Attention-deficit/hyperactivity disorder (ADHD) is a persistent early-onset condition of developmentally improper levels of distraction, hyperactivity and recklessness. Even though ADHD has habitually been viewed as a childhood disease, data from researches on experimental correlates, family records, behavior reaction and a number of laboratory tests prove the validity of the diagnosis ADHD in old age.
Although major signs are frequently apparent in disorderly actions and learning difficulties in children with ADHD, grown-ups with enduring signs classically exhibit subtler cognitive and behavioral destructions, which nevertheless are frequently linked to major educational, professional, interpersonal, expressive and even legal obscurities.
To facilitate advancement of knowledge on brain-behavior, information that is more neuropsychological is required mainly from grown-ups.
Introduction
Modern neuropsychological approaches of ADHD show that cognitive impairments contribute to disorders in adulthood. The extents at which adults are affected vary from one individual to the other. This paper attends to the problem of ADHD disorder in adults.
The paper formulates a methodology that seeks to experiment the ADHD effects. Finally, the paper discusses the findings of the experiment and gives specific conclusions. In the conclusion section, the researcher observes that further studies are recommended to gain more knowledge about the topic.
Traditional perspectives of ADHD portray a major deficiency of cognitive control. Contemporary studies emphasize that a number of factors contribute to adulthood disorders such as activation, stimulation, attentiveness, inspiration and reward system.
However, available data on adult ADHD are child-based implying that they have to undergo extensive empirical research concerning their applicability in individuals with enduring symptoms. Few researches have been conducted as regards to major cognitive control processes.
Major cognitive control processes are interference control and task-set management. The most recent study utilized tentative chronometric Stroop and task switching model. The model was used to investigate the effectiveness of processes used in testing interference control and task-set management in adults with ADHD disorder (Willcutt, & Doyle, 2005).
Method
Twenty-two grown-ups proved to be with ADHD disorder were used in conducting the study. There were seventeen males and five females. All participants were taken through the test to achieve accurate results. The researched were recruited through newspaper advertisements.
They were approximately eighteen to forty-five years of age. Clinical evaluation of patients was then carried out based on diagnostic procedures for ADHD in adulthood as spelled out by the country’s psychological professional code of conduct.
The participants were initially interviewed in order to obtain some key information as regards to ADHD disorder. The questionnaire used was semi-structured. To gain more insight, standardized self-report and guaranteed informer evaluation scales were also used to compute ADHD signs. Finally, symptom checklist was utilized to compare the effects of ADHD in adult patients.
The study was conducted in a laboratory in a controlled version. Patients with enduring childhood-onset ADHD were also included in the experiment irrespective of their subtype. Apart from controlling group variance with regard to age, education and sex, consistent approximate measure of verbal and figural aptitude were performed in all experiments.
The average approximated verbal IQ of the ADHD cluster had no major variance to that of the controlled cluster. Similarly, the average approximated figural IQ of the ADHD cluster had no difference to that of the controlled cluster. The extent at which ADHD affects patients in the study is not different from the previous studies conducted by other scholars.
As earlier noted, all studies were conducted in the neuropsychology laboratory and ADHD patients were treated professionally that is, their privacy was given a priority. The tests started immediately after interviewing patients, subjecting them to neurological assessments and taking them through IQ evaluation tests.
Since patients were not familiar to the regulations and rules of experimentation, some time was set aside in order to take them through an orientation process.
They were given general instructions on what they should do when being tested. Instructions were in written form since each participant could read and write. Electronic devices were employed to assist in providing accurate results (Murphy, 2002).
A tentative handbook of Stroop test was used to guide the researchers in performing the study. Trial-by-trial instructions were followed in carrying out the study. The stimuli used included words in native language, which were familiar to each participant.
The words were colored in blue, red, green and white. Patients were instructed to select the color that was presented by a given stimuli. There were three experiments in total. In the harmonious state, color words were displayed in a semantically analog color.
In the nonaligned baseline situation, XXXX was displayed in one of the four probable colors. In the unequal condition, color expressions were displayed in a color that is contrary to the meaning of the inscribed color expression.
Participants were instructed to press a button marked by a particular color (Tannock, Banaschewski, & Gold, 2006). Buttons were numbered from one to four. Each number denoted a particular color. The test was repeated severally to achieve credible results.
Discussion
Adult individuals with ADHD disorders usually blame sensitive levels of distractibility and inadequacy typified by recurrent exchange between incomplete responsibilities. In this experiment, the operations of sampled grown-ups diagnosed with childhood-onset ADHD were contrasted to health management issues on two tentative measures (Stroop, 1935).
The experiment assesses the effectiveness of cognitive control processes in managing distractibility and task-inappropriate aspects (Stroop experiment). The experiment further analyzes elastic harmonization of manifold task-sets in the face of interruption.
In the initial experiment, the study investigated Stroop’s intrusion control in adult ADHD using a trial-by-trial model (Stroop, 1935). In the experiment, variations among groups were anticipated to be different from measures of intrusion control.
No previous study has attempted to investigate cognitive elasticity using traditional task exchange model. The researcher in this study therefore theorized group variations in cognitive management processes.
The results from the task exchange statistics established that abnormal obstruction management in the ADHD test was not simply caused by impairment in superseding divergence prompted by dominantly represented vocal material.
In comparison with the vocal motivation in the engaged Stroop examination, the extraneous measurement of the task exchange motivation on bivalent tests is not dominantly embodied. Since the ADHD cluster intrusion results on the task-switching model were not specially calculated, they call for unique reflection.
Different from the projected premise, the researcher in this study never observed cluster exchange or integration cost RT variations in task exchange performance.
The comparative extent of RT variations between MB exchange vs. recurrence tests, over and above between MB recurrence and PRB tests was the same for the two clusters (Stroop, 1935).
Whereas the cluster integration cost RT correspondence replicates preceding conclusions in children, the cluster exchange cost RT correspondence stands contrary to the fundamental results of both preceding cued task exchange/ADHD experiments.
Conclusions
The contemporary study elucidates the usefulness of utilizing tentative tasks borrowed from the essential cognitive sciences to examine methods assumed to be harmful in a cognitive disarray.
Even though modern neuropsychological approaches of ADHD predict intrusion management and cognitive elasticity paucity in the disarray, preceding results acquired from traditional measures such as paper and pencil Stroop tests, have been contradictory. Here, the researcher noticed constant group intrusion variations on two autonomous tasks.
Tentative management of time allocated to organize for future task discovered that the ADHD cluster intrusion result observed on the task-switching model was reliant on ineffective task groundwork. In reality, all switching-related cluster variations were furthermore found to be reliant on nonconforming groundwork results.
Whereas ADHD group task research methods were competent enough to preserve task-sets in the environment of recurring random task exchange, it botched when temporary task-set information was required.
Apart from this method-specific cluster diversity, ADHD group presentation was as well generally sluggish and not perfect. Even though not an essential problem of the existing examination, subjective data confirmed that intra-individual reaction inconsistency may have accounted for indiscriminate ADHD cluster reaction.
Nevertheless, this likelihood was just evident in comparatively simple pure recurrence blocks of the task-switching model. In general, ADHD cluster discrepancies in intrusion management and cognitive elasticity could not be noticeably separated from irregular preliminary systems and reaction irregularity.
Therefore, it remains questionable as to whether disorganized ADHD cluster cognitive management was caused by top-down malfunction or bottom-up connection.
To elucidate this problem, upcoming neuropsychological analyses are encouraged to utilize tasks with extensive tests and direct management of bottom-up apparatus with more samples (MacLeod, 2010).
References
MacLeod, C. M. (2010). When learning met memory. Canadian Journal of Experimental Psychology, 64, 227-240.
Murphy, P. (2002) Inhibitory control in adults with Attention-Deficit/Hyperactivity Disorder. J Attention Disorder, 6, 1-4.
Stroop, R.J. (1935). Studies of interference in serial verbal reactions. Journal of Experimental Psychology, 18, 643-662.
Tannock, R., Banaschewski, T., & Gold, D. (2006). Color naming deficits and attention-deficit/hyperactivity disorder: a retinal dopaminergic hypothesis. Behavior Brain Function, 2(4).
Willcutt, E.G., & Doyle, A.E. (2005). Validity of the executive function theory of attention-deficit/hyperactivity disorder: a meta-analytic review. Biology Psychiatry, 57, 1336-1346.
This paper is aimed at discussing and drawing attention to the proposed diagnostic amendments made by the DSM-5 ADHD and Disruptive Behaviour Disorders Committee. The current Diagnostic and Statistical Manual (DSM-IV) published by the American Psychiatric Association provides a standard criteria for the classification of mental disorders (American Psychiatric Association, 2000; Rutter, 2004) and the diagnostic procedures that are used by clinicians and psychiatrics in addressing these abnormalities.
The Attention deficit Hyperactivity Disorder (ADHD) has for many decades been one of the most commonly medically diagnosed behavioural condition that occurs at some stage in a child’s development. ADHD according to Holowenko (1999) and the American Psychiatric Association (2010a) refers to a mixed group of disruptive behaviours that cause difficulties with the child’s development, behaviour and performance, family relationships and social interaction.
It is characterized by inattentiveness, an almost reckless impulsiveness and knee-jiggling, toe-tapping hyperactivity (Holowenko, 1999). The manifestation of the disorder and the difficulties that they cause, as posited by the American Psychiatric Association (2010a), are typically more pronounced when a person is involved in some piece of work such as studying or work and is less severe while the individual is resting.
We consider first the proposed changes to ADHD in the DSM-5 and latter provide a commentary on the advantages of adopting these changes.
Proposed Changes to ADHD
The DSM-5 ADHD and Disruptive Behaviour Disorders Committee have enlisted different variations in their interim recommendations. First, the committee propose to widen the age onset of the syndrome from the current before seven years to before twelve years of age. This is the age in which symptoms of the disorder are first present (Low, 2011).
The second modification pertains to the restructuring of ADHD subtypes. As noted by Low (2011), the current DSM edition includes three diverse subtypes that inform this disorder as earlier stated. Low (2011) notes that the continual reference to these subtypes is problematic in that the subtypes are progressively changing over time and may lead to double detection for subsequent tests.
A different type of change may be the one including at least four new impulsivity symptoms when the DSM-IV present at a given moment is not correctly captured. These four additions comprise symptoms whereby the incumbent tends to act without thinking, is often impatient, is uncomfortable doing things slowly and systematically and finds it difficult to resist temptations or opportunities (Low, 2011; Cowley, 2001).
Under the new strategy those individuals considered to do things without prior thinking comprise of those who start tasks without adequately preparing for them or speak without considering the outcome, whereas impatience will encompass the child feeling unusually restless in terms of wanting to move faster than others or even driving speedily (including cutting into traffic), as indicated by Sarkis (2011).
The draft also proposes to make modifications that will better represent the adult ADHD. This will be geared towards ensuring that there is a consideration of a proposal advocating for reduction of the observed symptoms in adults from the current six to four symptoms among the older patients who are aged seventeen and above.
The move is supported by the fact that the number of symptoms is inversely proportional to age with the severity of the disorder exacerbating and so the proposed changes will address this issue as well as make the criteria more developmentally appropriate for adults (Low, 2011; Sarkis, 2011).
It is also in the interests of the committee to make the draft elaborate the criteria description (American Psychiatric Association, 2010b) by providing a more detailed description of the symptoms with regard to the proposed diagnostic presentations (Low, 2011; American Psychiatric Association, 2010b).
Merits associated with these changes
The increment of age of onset of symptoms to be present on or before the age of seven to the age of twelve and the subsequent change from impairment to symptoms is expeditious since it is almost difficult to judge inattention before the age of five and it also enables the clinicians to shift focus from impairments to symptoms. The proposed change is geared also to increasing the number of patients who receive the clinical benefits.
Lowering the threshold for the minimum number of symptoms necessary for an adult 17 years and above is a favourable move since it takes into account research findings that impairment persists more profoundly after the age of 18 even though the symptoms for the disorder decline significantly as intimated by the American Psychiatric Association (2010b).
This therefore better represents an adult’s case and so appropriate diagnosis will consequently be administered. The inclusion of four additional impulsivity criteria will correct the current underrepresentation of impulsivity and the fact that the recommendation is drawn from interviews with adult ADHD patients will make it more valid and reliable (American Psychiatric Association, 2010b).
