In the current workplace, the most appropriate change would be the increase in the awareness of nurses regarding the methods of dealing with patients with ADHD. It is conditional upon the fact that there are many misconceptions in this area leading to the lack of seriousness when approaching this issue. As a result, the practitioners do not provide the required assistance to people with this condition. Therefore, it is vital to develop a project targeting their understanding and actions deriving from the corresponding needs to improve the mental health of the population.
Steps to Facilitate the Change
In this case, a unit manager would be responsible for facilitating the change as per Lewin’s theory. First, they should demonstrate the statistics of adverse outcomes of untreated ADHD to nursing personnel to convince them of the necessity of a change (“Lewin’s change theory,” n.d.). Second, this task should be followed by an explanation of their benefits in the situation if they help implement the project, including the effectiveness of their work and the decrease in stress. These ideas will be combined at the stage of unfreezing and help make a change in the long run for the benefit of both hospital employees and their patients.
Force Field Analysis: Facilitators and Barriers
The potential facilitators associated with a Force Field Analysis of the proposed change include the agreement of all participants on the necessity of implementing the project after its presentation and the subsequent discussion. These two factors will be beneficial for underpinning the willingness of the personnel to act on factual information and ensuring the inclusion of all nurses in the process (“Lewin’s change theory,” n.d.). In turn, the barriers would be the loss of time by staff and the need to develop new techniques without prior experience. Thus, this information will be utilized for providing direction for the work.
Based on the symptoms and information presented by Marcus’ teachers and parents, I would consider Attention Deficit Hyperactivity Disorder (ADHD) as a diagnosis. According to Austerman (2015), ADHD frequently develops at a young age, and the qualifying symptoms must be present “in at least two settings” (S2). Marcus is aged 10, and his hyperactive behavior and difficulties staying focused occur both at home and school. Furthermore, the situation is complicated by the fact that the boy lives in two different households on weekdays and weekends, one of which is stricter.
DSM-5 Criteria
ADHD is a neuro-developmental disorder whose symptoms in pediatric patients include persistent inattention, self-focused behavior, and hyperactivity that result in poor academic performance and difficulties getting along with other people. The DSM-5 raised the age limit from 6 to 12 for qualifying the disorder in children and now requires five instead of six inattentive or hyperactive-impulsive symptoms (Austerman, 2015). The specific DSM-5 criteria that Marcus meets are listed below.
Inattention
not paying attention to the teacher;
trouble following instructions;
getting distracted easily;
difficulty completing tasks both home and at school;
trouble doing activities that require mental effort (reading and taking tests).
Hyperactivity
fidgeting and not being able to stand still;
trouble sitting still during dinner or other events;
talking out of turn;
interrupting other students’ work;
taking his brothers’ toys without asking;
difficulty waiting for his turn.
Hence, five symptoms of inattention and six symptoms of hyperactivity are found in Marcus in three settings, which implies their attribution to ADHD.
Level 1 Cross-Cutting Symptoms Measure Score
The score that I would document for Markus would most likely be four in Domain III “Inattention,” as the boy experiences symptoms nearly every day for at least a year. Other domains appear irrelevant since Marcus does not show signs of problems attributed to depression, anger, mania, anxiety, etc.
Completed 6 interviews with all mothers. (children ranged in ages from:1x 10yr old, 1x 13yr old,1x 15yr old,1x 16yr old and 2 x 17yrs old) (2 x female and 4x males).
Understanding of the Role of the ADHD Clinic
This theme describes the participant’s understanding of the role of the ADHD clinic. The clinic’s role is to is help parents manage their child’s medication. However, many of the participants did not have a clear understanding of the role and, overall, the participants felt that there would be greater involvement of the Multidisciplinary Team (MDT) in the care of their child. They did not realize that the clinic focused on medication and the associated physical health needs of the child. For example, they believed that there would be greater involvement from Occupational Therapists and psychologists and his weight is checked, his blood pressure is checked. “My understanding is basically that they are there to help to support the child and the parents and any other family member what’s involved with, as in, like my daughter and to help them understand it more and more than likely just kinda it is good that there is something there for them” – one of the respondents noted. This answer shows the respondent’s expectation of multi-faceted support for parents and children.
It should be noted that the program for the diagnosis and treatment of ADHD in the clinic is a joint work of pediatric neurologists and psychotherapists, who are guided by generally recognized international standards for diagnosis and treatment. The main principles of the clinic’s specialists should be an objective diagnosis of the neurological status of the child and the characteristics of his/her behavior, the selection of drug treatment only on the basis of the principles of evidence-based medicine. An individual approach to the choice of methods of neuropsychological influence and building work both with the child and the family as a whole. It must also be remembered that ADHD is a variant of individual development within the normal range, characterized by the presence of motivation for learning, developed prerequisites for logical thinking, memory and the ability to fine motor coordination. However, to achieve the above-mentioned goals, ADHD clinics’ main task is focused on medication review. The analysis of interviews showed that respondents, in fact, expect complex results of neuropsychological influence based on MDT teams’ efforts and even the prevalence of psychotherapy approaches. At the same time, they are not considering significant regular physical examination of a child and reviewing drug treatment regular results, checking adherence to therapy, and so on: “…at the moment when we go, it is once every 3 months and his weight is checked, his blood pressure is checked, they ask me how he is getting on, they ask him how he feels. So it’s basically a check up and then a prescription, we don’t have any other interaction with the clinic.”
