Attention deficit hyperactivity disorder (ADHD) is a neurobehavioral disease which is characterized by such symptoms as inattentiveness, daydreaming, hyperactivity, impulsiveness, inability to focus on the same thing for a long time, and impatience (NIMH, 2010).
The key peculiarity of ADHD is that a patient displays several of these symptoms, and they are observed quite regularly. The diagnosis of this disorder is rather difficulty because these signs may not necessarily be connected with ADHD; they may be related to lack of sleep or emotional stress.
Some medications proved to be effective for the treatment of ADHD. The drugs, which are used by therapists, are usually classified as stimulants. They produce a calming effect on children with this disorder (NIMH, 2010).
Among them, one can single out dextroamphetamine, methylphenidate, atomoxetine and many others (NIMH, 2010). The choice of a specific medication primarily depends on the age of the patient. Some of them may not be applicable certain age groups such as adults.
Moreover, one should remember that this form of medication can lead to such side-effects as sleep problems and decreased appetite (NIMH, 2010).
More importantly, when we speak about the effectiveness of these drugs, we should point out that they do not eradicate the cause of the disorder; more likely they mitigate its symptoms. This is the key limitation of this treatment mode.
The researchers as well as practicing therapists support more natural ways of overcoming attention deficit hyperactivity disorder. For instance, Dr. David Jockers attaches importance to diet and proper intake of vitamins (Jockers, 2011).
Such vitamins and nutrients as Vitamin D, Pyridoxine, Folic acid, Zinc are indispensible of effective brain function (Jockers, 2011).
Provided that intake of these vitamins is insufficient, the symptoms of ADHD are more likely to become more severe. Thus, one can say that proper diet can be effective for the treatment of attention deficit hyperactivity disorder.
Controversy surrounds the diagnosis and treatment of ADHD as an illness. Some critics maintain that the condition is a work of fiction by the psychiatric and pharmacists who have taken advantage of distraught families’ attempts to comprehend the behaviour of their children to dramatise the condition.
Others claim that ADHD is a viable condition only not very well known in the scientific world. In an ADHD documentary, Drugging our Children in 2005, drugs have been discredited as being inadequate and immoral in addressing the disorder.
Controversy and medication not withstanding, families still find it hard to cope with children suffering from ADHD. As a result, there is need to identify means through which ADHD can be managed without being overly dependant on medication. (Blackman 1011-1025).
This paper seeks to discuss ADHD disorder, its probable causes and the advantages and disadvantages of using medication to contain the condition. It most importantly seeks to emphasis helpful application of other alternatives to medication in addressing the controversial yet increasingly common phenomena.
Attention deficit hyperactivity disorder is psychiatric complication affecting normal growth and development. This condition is common in children though it can persist through other stages of development like adolescence and adulthood.
The condition is based on a combined sequence of behaviour but is basically marked by attention difficulties and or pathologically intense levels of activity (Diagnostic and Statistical Manual of Mental Disorders). ADHD is divided into three special types;
overbearingly hyperactive and impulsive
majorly inattentive and
A blend of hyperactivity, impulsiveness and inattention.
Overly hyperactive-impulsive ADHD children may also exhibit lack of attention while the inattentive ADHD ones may also show symptoms of hyperactivity and impulsiveness. Both signs are however minimal compared to the dominant ones. Combined ADHD is the most common among children.
It is quite hard to define the symptoms of ADHD since it is difficult to clearly delineate between normal and clinical levels of hyperactivity, lack of attention and impulsiveness. However, the most common manifestations of ADHD are not being able to direct and maintain one’s mind on something for long, distractive tendencies, and or being overly active and acting unpredictably.
These symptoms recur constantly making it difficult for the individual to function normally across all spheres of life. This is because people with ADHD are mostly restless, easily distracted, cannot organise themselves, act and talk before considering the repercussions and are very impatient, have poor memory and cannot maintain permanent relationships.
Potential causes if ADHD
Various theories have been propounded to shed some light into the probable causes of ADHD. Among the common theories are the evolution theories, environmental theory, neuro diversity theory, social construct theory, low arousal theory, social theory and diet.
However, according to Bailly Lionel a lecturer in Child and Adolescent Psychiatry, the exact causes of the condition are not yet established. Meanwhile, scientific studies indicate that the condition is brought about by a blend of various factors.
ADHD is believed to be a hereditary disorder that can be carried on amid members of a family. Though it is yet to be known just what genes lead to the condition, research is still on to determine the exact genes or the mixture of genes that could make an individual prone to the disorder with the hope of developing a cure or curbing the disorder way before its symptoms manifest themselves.
ADHD is also thought to originate from the different substantial properties of the brain parts. Studies show that the condition is eminently inherited though the genetic factor is dismal. ADHD is an unfathomable synergy of genes and other external and internal factors (Acosta, Arcos-Burgos and Muenke 1-15).
Environmental factors are also likely to contribute to the condition. Cigarette smoke and alcohol abuse by expectant mothers affect the unborn making them prone to developing ADHD. This is because nicotine could cause oxygen deficiency to the foetus hence affecting the brain.
Children born prematurely are also likely to suffer from ADHD while infections in the course of pregnancy, at the time of birth and viral and bacterial childhood infections like measles could also cause the condition. Similarly, exposing young children to lead and some pesticides puts them at risk of developing the condition (van Cleave and Leslie 28-37).
To a small extent, ADHD is also associated with trauma suffered from brain injuries. Children with ADHD constantly sustain head injuries. However, this does not imply that that they developed the condition as a result.
The presumption that refined sugar is a likely cause of ADHD or worsens manifestations of the condition is widespread. However, research dismisses the notion as myth since studies indicate that there is no notable behavioural difference between children who took sugars or substitutes or even more than the required amounts of sugar.
Diet has also been identified as one of the probable causes of ADHD. According to a study by McCann, Barrett and Cooper, there is a connection between children’s consumption of various popular food additives (food colours and preservatives), with hyperactivity.
Sodium benzoate is a common preservative found in salad dressings, carbonated drinks, jams and fruit juices which has been pointed out among others to prompt symptoms of ADHD. However, more research is still on to fully establish just how they are related (McCann, Barrett and Cooper 1560-7).
In addition, the World Health Organisation advances that the manifestation of ADHD is a consequence of the malfunctioning of the society and not an individual problem.
It attributes the condition to failures in the family institution and flaws in the education system. Others conceive that thrusting children to care givers and the subsequent correlation impact a lot on the abilities of the child to pay attention or take care of themselves. At the same time, children in foster care are more likely to develop symptoms closely associated with ADHD.
Furthermore, (Cuffe, McCullough, Elizabeth and Pumariega 327-3) advance that children who are victims of violence and psychological trauma are prone to developing ADHD. Psychological illnesses like Complex post Traumatic Stress Disorder can end up causing attention problems that resemble ADHD.
According to a recent CNN article, children adopted across nations are more likely to develop psychological illnesses like ADHD/ADD. This has o some extent been attributed to the long duration it takes to be adopted during which time they could be violated or disregarded.
ADHD Treatment/ management
ADHD is a condition that needs to be treated and monitored. This is because if neglected, it can result in serious complications for an individual such as poor grades at school or ineffectiveness at the workplace, problems in forming and maintaining lasting relationships and low self evaluation.
There is no known cure of ADHD. Treatments only serve to alleviate the symptoms and make life better for the individuals suffering from the condition. This way, ADHD victims can lead a relatively normal life. However, research is still underway to discover more fruitful treatments for the disorder.
Medications
Stimulants are the most widespread medications for ADHD. Stimulants provide calm to children with the condition. They can either be pills, capsules, syrups or skin patches. The most conventional stimulant medications are Ritalin, Concerta, Dexerdrine, Metadate, Adderal and Focalin.
It should however be noted that these medications are not applicable to all individuals hence a matter of careful prescription when it comes to individual choice. This is because what goes well with one person may not fair well with another (The Diagnostic and Statistical Manual of Mental Disorders 284-287).
There are also other preferable medications other than stimulants such as atomoxetine, tricyclic anti-depressants, and bupropion and also generally prescribed medications for children from 3 to 6 years of age. However, not all the medications are sanctioned to be used in grown ups.
Pros and cons of medication
Medications serve to alleviate cases of hypersensitivity and impulsiveness in children. They also help children to focus more and be able to do constructive work and learn properly. Drugs also do help make physical interaction of the individuals better.
However, it has been reported that these drugs cause acute side effect like lack of appetite, sleep disorders, anxiety, irritability, stomach problems or headaches. Majority of these side effects are not severe and usually go away with time or when the dosage administered is lowered or by changing medications.
Sometimes the use of stimulants may result to drug abuse and over-dependence on the drugs as some of the drugs make individuals feel “different”. According to the National Institute for Drug Abuse Community Epidemiology Work Group, methylphenidate is reported to be abused among teenagers in the USA and the UK. They administer the drugs orally while some inhale the crushed drugs or mix with heroin and cocaine to have a more powerful effect.