The clause proposed to deal with inattention cases that are not hyperactive not only assigns a ‘descriptive name for a syndrome without hyperactivity but also recognizes the absence of empirical support for an idiosyncratic disorder by not assigning a new diagnostic code whereas allowing a small number of HI criteria to give it an immediate status’ (American Psychiatric Association, 2010b) which originally was not provided for.
Attention Deficit Hyperactivity Disorder as a Cognitive Disorder
According to Seth and Coghill (2010), ADHD relates perfectly well to both the behavioural and cognitive functioning of a child in his or her development. The consideration of ADHD as a cognitive disorder in the updated DSM-5 edition will shed light on those clinicians and other practitioners who view ADHD as a behavioural difficulty and allow them to appreciate that it is associated by far and wide to substantial cognitive impairments (Steele, Elkin and Roberts, 2007; Seth and Coghill, 2010).
The cognitive behavioural approach used by therapists can be extremely helpful for the adults with ADHD and who easily lose track of long term goals as he or she focuses impatiently on whatever seems most pressing at the moment as White (n.d.) indicates. Though the chronic ADHD is treated with medications, most of these patients continue to evidence at least some residual symptoms and functional impairments that may be amenable to a cognitive behavioural approach (Safren, 2006; Matson J, Andrasik and Matson M, 2008).
As such, pharmacotherapy is not an end in itself and thus evidence based alternative interventions such as behavioural school interventions and parent training are needed to complement (Knight, Rooney and Chronis, 2008; Chronis, Jones and Raggi, 2006). Hinshaw (cited in Kendall 2011) states that common co-morbidities of ADHD such as aggressive spectrum disorder and anxiety show little evidence of benefit from medication strategies alone, necessitating the cognitive-behavioural intervention strategies.
Conclusion
The Attention deficit Hyperactivity Disorder (ADHD) syndrome is a common impairment that has been there for ages affecting children as they develop from one stage to another. The American Psychiatric Association publishes standard criteria namely Diagnostic and Statistical Manual that provides clinicians and psychotherapists with a standard and a consistent way of addressing the disorder.
Improvements made on the criteria over the decades provide that ADHD could be handled cognitively as earlier discussed. This marks a mileage in the quest to make life better for patients with this disorder and offers more practical ways of understanding the disorder and as such it should be adopted by clinicians and other practitioners.
References
American Psychiatric Association (2000). Diagnostic statistical manual for mental disorders (4th ed). Washington, DC: American Psychiatric Association.
American Psychiatric Association (2010). A 10 attention deficit/hyperactivity disorder. Web.
American Psychiatric Association (2010). DSM-5: Options being considered for ADHD. Web.
Chronis, M., Jones, A., & Raggi, V.L. (2006). “Evidence-based psychosocial treatments for children and adolescents with attention-deficit/hyperactivity disorder. Journal of Clin Psychol Rev, vol.26 (4): 486-502.
Cowley, S. (2001). Public Health in Policy and Practice: A Sourcebook for Health Visitors and Community Nurses. New York: Pearson.
Holowenko, H. (1999). Attention deficit/hyperactivity disorder: a multidisciplinary approach. Jessica Kingsley Publishers: New York.
Kendall, P. C. (2011). Child and Adolescent Therapy: Cognitive-behavioural procedures, (4th Ed). Gilford Press: Amazon.
Knight, L. A, Rooney, M., & Chronis, T. A. (2008). Psychosocial treatments for attention-deficit/hyperactivity disorder. Journal of Curr Psychiatry Rep, vol.10 (5): 412-8.
Low, K. (2011). ADHD Diagnosis – changes being considered. Web.
Matson, J. L., Andrasik, F. & Matson, M. L. (2008). Treating Childhood Psychopathology and Developmental Disabilities. Springer: London.
Rutter, P. (2004). Community Pharmacy: Symptoms, Diagnosis and Treatment. New York: AMC.
Safren, S. A. (2006). Cognitive-behavioral approaches to ADHD treatment in adulthood. Journal of J Clin Psychiatry vol.67 (8), 46-50.
Seth, S. & Coghill, D. (2010). Do the diagnostic criteria for ADHD need to change? Comments on the preliminary proposals of the DSM-5 ADHD and Disruptive Behaviour Disorders Committee. Journal of Europen Child Adolescent Psychiatry, 20, 75-81.
Steele, R. G., Elkin, T. D. & Roberts, M. C. (2007).Handbook of evidence-based therapies for children and adolescents: bridging. Springer: London.
Nowadays more and more children are diagnosed ADHD. Many researchers accentuate the fact that the consequences of children’s hyperactivity and attention-deficit can influence the peculiarities of their mood and behavior in the period of adolescence.
That is why the problems connected with ADHD are widely discussed by psychologists today. Catherine L. Bagwell, Brooke S. G. Molina, Todd B. Kashdan, William E. Pelham, and Betsy Hoza conducted the study the main objective of which was to examine the association between childhood ADHD and anxiety and mood disorders in adolescence in 2006.
The results of the study were presented in the form of the article named as “Anxiety and Mood Disorders in Adolescents with Childhood Attention-Deficit/Hyperactivity Disorder” which was published in Journal of Emotional and Behavioral Disorders.
The researchers developed the study in order to support their scientific hypothesis. Thus, they were inclined to examine the dependence of the peculiarities of the adolescents’ behavior characterized with different levels of anxiety on the effects of ADHD symptoms which were diagnosed for these adolescents when they were children.
Moreover, the researchers determined two more aspects for the observation. That is why the investigation was developed to prove or disprove such hypotheses as the dependence of higher rates of anxiety of adolescents with ADHD on their diagnosis, the dependence of ODD and CD in adolescence on ADHD in childhood, and the influence of externalizing and internalizing disorders on the level of anxiety in adolescence (Bagwell, Molina, Kashdan, Pelham, & Hoza, 2006).
The study was realized with the help of the observations and interviews which were conducted according to definite questionnaires and analyzed with the help of diagnostic interview schedules. The results of the study were presented in the form of the tables. The researchers examined and compared two groups of adolescents.
The first group included 142 adolescents with ADHD, and the second group included 100 adolescents without ADHD (Bagwell, Molina, Kashdan, Pelham, & Hoza, 2006). Moreover, the parents of the adolescents also participated in the interview. The questionnaires contained the questions about the peculiarities of adolescents’ typical behavior and their mood. The difficulties with the study were connected with the analysis of the inappropriate answers to the questions of the interviews.
Having analyzed the results of the study with the help of schedules and logistic regressions, the researchers concluded that those adolescents who have ADHD are at risk for developing higher rates anxiety and mood disorders such as depression because of externalizing disorder symptoms and social problems which they experienced during their childhood (Bagwell, Molina, Kashdan, Pelham, & Hoza, 2006).
Moreover, the problems with parents or peer problems which were typical for their childhood can become more severe in adolescence. That is why clinic-referred children can face more problems in social communication and suffer from depressions more often in comparison with the representatives of a community-recruited group (Bagwell, Molina, Kashdan, Pelham, & Hoza, 2006).
The findings of the research allow speaking about the influence of ADHD diagnosis on the peculiarities of the adolescents’ behavior, their predilection to depressive states and higher levels of anxiety. Moreover, the researchers concentrated on the role of the relations with parents in overcoming negative effects of ADHD and its externalizing symptoms.
That is why parents should pay more attention to their children’s problems affected by ADHD in childhood in order to prevent them in adolescence. This issue requires its further investigation as well as the problems of the adolescents’ depressions and social disorders of adolescents which can be connected with the effects ADHD diagnosis.
Reference List
Bagwell, C. L., Molina, B. S. G., Kashdan, T. B., Pelham, W. E., & Hoza, B. (2006). Anxiety and mood disorders in adolescents with childhood Attention-Deficit/Hyperactivity Disorder. Journal of Emotional and Behavioral Disorders, 14 (3), 178-187.
SEBD stands for social, emotional and behavioural difficulties that children or infants suffer from during the early stages of their development. SEBD is a broad term that is used to categorise various behavioural disorders that affect the performance of children in learning activities as well as in peer and family socialization.
One of these disorders that will be the focus of this study is the attention deficit hyperactivity disorder (ADHD). Children who suffer from SEBD present a special challenge to parents, teachers or other related guardians as their behavioural deficiencies causes them to interfere with the daily activities in the home or in school.
In the classroom setting, SEBD behaviour usually manifests itself in the form of uncooperativeness, rebellion to authority, oppositional behaviour and general disruptiveness (Clough 2005).
While the classroom is the most common place for the symptoms of SEBD to be displayed, the same situation occurs in the family setting where parents and siblings are engaged in a 24 hour cycle of conflict with a child that suffers from SEBD.
The unifying factor of all SEBD disorders is that they are disturbing to both school teachers and parents of the affected child, meaning that any interventions and concerted efforts to deal with the disorder will involve parents, teachers, paediatricians and therapists.
Strategies that will be used in SEBD should, therefore, consider the important role that the society, the family and the school environment plays in the overall development of the child’s social, emotional and behavioural needs (Carsch 2006).
Literature Review of ADHD in Infants
Attention deficit hyperactivity disorder (ADHD) refers to a behavioural disorder that affects the overall development of a child psychologically and mentally. ADHD is usually characterised by poor or low attention in class or family settings, hyperactivity, restlessness and disruptive behaviour.
Each of these behaviours occur at infrequent times within different settings where in one instance the child might be attentive to what is going on and in the next minute they might display disruptive or inattentive behaviour.
This type of SEBD neurobehavioural disorder is one of the most researched and studied psychiatric disorder in children and infants. This is because it is seen as one of the most continuous behavioural and emotional traits that exist in the world population causing a general deterioration in the mental development of the child (Biederman 1998).
The research work conducted on ADHD has categorised the disorder as a type of SEBD disruptive disorder that affects the behaviour of children as well as their cognitive capabilities.
The number of children who are diagnosed with ADHD amounts to between 3 and 5 percent of the worldwide population of children where 16 percent of this number are school-going children.
The percentage of children that carry the disorder well into their childhood averages between 30 to 50 percent where they continue to suffer from the various symptoms presented by the disease.
Adults and teenagers tend to develop coping mechanisms that will enable them to deal with the behavioural impairments that come with the disorder which is not possible for small children and infants (Nair et al. 2006).
ADHD has further been divided into three sub-categories which include predominantly hyperactive-impulsive disorder where the sufferer exhibits hyperactive and impulsive behaviour and inattention to surroundings, predominantly inattentive where the symptoms exhibited by the sufferer are mostly hyperactivity and impulsivity as well as combined hyperactivity-impulsive and inattentive behaviour where the child or infant suffering from the disease demonstrates hyperactivity and impulsivity.
These are the key categories and symptoms that are demonstrated by children suffering from ADHD. Identifying and defining the symptoms of ADHD is however a difficult process as it is usually difficult to determine which levels of hyperactivity, impulsiveness and inattention constitute a symptom of ADHD.
Therefore for a proper diagnosis of the disorder to be made, the child or infant has to be observed in multiple settings for a period of six months or more (Ramsay 2007).
As mentioned in the previous paragraph, ADHD falls into three sub-categories which exhibit different symptoms in children. Other symptoms that are used to determine whether a child is suffering from ADHD include becoming easily distracted, forgetting certain details, poor attention or difficulty in focusing on a particular task, easily confused and difficulty in processing information in an accurate way.
The effects of these symptoms on a child’s ability to concentrate on their schoolwork are low as they develop a poor working memory and they have a low ability to retrieve vital information that will be important in their learning process. These symptoms also cause children to have poor organizational skills as well as difficulty in predicting certain outcomes from their learning experiences.
Children that suffer from ADHD have a low tolerance to frustration and disappointment, which might cause them to react poorly to overly stressful situations. They also tend to be very talkative and impulsive in their behaviour which makes it difficult for the concerned parties to deal with them properly (Lougy and Rosenthal 2002).
While children and infants are unable to control their impulsive and hyperactive behaviour, teenagers have been able to demonstrate a certain resistance to some of the symptoms that are related to ADHD.
Just like adults, teenagers are able to develop resistance mechanisms that will enable them reduce their hyperactivity, impulsivity and inattentive behaviour to a manageable level.