Analyzing categories of the respondents’ answers and relations between categories allow making some important conclusions. In particular, concluding that parents strongly believe that specially organized education and development of children with ADHD using various therapeutic methods can significantly increase the level of help provided and readiness to study at school. Positive moment is parents’ comprehension that the use of clinical therapy for the formation of school education and social life readiness is effective in corrective and developmental work with children suffering from ADHD. It consists in reducing hyperactivity, impulsivity of behavior, contributes to the formation of voluntary regulation of activity, communication skills, affects the cognitive processes development, and increases self-esteem. For example, one of the respondents noted the following: “It was trial and error, but most definitely his behaviour is improved, but it’s so much more than that, his social interaction with people. Everything has changed, I mean even when he was starting Secondary School, he goes to a Special School, so even at that that was a worry for dad’s name and I and they ran a workshop, M. did, it was for a week and we actually didn’t think he would want to go to that, but he really enjoyed it and it was very beneficial to him.” However, there is evident lack of understanding the purpose of every element in the system of ADHD management in children: “Then they went and we were seen by an OT from the Name of place but they told us because he was attending the CAMHS Team, so it’s a conflict of interest, so they couldn’t actually see him on the Name of place, so they gave us a home programme to do. We used the home programme but really we probably would have been better off with seeing a professional from time to time.”
Many parents feel an urgent need for communication and support from specialists, as well as a desire to cooperate with them. Parents expect that the clinic will inform them about the course of ADHD, about the impact of various methods of corrective treatment and supportive educational methods. Parents consider particularly necessary measure the family systems approach, which leads to a reflection of one’s own experience and has a beneficial effect on family therapy in general.
Already the first participant manifested evident lack of proper understanding of the clinic’ role: “…to be honest what I thought in the beginning and what it has turned out to be is two completely different things. I initially thought that they would actually have more help and information for me, but it seems like at the moment the only thing I am really getting out of it is check ups because child’s name is on medication so they check her height and weight, that she is growing normally and her blood pressure is fine.” Although other participants were not so categorical in their opinion, still all of them have no clear idea about the intention of ADHD clinics.
In general, the respondents are satisfied with the level of examination. The clinics offer a comprehensive plan for diagnosing and treating children-patients with suspected ADHD. In short, this comprehensive approach includes the following:
Questionnaires and appointments with therapist
Assessment of attention and concentration during meetings with a doctor
Computer diagnostics, consisting of specialized tests
Psychotherapy sessions
Recommendations for parents and caregivers
Selection of the necessary drug treatment, if required
The results of the interviews show that the attitude of parents towards the clinic and the assessment of the provided assistance is rather ambiguous. While some of the respondents expressed a very high assessment of the attitude of the clinic staff and the effectiveness of the care provided, others believed that the visit to the clinic did not bring any results. At the same time, the level of parents’ satisfaction with the results obtained after visiting clinic, is rather low, especially in comparison with the average assessment of health care services throughout the country.
Parents understanding of the role of the ADHD clinic is ambiguous. The overall code category lack of understanding as evidence by interviews where participants spoke about need for social supports for families. Only one participant out of the overall sample referenced the clinic been a medication review clinic. A number of parents did mention physical health reviews which would be in keeping with the medication review clinic.
Analysis of interviews shows that parents consider ADHD clinic rather as a kind of consulting center. One of the respondents was greatly disappointed by not receiving services of deep consulting, training, psychological support. One of the respondents perceived the clinic as regular check up and prescription facility. The respondent No.3 said the purpose of the clinic is to assess and treat children with ADHD.
At the same time, the clinic is intended for provision of an interdisciplinary, collaborative model of diagnosis and targeted treatment of ADHD and related disorders. The clinic’s team-based approach enables awareness of the clinical data on the part of both medical and psychology providers. In turn, this leads to an improved ability to offer the most optimal treatment options for each individual child and family. If medication has not produced the optimal response, targeted behavioral strategies may be recommended before the medication dose is increased, to avoid potential adverse medication effects. However, if the family cannot comply with parenting recommendations for some reason, the team may place greater emphasis on medication management. In other words, the general goal of the ADHD Clinic is to improve a child’s functioning over the course of several months. Some parents noted attendance of clinic since 2016 and some positive changes during the attendance period up to the current moment. However, the level of change in this case does not correspond to the period of observance in clinic. It can be the indicator of insufficient cooperation between parents and clinic staff, the main reason of which is namely parents’ misunderstanding of the clinic purpose, and wrong expectations.
At the same time, the respondent 4 claimed about the absence of proper attention to the child, conducting unnecessary interview with parents with the following repetition of their words, and other incomprehensible and inconsistent actions: “They told me they didn’t have any other……., whenever I applied for anything for child’s name, I was passed on and passed on and passed on to every place within reach and nobody was willing to take him on because he does have a diagnosis of Aspergers and SPD….hey did an assessment on him and they met child’s name once. They interviewed myself and dad’s name for 2 hours, twice, then reworded everything we said. So our experience of clinics has never been really good.”
Thus, understanding the role of clinic is naturally connected with the perceived experience of attending the clinic. Thematic analysis and correlation of categories make it possible to formulate the conclusion that the study results complement the understanding of the mechanism of formation of satisfaction with medical care in an ADHD clinic and indicate that the proportion of parents who are satisfied with medical care is not an independent criterion for the quality of service delivery. There is an obvious functional dependence of experiences of attending the clinic from understanding the role of clinic. If the parents expected psychological support and education and did not receive it in the clinic, they assess the activity and intention of this clinic as dissatisfactory and useless accordingly.