Similarly, using stimulants on individuals suffering from other complications like heart conditions may prove catastrophic as they make cause strokes, heart attacks or even sudden death. Medications may also cause other psychosocial problems like hallucinations, delusions, moodiness, and being overly suspicious. The use of some non stimulants like strattera atomoxetine in teenagers and children prompts suicidal tendencies and they therefore need to be observed strictly.
Even when some medications are safe and have minimum or no side effects, they still do not cure ADHD. The symptoms of the conditions are only controlled and depending on if the medications are adhered to, monitored and regulated. It is also not guaranteed that medications help boost children’s learning abilities and academic performance.
Alternatives to medication
According to Van Cleave and Leslie, effective treatment and management of ADHD involves a combined process of medication and complementary treatment. This is because medicines alone cannot guarantee efficacy. In some countries like the UK and the US, use of medication is only advised in cases of intense manifestation of ADHD.
Similarly, children under three years are not sanctioned to use medications owing to the un-ascertained lasting effects of the drugs. Moreover, owing to the controversies on whether ADHD is an illness or a scam by psychiatrists and pharmaceuticals, there has been need to identify other ways through which the condition can be contained.
Psychosocial therapy
It involves a variety of psychological and social curative processes that focus on helping ADHD children alter their behaviour. It includes behavioural therapy, psycho educational assistance, interpersonal psychotherapy, family therapy, group therapy, cognitive behaviour therapy, training in social skills, school based interventions among others.
It ranges from literary helping the child organise tasks, finish homework to assisting the children go through events that are emotionally draining (Van Cleave and Leslie 28-37).
Behavioural therapy imparts children with skills that can help them supervise and regulate their actions. It also aims at teaching children to learn to evaluate themselves positively for behaving in an admirable way. It involves having clear and precise set of rules, activities and a variety of systematised customary procedure that exercise restraint to a child’s behaviour and a feedback mechanism.
Through therapy, children learn social skills like waiting their chance in play, sharing, requesting for assistance, or how to react towards others. They also become able to interpret facial and tonal variations and what is required in response.
Guidance and counselling
Children with this condition require a lot of love, kindness, guidance and most of all, understanding from the people around them. This involves teachers, parents, siblings, neighbours, caretakers, friends and anyone who comes in contact with them.
This enables them be the best they can ever be. The children should not be blamed or made to feel guilty of their condition. Instead, they require special assistance to deal with the condition effectively.
Exchanging opinions and making consultations gives individuals with ADHD a forum to express their feelings and come up with effective ways of coping with ADHD such as low self esteem, lack of friends, inability to form and maintain relationships and other frustrations.
Social Skills Training
Through this approach, individuals suffering from ADHD learn more acceptable ways and skills of interacting with others that were previously unknown to them. This way, they ameliorate their fundamental ways of associating with others. Parents are trained on skills and attitudes that can help change the behaviour of the children in a loving and understanding manner.
This involves rewarding good behaviour and ignoring or redirecting unpleasant behaviour; in essence, focusing more on the child’s abilities and strengths rather than their weaknesses and disabilities. If for instance a child becomes uncontrollable, the child is driven away from the scene that upsets them and is given time alone to cool off. This way, even those around them get to learn how to manage their emotions.
Support Groups
It is about finding strength through association with people affected by ADHD. This not only refers to ADHD individuals but also parents and the loved ones. Through sharing with people facing the same situation, people learn from others and get encouraged to move on.
Alternative sleeping patterns
Children with ADHD have sleeping problems yet sleep is a natural requirement for normal growth and a remedy for many ailments. Sleep is achieved through developing a consistent sleeping schedule regardless of the day so that a child gets used to sleeping and getting up at a given time.
This also includes regular timing for meals, resting and going to bed and minimising or doing away entirely with any form of disturbing noises that would distract the child.
There are other approaches that compliment treatment like changing diets to involve food that are less in saturated sugar, artificial additives, caffeine, chocolate, tea and some energy beverages. This reduces chances of stimulating conditions related to the disorder (McCann, Barrett and Cooper. 1560 -7).
Conclusion
ADHD diagnosis is still largely dependant on the explication of the psychiatrist or clinician and in most cases a third party. Its probably caused by an amalgamation of internal and external factors. While the real diagnosis remains a bone of contention, ADHD remains an increasingly common childhood disorder for which research indicates a combination of medications and alternative can prove effective in controlling it.
There are risks in over-dependence and misuse of medication and medication on its own cannot effectively alleviate the problem. There is need therefore to focus on other ways of making those affected with the conditions cope easily and be able to lead a normal life.
After all has been done failure in these combined approaches in alleviating the problem means going back to the beginning and reviewing the diagnosis. Either there would be an error in the diagnosis or there may be other factors present at the time that also lead to lack of positive response. That will mean a total evaluation of all those factors.
Works Cited
Acosta, Maria T., Arcos-Burgos, Mauricio and Muenke, Maximillian. “Attention Deficit/hyperactivity Disorder (ADHD): Complex phenotype, simple genotype?” Genetics in Medicine 6.1(2004): 1–15. Print.
Bailly, Lionel. “Stimulant Medication for the Treatment of Attention-deficit Hyperactivity Disorder: Evidence-b(i)ased Practice?”. Psychiatric Bulletin (The Royal College of Psychiatrists) 29.8(2005): 284–287. Print.
Blackman, John. “Attention-deficit/hyperactivity Disorder in Preschoolers. Does it exist and should we treat it?” Paediatric Clinics of North America, 46 (1999): 1011 -1025. Print.
Cuffe, S.P., McCullough, Elizabeth L. and Pumariega, Andres J. “Comorbidity of attention Deficit Hyperactivity Disorder and Post-Traumatic Stress Disorder”. Child and Family Studies 3.3 (1994): 327–336. Print.
DSM-IV-TR workgroup. The Diagnostic and Statistical Manual of Mental Disorders, Washington, DC: American Psychiatric Association, 2007. Print.
McCann John D., Barrett Agnew and Cooper Anderson. “Food additives and Hyperactive Behaviour in 3-year-old and 8/9-year-old Children in the Community: A Randomized, Double-blinded, Placebo-controlled Trial”. Lancet 370.9598(2007): 1560–7. Print.
Van Cleave Jeanne, Leslie LK.”Approaching ADHD as a chronic condition: implications for Long-term Adherence”. Psychosocial Nursing and Mental Health Services 46.8(2008): 28–37. Print.
Attention deficit hyperactivity disorder (ADHD) is a chronic and impairing condition associated with a high lifetime risk of behavioral and learning dysfunctions. The maximum age at onset is 14 years, suggesting that diagnosis and treatment of this disorder in childhood are critical (Dakwar et al., 2014). ADHD is clinically significant because it is linked to severe functional impairment, comorbidities, and substantial economic burden on the healthcare system. Its symptoms include a lack of attention, hyperactivity, and impulsions (Dakwar et al., 2014). Pharmacologic agents, such as stimulants, are recommended as an efficacious first-line therapy for ADHD in childhood.
The refusal to use medication may be attributed to, among other factors, a perceived inefficacy of pharmacotherapy and social stigma. However, interventions, such as parent-mediated behavioral training and token reinforcement procedures, can help children manage ADHD symptoms (Hodgson, Hutchinson, & Denson, 2014). The proposed study aims to create awareness of the importance of interventions with ADHD among parents refusing to use medication.
Research Problem
Significance of the Problem
The refusal of ADHD medication could be due to psychological reasons. Behavioral interventions offer alternative evidence-based treatments for this disorder. However, attitudinal barriers, such as perceptions of misdiagnosis, may prevent parents from seeking therapy for their children. Partridge, Lucke, and Hall (2014) found that 78.3% of adults regard ADHD diagnosis in children as incorrect in most cases and are more likely to refuse the use of medication in treating this disorder. Thus, given the negative attitudes towards pharmacotherapy by parents, it is important to explore effective behavioral interventions for ADHD symptom management.
The misperceptions about ADHD diagnosis and limited use of behavioral modification strategies may be due to inadequate parental awareness and education on evidence-based choices. Most parents use the Internet for information about this disorder and its management (Sage et al., 2018). Educating the public on school-based and home-based interventions may lead to improved ADHD symptom management and outcomes. Therefore, it would be crucial to create awareness on teacher-, parent-, and computer-mediated behavioral strategies for ADHD treatment.
Benefits of the Research Project
The primary beneficiaries of this project will be school-age children, teachers, education administrators, and parents. Behavioral interventions can be used with ADHD as alternatives to pharmacotherapy. Through this project, parents will learn about home-based contingency management and behavioral tutoring strategies for reducing or preventing behavior problems. School-age children will acquire self-monitoring and self-management skills. Instructors and education administrators will benefit from reduced behavioral problems and classroom misbehavior. Adequate knowledge of school-based interventions will enable educators to be responsive to the learning needs of children with ADHD. As a result, they will ensure classroom conditions are conducive for ADHD students to succeed.