The symptoms from any of the three sub categories of ADHD usually diminish as children approach adolescence but in some teenagers, the symptoms remain making it difficult for them to engage in social interactions within the school setting.
These teenagers experience cases of hyperactivity which are demonstrated through antisocial or delinquent behaviours and also overactiveness and impulsivity which are on the extreme side (Jensen et al. 2007).
Educational, Psychological and Medical Assessment
According to the American Academy of Paediatrics for Clinical Practice Guidelines, to be able to gain a reliable diagnosis of ADHD, three criteria need to be meet and they include obtaining information about the child’s behaviour from more than one setting, determining conditions that might make it difficult to properly diagnose the disorder and the use of explicit criteria to diagnose the disorder through DSM-IV-TR.
For these criteria to be effective in diagnosing a child with ADHD, the following symptoms have to be present so that the child can be labelled as having ADHD; the child has to have had behavioural impairments from the age of 7, the child should have demonstrated behavioural and psychological deficiencies for a period of at least six months, the symptoms have to had created a major handicap in the following institutions of a child’s development: the classroom, home, society, playground and the community.
In this case for the child to be termed as suffering from ADHD, they have to demonstrate behavioural deficiencies in all these social institutions (Smucker and Hedayat 2001).
Educational assessments of ADHD are usually conducted within school or educational settings where the child or teenager’s behaviour is observed to found out if they are suffering from ADHD. Although the signs for this disorder are usually evident during the infancy years of the child, the disorder is usually diagnosed during the school going years.
Apart from paediatricians and therapists, teachers have been able to identify whether a child suffers from ADHD or not. This is mostly attributed to their ability to observe children’s behaviour during the learning process which has proven to be important when designing suitable learning strategies (Rader et al. 2009).
Educational assessment of the disease is, therefore, done by observing the performance of the child in class activities and learning activities. The teacher notes how the child is able to respond to certain learning tasks by determining whether their level of focus to completing the task as well as their attentiveness to class instructions.
If the child or adolescent demonstrates an inability to concentrate in class and has learning disabilities, then they can be termed to have attention deficit hyperactivity disorder. If they also demonstrate disruptive behaviour in class and increased hyperactive levels, they can be termed to have ADHD (Erkulwater et al. 2009).
Because the disorder causes children to be hyperactive, they might times disrupt classroom lessons by making a lot of noise or exhibiting restless behaviour which might be a cause of disruption to other children in the class.
This disruptive behaviour could also be attributed to how easily bored children suffering from ADHD get when they are involved in less enjoyable activities such as classroom learning.
For educational assessments to be effective in determining whether a child suffers from ADHD, they should be conducted with the assistance of therapists, paediatricians and other people who are qualified to perform such diagnostic assessments.
Parents are also encouraged to participate in the educational assessment of children to ensure they are informed on whether the child suffers from ADHD or not. For the assessment to be successful it has to include information of what support services will be needed to deal with the disorder in the learning and educational activities of the child.
The educational assessment will, therefore, be important in determining what educational plans need to be drawn up to ensure that the child’s learning needs are adequately dealt (Reynolds and Kamphaus 2003).
Psychological assessment of ADHD measures the potential ability of a child suffering from ADHD by focusing on what needs to be learned instead of what has been learned in the educational context.
Psychological assessments measure the cognitive strengths and weaknesses of children and adolescents who are suffering from the disorder by assessing their learning capabilities and potential to retain information during and after the learning process.
At times, psychological assessments are usually conducted through the use of capability tests such as the WAIS-III to measure the overall potential of the child and they at times also measure the intelligence quotient or IQ of the child (Olin and Keatinge 1998).
Psychological assessments play an important role in the diagnosis and treatment of ADHD as the results of the IQ test are usually used to determine whether a child suffers from the disorder.
The use of psychological assessments in the diagnosis of the disease mostly occurs when the symptoms exhibited by the child, adult or adolescent are consistent with the symptoms of other multiple diagnoses which makes it difficult for the physician to determine whether the individual suffers from ADHD.
Psychological assessments are useful in developing treatment options in the event clinicians are unsure of the most suitable types of treatment that can be used to deal with the disorder (Pliszka 2007).
Since the psychological assessment is able to measure critical aspects such as impulse control, emotional, behavioural and cognitive capabilities, it can be used by physicians and paediatricians to design suitable treatment plans that will help the patient deal with the behavioural impairments that are caused by ADHD.
The results of psychological assessments are also important in determining what educational plans will be drawn to suit the behavioural deficiencies of children suffering from the disorder.
Because it can easily identify the potential and cognitive abilities of sufferer’s, this method of assessing ADHD can be used to develop psychological recommendations that will be used to guide the parents, teachers and caretakers of the child on how they should handle them (Olin and Keatinge 1998).
Apart from measuring the behavioural potential and cognitive capability of the child believed to have ADHD, psychological assessments measure the self-control abilities of individuals by identifying the factors that infringe on a child’s ability to exercise self-control within certain settings.
For example, a psychological assessment can be used to help paediatricians and psychologists determine the factors that cause children with ADHD to develop disruptive behaviour during class time.
There are various psychological assessment models that are used to measure the cognitive and behavioural abilities of children believed to suffer from ADHD.
One of these models was developed by Cushman and Scherer in 1995 and it involves a series of steps one of which involves determining the type of information that will be gathered from the test and identifying the people who will be involved in the test.
Other steps in the model require the people involved in the assessment to identify the aspects that need to be measured and also select the measures that will be used to determine the outcome of the assessment (Olin and Keatinge 1998).
A medical assessment of ADHD, on the other hand, deals involves diagnosing the signs and symptoms of the disease to determine whether the child suffers from disorder. Medical examinations are the most common tools that are used to determine whether infants, young children, adolescents or adults suffer from ADHD.
These types of assessments have however been criticised as many clinicians argue that they are inadequate when it comes to diagnosing the symptoms of ADHD. Medical examinations that are done as a routine on children who have been diagnosed with ADHD rarely provide any useful medical interventions that can be used to manage or treat the disorder.
The results of a medical examination always support the results used during the diagnostic process by providing clinicians with important information that will be used to support the diagnostic process (Brock et al. 2009).
While medical examinations are viewed to be inadequate in determining whether a child suffers from ADHD, a medical diagnosis through the use of psychiatric assessments has proven to be effective in providing the right results.
The psychiatric assessment eliminates the symptoms that are used to diagnose ADHD through the use of techniques such as laboratory tests or physical examinations. In many of these psychiatric assessments, the DSM-IV criteria are what is commonly used to diagnose the symptoms of ADHD.
These DSM-IV criteria include six or more symptoms of inattention present in the infant, child, adolescent or adult for at least six months, the presence of six or more symptoms of hyperactivity and impulsiveness in the patient, the presence of socially impairing symptoms before the age of 7 years and the presence of these symptoms in a school, community, playground, home or social setting (American Academy of Paediatrics 2001).
The use of the identified DSM-IV criteria in diagnosing the symptoms of ADHD is usually highly effective when used with psychiatric assessment tests. The DSM-IV criteria are extensive and they cover all the symptoms of ADHD, which might be displayed by the child in any of three sub-categories of ADHD.
They, therefore, have a higher efficacy rate of ascertaining whether a child suffers from ADHD. Apart from medical assessments, other tools that can be used to determine whether a child or adolescent suffers from ADHD are self-reports.
The child is given an evaluation form where they tick off the symptoms that they think best depict their current behaviour. A commonly used tool in the self-report is a checklist where the sufferer ticks of any symptom that might be similar to what they are experiencing (Mash and Barkley 2008).
However, this method faces some discrepancies where according to Mash and Barkley (2008) the child might be unable to provide any useful information that will be used to diagnose whether they have ADHD.
Young children might also be unable to provide an accurate account of their behavioural impairments beyond what is usually provided by collateral informants.
These self-report are however effective in measuring the cognitive abilities and potential capability of clinically referred adults and teenagers as they have the cognitive ability to perform these self-evaluation tests.
Family reports, on the other hand, are usually performed by members of the affected child where they evaluate the behaviour of the child against a checklist of listed behaviours which are used to determine if a child is suffering from ADHD.
The parents of the child and any older siblings with the help of a paediatrician or therapist identify any behavioural impairment that the child might have which can be used to explain whether they are suffering from ADHD (Mash and Barkley 2008).
Treatment Interventions
Once a child or adult has been diagnosed with ADHD, the next step will involve identifying a suitable intervention for the person’s treatment plan. The traditional method of treatment for children diagnosed with ADHD has mostly been a prescription of Ritalin which is a stimulant that reduces the level of hyperactivity, impulsivity and inattentiveness.
However, the use of this drug has proven to be ineffective in dealing with the number of infants and young children that are being diagnosed with the disorder. This has seen the development of modern treatment interventions that are used in combination with drug therapies so as to alleviate the symptoms of ADHD in children (Brown 2009).
In the case of educational interventions, the school in collaboration with the parents of the affected child and therapists develop individualized educational plans that will be used for the students to cater to any learning deficiencies the child might have in the classroom setting.
These individualised plans do not however include drug therapy as they focus solely on improving the learning outcomes for the affected child. Under the individualised plan, an ideal classroom setting for the child suffering from ADHD would be one that has clearly defined rules and well-organized classroom structures.
It would also ensure that the child is not isolated from the rest of the class but is placed at the front near the teacher to facilitate guidance when the situation necessitates it (Hendriks 2010).
The amount of stimuli present in the classroom should be reduced to ensure that the child is not easily distracted or disrupted from their learning routine. The teacher should also observe class schedules and routines to ensure that there is less fluctuation in the energy levels of the child diagnosed with ADHD.
This will ensure that their hyperactivity is kept at a minimal as long as they are engaged in a mixture of low and high energy activities. Students who suffer from ADHD can also be involved in designing learning environments that will be appropriate for their behavioural impairments.
This will provide them with an opportunity to own their situation and also participate in change processes that will allow them to achieve learning outcomes.
Teachers can help children with ADHD in self-monitoring activities by selecting and explaining the behaviours that come with the disorder and also explaining to the student how they can be able to improve on their behaviour within the learning environment (Brown 2009).
Once particular behaviours of the disorder have been selected, the teacher helps the child develop a rating scale that will be used to rate the behaviour of the child based on whether they have improved or not.
The teachers show the child how they should use the rating scale to ensure they gain accurate and reliable results which they will use to determine whether their behaviour has improved.
Another educational intervention which can be used in the classroom setting is the positive behavioural interventions which involve creating positive school environments that will sustain the behavioural improvement of the affected child.
Positive behavioural interventions ensure that the school environment is able to improve the lifestyle of the affected child or teenager by reducing their behavioural impairments to a less desired level (Safran and Oswald 2003).
As mentioned earlier on, the most commonly used medical intervention that are used to treat children suffering from ADHD is Ritalin which is used to provide a calming effect to ADHD sufferers to reduce their levels of hyperactivity and restlessness.
Ritalin is therefore a type of a psycho-stimulant medication that decreases the stimulation levels of children suffering from ADHD. Various clinical guidelines have supported the use of pharmacological treatments as one of the drug therapies used to treat children, adolescents and adults (American Academy of Paediatrics 2001).
A study on the pharmacological treatment of ADHD revealed that 2.5 million children used psycho-stimulant medication in treating the disease, a number which had increased rapidly by about 12 percent every year for the number of children that were affected by the disease (Brown 2009).
Psycho-stimulant medication usually produces immediate improvements to the behavioural impairments that accompany ADHD as well as improving cognitive and social functions of the sufferer, thereby enabling them to participate in social interactions with their peers.
Psycho-stimulant medication also ensures that the cognitive and potential capabilities of the sufferer have undergone major improvements. The efficacy of this type of medication in treating ADHD sufferers has been documented in controlled clinical trials conducted by Gadow et al. in 1992 and Schahar in 1996 where the success rates have been notably high.
However, the psychological processes that underlie the use of psycho-stimulant medication have not been clearly understood by many of these researchers as well as the long term benefits that go with taking psycho-stimulant drugs (Schahar et al. 1996).
The psychological interventions that are used in treating children with ADHD involve the use of self-monitoring techniques where the affected patient observes their behaviour so that they can initiate impulse control measures and techniques to control hyperactive and impulsive behaviour.