Experiences of Attending the Clinic
The first participant, expecting some consulting and support from the clinic and getting, in fact, physical examination for medicine review, described her experience positively but solely in terms of medical personnel ‘soft skills’, that is, communication, politeness, attentiveness, and so on: “the doctor and nurse that I am seeing with child’s name at the moment, they are lovely, absolutely, I can’t say a bad word about them, they are absolutely lovely and they do the best they can with the resources they have.” All participants expressed highly positive experiences with attending the ADHD clinic. They spoke very positively about the staff the clinical nurse specialist and the registrar who run the clinic. The opinion of respondent 3 is quite representative for it: “They’ve always been a great support.”
Analysis of respondents’ answers shows that ADHD clinics adhere to patient-centered approach. Standard operations policy (SOP) was especially highlighted by parents as this is one of the values of operation within the mental health service. As parents noted, client-centered approach increase their confidence in clinic’s service.
It should be noted after analysis of interviews results that a kind of paradox is observed in the work of clinics with children-patients and in the interaction with parents. On the one hand, the main task of ADHD clinic is to review medication prescription, based on assessment of various physical parameters of a child. On the other hand, as our empirical study shows, parents get experience mostly on part of communication and loyalty of medical staff – one side of patient-centered approach. Positive relationships with clinicians were involved in the clinic quotes from parents whilst parents identified a number of factors that they were dissatisfied within the service and therapeutic relationships diminishing their satisfaction with the services.
It is known that the patient-centered approach is based on a number of key principles, namely: 1) The first principle of patient-centeredness is to respect consumer values, needs and preferences; 2) The second principle is the integrity, consistency, and continuity of the treatment and diagnostic process; 3) The third principle is the patient’s awareness of all the details of the medical and diagnostic process, the course of medical and social rehabilitation, etc. This principle is quite broad and covers many aspects. Thus, the patient, if desired, should have access to information about his disease, about the clinical condition, about treatment options, as well as about methods of prevention; 4) The fourth principle is the creation of comfortable conditions for the patient’s stay in the process of providing him with medical care at all stages; 5) The fifth principle is to provide emotional support for the patient; 6) The sixth principle is the creation of conditions for the patient to communicate with his immediate environment. Attention should be paid to the patient’s subjective comfort level, providing comprehensive support whenever possible; 7) The seventh principle is to ensure the continuity of the treatment process, as well as to meet expectations in terms of its modification over time. To ensure this principle, first of all, it is necessary to convey detailed information about drugs, restrictions, diets in a form accessible to the patient; 8) The eighth principle is basic and forms all the previous principles. It consists in ensuring the availability of medical care for a potential patient. These are physical accessibility to a medical organization, the availability of public transport, the ability to make an appointment with a doctor, the ability to choose a doctor, and a treatment method.
Analysis of the interview results shows that ADHD clinics evidently adhere to the fourth, fifth, and sixth principles, losing sight of the other important principles. While all parents-respondents had positive experience in communication with medical staff, they still did not understand the very purpose of attending the clinic. At the same time, namely this purpose determines the expediency of such clinics functioning. The first respondent noted absence of any benefits from attending the clinic, claiming that all the procedures provided there can be easily fulfilled at home by non-specialist: “Well to be honest, I actually don’t find it helpful at all, but that is the wrong to say really. Basically everything they do at the moment I could be doing at home. I could check her weight at home, I could check her height at home, I could even buy a blood pressure machine for home and check it that way and I mean my GP could just ring me with a prescription and she could do the height and weight as well and blood pressure.” Thus, the main task – medication review/prescription – is not fulfilled properly by ADHD clinics.
Moreover, the key basic principle of a patient-centered approach is to increase patient compliance and patient loyalty. In this aspect, it is worth distinguishing between these two concepts, although from a linguistic point of view, they are certainly synonymous. The separation of these concepts in the formation of a patient-oriented approach is necessary due to the different functional significance (load) of these definitions. Commitment to adherence to therapy, as well as the fulfillment of the doctor’s requirements for compliance with the treatment-protective regime, reflects the personal relationship in the “doctor-patient” system. However, this factor is determined by the patient’s level of confidence in the doctor’s competence, his/her level of professional training (qualification). At the same time, the category of “adherence” includes several components: the behavioral component (of the patient), focus on results, and the degree of possibility (conditions) of fulfilling the prescriptions. In practice, the level of “adherence” is usually measured by the correctness or incorrectness of the medication prescriptions (adherence to prescribed doses, adherence to the time interval, etc.). Taking into account medication review as the main task of ADHD clinics, focusing attention on compliance and loyalty seems appropriate. However, analysis of the respondents’ answers shows that clinics do not pay necessary attention to it. In turn, lack of compliance and loyalty leads to parents’ dissatisfaction special needs becomes a cardinally important prerequisite for providing competent assistance to the child with clinics’ services, although these two categories refer to parents’ area of responsibility.
The diagnostic process in case of ADHD is quite complex and time-consuming, requiring a high level of competence and a multidisciplinary team of specialists. It has several basic goals: establishing the diagnosis of ADHD, identifying comorbid problems and comorbid disorders, localizing the disorder in the biopsychosocial context of the child’s life – in particular, in the context of the family and social environment – in order to ultimately obtain a holistic picture of the child’s life. This is a kind of “reconnaissance” – it allows assessing the disposition of forces on the ‘field,’ internal, intrapersonal and external, interpersonal dynamics, the presence of both disorders, psychotraumatic factors, and protective, resource factors. Only if the specialist feels the dynamics of the situation, the prognostic significance of various factors in the child’s life and their complex interaction, it is possible to build a successful and realistic care plan, which is always the end result of a good diagnostic process. In fact, ADHD clinics carry out continuous diagnostic process while performing medication review, and pay attention even to minor changes. At the same time, as it is evident from the respondents’ answers, parents expect fast tangible results, not giving any significance to ‘small-steps’ checks: “…basically, all in all, I could just be doing all these checks directly with my GP and have the prescription renewed that way.”