Literature Review
Treatment-seeking Behavior
ADHD is a prevalent childhood-onset disorder associated with multiple learning and behavioral difficulties. The recommended evidence-based treatments are both pharmacological and non-pharmacological. However, their use depends on perceived efficacy, side effects, and parental approval. Several stimulants and non-stimulant FDA-approved drugs can be used to treat ADHD (Mojtabai et al., 2011). Despite the efficacy of these medications, up to 55% of parents whose children are diagnosed with ADHD refuse pharmacological interventions for this condition (Dakwar et al., 2014). As a result, the delay from symptom onset to therapy is high – 10 to 28 years (Dakwar et al., 2014).
The refusal of ADHD medication may be attributed to several factors. Parents may be unaware of alternative therapies or they do not think ADHD requires intervention. Sage et al. (2018) found that up to 87% of parents search the Internet for basic information on ADHD and its remedies. Thus, clinician-led education on ADHD treatment is limited and has been replaced by online sources and schools.
Further, stimulants are shrouded in controversy because of potential side effects, such as tics and elevated risk of substance use disorder (Mojtabai et al., 2011). However, psychotropic drug formulations that are long-acting have been produced to counter these effects. Nevertheless, most parents still refuse medication because of social stigma and attitudinal barriers. According to Mojtabai et al. (2011), doubts about intervention efficacy, stigmatization, and cost, among others, can discourage parents from seeking treatment.
Social Stigma and Seeking Intervention
Stigma is a strong predictor of treatment-seeking behavior. The general perception is that ADHD children exhibit self-harm and violence to others (Partridge et al., 2014). Symptom recognition is also a challenge, as most parents cannot distinguish ADHD as a neurodevelopmental disorder that requires intervention (Partridge et al., 2014). They have to contend with criticism over their parenting styles and children’s misbehavior, which discourages them from going for ADHD assessment. The fear of stigmatization forces most parents not to seek treatment (Ahmed, Borst, Wei, & Aslani, 2017). Further, stress and self-blame represent common psychological states of parents after an ADHD diagnosis.
Parents may also refuse pharmacological treatment for their child because of the fear of the impact of stimulant drugs. Potential side effects, such as substance-use disorder, low self-esteem, and psychosocial dysfunction reinforce parental fear of medications (Ahmed et al., 2017). They may also fear that their ADHD children will experience learning difficulties in school. Negative views about a child’s educational performance also amount to a stigma that discourages parents from seeking treatment services (Ahmed et al., 2017).
Interventions for Children with ADHD
Contingency management programs can be used in school or home settings to change behavior. Behavioral interventions, such as cognitive behavior therapy, are the recommended treatments for ADHD, specifically for minors with “mild to moderate ADHD or symptoms not meeting the diagnostic criteria” (Veenman, Luman, & Oosterlaan, 2017, p. 2). A common home-based program is behavioral parent training to reinforce positive behaviors. School-based treatments may be proactive such as peer tutoring and instructional modification or reactive, for example, verbal reprimands, self-management, and token reinforcement procedures (Hodgson et al., 2014; Veenman et al., 2017). These interventions may be provided through mediators or directly to the minor.
Children can also receive cognitive training to reinforce neuro-developmental capabilities. Such programs train the working memory to increase attention and reduce hyperactivity (Catalá-López et al., 2015). Neuro-feedback, which involves sensors that monitor brain activity, has been used to manage impulses (Catalá-López et al., 2015). Dietary interventions and complementary medicine can also be used to treat ADHD in children in different settings.
Research Design
The research design selected for the proposed study is quasi-experimental. This approach will involve comparing the pre-and post-intervention knowledge of parents participating in an ADHD-intervention awareness program. They will receive structured, on-site training on home-based contingency management and school-based interventions.
Research Purpose Statement and Questions
The proposed quantitative study aims to address barriers to the use of interventions with ADHD by parents who have refused to use medications. In this regard, the project will create awareness on behavioral programs that can be used with ADHD children at home or school settings to this parental sample. Their knowledge of the interventions, ability to cope with stigma, and attitudes towards these treatments will be measured at baseline and after an educational intervention. Based on the review of studies on treatment-seeking behavior and social stigma, this research will test the following three hypotheses on a sample of medication-refusing parents with ADHD children.
The post-test parental perceptions of the importance of ADHD behavioral interventions will be more favorable than baseline scores.
There will be a significant improvement in the parents’ recognition of ADHD symptoms after the awareness program compared to baseline data.
There will be a positive correlation between parental self-efficacy and the use of behavioral interventions.
Data Collection Plan
Participant Selection
The recruitment of parent participants with children diagnosed with ADHD to take part in the study will occur at Clinic ABC and Clinic XYZ. The rationale for using two different sites is to ensure a representative sample and improve external validity. A passive recruitment method will be used to recruit eligible participants. The inclusion criteria will be parents with ADHD children enrolled at the clinics, possessing a high school diploma and above, and refusing medication use. The invitation for participation in the study will be posted on the two clinics’ homepages and brochures. Those willing to participate will be contacted. Eligible parents will complete an informed consent form before participation.
Gaining Permission
Institutional approval will be secured from the university’s IRB before starting the study. Permission to research the two clinics will be sought from the management. The researcher will send a letter of intent to the board and hospital administrator of each facility to request and approval. Its content will include institutional affiliation, the nature of the study, target population, foreseeable risks, and measures to protect participating parents. It is expected that the management will grant the researcher permission to conduct the study and assist in developing a sampling frame and participant recruitment.
Data to be Collected
The first set of data that will be gathered will be the participants’ demographic characteristics. The researcher will collect the following information: age, sex, race, and educational level. Each parent will also provide details of his/her child, including gender, age, and ADHD-linked problems, and treatment history. The study will also obtain data on parental perceptions of ADHD behavioral interventions, symptom recognition, and self-efficacy in caring for children with this disorder.
Data Collection Instruments
Quantitative data will be collected using two different instruments. A demographic questionnaire will be employed to capture the personal details of the parents and those of their children. Thus, this tool will comprise two distinct sections.
A second structured questionnaire with closed questions rated on a five-point Likert-type scale will be used to collect data on the three variables: ADHD behavioral interventions, symptom recognition, and parental self-efficacy before and after an awareness program. It will be piloted to test and validate its content and face validity. In the first case, two reviewers will be sought to help assess the message of the questionnaire items. Subsequently, the instrument will be revised based on the reviewer’s advice. Face validity will involve a pilot study. This step will help evaluate the grammar, clarity, and relevance of the questions to the study.
Administration of Data Collection
The study will involve two data collection points: at baseline and the conclusion of an awareness program. First, the researcher will send a notification to eligible parents via e-mail and mail informing them to complete web-based questionnaires. Its content will include an introductory statement, details of the project, and assurances of confidentiality. Links to the demographic and study surveys will be provided.
A follow-up e-mail and letter will be sent to participants failing to respond to the invitation within one week. Parents will indicate their availability for a researcher-led three-day workshop at the clinics on parent-mediated behavioral interventions to prevent behavior problems in children with ADHD. Post-intervention data will be collected using a survey questionnaire similar to the one used at baseline.
Data Analysis and Interpretation Plan
Preparing Data for Analysis
Preliminary data handling procedures will involve scrutiny of the returned surveys for any errors and completeness. Those missing over one-third of the responses will not be analyzed. Outlier data points will be excluded to avoid measurement error. The utilization of a web-based survey will allow the researcher to validate the answers online. Valid quantitative data will be downloaded for further processing. The next step will involve importing the data into the SPSS software for statistical analysis. The researcher will ensure that this process is as accurate as possible. Mistakes will be avoided by counterchecking the data entered or edited against the survey forms.
Analyzing the Data
Data analysis will be performed using descriptive and inferential statistics. Therefore, the process will occur in two stages. In the descriptive analysis, the frequency and distribution of the participants’ demographic data will be done. The results will include the mean and median of their age, gender, race, and educational level. This procedure will also give the variance in parental perceptions of ADHD behavioral interventions, symptom recognition, and self-efficacy (dependent variables).
Inferential statistics (t-test) will be used to compare baseline and post-intervention data. The aim is to assess the impact of the awareness program on the intervention-seeking behavior of the participating parents. Chi-square tests will also be used to determine if there is a correlation between post-test outcomes and age, gender, or level of education. The response rate will also be computed.
Reporting Results
Respondents will be parents refusing medication use for their children with ADHD. Descriptive results will be presented first. They will be summarized in tables, percentages, and charts under the subheadings of parental age, gender, race, and educational level that will be organized by site. Significant group differences in demographic variables between the two samples will be reported. The researcher will also present baseline and post-intervention results in a table. Inferential tests (T-test and chi-square output) will be described after each of the three hypotheses. The report will highlight significant correlations between post-intervention measures and age, gender, or level of education.
Interpreting the Results
The proposed study aims to address barriers to seeking behavioral interventions for ADHD among parents refusing medication use through an awareness program. The independent variable will be the workshop, while the dependent ones will be parental perceptions of ADHD behavioral interventions, symptom recognition, and self-efficacy before and after the training. If the results will suggest an improvement in the first two measures, hypotheses 1 and 2 will not be rejected. A strong correlation between self-efficacy and intervention use will confirm hypothesis 3. The results will be compared to previous findings in the literature. Thus, the interpretation of data will involve a consideration of other studies.