Psychological interventions that have focused on the behavioural treatment of ADHD have proven to be effective in the past where individuals suffering from the disorder have been able to experience a behavioural change in their cognitive impairments.
Clinicians and therapists have recommended that psychological interventions should be conducted on preschool children that have been diagnosed with the disorder to ensure so as to sustain their behavioural change process (Fabiano et al. 2009).
The techniques that are used in psychological interventions include psycho-educational inputs where the performance of the child is observed in an educational setting, behavioural therapy where the child is taught techniques that are meant to reinforce and institute desired behaviours while at the same time eliminating the undesirable behaviours, cognitive behavioural therapy which deals with the treatment of dysfunctional behaviours and uncontrollable emotions that are some of the major symptoms of ADHD as well as solving problems that are caused by these behavioural deficiencies (Robertson 2010).
Other psychological interventions that are used to treat the disease include interpersonal psychotherapy which focuses on improving the interpersonal skills of the person suffering from
ADHD and family therapy where family members (parents and siblings) of the affected child are involved in nurturing and development activities that are meant to improve the socialisation process of the child (Kratochvil et al. 2009).
Psychological interventions are beneficial for children, adolescents and adults suffering from ADHD as they provide the right approaches for adjusting to their behavioural impairments while at the same time offering treatments that can be used to improve the cognitive and behavioural abilities of the individual sufferers.
Therapists who recommend the use of psychological interventions in treating ADHD should emphasize on the strengths and weaknesses of the sufferer to ensure that the outcome of the intervention leads to an improvement of the behavioural patterns of the ADHD sufferer.
Therapists should highlight and focus on the positive characteristics of the patients which will be used to necessitate change in cognitive behavioural therapies as well as the other techniques that are used in psychological interventions.
Psychological interventions provide patients with the opportunity of increasing their social skills so that they can be able to function more successfully in social situations (Young and Bramham 2007).
The aspects that are usually considered when developing psychological interventions to treat ADHD include considering the attention span of ADHD sufferers more importantly young children who are more than likely to have a high a lower attention span than teenagers.
Other aspects that need to be considered when developing psychological interventions include the memory capacity of the patient where their ability to retain information is measured as well as their potential capabilities which will be important in ascertaining whether they can be able to withstand psychological behavioural therapies (Ryan and McDougall 2009).
As mentioned earlier the medical intervention of treating ADHD has a lower efficacy rate when compared to that of psychological assessment as it focuses on repressing the symptoms of the disease rather than the behavioural deficiencies that accompany the disease.
The results of taking psycho-stimulant medication vary with many children who suffer from ADHD where children who are under psycho-stimulant medication such as Ritalin and generic methylphenidate might not show any improvements after beginning their treatment plans.
This means that there would be no difference between a child suffering from ADHD who has been placed under psycho-stimulant interventions and a child who is not under any ADHD medication. Doctors usually recommend discontinuation of psycho-stimulant medication if after a year there are no visible improvements in the health of the child (Faraone 2006).
Evaluating the Effectiveness of Treatment options
In their review of the effectiveness of educational interventions in treating children and adolescents suffering from ADHD, Chambless and Ollendick noted that interventions which involved parents, therapists and other qualified professionals had a higher efficacy in treating children with the disorder than when the intervention involved teachers only.
The effectiveness of these studies in determining the behavioural expectations and educational demands of young children has yielded different results from those of adolescents and older children. Chambless and Ollendick in their 2001 studies called for more research how the educational interventions could be conducted on preschoolers so as to determine the efficacy of these interventions on preschoolers (Mowder et al. 2009).
A study was conducted by Fabiano et al. (2009) on the effectiveness of psychological interventions in treating children that were suffering from ADHD.
The researchers conducted a meta-analysis that would be used to identify the relevant behavioural treatments needed for behaviour modification processes in children suffering from attention deficit hyperactivity disorders.
The researchers analysed over 174 behavioural treatment studies that had been documented by various researchers over the years where they noted that there was strong and consistent evidence that supported the effectiveness of the various psychological treatments in dealing the ADHD symptoms (Fabiano et al. 2009).
Another study that was conducted to determine the effectiveness of psychological interventions in treating ADHD was conducted by Cohen et al. 1981 where they noted that psychological interventions that were combined with psycho-stimulant medication were effective in treating children that were suffering from ADHD disorders.
Overall, research and studies conducted on how to treat ADHD in the past decade have shown that the combined use of medication with psychological behavioural treatments has a higher efficacy in treating ADHD in young children, adolescents and adults.
Studies that researched on the short term benefits of using psycho-stimulant medication alone without any behavioural therapy were less effective than when they were combined with psychologically therapy (Wolraich 2002).
The National Institute of Mental Health carried out a multimodal study of 579 children that were suffering from ADHD over a period of fourteen months.
Each of the 579 children received four different types of interventions which included medical interventions, psychological interventions that were focused on behavioural therapy, educational interventions and interventions that combined psychological, medical interventions.
The results of the study revealed that ADHD children who were treated with psycho-stimulant drugs only without the combination of psychological therapy had a lower efficacy when compared to children that received a mixture of behavioural therapy and medication who were able to record an improvement in their ADHD symptoms.
The results of the NIMH study revealed that combined treatments were the most effective in reducing behavioural impairments in children, adolescents and adults suffering from ADHD (MTA Cooperative Group 1999).
Recommendations
The best treatment options that can be used in treating children, adolescents and adults suffering from ADHD are the psychological treatment options which according to research studies have been determined to be more effective than medical or educational interventions.
This is mostly attributed to the fact that psychological interventions focus on reducing the behavioral impairments that children or adults with ADHD suffer from by eliminating the symptoms presented by the sufferer of the disease.
When psychological treatments are combined with medication, they have a higher efficacy rate of treating children, adolescents and adults that suffer from the disease. To therefore effectively deal with the disorders that are caused by ADHD, psychological therapy can be combined with medical treatments to achieve a high efficacy.
Conclusion
The research has focused on the social, emotional and behavioural difficulties or disorders that affect children, teenagers or adults. The SEBD disorder that has been focused on in this study is the attention deficit hyperactivity disorder otherwise denoted as ADHD.
The research has provided a literature review of the disorder by identifying the various sub categories and symptoms that make up the disorder.
The various educational, medical and psychological interventions that are available to treat the disorder were assessed and the treatment interventions that were incorporated by any of these three methods were discussed to determine which method was effective in treating or improving the symptoms of ADHD.
Based on the discussion, psychological interventions were identified as the most effective and medical interventions were deemed to be effective when they were combined with psychological therapy.
References
American Academy of Paediatrics (2001) Clinical practice guideline: treatment of the school-aged child with attention-deficit/hyperactivity disorder. Pediatrics, Vol. 108, No. 4, pp 1033-1044
Biederman, J., (1998) Attention-deficit/hyperactivity disorder: a life-span perspective. The Journal of Clinical Psychiatry. Vol. 59, No.7, pp 4-16
Brock, S. E., Jimerson, S.R., and Hansen, R. L., (2009) Identifying, assessing and treating ADHD at school. New York: Springer Dordrecht Heidelberg
Brown, T., (2009) ADHD comorbidities: handbook for ADHD complications in children and adults. Arlington, US: American Psychiatric Publishing, Inc.
Carsch, M. H., (2006) The handbook of social, emotional and behavioural difficulties. London, UK: Continuum International Publishing Group
Clough, P., (2005) Handbook of emotional and behavioural difficulties. London, UK: Sage Publications
Erkulwater, J., Mayes, R., and Bagwell, C., (2009) Medicating children: ADHD and pediatric mental health. Cambridge, UK: Harvard University Press
Fabiano, G. A., Pelham, W. E., Coles, E. K., Gnagy, E. M., Chronis-Tuscano, A., and O’Connor, B.C., (2009) A meta-analysis of behavioural treatments for attention-deficit/hyperactivity disorder. Clinical Psychology Review, Vol.29, No.2, pp 129-140
Faraone, S. V., (2006). Comparing the efficacy of medications for ADHD using meta-analysis. Medscape General Medicine, Vol.8, No.4
Gadow, K. D.,Nolan, E. E., and Sverd, J., (1992) Methylphenidate in hyperactive boys with comorbid tic disorder. Journal of American Academy of Child and Adolescent Psychiatry, Vol.31, pp 462-471
Hendriks, J. H., (2010) Evidence-based assessment, analysis and planning interventions. Child and Adolescent Mental Health, Vol.15, No.2, p. 126
Jensen, P. S. Arnold, L. E., and Swanson, J. M., (2007) 3-year follow-up of the NIMH MTA study. Journal of the American Academy of Child and Adolescent Psychiatry. Vol. 46, No.8, pp 989-1002
Kratochvil, C. J., Vaughan, B. S., Barker, A., Corr, L., Wheeler, A., and Madaan, V., (2009) Review of paediatric attention deficit/hyperactivity disorder for the general psychiatrist. Psychiatric Clinical Journal for Northern America, Vol. 31, No.1, pp 39-56
Lougy, R. A., and Rosenthal, D. K., (2002) ADHD: a survival guide for parents and teachers. Duarte, California: Hope Press
Mash, E. J., and Barkley, R. A., (2008) Assessment of childhood disorders. Oxford, UK: The Guilford Press
Mowder, B. A., Rubinson, F., and Yasik, A. E., (2009) Evidence-based practice in infant and early childhood psychology. New Jersey: John Wiley and Sons
MTA Cooperative Group (1999) A 14-Month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. Archives of General Psychiatry, Vol. 56, 1073-1086.
Nair, J., Ehimare, U., Beitman, B. D., Nair, S. S. and Lavin, A., (2006) Clinical review: evidence-based diagnosis and treatment of ADHD in children. Mo Med, Vol. 103, No. 6, pp. 617-621
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Pliszka, S., (2007) Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry, Vol.46, No.7, pp 894-921
Rader, R., McCauley, L., Callen, E. C., (2009) Current strategies in the diagnosis and treatment of childhood attention-deficit/hyperactivity disorder. American Family Physician, Vol. 79, No.8, pp.657-665
Ramsay, R. J., (2007) Cognitive behavioural therapy for adult ADHD. New Jersey: Routledge
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Robertson, D., (2010) The philosophy of cognitive-behavioural therapy: stoicism as rational and cognitive psychotherapy. London: Karnac Publishers
Ryan, N., and McDougall (2009) Nursing children and young people with ADHD. New York: Routledge
Safran, S., and Oswald, K., (2003) Positive behaviour supports: can schools reshape disciplinary practices? Exceptional Children, Vol.69, No.3, pp. 361-373
Schahar, R., Tannock, R., and Cunningham, C., (1996) Treatment of childhood hyperactivity in hyperactive disorders. Cambridge, UK: Cambridge University Press.
Smucker, W. D., and Hedayat, M., (2001) Evaluation and treatment of ADHD. American Family Physician, Vol. 64, No.5, pp 817-829
Wolraich, M. L., (2002) Current assessment and treatment practices in ADHD. Kingston, New Jersey: Civic Research Institute
Young, S., and Bramham, J., (2007) ADHD in adults: a psychological guide to practice. West Sussex, England: John Wiley and Sons Limited
Among the most complicated mysteries of the universe and human nature, the question concerning the way in which a human brain or, to be more exact, human nervous system, works seems to be the hardest to answer.
Despite the fact that in the present-day world, a lot of complicated questions in the sphere of medicine have been answered successfully, the question concerning whether a certain specific state should be considered a disorder or merely a specific state of mind, remains open.
Among the above-mentioned states, the phenomenon known as ADHD, or Attention Deficit Hyperactivity Disorder, deserves to be mentioned. Because of the fact that most children, as the results of numerous researches show, have ADHD at certain stages of their development, the classification of the phenomenon as a disorder is questioned (Wright, 2012).
Checking the latest research results on ADHD and comparing them to the previous records, one can possibly find out whether ADHD is an actual disorder or merely specifics of most children’s development.
To start with, the key symptoms of the disorder in question must be named. However, even at the very first stage of defining the key features of the disorder, one must admit that the existing descriptions of the symptoms are rather vague. According to the existing evidence, the children with ADHD tend to display such negative qualities as “inattentiveness, forgetfulness, hyperactivity, and impulsivity” (Seitler, 2011, 116).