Accordingly, the process of medication review for ADHD patients should be closely connected to the diagnostic process, with the application of the same criteria, with the systemic judgement of a specialist. It implies both close interaction in communicating with parents and high-quality physical examination of a child. The results of our study show that, although medical staff in ADHD clinics attempts to include all the necessary components to physical examination and psychological tests, communication with parents or child is carried out rather on the level of ‘soft skills,’ and not professional analysis. In particular, the respondent 5 noted: “I think it is brilliant every time we go its very centered on child’s name and what she is doing and how she is coping and name of nurse &Registrar/doctor have loads of time for Child’s name and they always make her feel at ease and she is comfortable enough to talk to them.” Thus, this experience resembles visiting children educational center, and not the clinic dealing with the disease such as ADHD.
However, establishing a diagnosis and achieving an understanding of the situation in the paradigm of the biopsychosocial model are not the only goals of the diagnostic process. Another extremely important and often neglected goal is to establish a therapeutic alliance with family and child, create partnerships, a common vision of problems, goals and a jointly formed plan of action to achieve them. Without alliance with the family, therapeutic interventions are doomed to fail. Despite the fact that building relationships with family may seem easy and self-evident, namely in this area the foundations of misunderstandings are most often laid, which lead to ineffective cooperation and, accordingly, the absence of the expected result. The ability to build partnerships, equal relationships requires both certain communication skills and personal characteristics. This area is often not given enough attention, as it is evident from the interviews. Therefore, parents often complain and express dissatisfaction with the quality of the relationship they have with specialists.
An alliance with parents is also impossible without a common vision and understanding of the child’s problems. The diagnostic process is indeed a general study of problems, it helps to see more deeply and comprehensively the biopsychosocial interactions in the child’s life, not only to the specialist, but also to the parents, and, therefore, inevitably is accompanied by psychological education and training of the child’s relatives. Understanding the child’ special needs becomes for parents a crucially important condition for providing him/her with competent help and successful upbringing.
The participant 3 described her experience in the following way: “…regards getting help in school, for doing his exams. For Occupational Therapy, for Speech & Language, well he was waiting to do Speech & Language, I don’t know how we’re going to do it but because it was meant to happen through all this, but I have no complaints in any way.” Such result seems to be a ‘patchwork’ in the system of ADHD complex therapy. There is no area for biopsychosocial interactions and results of multidisciplinary team work.
At the same time, an array of measurable positive results from attending ADHD clinic can be compiled from the respondents’ answers. In particular, the respondent 4 noted positive changes in learning process: “Oh god a lot, her school work as soon as when she started attending the ADHD clinic her writing as big now it is very neat, there has been so many changes because before when she wasn’t in the ADHD clinic she was hyper and everyone couldn’t understand but now they kinda do so she is a lot calmer with them in a way.” Among other benefits mentioned, there are improvements with concentration and with cognitive and motor skills; children became more manageable and sleep better.
The entire support system should be built on the basis of the coordinated work of a multidisciplinary team of specialists who adhere to the same values in their work and own a single system of methods. Understanding this should be the basis for the correct perception by parents of the purpose of the functioning of clinics. In this context, the role of clinics seems to be very significant.
Despite the fact that building relationships with family may seem easy and self-evident, namely this is the area where the foundations of misunderstandings are most often laid, which lead to ineffective cooperation and, accordingly, the absence of the expected result. The ability to build partnerships, equal relationships requires both certain communication skills and personal characteristics. In the training of specialists for working in ADHD clinics, this area is often not given enough attention. Therefore, parents often complain and express dissatisfaction with the quality of the relationship they have with specialists. An alliance with parents is also impossible without a common vision and understanding of the child’s problems. The diagnostic process is indeed a general study of problems, it helps to see more deeply and comprehensively the biopsychosocial interactions in the child’s life, not only for the specialist, but also for the parents. Therefore, it is inevitably accompanied by psychological education and training of the child’s relatives.
For parents, understanding the child, their special needs becomes a cardinally important prerequisite for providing competent assistance to the child, for his successful upbringing. Parenting is usually citing as the most important therapeutic intervention available for children with ADHD. Thus, the diagnostic process is at the same time therapeutic one – the border between diagnosis and the beginning of therapy is very arbitrary. This is, in fact, the core benefit expected from the ADHD clinics, and lack of parents’ understanding of it hinders recovery process.
The measures which have significant meaning for therapy, already in the diagnosis process, are often carried out, for example, with the involvement of both parents in the study of ways to solve problems, reattribution (that is, redistribution of responsibility) regarding the causes of behavioral problems, etc. During a qualitative diagnostic process, parents usually experience not only a certain “catharsis,” liberation from feelings of guilt, disappointment, hopelessness, confusion, etc., but the motivation for action, unity, and hope strengthens. If to return to the metaphor of “reconnaissance,” then the diagnostic process not only provides a map of the location and interaction of forces, but also contributes to the mobilization of resources, the pooling of efforts and the establishment of effective partnerships, education of the child’s relatives.
Many of the parents identified the need for further MDT involvement outside of the ADHD clinic. Whilst this is not a critique of the ADHD clinic it was reference more to the wider CAMHS service. Many of the parents requesting more occupational therapy(OT) involvement. The lack of clear information and lack of resources about a service can lead to parents becoming frustrated. The conclusion can be made in this regard about the lack of necessary informing parents about the activity and purpose of ADHD clinics.