Ethically and Culturally Relevant Considerations
A key ethical consideration for this project is maintaining confidentiality. Since this research involves human participants, their privacy and anonymity are critical. For example, a unique code will be assigned to each parent to protect his/her real identity. Through a passive recruitment method, the clinic managers will give identifiers – numbers or pseudonyms – to participants. Both the baseline and post-intervention surveys will be web-based to maintain the respondent’s anonymity. Demographic data will not include the parent or child’s name or zip code to protect participant privacy.
Another ethical measure will involve securing informed consent. The researcher will mail an information sheet highlighting the research’s aims, design, and benefits, and possible risks. This consent form will also inform potential participants of their roles and obligations in this study. It will indicate their right to withdraw from the project at any point. Parents signing and returning the consent forms will be deemed to have accepted to take part in the research.
Potential harm to respondents will be minimized through a short training period – three days. Further, parents who may not attend the workshop will have the option of receiving relevant materials via email. As such, participants will not experience more harm than they would in their daily lives. Cultural sensitivity will be ensured during data collection. Language differences exist in the study sites. For this reason, measures will be taken to address the linguistic diversity of the participants. For example, though the questionnaire will be primarily in English, non-English speakers will still receive this instrument in their preferred language. The participants will not be drawn from vulnerable populations. They will be addressed respectfully and accurately irrespective of culture, age, or sex.
Conclusion
ADHD is a childhood-onset disorder associated with significant functional impairment. This quantitative study will involve an awareness program to promote behavioral interventions as alternative therapies for ADHD. Samples drawn from two research sites – Clinic ABC and Clinic XYZ – will participate in a workshop and their post-test perceptions, symptom recognition knowledge, and parenting self-efficacy compared with baseline data.
Various challenges are anticipated at the research sites. First, gaining access to the clinics to conduct the study may be a problem due to patient confidentiality issues. ADHD is associated with stigma. As such, healthcare organizations may not want parents whose children have this disorder to participate in research. To meet this challenge, the researcher will provide assurances of confidentiality to the management and offer to use a passive recruitment method and unique identifiers and hold on-site awareness workshops.
Enlisting an adequate number of participants may also be a problem. The researcher will use two measures to address this challenge. First, the invitation letter will emphasize the benefits of the project to potential participants, such as it is an opportunity for parents to gain knowledge on home-based contingency management. Second, follow-ups will be made on all eligible participants to address their concerns and increase participation. Managing the logistics of the project is another potential challenge given that the study will be conducted at two research sites. To overcome this problem, the workshops in the two clinics will be held on separate dates.
References
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Veenman, B., Luman, M., & Oosterlaan, J. (2017). Further insight into the effectiveness of a behavioral teacher program targeting ADHD symptoms using actigraphy, classroom observations, and peer ratings. Frontiers in Psychology, 8(1157), 1-10. Web.
Leading to problems with emotional control, ADHD affects people’s lives extensively. The phenomenon of ADHD is traditionally defined as a mental disorder that causes a drop in attention span (Hu, Chou, & Yen, 2016). However, apart from the specified issue, ADHD may also entail comorbid mental health concerns, including anxiety, depression, and substance abuse. Therefore, a combined framework involving interventions and medications is required to limit the impact of comorbid issues and address ADHD.
Due to the complex nature of the issues that are comorbid with ADHD, patients will have to be provided with complex treatment strategies involving behavioral therapies, interventions, and medications. For example, a combination of long-acting stimulants and psychoeducation should be seen as important since it allows improving self-regulation inpatients and provides vulnerable groups with tools for controlling their emotions (Katzman, Bilkey, Chokka, Fallu, & Klassen, 2017). The resulting rise in awareness and emotional intelligence levels is likely to leave a positive impact on patients, helping them to manage their mental health issues.
Monitoring should also be incorporated into the range of tools for assisting ADHD patients with comorbid issues. For instance, a detailed analysis of patients’ responses to the proposed treatment is required to ensure that the selected intervention has a positive effect on a patient (Hu et al., 2016). The monitoring process also requires a patient’s participation, with the provided feedback informing the further choice of a strategy selected by a therapist.
Due to the effects that ADHD has on one’s social interactions and the overall perception of one’s self, the specified disorder tends to cluster with anxiety, depression, and substance abuse. Due to the effects that ADHD has on patients’ relationships with their family members and friends, the development of comorbid health problems becomes highly possible. Therefore, a multifaceted approach toward managing ADHD patients’ needs is required.
References
Hu, H. F., Chou, W. J., & Yen, C. F. (2016). Anxiety and depression among adolescents with attention-deficit/hyperactivity disorder: The roles of behavioral temperamental traits, comorbid autism spectrum disorder, and bullying involvement. The Kaohsiung Journal of Medical Sciences, 32(2), 103-109. Web.
Katzman, M. A., Bilkey, T. S., Chokka, P. R., Fallu, A., & Klassen, L. J. (2017). Adult ADHD and comorbid disorders: Clinical implications of a dimensional approach. BMC Psychiatry, 17(1), 302-316. Web.
The chosen study is a systematic review and meta-analysis of studies assessing the role of peer inclusion in interventions for children with ADHD. The authors examine a wide range of past studies that reported on the effects of peer inclusion interventions and present the overall results, showing why further research on peer inclusion interventions for children with ADHD is required (Cordier, Vilaysack, Doma, Wilkes-Gillan, & Speyer, 2018). The present paper will seek to evaluate the report and provide suggestions for its application in research and practice.
Evaluation of the Research Problem
The main research problem identified by the authors is the lack of consensus on the efficacy of peer inclusion interventions. As shown by Cordier et al. (2018) peer involvement is used in various interventions for children with ADHD, such as SST and summer treatment programs. Nevertheless, few studies examined the efficiency of peer inclusion in social interventions for children with ADHD.
Evaluating the Significance of the Problem
Forming an appropriate research foundation is essential to applying knowledge in counseling practice. The lack of consensus on the role of peer involvement in social interventions for children with ADHD can affect the quality of recommendations provided by counselors to parents or organizations. Therefore, the issue addressed by the authors is relevant to counseling.
The researchers also provide information on the problem’s significance. Firstly, they state that peer inclusion is often used in interventions for children with ADHD, as well as other disorders that imply impaired social functioning (Cordier et al., 2018). Secondly, the researchers explain how evidence-based interventions using peer involvement can benefit kids with ADHD to improve social functioning and promote successful interpersonal relationships.
Evaluation of the Literature Review
The authors include a literature review in the introductory section of the work. The literature review is comprehensive and detailed, explaining all major aspects of the topic. In particular, the section focuses on the roots of impaired social functioning in children with ADHD, as well as the application of peer mediation in intervention programs. Cordier et al. (2018) also explain why peer-mediated or peer-inclusive interventions might be effective in children with ADHD, which supports their hypotheses. Thus, the literature review uses a sufficient range of sources to form a basis for the present study. However, one limitation of the literature review is that it does not consider possible barriers, considerations, and costs associated with peer inclusion in interventions, thus presenting a rather one-sided view of the problem.
Evaluation of Research Design, Purpose Statement, Questions, and Hypotheses
Research Design
The researchers use a quantitative systematic review and meta-analysis design for their report. This form of research includes merging and analyzing the results of past research studies to determine the overall trends in results. This design meets the goals of the study, as it allows analyzing significant volumes of information from previous researches to determine if the overall results of peer inclusion are positive, negative, or insignificant.
Research Purpose Statement
The authors include a clear purpose statement at the end of the introductory section, stating that the study was designed “to examine the efficacy of peer inclusion in interventions targeting the social functioning of children with ADHD” (Cordier et al., 2018).
Research Questions
The authors do not provide a list of research questions. However, from the aims and objectives of the study, as well as the design, it is possible to draw the following research questions:
Does peer inclusion affect the outcomes of social interventions for children with ADHD?
Is there a sufficient number of high-quality quantitative studies confirming the positive effect of peer inclusion on the results of social interventions for children with ADHD?
What are the variables affecting the results of peer inclusion interventions for children with ADHD?
Hypotheses
The authors do not provide a list of clear research hypotheses applicable to the present study. However, they state that “a greater overlap in the approach to address the social skills difficulties was expected” (Cordier et al., 2018). Also, the authors expected that some studies analyzed in their research would be biased.
Evaluation of Data Collection Plan
Selection of Participants
As the study design was a systematic review and meta-analysis, the researchers used the data that was already collected for previous studies. The process for the selection of suitable studies, on the other hand, followed a systematic approach. The authors established clear selection criteria for the articles and only included articles that met the criteria. Such an approach to data selection helped to ensure that participants had a primary diagnosis of ADHD and were either children or adolescents, thus contributing to the outcomes of the study. To improve the selection process and provide more focus to the study, it would be useful to introduce other criteria, such as recency and intervention type.