Likewise, in the case study in question, the patients displayed similar symptoms, as Nelson, Duncan, Peacock and Bui (2012) say. Analyzing the above-mentioned, one must admit that the above-mentioned qualities can be discovered in children of a certain age quite often.
Another essential detail of the case study in question, the background of the patients is rather important for understanding the mechanisms of the phenomenon. According to the research design offered by Nelson, Duncan, Peacock and Bui, the settings of the research and the patients’ background were the following:
“The ADHD Telemedicine Clinic served English- and Spanish-speaking families for a half-day/week while school was in session, with initial intake slots of 90 min” (Nelson, Duncan, Peacock and Bui, 2012, 294).
Hence, it can be concluded that the research was carried out among the children who were under a considerable pressure in school as the representatives of minority, which could have been the reason for the rapidly developing symptoms of the alleged disorder.
As it has been mentioned above, the children who have been observed in the given case study have experienced certain issues which must have had an impact on their development and, therefore, served as the causes of the ADHD phenomenon.
To start with, the children in the case study have very specific background – according to the case, they are all belong to the cultures of the national and social minorities, which makes their process of integration into the society all the harder. According to the case study settings, the children whose behavior was observed came from the English- and Spanish-speaking families with other than American backgrounds.
Since there are still considerable arguments against adding the ADHD to the list of disorders, it is necessary to mention that the symptoms of ADHD as they are not quite as palpable as the ones of, say, influenza. However, when a range of symptoms can be observed at once, there are sufficient reasons to suggest that the case in point is exactly the instance of ADHD.
For instance, according to the case study, “All children presenting to the ADHD clinic had a concern related to the core ADHD symptoms of inattention, hyperactivity, and/or impulsivity” (Nelson, Duncan, Peacock and Bui, 2012, 295). It is necessary to mark that, when observed separately, the above-mentioned phenomena can be considered features of character and a very specific temperament of a child.
When stacked together, however, the given phenomena can be regarded as the symptoms of ADHD. Therefore, the recurrent symptoms make a solid proof for the fact that ADHD can be considered a disorder.
On the other hand, it must be born in mind that, because of the rapid development, on its certain stages, children can display certain anti-social features of character. Therefore, whether the given characteristics should be regarded as symptoms is not clear yet.
In addition, it is necessary to mention that some of the symptoms which the children in the case study displayed could to be considered as the ones of ADHD.
For instance, the fact that “Almost all of the children seen had a co-occurring learning concern, with 95% having some delays or difficulties that were referred back to the school for further evaluation” (Nelson, Duncan, Peacock and Bui, 2012, 295-296) can be viewed as a lack of the general skills that the children of the given age should have.
Hence, the issue can concern the readiness for school learning rather than an ADHD disorder. It is worth mentioning that in certain cases, the disease has been progressing for several years, which busts the myth about ADHD having little impact on people (Fritz, 2000).
It is also worth mentioning, however, that there is no mentioning of the children’s behavior changing over the course of treatment whatsoever in the case study. According to the results of the research, the children displayed certain behavioral issues which were supposed to vanish without a trace after the suggested interventions.
However, as for the changes in the behavioral patterns, the experimental group did not show either the disorder progress in the course of the study; the children seemed to have the same symptoms described above all the way during the research.
Analyzing the short-term goals intervention, one must admit that it addressed the problem in a rather adequate way. To start with, the test for a probable comorbidity was rather appropriate. In addition, the fact that the treatment was split in several sessions was rather wise (Seitler, 2011, 120).
As for the long-term goals, the authors of the case study did a very satisfying job as well. According to what Wheeler (2010) claims, the use of pharmaceutical treatment is also extremely important along with psychological interventions.
However, it is necessary to mention that the discussion of the Ritalin treatment has been going on for years (Breggin & Barkley, 2012), with some of the researchers arguing against the use of the medicine:
“Shockingly, many ADHD/Ritalin advocates… deny the addictiveness of stimulants and show… little concern about making these drugs available to so many children, their families, and their friends” (Bratter, 2007, 4), and some insisting that Ritalin can help children restore the balance within their nervous system fast and efficiently (Seitler, 2011, 118).
As for the research in question, the authors decided to avoid using such medicine as Ritalin and resorted to an elaborated strategy involving school and parents. Hence, the status of ADHD as a disorder becomes even more questionable. It seems that the therapeutic strategy involving the school-based medicine seems to be the most successful solution for the problem.
Since children spend most of their time at school, it is natural to suggest that in the school environment, the results of the treatment will be displayed in the most graphic way. With the strategic modality focused on the children’s school activities, the research was bound to be successful.
Although it is obvious that ADHD can be easily distinguished from a standard behavior; moreover, specific symptoms of ADHD have been spotted, which means that the given phenomenon is a serious health issue which needs to be addressed and treated in a corresponding way, it still cannot be considered a disorder.
Despite the fact that the people with ADHD tend to behave in a non-traditional way which is not appropriate in the society, it is still clear that there is no obvious damage to the psychological state. In other words, the phenomenon related to as ADHD should be considered not as a disease or a disorder, but a specific model of behavior which has been acquired due to certain life circumstances or methods of child upbringing.
Therefore, it can be considered that ADHD should not be classified as a disorder; however, the people with the ADHD syndrome should be provided the appropriate medical interventions as people with a specific condition.
Reference List
Bratter, T. E. (2007). The myth of ADHD and the scandal of Ritalin: helping John Dewey students succeed in medicine – free college preparatory and therapeutic high school. International Journal of Reality Therapy, 27(1): 4-12.
Breggin, P. R. & Barkley, R. A. (2012). Is Ritalin overprescribed? Taking Sides, 5(10), 231-250.
Fritz, G. (2000). The time is right to dispel myths about ADHD. New York, NY: CABL. Nelson, E.-L., Duncan, A. B., Peacock, G. & Bui, T. (2012). Telemedicine and adherence to national guidelines for ADHD evaluation: a case study. Psychological Services, 9(3), 293-297.
Seitler, B. N. (2011). Is ADHD a real neurological disorder or collection of psychosocial symptomatic behaviors? Implications for treatment in case of Randall E. Journal of Infant, Child, and Adolescent Psychotherapy, 10, 116-129.
Wheeler, L. (2010). Critique of the article by Visser and Jehan (2009): ‘ADHD: a scientific fact or a factual opinion? A critique of the veracity of Attention Deficit Hyperactivity Disorder.’ Emotional and Behavioural Difficulties, 15(3), 257-267.
Wright, R. H. (2012).Is attention-deficit/hyperactivity disorder (ADHD) a real disorder? Taking Sides, 5(05), 132-154.
Attention deficit-hyperactivity disorder (ADHD) is a neurobehavioral and psychiatric disorder that affects at least one in every 20 children in the western world (Pineda, Ardila, RosselliMet al, 1999).
It is characterized by hyperactivity or impulsiveness, and in most cases, difficulties in paying attention. Since 1970s, there has been a debate over the existence of Attention Deficit Hyperactivity Disorder (ADHD).
In fact, the existence of the condition, its treatment and diagnosis, have been considered controversial topics since the condition was first suggested in the medical, psychology and education.
The controversial aspect of ADHD has attracted researchers from a number of fields, with an aim of determining whether the condition is real or whether it is a myth (Brown, Freeman, Perrin, et al, 2001).
Yes, ADHAD exists and Is a Brain Condition That Affects Children and Adults
The American psychiatric Association (2004) asserts that ADHD actually exists and in the United States alone, it affects at least one in every 20 children. Studies have shown that sufferers of ADHD have relatively similar symptoms.
These symptoms includes inattention (the patients are easily disrupted), impulsivity as well as hyperactivity. In addition, APA (2004) asserts that ADHD victims may have a number of their aspects of behavior and performance adversely affected both at home and school.
Studies reveal that the condition may persist throughout adolescent, and in some cases, it may progress towards adulthood.
Over the last three decades, biomedical studies have confirmed the existence of the condition. For instance, the study by the National Institute for Health and Clinical Excellence (2008) found that the condition has a strong genetic linkage, with a high rate of hereditary and running in certain family lines.
In fact, this study confirmed that about 75% of all the cases are hereditary (Swanson, Sergeant, Taylor, et al, 1998). Recently, studies by Arcos-Bugos and colleagues (2010) have identified a number of candidate genes that are closely associated with the condition, including DAT1, DRD5, DRD4, HTR1B, 5HTT and SNAP25.
In fact, most of these genes are associated with and may affect dopamine transporters, further provides a strong indication of the presence of ADHD as a hereditary factor.
In addition, studies by Geizer, Ficks and Waldama (2009) have shown that a gene variant LPHN3 accounts for more than 9% of all the ADHD cases. These studies provide a strong evidence of the existence of ADHD.
No, ADHD Does Not Exist
According to the US Department of Health and Human Services (1999), opinions regarding the existence of ADHD include a belief that the condition does not exist at all. Other opinions attempt to make the people belief that the condition is a purely hereditary factor running in families.
In addition, according to NIHCE (2004), ADHD diagnosis lacks any biological basis, indicating that the condition could only be an exaggeration of one of the known psychiatric conditions rather than a disease by its own.
According to Ramsey (2007), ADHD is a controversy that only results from a misunderstanding and misconception of diagnosis criteria and how medical practitioners use these criteria.
Personal Opinion on ADHD and Application in the Classroom
ADHD is a psychiatric condition that should not be ignored in education. The fact that students with ADHD normally tend to be disrupted from concentrating in the class is a factor that requires adequate measures to ensure that student’s conditions are addressed (Biederman, Wilens, Mick et al, 1998).
Screening and testing is necessary to determine the children who require special attention.
Considering ADHD in the classroom, a teacher would observe the affected child getting frequent cases of inattention, which in turn disorients the child. Special education may be required in cases where the child’s condition is advanced.
References
American Psychiatric Association. (2004). Diagnostic and statistical manual of mental disorders. Washington: American Psychiatric Association
Arcos-Burgos, M., Jain, M., Acosta, M. T., Shively, S., et al. (2010). A common variant of the latrophilin 3 gene, LPHN3, confers susceptibility to ADHD and predicts effectiveness of stimulant medication. Mol Psychiatry 15(11), 1053-66
Biederman, J., Wilens, T., Mick, E., et al. (1998). Is ADHD a risk factor for psychoactive substance use disorders? Findings from a four-year prospective follow-up study. J Am Acad Child Adolesc Psychiatry 36, 21–29
Brown, R. T., Freeman, W. S., Perrin, J. M., et al. (2001). Prevalence and assessment of attention-deficit/hyperactivity disorder in primary care settings. Pediatrics, 2(4), 107-114
Gizer, I R., Ficks, C., Waldman, I. D. (2009). Candidate gene studies of ADHD: a meta-analytic review. Hum Genet 126(1), 51-90
National Institute for Health and Clinical Excellence. (2008). CG72 Attention deficit hyperactivity disorder (ADHD). London: NIHCE
Pineda, D., Ardila, A., Rosselli, M, et al. (1999). Prevalence of attention deficit/ hyperactivity disorder symptoms in 4- to 17-year-old children in the general population. J Abnorm Child Psychol, 27, 455–462.
Ramsay, J. R. (2007). Cognitive behavioral therapy for adult ADHD. New York: Routledge
Swanson, J. M., Sergeant, J. A., Taylor, E., et al. (1998). Attention-deficit hyperactivity disorder and hyperkinetic disorder. Lancet, 351, 429–433
US department of health and human services. (1999). Treatment of Attention-Deficit/Hyperactivity Disorder. Washington, DC: department of health and human services.
Cognitive Behavior Therapy (CBT) refers to a set of intervention strategies devised to cause behavioral changes among children with ADHD symptoms or other similar conditions. As opposed to medical interventions, which involve the administration of medicinal drugs, CBT revolves around eradicating the negative behaviors exhibited by children suffering from the condition.
Even though skeptics maintain that CBT is a short-term intervention strategy, which is meant to cause short-term changes in behavior, research indicates that the coping skills imparted to individuals suffering from ADHD remain viable even after withdrawal of the interventions (Jarrett, 2013). CBT involves organizing sessions with the subjects in which coping strategies are trained to the beneficiaries.