Moreover, challenges of changing needs at different developmental stages were noted during the interviews. Parents interviewed in the study identified needs at different developmental stages. They mentioned a change in needs depending on the child’s developmental stage. One of the most identified needs parents discussed was the transition to adult services. Here, again, lack of clinic core purpose is evident – parents, in fact, expect help by the principle of single-window system, although it is not the case in ADHD treatment institutional network.
Needs Identified by Parents Who Attend the ADHD Clinic
Most parents, regardless of the type of family, do not have enough knowledge about what ADHD is, how ADHD manifests itself, whether ADHD differs from other manifestations of mental health disorders, whether drug-free correction is possible, etc. Low awareness of adults about ADHD, ignorance of tactics and forms of interaction creates an aura of social misunderstanding, pressure and discontent around such a child. As the interview results show, parents expect results from the efforts of an interdisciplinary team of professionals. “If I was to ask for anything it would be for child’s name to go back over for another occupational therapy appointment. I know he is getting Speech & Language but the girl had rang, well obviously because of the Covid now, she said she would get in touch around an appointment, but that was back in March I think. But whenever she gets an appointment that’s fair enough to fit us in” – one of the respondents said. The other respondent’ reply also is representative in showing parents’ perception of the needs: “I would like Child’s name to go to a summer camp that would help for his ADHD. When changed teacher in school his previous teacher didn’t inform his new teacher about Child’s name difficulties and no supports were in place for him then.”
Another respondents noted the need of the child to communicate with other children suffering from ADHD – in her opinion, it will benefit psychological state of the child and comprehension of the disease: “Well yeah I mean it could even like for teenagers when they get to a certain age just to make them feel more secure about themselves so that they can talk with other ones with the same kind of, I don’t want to say, ‘disease’ but you know what I mean, that have the same issues as they have. I mean child’s name ADHD isn’t really one that she can’t sit still, it’s more in her head, she can’t concentrate, and she can’t focus her thoughts so it is all scrambled in her head.” As it was mentioned above, the respondents mainly expect single-window system in ADHD clinic, with complex range of services, including occupational therapy: “I know OT has helped him so if it was an option that you could get OT there instead of having to go one place for this and another place for that. To have it all in the one place.” All the respondents noted crucial necessity for peer support group for those with ADHD. The respondet 6 even suggested the expedience of specalized summer camp: “I would like Child’s name to go to a summer camp that would help for his ADHD.”
Thus, patents expect ADHD clinics to work as multidisciplinary and multifunctional centers for treatment of ADHD, although this is not the purpose of these clinics. Such inconsistency of expectations and reality leads to improper perception of the results provided by clinics, dissatisfaction of parents, and their subsequent overall disappointment in the national system for treatment of children suffering from ADHD. The presence of semantic barrier is observed, and overcoming it involves a detailed clarification of the interaction process. This situation requires broad discussion, an attempt of which is made in the next chapter. Analysis of modern approaches to the organization of the psychocorrectional process with the participation of children with ADHD allows concluding that it is necessary to include various forms and methods, which is supported also by our empirical research.
On the one hand, socio-psychological – primarily, family – factors act as one of the links in ADHD pathogenesis, and on the other hand, the clinical manifestations of ADHD lead to the development of problems in the family. For example, factors that may decrease familial anxiety regarding the transition to onward services include clear pathways and guidelines with young people with ADHD, effective discharge planning and peer support for parents and children. It is generally accepted that the treatment of behavioral disorders should be comprehensive, that is, include both medication therapy and psychotherapeutic methods. In this regard, analysis of the interviews results in complex with previously conducted literature review have the potential to propose rational ways to combat the problem. A comprehensive method of treatment, including the choice of the type and doses of psychopharmacological drugs based on the results of computer analysis of the EEG of each patient, can significantly improve the outcomes of ADHD. The method also implies the use of adaptive biofeedback, physiotherapeutic treatment and specially developed methods of group and family psychotherapy. In turn, the results imply elimination ADHD main manifestations within several months, instead of several years – when using the currently existing treatments.
Evidently, to obtain a full-fledged therapeutic effect, it is necessary to combine the use of psychopharmacology, adaptive biofeedback, physiotherapeutic treatment. Methods of individual, group and family psychotherapy are needed, which requires special training of neurologists, psychotherapists and psychologists. Taking into account the results obtained during empirical study, evidently, it is expedient to include some of additional functions in the practice of ADHD clinics activity.
There is no question that attention deficit hyperactivity disorder, or ADHD, like any other medical condition, needs to be treated. National Health Service (2021) states that treatment for ADHD tends to help alleviate the symptoms and reduce the condition’s influence on a person in their everyday life. However, there is a controversy regarding the treatment of children with ADHD, specifically, whether they should be given drugs. On the one hand, according to Woolfolk (2017), medication does have beneficial short-term effects on those resorting to it, which include improvements in social behaviors, anxiety reduction, and overall quality of life. On the other hand, many drugs result in children experiencing negative side effects such as insomnia, nausea, and higher heart rate and blood pressure (Woolfolk, 2017). The answer lies in balance: medicine can be used for ADHD treatment, but not heavily relied on; moreover, it is to be combined with therapy.
When it comes to medication, there are several types of it approved by U.S. Food and Drug Administration for children as young as six years old. According to the Center for Disease Control and Prevention (2021), two major categories are stimulants, which are fast-acting drugs, and non-stimulants, which, while not working as quickly as stimulants, have longer-lasting effects. One must be careful with any type of medication: a child might respond well to one drug and poorly to another; moreover, the same drugs can affect different children differently. In addition to medical treatment, National Health Service (2021) recommends behavioral therapy, which is aimed at strengthening positive behaviors and eliminating undesired ones. Therapy can include sessions with children themselves, as well as training for parents and classroom behavioral interventions for teachers. It has been estimated that when medicine and therapy are applied as treatment together, the outcomes for children with ADHD are excellent.