Gaining Permission
The authors do not describe the process of obtaining permission to use the data in their study. A possible approach would be to contact the authors of selected studies and ask them if the participants agreed to the secondary use of data when signing an informed consent form.
Determining the Data to Collect
The data collected by the researchers included information about selected studies, their participants, interventions used, and outcomes. Thus, the researchers collected an appropriate scope of data based on the aims of the review.
Data Collection Instruments
The researchers used data extraction forms to obtain information from the selected studies. Extraction forms were an appropriate instrument for this study, as they allowed to synthesize the data and create tables to ease the review and comparison processes. However, the use of extraction forms creates concerns with regards to the quality of data collection, as some data items were not standardized. Also, the researchers present no evaluation of the validity, and reliability of extractions forms used in research.
Administering Data Collection
As mentioned above, the researchers used data extraction forms but offered limited standardization of some items. Besides, the researchers failed to address ethical problems relevant to secondary studies. Thus, the issues of standardization and ethics were not appropriately addressed by the authors.
Evaluation of Data Analysis and Interpretation Plan
Preparing Data for Analysis
By applying data extraction forms, the authors ensured that the data was distributed into key data items. In preparation for analysis, some of the items were operationalized. In particular, the meta-analysis focused on pre-and post-measures of social skills and the mean difference in pre-and post- skills measures, as reported by the selected studies (Cordier et al., 2018).
Analysis of the Data
The authors used a random-effects model and forest plots to generate data on effect sizes, thus responding to the primary question of the study regarding the efficacy of peer involvement in interventions for children with ADHD. In addition, the authors applied meta-regression to determine other variables affecting intervention results, as prompted by the third research question. The authors also analyzed the quality of studies using the Begg and Mazumdar rank correlation procedure and the fixed-effect model to test for publication bias.
Reporting the Results
The researchers reported the results using tables, graphs, and discussion. The tables were particularly useful in presenting general information about the selected studied, whereas the graphs provided a visual interpretation of effect sizes comparison. The tables also included subgroup analysis and meta-regression results, thus reporting on some stages of the analysis. However, the discussion of results was more useful than visual reporting, as it assisted in interpreting statistical figures obtained by the researchers. Overall, the reporting methods used by the authors are appropriate and help to present information clearly.
Interpreting the Results
The authors concluded that the effect size of peer inclusion interventions compared to other intervention types was not significant. Also, Cordier et al. (2018) noted that variation of results across the studies was significant, and thus, past research does not offer a strong foundation for the use of peer involvement in interventions for kids with ADHD. The authors discussed the limitations of their study, including inadequate blinding, randomization, and small sample size.
Evaluation of Ethical and Culturally Relevant Strategies
The authors did not use any culturally relevant strategies in their research, which was mainly because it relied on past studies for data. The authors attempted to address ethical problems by evaluating the quality of the studies selected and ensuring a lack of bias. In order to address cultural and ethical concerns effectively, the authors should have obtained permission for research, included information about the participants’ cultural or racial differences, and offered an analysis of their possible role in interventions. For instance, addressing possible cultural barriers to peer inclusion interventions and offering ways of overcoming those barriers would provide evidence of the use of culturally relevant strategies.
Conclusion
Despite a number of limitations, the study provides a useful overview of evidence regarding the usefulness of peer inclusion in interventions for children with ADHD. The information discussed by the authors can be used by counselors to decide on the appropriateness of such interventions and provide recommendations to parents.
Reference
Cordier, R., Vilaysack, B., Doma, K., Wilkes-Gillan, S., & Speyer, R. (2018). Peer inclusion in interventions for children with ADHD: A systematic review and meta-analysis. BioMed Research International, 2018(1), 1-52.
Vyvanse is the brand name for Lisdexamfetamine Dimesylate which is a single daily dose drug that has been approved by the Food and Drug Association (FDA) for the treatment of the symptoms of Attention Deficit Disorder or Attention Deficit Hyperactivity Disorder (ADD/ADHD) in adults and children aged 6-12 years old (Handelman par.1). Additionally, Vyvanse is a neurostimulant that affects the central nervous system directly through the neurotransmitters and the nerves involved in controlling impulse and hyperactivity (Handelman par.1). It is produced by Shire and New River Pharmaceuticals in its inactive form (pro-drug) which has to undergo digestion in the stomach and through the first-pass metabolic effect in the liver into L-lysine, an amino acid and dextroamphetamine, which is the active form of the drug that treats ADHD (Rosack, p. 1). Besides, the drug is available in all pharmacies across the United States in order to reach out to about 4.4 million children aged 4-17 years old who are suffering from ADHD.
Statistics provided by CDC indicate that the number of children reported to have been diagnosed with ADHD during their life-time represents about 7.8% of all school-going children in the United States. ADHD is a neuropsychological disorder that is common among children and adolescents and it manifests itself in a series of attention problems, hyperactivity in children and impulsivity that can be severe than in normal cases. Diagnosis of the disorder involves observation of the symptoms related to hyperactivity/impulsivity which normally occur before age 7 years in many children. Research also documents that there is no cure for the disorder except for the numerous medications which are usually combined with educational and psychological interventions in modifying the symptoms of the disorder (Wilens, pp. 2-6).
This paper seeks to analyze the appeals, claims, supports and warrants that have been raised in order to justify the application of Vyvanse as a possible remedy in the treatment of ADHD/ADD in adults and children. Additionally, the paper creates a persuasive discourse that utilizes the modes of appeal, supports, claims and warrants. In this case, the paper will be based on the analysis of the arguments documented in order to support this case.
Vyvanse – The ADD/ ADHD Medicine
Approval of Vyvanse by FDA
Vyvanse was approved after clinical studies through reports of mothers with children suffering from ADHD indicated that the drug could achieve control over the ADHD symptoms consistently for more than 12 hours. In these studies, about 121 mothers were assigned the responsibility of submitting their reports 3 times a day; at 10 a.m., at 2 p.m. and at 6 p.m. The results from these studies indicated that about 40% of the subjects reported that the termination of the effect of the medication occurred before 4 p.m. while approximately 60% of the subjects indicated that the effect could last up to 6 p.m. (Waknine par.3). These results were generated from the data collected during the phase II and phase III of the clinical trials involving human subjects. During these studies, the active constituent of the drug, Lisdexamfetamine Dimesylate was used at three strengths; 30mg, 50mg and 70mg. It is documented that the test drug generated statistically significant data indicating that it achieved improvement of the ADHD symptoms over a period of 12 hours relative to the placebo (a simulated medical intervention that produces improvement of a medical condition that is not attributable to any medication). In another phase II study that involved tests carried out on school-age children, the use of the active form of the drug or salts (analogs) that consisted of amphetamine such as Adderall XR, there was observable improvement of the symptoms of ADHD among the children relative to the placebo. This also involved improvement of the academic output especially in solving mathematical exercises (Waknine par.8). Further studies that concurred with these results were carried out during the phase III clinical human trials. During this stage, a one month study was conducted using the three strengths of the active ingredient in a randomized test that also involved use of the control drug and the placebo. All the three dosage levels recorded improved symptoms of ADHD for the Lisdexamfetamine Dimesylate compared to the effects of the control and the placebo. The subsequent 6-12 month study involving daily treatment with the drug recorded that there was a 60% improvement of the symptoms of ADHD in addition to a 95% improvement of the behavior of the children patients (Handelman par.10).
The significance of these studies was to demonstrate that the drug is capable of achieving improved symptoms of ADHD for up to 12 hours a day. This is important for the school-age children suffering from this disease since despite the fact that the drug helps them to accomplish their academic activities during day-time; the same effect is also needed to allow the kids to carry out their homework and still spend some time with other family members after school. Moreover, Vyvanse coordinates with an individual’s metabolic processes in delivering the active constituents of the drug to target sites thereby achieving improvement of the physiological and psychological functions that are affected by ADHD such as behavior, listening and focus.
The characteristics of Vyvanse that guarantee safety and efficacy to patients relative to other related medications
As earlier indicated, Vyvanse is a pro-drug in which the active ingredient, d-amphetamine is conjugated with the amino acid L-lysine. It is administered orally whereby it is well tolerated in many patients. The drug undergoes digestion in the stomach and absorption through the intestinal tract into the liver whereby it undergoes the first-pass effect in which case the hepatic enzymes break it down into L-lysine, which contains no therapeutic effect and d-amphetamine, which is the active component of the drug that treats ADHD (Rosack 1). Research indicates that d-amphetamine is a therapeutic remedy that is characteristically different from other abused stimulants which has been employed in the treatment of ADHD for many years. This drug component occurs in the market under other brand names such as Dexedrine and Dextrostat (Handelman par.2).
Due to the necessity of enzymatic digestion of the pro-drug before achieving therapeutic potential, Vyvanse is rarely abused. Therefore, when drug and substance abusers try to snort or inject the drug into their bodies, the same effect as that observed with other abused drugs is not achieved or may not be felt. In a study undertaken by Shire/New River Pharmaceuticals on human substance abusers, the drug achieved a value for the Drug Liking Effects (DLE) that was less than that recorded with the use of pure d-amphetamine of the same dosage. These statistically significant and testable data results have guaranteed the drug the full FDA and DEA approval as a safe medication for the treatment of ADHD. However, there are claims that the drug can also be activated in the bloodstream into its active ingredient but there are no scientifically proven materials to support the claim.