This paper seeks to support the hypothesis that CBT is an effective intervention strategy in the treatment of ADHD through a review of the literature available on the topic. The research question is the efficacy of Cognitive Behavior Therapy in children with ADHD.
Components of CBT
CBT can be performed in either an individual or a group setting depending on the characteristics of the clients. Ideally, an individualized CBT involves training each client separately and these sessions take shorter periods, usually 60 minutes (Cabiya et al., 2008). On the other hand, group therapies involve training the entire group simultaneously.
Usually, these sessions last for longer periods, usually 90 minutes per session, to allow each client to comment on his or her personal experiences (Daley et al., 2015). In most cases, CBT is executed on both outpatient and inpatient basis. However, psychologists argue that the therapy produces better results when executed in an outpatient setting since it allows the counselor to understand the environment of the client.
The interventions offered to clients vary from one individual to another depending on the intensity of the ADHD symptoms exhibited by that individual. Conversely, Ghafoori and Tracz (2001) recommend the following standardized interventions for all victims of ADHD
Functional analysis of the symptoms
Examining the patient’s cognitive processes
The identification and debriefing of past and future high-risk situations
Personalized training in coping with undesirable behaviors
Practicing skills during sessions
Encouraging and reviewing extra practice of skills between sessions
The administration of CBT may vary from one group to the other depending on the severity of the symptoms and the anticipated end results from such interventions. However, a normal CBT involves daily 60 minutes sessions divided into three 20-minutes sub-sessions.
Under the arrangement, each 20 minutes session centers on a special theme distinct from the themes of the subsequent sessions. The first 20-minutes session involves the identification of the patient’s negative behaviors and the practical difficulties experienced by the individual in implementing skills learned in the previous session.
In this session, the client does much of the talking while the counselor listens carefully and poses various questions to gain insight on the perception of the beneficiary regarding the previous session (Ghafoori & Tracz, 2001). The counselor utilizes the next 20 minutes to introduce the topic of the day. In this session, contrary to the first session where the client does most of the talking, the therapist talks while the clients listen.
In this phase, the counselor may pose questions to assess whether the client understood the presented theme in the first session. Repetition of major concepts may be inevitable to ensure that the client understands the topic introduced. Some of the common topics that form the themes for this session include, but not limited to
Coping with undesirable behaviors
Shoring up motivation and a commitment to quit such behaviors
Refusal skills/assertiveness
Seemingly irrelevant decisions
An all-purpose coping plan
Problem solving
Case management
The last 20 minutes session is tailored towards igniting discussion between the client and the therapist guided by the topic introduced in the previous session. Towards the end of the session, the clients are asked to propose a theme of their choice to be explored in the next lesson.
The Efficacy of CBT in children suffering from ADHD
A research conducted by Abdollahian, Mokhber, Balaghi, and Moharrari (2013) reveals that CBT is effective both in the short run and in the long-term. The study was conducted quantitatively on children aged between seven and nine years. The study confirmed that children who received cognitive behavior treatment exhibited fewer symptoms of ADHD both in the short run and in the long-term.
The study revealed that the skills acquired by the children in the sessions were relevant in the long term since the children’s behaviors were modeled entirely (Abdollahian et al. 2013). The results of the study concurred with that of Cabiya et al. (2008) in that children who received cognitive behavior treatment exhibited fewer symptoms of ADHD both in the short run and in the long-term.
Breinholst, Esbjørn, Reinholdt-Dunne, and Stallard (2012) add to the data available on the efficiency of CBT in the treatment of ADHD through a review of the literature by different researchers. To qualify for inclusion, an article had to be a randomized controlled trial (RCT) making a comparison between child-only cognitive behavioral therapy (CBT) and CBT coupled with active parental involvement.
The majority of the articles reviewed in this study revealed that both child-only CBT and CBT combined with active parental involvement were equally effective in treating the condition. Various studies concur that CBT is effective in the treatment of ADHD among children diagnosed with the condition. Cabiya et al. (2008) proved this theory from a quantitative research conducted on children aged between 8 and 13 years.
The research recruited 608 children with ADHD symptoms drawn from either gender. The sample was divided into two research groups, viz. the treatment group, and the control group. Teachers were actively involved in the selection of children to be recruited in the study due to their outstanding knowledge they had regarding the children’s behaviors in the classroom.
The study revealed that CBT was effective in the treatment of ADHD among children as it produced positive results on the treatment group as opposed to the control group. The treatment group showed great improvement regarding the notable behavioral changes through increased self-esteem and enhanced ability to share ideas.
Chavira, Bustos, Garcia, Ng, and Camacho (2015) employed qualitative techniques to extract information from the target population, regarding their proposals on the best ways to avail CBT among children in Latin America. Phone calls were made to individual participants and suggestions from each participant recorded.
Besides, interviews with parents of the children suffering from ADHD were conducted to gain insight into their perception regarding the effectiveness of CBT. The results showed that the parents perceived the therapy positively. Besides, most parents were of the opinion that the treatment was effective in containing the severity of the disease.
However, parents cited the need to address specific issues hampering the effectiveness of the intervention method. Some of the barriers identified included time, convenience, and illiteracy. Daley et al. (2015) analyzed research findings by different researchers documented in the available literature. Data collection was done quantitatively from various databases such as the Ovid, Web of Knowledge, ERIC, and CINAHAL.
The study reviewed 32 articles containing evidence regarding the effectiveness of CBT in the treatment of ADHD. The reviewed articles contained findings from researches conducted on defined samples of children suffering from the illness. The research concluded that there is no direct connection between CBT and the reduction of symptoms. However, the intervention assists in averting undesirable behaviors associated with the illness.
The study also established that training parents on the appropriate ways of handling their children’s behaviors would go a long way in averting the negative behaviors. Some researchers have based their studies on the evidence available in the literature to prove the hypothesis that CBT is an effective cure for ADHD amongst children.
Fabiano et al. (2009) conducted a meta-analysis of 174 articles exploring the topic on CBT with the aim of comparing the recommendations by different authors. The studies to be reviewed in this research had to meet certain inclusion criteria, viz. they had to be based on children yet to join the school.
The reviewed studies involved both qualitative and quantitative methods of data collection and analysis. The review revealed that children who received CBT were more likely to respond positively to behavioral changes than their counterparts who did not receive the therapy. In almost all the studies reviewed, children involved showed improvements in behavior, thus prompting the researchers to conclude that CBT is an effective treatment procedure for children with disruptive behaviors.
Fehlings, Roberts, Humphries, and Dawe (1991) also proved the effectiveness of CBT in the treatment of ADHD. The authors conducted research on a sample of 25 children aged between 7 and 13 years. The study was conducted quantitatively whereby the participants were divided into two groups with the treatment group receiving CBT while the control group received supportive therapy.
The results of the findings revealed that CBT was effective in the treatment of ADHD among children. It was successful in eliminating the undesirable behaviors amongst the participants. Parents and teachers reported great changes in the children’s behaviors that were characterized by the elimination of undesirable actions.
Similarly, Jarrett (2013) proved the effectiveness of CBT in the treatment of ADHD. The author designed a research to target children with ADHD symptoms aged between 8 and 12 years. Parents of the participating children were also recruited into the study. They were afforded some training regarding CBT to handle their children’s behavior back at home effectively.
Interventions in this research involved ten sessions each week in which parents and their children were engaged separately for 50 minutes and 30 minutes respectively. The research sought to unravel the effectiveness of CBT in reducing both anxiety and ADHD symptoms. The results revealed a great reduction in both anxiety and ADHD symptoms among the participating children. This aspect indicated that the therapy is an effective treatment method for both conditions.
Klassen, Miller, Raina, Lee, and Olsen (1999) carried out research on a sample of 999 children below 18 years with participants being grouped into three groups. CBT was availed to the first group. The second group received medical treatment alone while the final group received both treatments. The research was conducted quantitatively to compare the efficacy of the mentioned interventions.
Contrary to findings by most researchers in this field, the researchers found that CBT alone was not effective in the treatment of ADHD. The research proposed a combination of both interventions if the desired results are to be obtained. Children who received both treatments concurrently recorded a huge decrease in the ADHD symptoms as compared to their counterparts who received either CBT or medical treatment alone.
The research disputed findings by other researchers who have found CBT as an effective treatment method for the condition. Another significant contribution to the evidence on efficacy of CBT was made by Kerns, Read, Klugman, and Kendall (2013) based on findings from a qualitative research conducted on a sample of 91 children with developmental disorders including children suffering from ADHD.
The study availed two forms of treatment to the beneficiaries, viz. CBT treatment, and waitlist treatment condition. CBT involved engaging the participants in daily sessions aimed at eliminating the undesirable behaviors exhibited by children suffering from the condition. Results from the research showed that both interventions were successful in reducing anxiety among victims of ADHD.
Besides, the results indicated a great change in behavior of the participants illustrating the effectiveness of CBT as a treatment strategy. In another study, Moreno-García, Delgado-Pardo, de Rey, Meneres-Sancho, and Servera-Barceló (2015) found CBT as an effective intervention strategy for the treatment of ADHD among children. The research was conducted on a sample of children to determine the effectiveness of the three ADHD intervention strategies, viz. neurofeedback, pharmacological treatment, and behavioral therapy.
The study recruited 57 participants selected randomly from children with symptoms of the illness. The participants were aged between 7 and 14 years. They were picked randomly to obtain the three treatments plans. Records regarding each patient’s progress were maintained, and medical practitioners involved in the research were required to report on all the observable changes.
Results of the study indicated that the three types of interventions produced similar results regarding behavior change. Therefore, the research team concluded that each of the three interventions were effective for the treatment of ADHD among children. Ozsivadjian, Knott, and Magiati (2012) conducted a qualitative research to gain insight on the parents’ perception regarding their children’s behaviors.
Parents participating in the study cited certain undesirable behaviors exhibited by their children such as reluctance to engage in social relations, repetitive behaviors, somatic problems and concentration deficiency among others (Ozsivadjian et al., 2012). Besides, parents expressed their children’s reluctance in sharing ideas with others for fear of being victimized.
However, most parents emphasized the undesirable behaviors by their children, which heightened their dependence on others. The high dependence was attributable to the view that the children perceive that their counterparts are only focusing on the negative side, thus creating anxiety. Since the ADHD is compounded by such negative perception by children, CBT could be useful in modeling the victims’ behaviors, thus alleviating the negative behaviors.
Webster-Stratton, Reid, and Beauchaine (2011) investigated the effects of encouraging parents and guardians to embrace non-punishment strategies when attempting to alter their children’s behaviors. The research recruited parents and children to participate in the training that centered on behavioral change.
Data was collected through interviews coupled with questionnaires. Ninety-nine (99) children aged between four and six years were recruited to the program with the sample being divided into two groups, viz. the treatment and the control groups. The study combined both qualitative and quantitative techniques to collect data regarding behavioral changes from the participants before and after interventions.
Parents were then asked to report on the changes notable on their children’s behaviors following the interventions afforded by both the guardians and the researchers. Most parents reported significant changes regarding hyperactive, oppositional, and aggressive behavioral problems that were prevalent among the kids before the interventions.
Additionally, the reports indicated that the children’s confidence level had improved significantly following the behavioral interventions afforded by the researchers in partnership with the parents. Young (2012) found that CBT was effective in averting undesirable behaviors among children suffering from ADHD. The study recruited 68 children with symptoms of ADHD who were not under any form of medication at the time of the study.
The participants were aged between 14 and 18 years. The research invoked both quantitative and qualitative methods whereby all the participants received CBT in six consecutive phases. Interviews were used to collect data from children and parents to supplement data collected through observations and the questionnaires.
Various stakeholders were given a questionnaire on which they were to record behavioral changes on each child upon the completion of each stage of CBT interventions. The research escalated with the parents and teachers reporting positive changes in the participating children’s behaviors. The children also displayed some improvements in their self-esteem levels.
Conclusion
CBT is an intervention strategy that aims at altering the behaviors of an individual in place of administering medicinal drugs. Literature reviewed in this paper reveals that CBT is an effective treatment intervention strategy for children suffering from ADHD.
The studies reviewed in this article are based on quantitative, qualitative, and mixed methods, and they all concur that CBT is an effective treatment strategy for the condition. However, the studies recommend further research on the topic using a larger sample to fill gaps in the available findings.