The organization’s main mission is anchored on improving the lives of many individuals in the world who are affected by Attention-Deficit/Hyperactivity Disorder (ADHD). Moreover, the organization values integrity and appreciates open communication. In addition, the organization observes service quality provision and nurtures flexibility of their teamwork in satisfying customers. Diversity is also another factor that the organization strives to incorporate into all of its systems.
Summary of Services
Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD) is an organization that is determined to handle individuals affected by ADHD. The organization was founded in 1987 following the rampant frustration and isolation that parents experienced due to ADHD-affected children. There were no agencies and groups to intervene for families with children affected by ADHD during this time. Therefore, CHADD came into existence with the primary aim of changing ADHD situations, which most people misunderstood as a ‘behavior problem.’ The organization acknowledges ADHD as a potentially serious disorder yet treatable.
CHADD is creating an overornament both for children and adults affected by ADHD (CHADD, 2022). This is a Maryland-based organization supporting people enduring the effects of the condition. One of the organization’s activities is enhancing children’s education services and accommodations in regular classrooms.
The organization holds that children affected by ADHD have the right to education just like other normal children. Moreover, through an awareness campaign, the organization has created a favorable environment in workplaces for people suffering from this condition. The history report of the organization reveals that one parent group in Florida grew dramatically and was ranked the leading non-profit national organization intervening for children and adults affected by ADHD.
Reference
CHADD. (2022). Improving the lives of people affected by ADHD. CHADD. Web.
The main topic of the article is that people with ADHD have sleeping problems, which causes a violation of biological rhythms. The author hypothesizes that there is an insufficient release of the sleep hormone – melatonin, which allows people to fall asleep (Carroll, 2017). It is possible to measure how much this is the cause through laboratory studies, as well as in real everyday life. Laboratory research helps track the level of melatonin in different patients, that is, those who have problems with sleep and those who do not, as well as patients with and without ADHD. This type of research is much more accurate than checking the quality of sleep and the ability to fall asleep in real life. Actual research can only be carried out by monitoring the most appropriate time for falling asleep, which may be inaccurate. This is because of the activity of a person in the middle of the day and the condition around them.
It is necessary to consider in detail the evidence that is carried out in support of the claim. The authors claim that studies show that sleep helps with many diseases, including ADHD. The study is conducted by analyzing saliva and allows us to understand at what point people with ADHD have the highest level of melatonin that will enable them to fall asleep (Carroll, 2017). It was also revealed that dopamine, which is a hormone of daytime activity, is an obstacle to falling asleep.
The advantage of the conducted research is that the information is confirmed by various sources, as well as by professors interested in this topic. The study also has a plus in that it gives clear recommendations on how to increase the level of calm and promote an increase in the level of the hormone melatonin, which allows one to fall asleep. The downside of the study is that the study group included 52 adults with ADHD and 52 adults without it (Carroll, 2017). That is, gender, occupation, and daily routine were not specified in any way. This could probably harm the results of the study since they were not as accurate as when dividing people into different categories.
The conclusion that people with ADHD have problems with sleep can also lead to the fact that they do not have any positive changes in the disease. That is, a sufficient amount of sleep and rest helps them reduce the symptoms of their disease and feel better. Unintentionally, the study could be influenced by the fact that the subjects are not ready to disclose the complete picture of their condition and may also slightly change the situation in their favor. So the reliability decreases and does not give the study accurate and reliable results.
The text often contains references to the study of various researchers and the statements of experts on the topic. Dr. Kooij, a professor of psychiatry at the Amsterdam Medical Center, drew attention to the fact that ADHD worsens without sleep (Carroll, 2017). This source cannot be considered reliable since it is not scientific, and it is not published in scientific research publications. In addition, the text contains references to professors who are not specified in the area of sleep in their work. This makes the research even less reliable and makes one doubt how much it can be trusted at all.
It can be said that the brain is the most complex part of the human body, and sometimes such a high complexity creates problems for its bearers. One of the most common ones is attention deficit hyperactivity disorder (ADHD). Lyness notes that “ADHD is caused by differences in the brain’s ability to pay attention, slow down, and be patient.” This condition is among the leading neurological problems in the world today. It starts in childhood and, unfortunately, stays on forever.
There is no cure for it, but neurologists and other medical professionals keep looking for one. They are also constantly developing new coping techniques and improving existing ones. Recent studies show that “the prevalence of attention-deficit / hyperactivity disorder, or ADHD, has continued to climb significantly among adults in the United States within the past decade” (Howard). Such a state of affairs may be due to the constantly improving screening and diagnostic techniques or a rapidly changing world. This paper aims to share personal experiences of having ADHD and suffering from isolation and depression.
Living with ADHD
It is difficult to explain what life with ADHD is. It can be said that it is one of those disorders that lurks in someone’s behavior but somehow constantly affects it. One must sometimes remind themselves that they are a person with ADHD to control their behavior and emotions, especially around others. A school is a place of many challenges for children with ADHD, and I was no exception. I can still remember how teachers constantly asked me to focus on the subject, but other things constantly distracted me; it was just in my nature. When I thought I was behaving adequately, the teachers saw me as an “impulsive, fearless and chaotic” kid (“Living with”). When the teenage years came, my classmates began to notice those little oddities in my behavior too. Some classmates began to joke at me and make fun of my condition. Of course, my friends protected me, but those jokes made me think that I was weird and out of the norm.