Additionally, Vyvanse contains other characteristics which make the drug user-friendly. It occurs as a capsule which can be swallowed wholly by adults or mixed with water and given to young children. Moreover, the drug occurs in various strengths such as 20mgs, 30mgs, 40mgs up to 70 mgs which offer the physician and the patient the flexibility of choosing the right dosage. It is also worth noting that the drug is prescribed once a day but guarantees 13 hours of improved symptoms of ADHD (Handelman par.6).
Side Effects
Despite of the numerous advantages that the drug presents to its users, it is worth noting that Vyvanse like most other stimulants has side effects on the users. These include: difficulties with sleeping, lose of appetite, irritability, mild stomachaches and emotional lability. It should however be noted that these side effects decrease or disappear with time and in case of prolonged side effects or severity, patients are advised to seek medical attention.
Contraindications
Patients and the general public are advised to avoid using Vyvanse together with the MonoAmineOxidases (MAOs) such as Marplan, Parnate or Emsam among others. And if a patient uses any of these MAOs, he/she should avoid using Vyvanse until after two weeks. This is because; patients may experience the occurrence of severe side effects due to cross-reactivity of the two families of stimulants. Patients who are allergic to the active component in Vyvanse, Lisdexamfetamine are advised to avoid using the medication. Moreover, patients who maybe suffering from other complications such as arteriosclerosis, hypertension, heart diseases, alcoholism, severe anxiety among others are not advised to use this medication. Some of these medications are reported to have caused death in some patients and thus patients are advised to open up to their physicians and tell them about their heart diseases or any other diseases before they accept Vyvanse to be prescribed. However, it is imperative to note that Vyvanse is highly tolerated drug among many patients who have used it.
Conclusion
This paper has given an in-depth analysis of the appeals, supports, claims and warrants documented in support of the use of Vyvanse for the treatment of ADHD in children and adults. As indicated, the drug has passed through all the stages of drug testing and generated positive results which have guaranteed its full FDA and DEA approval. Besides, the drug has numerous characteristics which make it user friendly and tolerable. One notable characteristic is that the drug requires enzymatic activation in the liver before it exerts its therapeutic effects. This makes it almost impossible for drug and substance abusers to snort or inject it into their bodies.
Despite of the fact that the drug has numerous advantages, it is noted that it has a number of side-effects particularly stomachaches and causing lack of sleep. Additionally, it is noted that the drug should not be prescribed for patients who may be suffering from other complications which may be exacerbated by the administration of Vyvanse. Otherwise, Vyvanse is a tolerable drug among many patients and it has gained the confidence of many physicians and patients since it is considered an alternative remedy for the treatment of ADHD.
Works Cited
Handelman, Kenny. Vyvanse – the new medicine for ADD/ADHD. Medical Integrity Inc, 2008.
Rosack, Jim. Clinical & Research news: novel drug for ADHD wins FDA approval. Psychiatric News. American Psychiatric Association; 42(7): 1, 2007.
Wilens, Timothy E. Straight talk about psychiatric medications for kids. New York: Guilford Publication Press, 2009.
Waknine, Yael. FDA approvals: Cymbalta, Vyvanse, Kadian. Medscape Medical News: Medscape, LLC., 2010.
Attention- Deficit Hyperactivity Disorder (ADHD) is a disorder affecting people under the age of 19 years. It is characterized by continued patterns of inattention and Hyperactivity. ADHD presents itself during early childhood to school going children. There is no medical cure currently available hence it is classified as chronic or persistent medical condition. ADHD spears to be a hereditary neurobehavioral disorder and most children diagnosed with it retain it through adulthood.
It becomes very hard for school going children with ADHD to concentrate in class room as they are not able to complete assignments and task, focusing is also an issue they have to contend with. These children are easily frustrated, angered, defeated and stressed making it hard for them to associate with other children in school. There are more complicated problems related to ADHD and it is for this reason that early testing of ADHD is very important.
For a long time there have be no particular diagnostic test for ADHD. The combined contribution of professionals like speech therapist, psychologists, health advisor and teachers helps to determine if a person is suffering from ADHD. It is against this background that the new Biological ADHD testing has been received by many players in this field with much enthusiasm.
The research, leading to the discovery of the Biological testing for ADHD was conducted in Thessaloniki, Greece with 65 children volunteering for the research. The research was based on close examination of the eye movement. According to the data presented by the researcher, the results for Biological testing are 93% accurate. The best part of the research is that the biological testing can be used to detect early cases of Attention-Deficit Hyperactivity Disorder in children, leading to early treatment and management of the condition.
In Biological Testing of ADHD, a child sits in front of a computer screen wearing special kind of spectacles for monitoring the eye movement of the child. During the 10 minutes test, the child is asked to look and lock his /her eye on a spot of light traversing the screen.
There is a large difference in the eye movement of a child with ADHD compared to a normal child. A normal child follows the light for between 60 seconds to five minutes while a child with ADHD will follow the light for less than five seconds. Additional testing using different criteria like fixed light, smooth pursuit and light cascading also give very accurate results.
This Biological ADHD Testing will greatly benefit children from the age of three years as it will reliably identify children who have ADHD, ensuring that early effective intervention are put in place, reducing loss of confidence and other psychological problems.
Besides early detection of ADHD, those who suffer from ADHD will have more confidence in the Biological diagnosis as opposed to just talking to some professional. Besides, the test takes only ten minutes, making it easier for those who are suffering from ADHD to concentrate easily as opposed to sitting down with a speech therapist or a psychologist for more than one hour while undergoing examination.
Reference:
Joel T. Nigg (2006) ADHD: Understanding What Goes wrong and Why, Guilford Publishers, United Kingdom.
Michael I. Reiff (2004) ADHD: A Complete and Authoritative Guide, Alex Letourneau publishers, United States.
Attention Deficit Hyperactivity Disorder (ADHD) is one of the neurological-behavioral disorders that begin in childhood. A child suffering from this condition is impulsive, with difficulty concentrating on any tasks. Although from the outside, the state may seem like just a lot of activity in a growing organism, this disorder can have dire consequences, especially in adulthood. According to research, children with ADHD are more at risk of being socially isolated and may experience learning difficulties (Pelsser et al., 2017). However, many of them additionally suffer from other diseases, such as autism. Finally, there is a high probability that the child will carry over the condition into adulthood. Therefore, there is a need to pay close attention to this problem and seek a durable solution that can make life easier for children.
The Problems of Medications
At the moment, there are several ways in which they mainly help people suffering from the disease. The most common and essential is the pharmacological method, which consists of various kinds of psychostimulants. Despite the method’s apparent effectiveness, many studies show the presence and manifestation of different effects when taking these drugs (Woo et al., 2014). First of all, psychostimulants suppress behavioral reactions, interfering with the natural development of self-discipline in a child. Secondly, these medications must be taken with great frequency; otherwise, their effectiveness is reduced. Thirdly, in addition to possible problems with other body systems, for example, with the skin, narcotic addiction to such drugs can develop in children. Thus, it is necessary to look for similar ways to solve this problem and use non-pharmacological approaches. For example, one such method is choosing the right diet, as studies show that many children with ADHD have low reserves of certain nutrients (Millichap & Yee, 2012).
Causes of ADHD
Despite many years of research, the causes of this disease are still largely unknown. There are quite a few groups of factors that can, to varying degrees, influence the formation of this condition. Among other things, it is believed that genetics and a hostile environment may cause ADHD. The last factor is a trigger that can lead to the development of a child’s genes’ reaction. According to research that dates back to the 1970s, nutrition can significantly impact human advancement and various conditions. It may be a lack of certain substances that help the development of cognitive functions. In the absence of specific micronutrients acting as neurotransmitters, serotonin production is disrupted, leading to behavioral disturbances. Therefore, the treatment of ADHD can be carried out by medication and by regulating a person’s diet.
The Importance of Diet
The reason for such a dramatic effect of nutrition on children is the process of human development itself. According to research, children under five years of age are much more vulnerable and susceptible to the characteristics of the food they eat (Zhou et al., 2016). This reaction is due to the active form of the human body at this stage. Therefore, if children lack certain micronutrients, they may develop developmental problems in one area or another, manifested in ADHD conditions. Improper nutrition can lead to a disruption in genes’ development, ultimately leading to irreversible changes. This fact is supported by various studies that link nutritional supplements and the progression of the syndrome (Pelsser et al., 2017). Thus, diet is one of the factors that can help prevent the development of ADHD. However, it is necessary to research to identify the appropriate type of meals and its effects on patients with similar diagnoses.