References
Abdollahian, E., Mokhber, N., Balaghi, A., & Moharrari, F. (2013). The effectiveness of cognitive-behavioral play therapy on the symptoms of attention-deficit/hyperactivity disorder in children aged 7–9 years. ADHD Attention Deficit and Hyperactivity Disorders, 5(1), 41-46.
Breinholst, S., Esbjørn, H., Reinholdt-Dunne, L., & Stallard, P. (2012). CBT for the treatment of child anxiety disorders: A review of why parental involvement has not enhanced outcomes. Journal of Anxiety Disorders, 26(3), 416-424.
Cabiya, J., Padilla-Cotto, L., González, K., Sanchez-Cestero, J., Martínez-Taboas, A., & Sayers, S. (2008). Effectiveness of a cognitive-behavioral intervention for Puerto Rican children. Inter-American Journal of Psychology, 42(2), 195-202.
Chavira, A., Bustos, E., Garcia, S., Ng, B., & Camacho, A. (2015). Delivering CBT to Rural Latino Children with Anxiety Disorders: A Qualitative Study. Community Mental Health Journal, 5(7), 1-9.
Daley, D., Van der Oord, S., Ferrin, M., Danckaerts, M., Doepfner, M.,…Sonuga-Barke, J. (2015). The impact of behavioral interventions for children and adolescents with attention deficit hyperactivity disorder: a meta-analysis of randomized controlled trials across multiple outcome domains. Journal of the American Academy of Child and Adolescent Psychiatry, 2(6), 5-36.
Fabiano, A., Pelham, E., Coles, K., Gnagy, M., Chronis-Tuscano, A., & O’Connor, B. (2009). A meta-analysis of behavioral treatments for attention-deficit/hyperactivity disorder. Clinical Psychology Review, 29(2), 129-140.
Fehlings, L., Roberts, W., Humphries, T., & Dawe, G. (1991). Attention Deficit Hyperactivity Disorder: Does Cognitive Behavioral Therapy Improve Home Behavior. Journal of Developmental & Behavioral Pediatrics, 12(4), 223-228.
Jarrett, M. (2013). Treatment of comorbid attention-deficit/hyperactivity disorder and anxiety in children: processes of change. Psychological Assessment, 25(2), 545-47.
Kerns, M., Read, L., Klugman, J., & Kendall, P. (2013). Cognitive behavioral therapy for youth with social anxiety: differential short and long-term treatment outcomes. Journal of Anxiety Disorders, 27(2), 210-215.
Klassen, A., Miller, A., Raina, P., Lee, K., & Olsen, L. (1999). Attention-deficit hyperactivity disorder in children and youth: a quantitative systematic review of the efficacy of different management strategies. Canadian Journal of Psychiatry, 44(10), 1007-1016.
Moreno-García, I., Delgado-Pardo, G., de Rey, V., Meneres-Sancho, S., & Servera-Barceló, M. (2015). Neurofeedback, pharmacological treatment and behavioral therapy in hyperactivity: multilevel analysis of treatment effects on electroencephalography. International Journal of Clinical and Health Psychology, 7(4), 75-99.
Ozsivadjian, A., Knott, F., & Magiati, I. (2012). Parent and child perspectives on the nature of anxiety in children and young people with autism spectrum disorders: a focus group study. Autism, 16(2), 107-121.
Webster-Stratton, H., Reid, J., & Beauchaine, T. (2011). Combining parent and child training for young children with ADHD. Journal of Clinical Child & Adolescent Psychology, 40(2), 191-203.
Young, M. (2012). Is behavioral intervention an alternative medicine in childhood/adolescent ADHD? (Doctoral dissertation). Web.
ADHD (Attention-deficit hyperactivity disorder) is described as a developmental disorder that is concerned with neurological behavior (Lerner & Wigal, 2008). ADHD appears to affect between 3 and 5 percent of the population of children, and its symptoms manifest themselves before such children have reached the age of 7 years. DHD is distinguished by constant inattention and impulsiveness patterns and these patterns may or may not be accompanied by a hyperactivity component (National Institute of Mental Health, 2008).
Statistics indicate that boys are twice as much likely to suffer from ADHD, in comparison to girls (Lerner & Wigal, 2008) although several studies have indicated that this could be a result of subjective bias (Murphy & Barkley, 2005). With maturity, adolescents, as well as adults suffering from ADHD, have a higher likelihood of experiencing a mechanism to scope, as a way of compensating for the impairment that they exhibit. Besides, a genetic element is often thought to be at play, with regard to ADHD (Lerner & Wigal, 2008). Treatment methods for ADHD often entail a modification of behavior, medication, counseling, and a change of lifestyle (Murphy & Barkley, 2005).
Impulsiveness entails a behavior in which individual tends to act without a prior thought of the ensuing consequences of their actions, disorganization and interruption tendencies during a conversation with other people (Martin, 2006). On the other hand, hyperactivity is characterized by restlessness tendencies, squirminess, and fidgeting, as well as restless sleeping episodes. ADHD may also be characterized by episodes of inattention in which the victims are distracted too easily, have a tendency to daydream, and have difficulties in listening, or completing assignments (Murphy & Barkley, 2005).
Behavior regulation
The inhibitory and excitatory postsynaptic potentials, as well as the transmitters and synaptic transmission, are actively involved in the generation and control of various behaviors. In this regard, a postsynaptic potential refers to an alteration of the ‘resting potential’, following a presynaptic cell stimulus. According to Wickens (2005), a positive postsynaptic excitatory potential comes about as a result of positive cells.
On the other hand, if the cell turns out to be negative, then a negative postsynaptic excitatory potential ensues. Wickens (2005) further opines that neurotransmission comes about following a nerve impulse accumulation at the axon hillock, located inside a neuron. As a result of these nerve impulses accumulating, neurotransmission (otherwise referred to as synaptic transmission) occurs. It is this synaptic transmission, therefore, that enables the various neurons to communicate.
Primary transmitters
There are about four transmitters that are often termed primary transmitters. These include dopamine, serotonin, acetylcholine, and GABA.
Serotonin
Serotonin production within the brain is associated with the occipital brain lobes located next to the brain’s rear. This is the area that is charged with the responsibility for vision control as well as a regulation of one’s brain’s ability to go to ‘resynchronize’ and go to rest (Murphy & Barkley, 2005). All of this is made possible thanks to the generation of serotonin together with its accompanying delta waves in the brain. At a time when the levels of serotonin in an individual are quite well balanced, such an individual makes rational thoughts, and they also tend to enjoy deep sleep.
An overproduction of serotonin may lead to paranoid and nervous individuals. Besides, excessive serotonin levels could also result in inferiority and inadequacy feelings, thereby leading to depression, sadness, depression, and anger. It has also been shown that the inception of serotonin deficiencies is often exhibited by such early signs of warning that indicate a disengagement between, on the one hand, the body and on the other hand, the mind (Wickens, 2005). A number of these symptoms thus entails hallucinations, hypertension, depression, palpitation, loner behavior, allergies, pain and aches in the muscles, urinary frequencies, codependency, restlessness, loss of memory, phobias, shyness, and perfectionism.
Acetylcholine
This is used in reference to the neurotransmitter that is generated by neurons located at the brain’s parietal lobes. There is a correlation between acetylcholine and the brain’s alpha waves, responsible for regulating the speed of the brain. The neuron acetylcholine acts as a lubricant, in effect ensuring that brain cells always remain in a moist state, thereby enabling an easier passage of information and energy through cells (Wickens, 2005). In addition, acetylcholine functions as a building block of myelin, responsible for insulating the body, as well as nerve protection.
A balance acetylcholine level results in a confident and creative individual. It has been documented that virtually all the deficiencies of acetylcholine result in dehydration. Some of the other diseases and symptoms that may come about due to its deficiency include anxiety, Alzheimer’s disease, inflammatory disorders, osteoporosis, mood swings, bipolar disorder, memory disturbances, and disorders of learning (National Institute of Mental Health, 2008).
Dopamine
This refers to those waves of the brain that are responsible for the alertness exhibited by individuals. These brain waves get created from dopamine-producing neurons, in the brain’s frontal lobes. Dopamine plays the role of a natural amphetamine, thereby facilitating energy control, motivation as well as excitement (Martin, 2006). In addition, dopamine is responsible for controlling metabolism, voluntary movements, blood pressure, digestion, setting of goals, intelligence, production of adrenaline, abstract thoughts, and also facilitates in making long-term plans.
On the other hand, its deficiency often results in anemia, a loss in bone density, pain in the joints, disorders of the thyroid, depression, mood swings, anger, forgetfulness, elevated blood pressure, instability in blood sugar, and hyperactivity. Hormones or medications are usually used in treating severe deficiencies of dopamine.
GABA
This transmitter is responsible for the production of calmness, and also plays a role in the endorphins production. An individual that exhibits a balanced level of GABA is often characterized by a sense of reliability and stability (Martin, 2006). On the negative side, however, GABA levels in excess may lead to individuals abandoning their personal needs, and instead, opt to let the plight of others take center stage. A deficiency of the GABA transmitters, at the early stage, may entail irritability and nervousness, or even feelings of anxiety. At times, individuals exhibiting these deficiencies may even start experiences feelings of being stressed out, overwhelmed even, as well as light-headedness, allergies, and aching muscles.
The deficiency of GABA, just like the rest of the neurotransmitters of the brain, influences the key functional domains of the brain. Personality, memory, physical, as well as attention issues, could also manifest themselves as a result of a deficiency of GABA (National Institute of Mental Health, 2008). Such issues may include chronic pain, headache, backache, loss of muscle, palpitations, constipation, insomnia chronic pain, urinary frequency, restlessness, rage, incoherent flows of thoughts, and difficulties in paying attention.
References
Lerner, M., & Wigal, T. (2008). “Long-term safety of stimulant medications used to treat children with ADHD”. Pediatric annals 37 (1): 37–45.
Martin, G.N. (2006). Human Neuropsychology (2nd Ed.). Harlow: Pearson.
Murphy, K. R & Barkley, R. A. (2005). Attention-Deficit Hyperactivity Disorder. (3rd edition). New York: The Guilford Press
National Institute of Mental Health (2008). “Attention Deficit Hyperactivity Disorder (ADHD)”. Web.
Wickens, A. (2005). Foundations for biopsychology. (2nd edition). London: Prentice Hall.
Contemporary research in the sphere of child psychology has proved that over a forty years period, “behavioral parent training has evolved into a more sophisticated array of parenting interventions” that have proved their usefulness in a significant number of contexts (Reis, Sprecher, & Sprecher, 2009, p. 157). Attention Deficit Hyperactivity Disorder (ADHD) can be considered to be one of such contexts. The seriousness of the problem can be proven by statistical information, stating that nowadays there are about four million children suffering from ADHD in the USA (Wender, 2000, p. 4). Coch et al. (2007) also state that ADHD affects about 3-7% of children of school age, stressing possible difficulties connected with ADHD, such as “academic underachievement, disturbed family relations, and peer rejection” (p. 239).
What is more, socialization is a necessary process for children, which enables them to form their values and norm and become adequate citizens of society, however, it is difficult for children with ADHD (Huang et al., 2003, p. 275). These facts considered, it is possible to state that the seriousness of ADHD accounts for the necessity of the use of behavioral parental training as the treatment of the disorder.
Definition
Behavioral parenting training is considered to be one of the most frequently used behavioral interventions for parents who have children that demonstrate the signs of behavior problems (Maughan et al., 2005). Mah and Johnson (2008) qualify it as one of the most effective ways “to change parenting behavior” and define it as “evidence-based treatment for externalizing child behavior problems” (p. 219). The main basis for the training is formed with the help of social learning principles, that state that children are apt to learn “noncompliant behavior via an interaction of reinforcement processes and modeling from other people” that create a child’s environment (Wierson, & Forehand, 1994, p. 146).
Since the parents are the most important actors in the environment of their children, they may be considered to be their teachers; this is the postulate of behavioral parenting training. Considering the definition and the essence of behavioral parenting training, it is necessary to mention that this type of treatment has changed a lot, initially being a clinic-based treatment, that provided individual family sessions for parents sometimes accompanied by a child (Chronis et al., 2004, p. 5). Nowadays individual behavioral parenting training is used along with group-based training.