ADHD, Isolation, and Depression
I began to isolate myself and look for hobbies that do not require interaction with people. It calmed me down and helped me for a while. However, over time, I noticed that I became hot-tempered and rude with friends and family. My communication and interaction with them became short and cold. I did not like where things were going, so I finally decided that it was time to stop being afraid of others’ judgments and start taking care of my ADHD. The weekly schedules, focusing on education, learning how to concentrate, discussing my condition with friends and classmates were my new approach to ADHD and society.
Although my experience is not dramatic, it clearly shows how untreated ADHD leads to isolation and almost depression. According to Smith, “doctors sometimes call them comorbid or coexisting conditions.” My main advice to people with ADHD is not to give up on themselves and not take mean words said by uneducated people personally; mental health and self-esteem are more important.
Conclusion
I discuss ADHD, isolation, and depression in this paper. It is true, ADHD does indeed make one’s life different from what is considered the norm. However, the question arises of what is the norm, how to define and measure it. I have interacted with other people with ADHD, and I know that they are some of the most wonderful, passionate, and bravest people out there. Society still needs to learn to accept people with ADHD and interact with more respect.
Jennifer is currently at the local detention center and has different problems that must be addressed. After completing the duration to be served for all the charges, it is important to get assistance to help her become fit to be absorbed back into society. One solution is admitting Jennifer into an all-girls residential facility that deals with the treatment of Attention-deficit/hyperactivity disorder (ADHD). In the facility, Jennifer can also benefit in relation to substance abuse, relationship problems, and limited education through different ways such as therapy and coaching. Upon discharge, Jennifer needs to have set goals to rejoin the society and receive assistance to get employment for supporting daily expenses. This case plan will identify different areas and goals that Jennifer will need assistance with in order to maintain mental and physical well-being while focussing on long-term goals to rejoin the society.
Attitudes and Orientation
ADHD is likely associated with attitude and orientation behavior such as defiance and aggression. The goal is to reduce the defiant behavior exhibited by Jennifer, as shown by her action of skipping school and engaging in crime. While no relevant skills are likely to help her, encouraging strategies such as rewarding good behavior can motivate her to change her attitude and orientation. Giving clear directions for what is wrong or right can also influence a change of attitude.
Employment/Vocation
Currently, Jennifer is unstable and relevant skills to gain employment are not known. Due to her condition, employment is not recommended for now. However, one of the personal goals should be to develop skills that will enable them to join the workforce afterward. The first step to this goal is to ensure Jennifer is assigned duties such as cleaning for about two hours per day. Additionally, vocational training can be offered through the correction facility to prepare Jennifer to be qualified for job positions upon release.
Personality and Behavior
Jennifer needs assistance to improve her mental health, personality, and behavior. This goal can be achieved through the help of mental health and behavioral counselors to enhance behavioral modification and the ability to cope with challenges calmly and healthily. Individual cognitive behavioral therapy can help improve coping skills and the ability to deal with problematic emotions. Another suggestion to improve personality and behavior is through group therapy. The sessions can bring together multiple individuals with similar ADHD or other conditions to discuss their situation. Additionally, interacting with peers can help promote Jennifer’s social skills and ability to communicate and relate with others. Social skills training during group therapy sessions can enhance peer relationships and interpersonal skills for those involved (Van Der Stouwe et al., 2021). Such interactions can help Jennifer gain confidence and develop desirable personal and behavioral traits. Lastly, long-distance family therapy can help family members, such as Jennifer’s grandmother, learn how to help in adjusting to the reality linked to the loss of parents, which has a negative impact.
Education
Jennifer has not been attending school consistently for the last three years; hence there is a need to ensure he compensates for this duration. In the residential center, Jennifer should be required to attend class and undergo testing to check if she is suitable to take classes for an Individualized Education Program (IEP). An evaluation can identify Jennifer’s qualities to ensure she receives special education services to serve her unique educational needs.
Family Dynamics
Jennifer has a stressed or strained relationship with family members, mainly due to her relationship with older women. She experienced parent abandonment which can be linked to difficult family relations with the mother. The goal of changing family dynamics can involve engaging those close to Jennifer and reminding them of the need to support her. Family members may misunderstand and misinterpret ADHD symptoms and dismiss them as misbehavior (Goldstein et al., 2018). However, they should be educated on the importance of avoiding judging Jennifer and why they should stay positive and show empathy.
Substance Abuse
Jennifer has a history of Substance Abuse Disorder (Marijuana) from the age of 11 years. This issue can be handled by requesting a substance abuse counselor to arrange different sessions and establish a plan to solve the problem. One of the appropriate ways to monitor the situation is to ensure blood measurement of the level of the drugs is examined. This assessment can reveal whether the condition of substance use is still in progress. Additionally, the facility should ensure that there are no entry point loopholes allowing Jennifer to access marijuana. Cessation for a long duration and replacement with other activities can help her to forget and recover from any addiction. Lastly, educational information and counseling regarding the negative effects of substance abuse can help Jennifer recover from the situation.
Peer Relationships
Jennifer has a poor relationship with peers, which can be linked to his condition of skipping school and been a ran away. Her major relationships are with older females, which is against his mother and other family members. Teens with ADHD can have difficulty forming long-term relationships with their agemates, as with Jennifer. This situation can be eased by encouraging more peer interactions and organizing group activities. A counselor can establish activities that increase Jennifer’s communication and interaction with others and monitor her to ensure positive progress.
Leisure and Recreation
Jennifer’s behavior as a run-away and difficulty interacting with others makes it difficult to engage in leisure and recreation activities. To enhance her involvement in such activities, staff, and design a schedule to ensure compulsory participation, such as playing certain games. Staff members can take Jennifer on frequent walks or outings and involve peers in leisure activities that they may like to do.