Oligoantigenic Diet
The first type of diet considered is the oligoantigenic, elimination diet, which is most commonly used to treat various allergies. This diet’s essence is to exclude all kinds of food from the diet that can cause allergic reactions, such as cheeses, citrus fruits, nuts. Removing these types of nourishment from consumption allows you to stabilize the human condition, after which you can return the products one by one, observing the state and reaction of the body. In the case of ADHD, avoiding allergic foods is less important than focusing on healthy foods that do not cause allergies. Such foods include, for example, carrots, peas, pears, and tapioca (Dölp et al., 2020). Due to its richness in various vitamins and other micro-nutrients, this diet can be very beneficial for children who have ADHD.
Omega-3 Fatty Acids Diet
The second diet under consideration focuses not on food types but a specific microcomponent – omega-3 fatty acids. Research shows the usefulness of this element, especially for the developing organism (Millichap & Yee, 2012). The human body cannot produce some fatty acids; therefore, food may be their only source. In its absence, a vital component will be lacking needed for the development of the human body. Foods containing omega-3 are primarily fish and other seafood, with particular attention paid to sea fish such as tuna, sardines, and salmon. Besides, omega-3s are found in nuts, seeds, and vegetable fats, making them healthy to consume. This component is critically important for developing children, mostly under ten years of age, and therefore must be included in their diet (Heilskov Rytter et al., 2014).
Low-Carbohydrate Diets
The following two types of nutriments can be combined due to similar goals and principles of construction. They focus on the balance of fat, carbohydrates, and protein, with both nutrition plans being low-carb. The keto diet is high in fat and moderates in protein, while carbohydrate sources such as rice or sugar are prohibited. This type of nutrition is often used for children with epilepsy because of its ability to reduce blood glucose fluctuations (Bostock et al., 2017). It is this property that makes this diet potentially beneficial for treating children with ADHD. The Robert Atkins diet is also low-carb, but it focuses more on protein than fat. Its main task is to reduce human weight by burning existing body fat reserves (Bostock et al., 2017). Due to the similar blood glucose regulation principle, this diet may also benefit children with attention deficit disorder.
Polyphenol Diet
Finally, the last type of nutrition is the polyphenol diet, which concentrates on plants’ chemical compounds. These substances are natural antioxidants and prevent radicals’ damage, thus being extremely important for the body’s functioning. These substances can be found in many condiments, such as cloves, cocoa, dark chocolate, fruits, and berries. The absence of such elements may cause an imbalance between antioxidants and radicals, which leads to oxidative stress. Studies have shown that this stress may be one of the sources of ADHD, so eating plant foods and following this diet can help manage this condition (Dvořáková et al., 2006).
Two Types of Diets
Thus, virtually all available nutrition plans can be divided into two categories based on how they function. The former excludes any elements from human nutrition, as is the case with the oligoantigenic diet. On the contrary, the latter focuses on adding specific critical components to restore balance within the body. However, some diets can only be harmful, as is the case with sugar, so it is imperative to consult a doctor (Heilskov Rytter et al., 2014). In many cases, the same product may cause additional ADHD symptoms in large quantities or manage them in small doses. Hence, the root of the current problem can often be found in the child’s foods the most. By adjusting the diet, removing unnecessary components, and adding missing ones, it becomes possible to correct the existing symptoms.
Conclusion and Recommendations
Thus, nutrition is an undoubtedly vital element for the full functional development of a child. It is necessary to include many different foods in their diets following specific proportions to provide the developing body with all the essential trace elements. First, it is needed to study children’s behavior when they interact with certain types of food. This observation will allow you to establish what exactly the child needs at the moment. Secondly, it is important to contact qualified medical specialists who can give a professional assessment of the situation. Third, you need to do your best to support children and create a calm environment for them, allowing them to feel safe since psychology plays a vital role in ADHD. Finally, it is crucial to study the baby’s need for various micronutrients at different life stages. All of these factors, when taken together, can reduce the risk of ADHD and help minimize the impact of these symptoms on a child’s life.
Woo, H.D., Kim, D.W., Hong, Y.S., Kim, Y.M., Seo, J.H., Choe, B.M., Park, J.H., Kang, J.W., Yoo, J.H., Chueh, H.W., & Lee, J.H (2014). Dietary patterns in children with attention deficit/hyperactivity disorder (ADHD). Nutrients, 6(4), 1539-1553. Web.
Zhou, F., Wu, F., Zou, S., Chen, Y., Feng, C., & Fan, G. (2016). Dietary, nutrient patterns and blood essential elements in Chinese children with ADHD. Nutrients, 8(6), 1-14. Web.
The participants for this research project were very carefully chosen and sorted in the best possible way to ensure as much parity as possible. All the ADHD participants were recruited by a single pediatrician who tested all of them very thoroughly. The control group was matched for age, grade and cultural group and the records were checked for other attributes and to eliminate the possibility of undiagnosed ADHD or other learning disabilities. Girls were excluded after finding that there were too few for a viable group and also because girls simply do not play video games much, and this was a prime [art of the study. The only criticism which can be advanced against this selection is based on the nature of this type of study. The researchers actually did an excellent job in preparation for the study.
The participants were matched for age and grade, and they were all from the same locality and socio-economic group. Then they were all screened for basic IQ using the Wechsler Intelligence Scale for Children. Vocabulary, Block Design, Similarities and Object Assembly were tested and only those with at least a score of 80 were accepted. Parents of the ADHD children completed an assessment chart in order to type the ADHD as closely as possible. Principals and consulting psychologists confirmed that those in the control group had no problems during the past two years.
The participants in the testing group and those in the control group were matched for age within 6 months, for IQ within 15 points and finally for performance on the tasks of the study. Boys who did not complete the tasks were excluded and any for whom there was no appropriate match were excluded. In this way, while no overall comparison can be made for large generalities, individual and small group comparisons from this study are invaluable to research on ADHD and cognitive functioning. By matching for all possible variables which affect cognitive functioning, the variables were minimized in order to aid in achieving quantifiable results. The more variation there is in subjects, the harder it is to group them for quantification.
It would be hard to improve upon the plan used for creating the groups for this study. Perhaps a larger sample would have more meaningful results, but that is probably true of every study. However, the only way to use larger groups would have been to go outside the local area, and then we again have the problem of matching for the socio-economic group. Therefore, even with a huge expansion of this study, the final results would only be quantifiable for smaller groups. However, if it were possible to expand this study group and the matching control, one might learn a great deal by matching results and looking for parallels.
Another interesting possibility would be to conduct this study using only children with no learning disabilities and to also include other groups with varying learning disabilities. ADHD, being primarily a problem of sustaining attention and maintaining focus on tasks is only one disability that might be aided by the use of video games and exercises such as the Zoo navigation exercise. These two activities provided more than a way to measure differences in cognitive function. They are also useful tools for teaching, though that study has yet to be completed for these groups. It would be an interesting expansion to study these two activities as teaching tools and to document progress, or lack thereof, over time.
I could not find any way to improve the method of selection and matching for this study. I also found no fault with the criteria or the methods for measuring cognitive function. What I suggest, however, is that the two primary tasks may, indeed, be actually excellent teaching tools, especially for ADHD boys. Any activity which encourages a child to focus longer than usual should be valuable for teaching, especially with ADHD students. I believe this area should be explored.
Problem 1: Probability Using Standard Variable z and Normal Distribution Tables
The problem at hand is that there is a need to determine which of the therapies administered is effective in the management of ADHD. Ten children received the ten different interventions each. They were given science textbook to read and their reading time was measured in seconds. The number of seconds were then compared to the standard mean. The z-score and p-value can help researchers determine which of the therapies is statistically significant. In the first test, the standard deviation of 30 was used.
Hypothesis
Null hypothesis: There is no significant difference between the experimental mean and the population mean at 95% confidence level in all the interventions conducted.
Alternative Hypothesis: The experimental mean and the population mean is different at 95% confidence level.
Condition
If the p-value is less than the alpha value of 0.05, the researchers reject the null hypothesis and conclude that there is a significant difference between the experimental mean and population mean in all the interventions conducted.
Findings
After running the tests using the standardized z and normal distribution table, the following results were obtained. The p-value of each of the intervention is recorded in the last column as shown in the table below.
µ = 100 seconds and σ = 30
Child
Mean seconds of concentration in an experiment of reading
z-score
p-value
1
75
-0.83
0.203
2
81
-0.63
0.264
3
89
-0.37
0.356
4
99
-0.03
0.488
5
115
0.50
0.309
6
127
0.09
0.184
7
138
1.27
0.102
8
139
1.30
0.097
9
142
1.40
0.081
10
148
1.60
0.055
Conclusion
Which child or children, if any, appeared to come from a significantly different population than the one used in the null hypothesis?
From the results, it is clear that out of the ten interventions conducted, none of them is statistically significant. All of the interventions have p-value of more than 0.05. Consequently, it is possible to conclude that all of the ten interventions administered are not effective in changing the reading speed of the child. In other words, the interventions administered are not effective enough to improve the reading attention of children with ADHD.
What happens to the “significance” of each child’s data as the data are progressively more dispersed?
Since the p-value is less than the alpha value of 0.05, it is possible to conclude by saying that the average time taken by the ten children reading after the therapy is not statistically different meaning that the therapy did not improve their reading attention.