The ways how behavioral parenting is taught and the elements of behavioral parenting training programs
Several approaches may be allied when it comes to behavioral parenting training. However, no matter if parents and clinicians agree on an individual behavioral parenting training program or group-based training, all of these programs should have several attributes, which are as follows: they are action-focused which means that action in the form of special training activities prevails over talk; they are problem-solving oriented, which means that family strength is used to solve specific challenges that are offered intentionally (Reis, Spercher, & Sprecher, 2009, p. 157).
Specific parenting strategies are also offered to parents and they can combine them with those that were used by them before training. A necessary part of behavioral parenting training is collaborative goal-setting that is done by parents and children together under the guidance of a specialist (Reis, Spercher, & Sprecher, 2009).
Besides, the role of the intervention professional in the programs is more a consultative one instead of prescriptive. This is necessary for one more element of the training program: “adoption of positive frame” that consists in the focus the competencies of a parent and a child, positive behaviors, and their expansion (Reis, Spercher, & Sprecher, 2009).
Wierson and Forehand (1994) single out such stages of behavioral training programs for parents as assessments conducted by a specialist with the help of questionnaires for parents and direct observation and treatment itself. The same authors mention role-play of a parent and a therapist simulating behavior with a child and home tasks for parents based on problem-solving. Also, giving attends, the use of reinforcement strategies, application of the principles of ignoring are the techniques that make behavioral parenting training effective.
Effectiveness of behavioral training of parents of children with ADHD
Behavioral parenting training has been commonly recognized as a very effective approach for the treatment of children with ADHD (Chacko et al., 2009). Chronis et al. (2004) state that behavioral parenting training is beneficial for children with ADHD as well as for their parents who demonstrate improvements in such spheres as stress management, positive reports on social behavior and acceptance are also mentioned (p. 2). Huang et al. (2003) mention a “significant decline in the severity of symptoms and problem behaviors at home with the progression of training” (275).
However, there are cases when there is a risk of poor outcomes of the training, such as in families with single mothers (Chacko et al, 2009). Though scientific research has always focused on the effectiveness of mothers’ participation in behavioral parenting training for parents of children with ADHD, Fabiano (2007) conducted a study focused on the role of fathers and the effectiveness of their participation in the training programs for parents of children with ADHD and the study has shown that fathers’ participation in training is beneficial for family relations.
Conclusion
The present paper proves that Attention Deficit Hyperactivity Disorder is a significant problem in contemporary society due to a great number of children suffering from it. Behavioral parenting training is an effective treatment of the disorder that shows significant positive results in relation to both parents and children. However, the techniques and strategies of the training need improvement and this creates a suitable field for future research in the sphere.
Reference List
Coch, D., Dawson, G., & Fisher K.W. (2007). Human Behavior, Learning, and the Developing Brain: Atypical Development. NY: Guilford Press.
Chacko, A., Wymbs, B.T., Wymbs, F.A., et al. (2009). Enhancing traditional behavioral parent training for single mothers of children with ADHD. Journal of Clinical Child & Adolescent Psychology, 38(2), 206-218.
Chronis, A.M., Chacko, A., Fabiano, G.A. et al. (2004). Enhancement to the behavioral parent training paradigm for families of children with ADHD: Review and future directions. Clinical Child and Family Psychology Review, 7(1), 1-27.
Fabiano, G.A. (2007). Father participation in behavioral parent training for ADHD: Review and recommendations for increasing inclusion and engagement. Journal of Family Psychology, 21(4), 683-693.
Huang, H-L., Chao, C-H., Tu, C-C., & Yang, P-C. (2003). Behavioral parent training for Taiwanese parents of children with attention-deficit/hyperactivity disorder. Psychiatry and Clinical Neuroscience, 57, 275- 281.
Mah, J.W.T., & Johnson C. (2008). Parental social cognition: Considerations in the acceptability of an engagement in behavioral parent training. Clin Child Psychol Rev, 11, 218-236.
Maughan D.R., Christiansen, E., Jenson, W.R. et al. (2005). Behavioral parent training as a treatment for externalizing behaviors and disruptive behavior disorders: A meta-analysis. School Psychology, 34(3), 267-286.
Reis, H.T., Sprecher, S., & Sprecher S.K. (2009). Encyclopedia of Human Relations. NY: SAGE.
Wender, P.H. (2000). ADHD: Attention-deficit Hyperactivity Disorder in Children and Adults. NY: Oxford University Press.
Wierson, M, & Forehand R. (1994). Parent behavioral training for child noncompliance: Rationale, concepts, and effectiveness. Current Directions in Psychological Science, 3(5), 146-150.
This is a paper on the topic of attention-deficit hypersensitive disorder (ADHD) that I have been studying as part of the course on special education. The purpose of the paper is to highlight my insights on the topic and the relevance of those ideas to my personal and professional development. The paper provides a background of my interaction with the topic, and it delivers the reasons why I have decided to reflect on my learning.
Within the paper, I also explain my assumptions and aspirations for the knowledge that I have gained. The highlights are that I have been familiar with attention deficit disorder since childhood, yet the addition of hypersensitivity into the condition was novel in my learning. I was intrigued and wanted to understand more about the subject and clear any misconceptions that I had. Eventually, I fit the learning into my overall career development plan where I am looking forward to consulting and research opportunities in actual practice. I also feel that the new information is instrumental in assisting me to obtain the right employment positions that will allow me to meet my goal to contribute back to society with my knowledge and skills.
What resonated with you about the specific topic and why?
I have had a growing interest in attention deficit hypersensitive disorder (ADHD) because I consider it a commonly misdiagnosed condition. The thoughts of misdiagnosis and the need to recognize the condition early so that it can be remedied or handled is an issue that concerns me. I would like to be able to play a leading role in ensuring that society gets healthier. I understand that one way of doing so is by being more informed about conditions such as ADHD that affect people.
When studying special education, a major goal is to ensure that people who do not have sufficient natural abilities get to learn coping mechanisms such that they are at par with their peers and can exercise their ingenuity at will. Since ADHD is a topic of a condition that has the potential to cripple the abilities of a person, I have become attached to it much.
In my past, I have had experiences with friends and acquaintances that appeared hypersensitive. In some cases, they ended up behaving awkwardly on social occasions. In addition, I have been reading about ADHD, and when I got an opportunity to study it, I felt it was the natural thing to do. I wanted to be equipped first for my personal interaction and for being able to give back to society. I know that there are various ways available for contributing to people’s development. However, many of the available methods assume that everyone can harness them from an equal capacity basis (Lopez – Vergara & Colder, 2013).
An observation I make in my social interactions is that people are different; some of them are lacking sufficient capacity to participate effectively in society. As such, they are unable to benefit from a number of interventions that seek to aid human development. In my case, being of assistance to such people will require me to be knowledgeable enough to understand my position and their position in a particular social development matter. From there, I will know the right direction to pursue as I seek to offer my assistance.
Other than the need to offer help as a way of giving back to society, I am also wondering what is next in the development of the field. Being thorough about the topic will let me spot trends and hopefully find a career growth opportunity.
What I wanted to learn by exploring the topic/issue/disability/learning difference further
I wanted to have a deep understanding of ADHD so that I could be able to explain a number of problems with a child’s and in some cases, an adult’s intellectual, social, and psychological development (Lopez – Vergara & Colder, 2013). I was keen on finding out how behavior ends up affecting these factors in the development of a person. I wanted to see how the integration of medication and therapy in the field of healthcare and education plays a role in assisting individuals with ADHD cope with their living environment. At the same time, I wanted to learn the current situation and the emerging trends that are affecting the field of study and practice of teaching special education, with an emphasis on the effects of any present strategy on the development of a person with ADHD.
I understand that being hypersensitive is not a disorder by itself. Thus, my inquiry into this topic was mainly because this characteristic of a person occurs within another topic of attention deficit that is considered a disorder. Thus, I wanted to know how hypersensitivity and attention deficit occur and influence each other in a person’s character. Knowing this would allow me to make sense of the developments in education concerning special education, which is going to be part of my career.
Hypersensitivity is a wide topic with a variety of applicable knowledge. In this regard, it can be too confusing to work with the entire scope of hypersensitivity. Therefore, having sufficient knowledge of the topic and any related concept would allow me to narrow down to a niche of the subject, which can then serve as my basis for specializing when I am in my professional practice. It will also be a good thing to do for my additional learning needs.
After learning about hypersensitivity as a characteristic of attention deficit disorder, I wanted also to understand other characteristics of the condition. This would provide me with an all-round capacity to handle personal and organizational queries on the matter. It would also enable me to provide a convincing rationale for my career goals. Knowledge of these concepts and their prevalence in society will make me a better practitioner, and that is why I opted to explore this hypersensitivity topic further.
Further exploration urges also emerged after finding out the basic characteristics of hyperactivity like fidgeting, talking nonstop, being constantly in motion, and having difficulty in doing quite tasks and activities (Lopez – Vergara & Colder, 2013). These are also characteristics of other medical and non-medical conditions. Therefore, it is helpful to know how to identify and differentiate them to avoid misinterpretations. Correct recognition will make intervention easier. In this case, I was considering intervention in education and health care. Besides that, I have been interacting with a number of research reports and general scholarly texts on the matter.
For example, research by Park et al. (2011), sought to find out the prevalence, correlates, and comorbidities of ADHD symptoms in a Korean community. Researchers opted to use official data from a national survey done in the country. In their research, they do a literature review to support their claim that ADHD persists into adulthood, and given its characteristics, it ends up causing social difficulties and affective problems. It is from such realization that my urge to understand the concept emerges. I wanted to learn how such disabilities arise in adults due to the condition that has persisted throughout their growing years. This knowledge is relevant to an entire field of special education. As a practitioner, I am going to need it for effective intervention programs.
How the information gained will support my academic and professional development
From the beginning, the information is going to let me tell situations apart. For example, I will be able to tell apart typical toddler behavior and a hyperactive characteristic associated with attention deficit disorder. I am also going to contribute to the identification of ADHD in individuals. This contribution is significant because it ensures that many individuals end up getting the right medical and social attention early. It ensures that they have a chance to live healthy lives. In retrospect, the aim of special education and medical practice is to diagnose disabilities early and address them to minimize their adverse effects and eliminate them from society when possible.
I want to know the right careers to recommend for people who have ADHD. They can be my students, and they will look upon me as an authoritative figure. Therefore, the right theoretical and practical knowledge about the condition and opportunities necessary for coping in society is an added advantage for my resume. I am also going to play a role as a consultant for organizations that want their employees to be the most productive when they are working.
Doing this will need the best approaches for the identification of individual and group projects and coming up with working solutions for curtailing harmful effects of hypersensitivity and other attributes of ADHD. This should lead to better collaboration and teamwork. I cherish the ability to consult with companies and other institutions effectively when I am working for a consulting company or when I am acting as a private practitioner.
Overall, the information that I learn is helping lay my foundation for additional education. I can use my qualifications to get jobs and to gain entry into education programs for furthering my academic achievements. In addition, the qualifications are also useful for seeking practice opportunities. I need to provide sufficient proof of my capability, and that is what the information I gain will help me to do. I also intend to research more about the gaps in theory and practice so that I contribute to the existing scholarly knowledge on the subjects. Additional valid research will also contribute to the ongoing trend of finding out more information about the topic.
This goes on to provide a basis for improving current intervention programs and create alternative ones that can deal with any shortcomings identified in the current programs. In my career, such research work will make me valuable in many institutions, and it will serve as a basis for accessing additional resources to do additional immersive practical work with individuals living with ADHD.
References
Lopez – Vergara, H. I., & Colder, C. R. (2013). An examination of the specificity of motivation and executive functioning in ADHD symptom-clusters in adolescence. Journal of Pediatric Psychology, 38(10), 1081-1090.
Park, S., Cho, M. J., Chang, S. M., Jeon, H. J., Cho, S.-J., & Kim, B.-S.,… Hong, J. P. (2011). prevalence, correlates, and comorbidities of adult ADHD symptoms in Korea: Results of the Korean epidemiologic catchment area study. Psychiatry Research, 186(2-3), 378-383.