also differed and contributed to different outcomes. Due to this the research suggests inclusion of all relevant behavioral therapy guidelines to achieve maximum utility and relief of the symptoms in attention deficit hyperactivity disorder patients (Vallerand et al., 2014)
It’s possible that the research by Vallerand didn’t acknowledge all the relevant behavioral guidelines due to the inclusion criteria used in the study (Vallerand et al., 2014). The omitted guidelines have been shown to have a significant impact on behavioral modification in patients. Research done by Paul Hodgkins et al notes that the type of behavioral change instructions is unique for every patient and has to be tailored according to the disease pattern and symptoms observed in the patient (Hodgkins et al., 2012).
According to the research by Paul Hodgkins et al regarding amphetamine and methylphenidate medication use children with the mental disorder: ADHD, both the drugs improved the symptoms by reducing motor-related activity compared to the patients that were given placebo medications (Hodgkins et al.,2012).There was no drug that commanded overall superiority as the outcomes were different in different subjects, some showed amphetamine superiority while others showed methylphenidate, some registered no difference between the drugs (Hodgkins et al., 2012).The research points out the duration of action of the drug had a significant impact on the outcome (Hodgkins et al., 2012).
The drugs had different adverse effects, and the study concludes that amphetamines resulted in apathy and unenthusiastic emotions, stomach pains while patients taking methylphenidate had fatigue, sleeping disorders, and nugatory emotions such as crying and sadness (Hodgkins et al., 2012). Children on amphetamine had more and severe side effects compared to those on methylphenidate (Hodgkins et al., 2012). However, increased nervousness and mannerisms were illustrated in boys taking methylphenidate compared to those on placebo. Such occurrences were negative in amphetamine patients (Hodgkins et al., 2012). Maximization of the positive effects of the drug in order to achieve reduction or abolishment of symptoms required thorough assessment of the patient’s condition, adequate monitoring of the patients to immediately treat any complications and severe side effects and ensuring total adherence to the drugs contributes in the optimization of the medicine effects (Hodgkins et al.,2012)
Combination Treatment Method
The research notes the significance of ADHD management that incorporates all forms of treatment has been acknowledged and approved in ADHD treatment guidelines (Hodgkins et al., 2012). Multimodal regimens showed superior outcomes compared to pharmacological therapy alone (Hodgkins et al., 2012). The study (Hodgkins et al., 2012) also explains that the multimodal treatment was superior as it was not affected by non-adherence. It supports prior studies that encourage the combination of pharmacological therapies and behavioral modification training methods due to the advantages linked to it (Hodgkins et al., 2012). This combination approach has been crucial in cases of attention deficit hyperactivity disorders that have coexisting diseases and in situations of financial incapability as its cost effective (Vallerand et al., 2014).
It is evident that all the treatment regimens had no significant impact on inattention noted in attention deficit hyperactivity patients and some instances worsened. However, other symptoms including hyperactivity and impulsiveness improved with treatment (Oord et al., 2012).
The various treatment methods have significant impacts on management (Tatlow-Golden et al., 2016). The studies in this review also recognize the deficits in knowledge of general practitioners regarding the various treatment modules and diagnosis of the attention deficit hyperactivity disorder (Tatlow-Golden et al., 2016). The research also notes that parents of children who have this mental disease; ADHD had higher levels of stress compared to other parents (Oord et al., 2012).
Hodgkins, P., Shaw, M., Coghill, D., & Hechtman, L. (2012). Amfetamine and methylphenidate medications for attention-deficit/hyperactivity disorder: complementary treatment options. European child & adolescent psychiatry, 21(9), 477-492.
McCarty, C. A., Vander Stoep, A., Violette, H., & Myers, K. (2015). Interventions developed for psychiatric and behavioral treatment in the Children’s ADHD Telemental Health Treatment Study. Journal of Child and Family Studies, 24(6), 1735-1743.
Oord, S., Prins, P. J. M., Oosterlaan, J., & Emmelkamp, P. M. G. (2012). The Adolescent Outcome of Children with Attention Deficit Hyperactivity Disorder Treated with Methylphenidate or Methylphenidate Combined with Multimodal Behaviour Therapy: Results of a Naturalistic Followup Study. Clinical psychology & psychotherapy, 19(3), 270-278.
Tatlow-Golden, M., Prihodova, L., Gavin, B., Cullen, W., & McNicholas, F. (2016). What do general practitioners know about ADHD? Attitudes and knowledge among first-contact gatekeepers: systematic narrative review. BMC Family Practice, 17(1), 129.
Vallerand, I. A., Kalenchuk, A. L., & McLennan, J. D. (2014). Behavioural treatment recommendations in clinical practice guidelines for attentiondeficit/hyperactivity disorder: a scoping review. Child and Adolescent Mental Health, 19(4), 251-258.