Risk Assessment and Classification Systems
Risk assessment is crucial in identifying and quantifying potential dangers and understanding the defense. In the case plan, the risk assessment was utilized to understand potential areas that can be risky for the client’s health. For instance, Jennifer has no remorse for previous negative action, which presents a high risk to her current behavior. Additionally, the fact that she experienced an unstable lifestyle with traumatic encounters increases her vulnerability to becoming hopeless, which is a high risk. The classification system was used to allow proper alignment of suggestions or options to solve different issues and goals to prepare Jennifer to rejoin society. For instance, identifying the best resources for substance abuse treatment and strategies that can offer the best outcome was decided by classifying risks in every situation.
Supervision Strategies
Supervision strategies were used to ensure every activity was linked to someone capable of executing it while ensuring Jennifer’s safety. Currently, Jennifer, due to the unstable condition identified during the evaluation. For instance, supervision is highly needed to ensure she participates in leisure activities. For activities related to the improvement of personality and behavior, a counselor is suitable for ensuring the proper techniques and supervision are applied.
Conclusion and Overall Recommendations
Jennifer experienced several difficulties at a young age, considering the associated trauma and family neglect. Parental loss, rape experience, and childhood challenges mark Jennifer’s past, which presents a high risk of the unfavorable actions she has been committing. Considering that she has ADHD, Jennifer needs support in preparation to rejoin society after release from the detention center. Such assistance can be solicited from different regions, organizations and individuals.
Attention deficit hyperactivity disorder is a common behavioral problem that occurs in childhood and can be transferred to adulthood. According to Sayal et al. (2018), ADHD is common in young boys as it is easier to identify the problem. People usually meet problems with studying and communicating, which are crucial in their personal and social lives. The disorder is well-known, and there is no struggle to identify the problem. However, some facts might not be spread, and people should pay attention to these factors to understand the ADHD issue.
ADHD in Females
ADHD is not fully studied in girls. Emotionality in women is clearer than in men, which might confuse specialists in defining ADHD in females. This problem is supported by girls showing their anger and stress more openly (Sayal et al., 2018). Moreover, they prefer to talk about their conditions to avoid keeping them inside. Professionals in the medical sphere should conduct more tests to understand how women are affected by ADHD.
Diet During Pregnancy
It is also suggested that ADHD can appear in children when their mothers follow diets during pregnancy. Sayal et al. (2018) suggested that omega-six can be one of the causes of ADHD in young children. Disbalance in consumed food is not beneficial for the person and might cause additional health issues. The development of the disease can be supported by the fact that a woman should receive enough vitamins to support the life activity of her body and the child’s body. Consequently, diets during pregnancy might not be beneficial for a new organism.
Early School
The external factors during the growth of the child might develop ADHD. For instance, when parents send their children to schools at an earlier age than average, it might cause psychological problems. Children should develop within the barriers of their age (Sayal et al., 2018). Peer pressure might also become the key cause of attention deficit hyperactivity disorder. Therefore, parents should ensure that their children understand how to stay in society before moving to further education.
Conclusion
In conclusion, ADHD is one of the common psychological problems easily identified in individuals but remains unclear for those who study the causes. There are many different suggestions regarding the development of the problems, which propose that the disorder develops when the child is not born or during socialization. Consequently, it is important to understand the child’s behaviors to identify the issues early and apply the working treatment.
The three disorders, Sensory Processing Disorder (PSD), Attention Deficit Hyperactivity Disorder (ADHD), and Autism Spectrum Disorder (ASD), are often confused with each other due to the connections and similarities that exist. However, there are nuanced differences that distinguish them from each other, which is the subject of this paper. These conditions have the same appearance on the surface, but there are dissimilarities deep down. The following discussion will cover the elements that connect and differentiate these diseases.
On similarities, first, all three are developmental disorders, conditions caused by mental impairments. All conditions are characterized by less-than-desirable brain functioning that gets in the way of the child’s normal operation. For instance, these disorders make it hard to concentrate and cause significant restlessness. Another similarity these conditions have with each other is in diagnosis, which is based on observation and using elements from the Diagnostic and Statistical Manual, Fifth Edition (DSM-5). There is also no treatment for these disorders and doctors use different therapies to alleviate symptoms and introduce some normality in the child’s life.
The differences between the conditions are in how they manifest. SPD occurs when the brain fails to deal correctly with information coming in from the body’s senses: The out-of-sync child: Recognizing and coping with sensory processing disorder (Kranowitz, 2006). The condition is characterized by either hypersensitivity or hyposensitivity. In the former case, the child is easily overwhelmed by sensory stimuli, while in the latter, they have inadequate sensory stimulation. ADHD deals with focusing and handling impulsive behaviors: An ADHD primer (Weyandt, 2017). Children with this condition are easily distracted, in constant motion, impulsive, hyperactive, and/or inattentive. ASD is when children display persistent deficiencies in moving the stages included in normal human development: Assessment of autism spectrum disorder (Goldstein & Ozonoff, 2018). Further, children struggle with attaining certain milestones like showing emotion, socializing, and communicating. A child with autism will often attend to details like moving and learning in ways his/her age mates do not.
Sensory Processing Disorder (PSD), Attention Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD) are mental disorders that impede normal functioning. These conditions often share the same symptoms, but there are differences in the way they manifest. The first disorder occurs when the brain does not deal with sensory information well, the second deals with behavior control, and the last is when a child struggles with going through the stages of normal human development.
References
Goldstein, S., & Ozonoff, S. (Eds.). (2018). Assessment of autism spectrum disorder. Guilford Publications.
Kranowitz, C. S. (2006). The out-of-sync child: Recognizing and coping with a sensory processing disorder. Penguin.