APA statement of conclusion
For each of the ten children, the therapy they received was not effective enough to improve their reading attention time as evidenced by the fact that their mean reading after therapy is significantly different from their reading duration before the therapy.
Child 1. Since the p-value calculated (0.203) is more than the alpha value set (0.05), we fail to reject the null hypothesis and conclude that there is no significant difference between the mean reading time before and after the therapy.
Child 2. Since the p-value calculated (0.264) is more than the alpha value set (0.05), we fail to reject the null hypothesis and conclude that there is no significant difference between the mean reading time before and after the therapy.
Child 3. Since the p-value calculated (0.356) is more than the alpha value set (0.05), we fail to reject the null hypothesis and conclude that there is no significant difference between the mean reading time before and after the therapy.
Child 4. Since the p-value calculated (0.488) is more than the alpha value set (0.05), we fail to reject the null hypothesis and conclude that there is no significant difference between the mean reading time before and after the therapy.
Child 5. Since the p-value calculated (0.309) is more than the alpha value set (0.05), we fail to reject the null hypothesis and conclude that there is no significant difference between the mean reading time before and after the therapy.
Child 6. Since the p-value calculated (0.184) is more than the alpha value set (0.05), we fail to reject the null hypothesis and conclude that there is no significant difference between the mean reading time before and after the therapy.
Child 7. Since the p-value calculated (0.102) is more than the alpha value set (0.05), we fail to reject the null hypothesis and conclude that there is no significant difference between the mean reading time before and after the therapy.
Child 8. Since the p-value calculated (0.097) is more than the alpha value set (0.05), we fail to reject the null hypothesis and conclude that there is no significant difference between the mean reading time before and after the therapy.
Child 9. Since the p-value calculated (0.081) is more than the alpha value set (0.05), we fail to reject the null hypothesis and conclude that there is no significant difference between the mean reading time before and after the therapy.
Child 10. Since the p-value calculated (0.055) is more than the alpha value set (0.05), we fail to reject the null hypothesis and conclude that there is no significant difference between the mean reading time before and after the therapy.
To determine whether the variation between the samples had some influence on z and p-value, similar experiment was analyzed using the standard deviation of 40. The findings are summarized on table below
µ = 100 seconds and σ = 40
Child
Mean seconds of concentration in an experiment of reading
z-score
p-value
1
75
-0.63
0.264
2
81
-0.48
0.316
3
89
-0.28
0.390
4
99
-0.03
0.488
5
115
0.38
0.352
6
127
0.68
0.248
7
138
0.95
0.171
8
139
0.98
0.164
9
142
1.05
0.147
10
148
1.20
0.115
Which child or children, if any, appeared to come from a significantly different population than the one used in the null hypothesis?
Although the data are increasingly more spread compared to table 3 data, none of ten therapies administered was effective in changing the reading speed of the children. In other words, the mean reading speed of the children before and after the therapy is statistically the same. Similar to the first study depicted in table 3, no child benefited from intervention. In fact, the only difference is that the significance difference widen.
What happens to the “significance” of each child’s data as the data are progressively more dispersed?
By making the data more distributed, the p-value move further from 0.05 meaning that the mean reading time after intervention is almost similar to the mean reading time before intervention.
APA statement of conclusion
The more dispersed the data, the lesser the effectiveness of the intervention becomes.
Child 1. Since the p-value calculated (0.264) is more than the alpha value set (0.05), we fail to reject the null hypothesis and conclude that there is no significant difference between the mean reading time before and after the therapy.
Child 2. Since the p-value calculated (0.316) is more than the alpha value set (0.05), we fail to reject the null hypothesis and conclude that there is no significant difference between the mean reading time before and after the therapy.
Child 3. Since the p-value calculated (0.390) is more than the alpha value set (0.05), we fail to reject the null hypothesis and conclude that there is no significant difference between the mean reading time before and after the therapy.
Child 4. Since the p-value calculated (0.488) is more than the alpha value set (0.05), we fail to reject the null hypothesis and conclude that there is no significant difference between the mean reading time before and after the therapy.
Child 5. Since the p-value calculated (0.352) is more than the alpha value set (0.05), we fail to reject the null hypothesis and conclude that there is no significant difference between the mean reading time before and after the therapy.
Child 6. Since the p-value calculated (0.248) is more than the alpha value set (0.05), we fail to reject the null hypothesis and conclude that there is no significant difference between the mean reading time before and after the therapy.
Child 7. Since the p-value calculated (0.171) is more than the alpha value set (0.05), we fail to reject the null hypothesis and conclude that there is no significant difference between the mean reading time before and after the therapy.
Child 8. Since the p-value calculated (0.164) is more than the alpha value set (0.05), we fail to reject the null hypothesis and conclude that there is no significant difference between the mean reading time before and after the therapy.
Child 9. Since the p-value calculated (0.147) is more than the alpha value set (0.05), we fail to reject the null hypothesis and conclude that there is no significant difference between the mean reading time before and after the therapy.
Child 10. Since the p-value calculated (0.115) is more than the alpha value set (0.05), we fail to reject the null hypothesis and conclude that there is no significant difference between the mean reading time before and after the therapy.
Problem 2: Two-Sample Inferences
In problem 2, the issue that was being investigated was whether the TB vaccination was effective or not. To address the issue, a group comprising of TB cases from 10 geographical regions received the TB vaccines. The patients in each region were then followed up to see whether new cases would increase or decrease. The data was recorded as shown in table below.
Geographical regions
Before vaccination
After vaccination
1
85
11
2
77
5
3
110
14
4
65
12
5
81
10
6
70
7
7
74
8
8
84
11
9
90
9
10
95
8
Hypothesis
The null hypothesis is that the mean of the cases before vaccination and the cases after vaccination sets of arithmetic tests are equal.
Therefore, the alternative hypothesis is that mean of the cases before vaccination and the cases after vaccination sets of arithmetic tests are not equal.
Set significance level
= 0.05.
Determine the appropriate test statistic
The most appropriate statistical test adopted is the paired t-test. The paired t-test (test of the difference in mean value) is to determine whether there is a difference between two dependent samples (Rosner, 2016). The minitab program was used to perform the analysis.
Findings
The findings from the paired t-test generated is shown below.
Comparing Means (Paired two-sample t-test)
Descriptive Statistics
Variance
Sample size
Mean
Variance
10
83.1000
171.2111
10
9.5000
6.9444
Summary
Degrees Of Freedom
9
Hypothesized Mean Difference
0.0000E+0
Test Statistics
19.0714
Pooled Variance
89.0778
Two-tailed distribution
p-level
0.0000
Critical Value (5%)
2.2622
One-tailed distribution
p-level
0.0000
t Critical Value (5%)
1.8331
Conclusion
Since the p-value is less than 0.005, we reject the null hypothesis and conclude that there is significant difference between the average scores of the cases before vaccination and the cases after vaccination. The findings show that the TB vaccination is effective because the regions which received the vaccination registered a significantly lower number of new cases. The implication of the findings is that the researchers can now recommend the need for vaccination because it is apparent that vaccination is likely to reduce the number of new TB cases.
Problem 3: Cross-Sectional Study
The last problem involves cases of poisoning with chemicals in the homes of 100,000 people in two regions. The samples are independent because the way the data was collected. The issue is to determine whether the cases of poisoning in the two regions is statistically significant or not.
Hypothesis
The null hypothesis is that the mean of the poisoning cases in region 1 is equal to the mean of the poisoning cases in region 2.
Therefore, the alternative hypothesis is the mean of poisoning cases in region 1 is not equal to the mean of poisoning cases in region 2.
Set significance level
= 0.05.
Determine the appropriate test statistic
The most appropriate statistical test adopted is the unpaired t-test. The unpaired t-test (test of the difference in mean value) is to determine whether there is a difference between two independent samples (Rosner, 2016). The minitab program was used to perform the analysis.
Findings
The findings from the chart generated is shown in table below
Comparing Means (t-test assuming unequal variances)
Descriptive Statistics
VAR
Sample size
Mean
Variance
10
127.8000
1,558.1778
10
11.2000
2.8444
Summary
Degrees Of Freedom
9
Hypothesized Mean Difference
0.0000E+0
Test Statistics
9.3324
Pooled Variance
780.5111
Two-tailed distribution
p-level
0.0000
t Critical Value (5%)
2.2622
One-tailed distribution
p-level
0.0000
t Critical Value (5%)
1.8331
Conclusion
From the table, it is clear that the p-vale is less than 0.05. Since the p-value calculated is less than the alpha value, we reject the null hypothesis and conclude that there is significant difference in the number of poisoning cases between the two regions.
The implication of the findings is that one of the regions could be having support measures to prevent its citizens from engaging in poisoning. There are many other factors that can explain the difference. It is, therefore, crucial for the public health care team to do more research to establish what could be the underlying factors responsible for the difference so that they can take appropriate measures.
Reference
Rosner, B. (2016). Fundamentals of biostatistics. Nelson Education.