Increasing Education of ADHD Therapies for Pediatric Nurses - Research Paper Example

? Education of ADHD Therapies for Pediatric Nurses Attention-deficit disorder (ADHD) is a behavioral condition that makes it difficult to focus on everyday requests and routines (American Psychological Association 2013). Individuals suffering from ADHD have a difficult time organizing, focusing, reasoning and coming up with pragmatic plans. They may at times be fidgety, loud and may also demonstrate an inability to adapt to changing conditions/situations (American Psychological Association 2013). Among children, ADHD maybe manifested through social ineptness, insolence and belligerence. For a long time, ADHD diagnosis was limited however; the situation has changed due to greater levels of awareness that has allowed better diagnosis and better treatment. The treatment methods largely adopted are based on medication which has been found to have mild to extreme effects on the users. These side effects have endangered the life of the users even though they have had a somewhat commendable effect on the individual in regard to the condition. Personally, I have had a chance of attending to an ADHD patient, a 12 year old child who had been placed with me for adoption. The child was diagnosed with ADHD four years ago and has since been on medication and no other complimentary interventions have been initiated to treat the disorder. Being in this situation has prompted me to delve deeper into finding an alternate solution in the treatment of ADHD. Through sufficient and quality research a workable and efficient means of treating ADHD can be arrived at, one that has minimal effect on the individual. In a bid to accomplish this task, this paper will start with an in depth review of ADHD including existent statistics, medication, effects of medication, non-medication therapies and their effectiveness in treating ADHD. This will be followed by a look at a viable solution to the ADHD problem and an evaluation of the present obstacles to implementing this solution. In conclusion, it is expected that this study will have availed a new way through which ADHD can effectively be handled with minimal effects to the individual. Literature review The Centre for Disease Control and Prevention (CDC) estimates that there are 5.2 million children aged 3-17 that have already been diagnosed with ADHD in United States. This means that 8.4% of all children have been diagnosed with ADHD (Centre for Disease Control and Prevention 2012). This points to increased diagnoses as a decade earlier lower rates had been reported with the overall diagnoses at the time being 6.9%. Based on gender, reported diagnoses indicate that boys are much more affected than girls, boys ADHD prevalence increased from 9.9% in 2000 to the current level of 12.3%, for girls the rate in 2000 was 3.6% and this has also increased, though in a lesser magnitude to 5.5% (Centre for Disease Control and Prevention 2012). Another notable variable in the prevalence of ADHD is income levels, in 2000 the prevalence rates were the same across all income groups, but presently the prevalence has increased among children in low income families (100%-199%) as compared to families with income greater or equal to 200%. Lastly, ethnicity also seems to be a notable variable, in 2000 the prevalence rate among non-Hispanic white children ranged from 8.2%-10.6% while that of non-Hispanic black children ranged from 5.1%-9.5% indicating a higher prevalence among non-Hispanic white children (Centre for Disease Control and Prevention 2012). These variations seem to have presently leveled out within non-Hispanic white, and non-Hispanic black groups. Treatment for ADHD has proceeded on two fronts; biological and psychosocial interventions. Typically, the goal of biological treatments is to reduce the children’s impulsivity and hyperactivity and to improve their attention skills (Barlow & Durand, 2009). Psychosocial treatments generally focus on broader issues such as improving academic prowess, decreasing troublesome activities, and improving social skills. Although these two kinds of approaches have typically developed independently, recent efforts combine them to have a broader impact on individuals with ADHD (Barlow & Durand, 2009). The first class of medication used for children with ADHD is the stimulants. Since the use of stimulant medication with children with ADHD was first described in 1937, multiple studies have documented the effectiveness of this kind of medication in reducing the core symptoms of the disorder (Barlow & Durand, 2009). Statistics indicate that close to 2.5 million children diagnosed with ADHD are being treated with these medications (CDC). The most commonly administered drugs are methylphenidate (Ritalin, Metadate, Concerta) and D-amphetamine (Dexedrine, Dextrostat) which have been found to be successful in at least 70% of cases albeit temporarily arresting hyperactivity and impulsivity and improving concentration on tasks (Centre for Disease Control and Prevention 2012). Adderall, which is a longer acting version of these psycho stimulants, reduces the need for multiple doses for children during the day but has similar positive effects (Solanto, 2011). Initially, it seems paradoxical to expect that children would calm down after taking a stimulant. However, on the same low doses, children and adults with and without ADHD react in the same way. It appears that stimulant medications reinforce the brain’s ability to focus attention during problem-solving tasks. Although the uses of stimulant medications remain controversial, especially for children most clinicians recommend them temporarily, in combination with psychosocial interventions to help improve children’s social and academic skills (Barlow & Durand, 2009). The concerns over the use of stimulants now include their potential for abuse. Drugs such as Ritalin maybe abused for their ability to create elation and reduce fatigue. This is particularly worrisome for children with ADHD because they are at an increased risk for later substance abuse. In recent times, a new drug Strattera (or atomoxetine)-has been administered with reasonable effect on children (National Institute of Mental Health 2013). It is a selective norepinephrine-reuptake inhibitor and therefore does not produce the same “highs” when used in larger doses. Recent research has also demonstrated that certain drugs, mostly antidepressants (bupropion, imipramine) and a drug used for treating high blood pressure (clonidine), may have similar effects on individuals with ADHD (Barlow & Durand, 2009). Not all children with ADHD have depression or high blood pressure, even though depression is a major aspect in these children, but these drugs work on the same neurotransmitter systems involved in ADHD. All these drugs seem to improve compliance and decrease negative behaviors in many children, and their effects do not usually last when drugs are discontinued (National Institute of Mental Health 2013). Some portion of children with ADHD do not respond to medications, and most children who do respond show improvements in ability to focus their attention but do not show gains in the important areas of academics and social skills. In addition, the medications often result in unpleasant side effects, such as insomnia, drowsiness, or irritability (Barlow & Durand, 2009). Due to these findings, researchers have applied a number of behavioral interventions to aid these children at home and in school. In general, the programs set such goals as increasing the amount of time the child remains seated, the number of math papers completed, or appropriate play with peers. Reinforcement programs reward the child for improvements and, at times, punish misbehavior with loss of rewards (Tuckman, 2008). Other programs incorporate parent training to teach families how to respond constructively to their child’s behavior and how to structure the child’s day to help prevent difficulties. Social skills training for these children, which includes teaching them how to interact appropriately with their peers, also seems to be an important treatment component (Steele, Elkin & Roberts, 2008). In large congruence with the observations made with my 12 year adopted child, most specialists and clinicians have resulted to medication as a comprehensive treatment for ADHD. Paralleling results with children, the stimulant drugs methylphenidate (Ritalin and Concerta) as well as amphetamine (Adderall and Vyvanse) have been shown to be effective in reducing the core symptoms of ADHD as measured by psychiatrists’ ratings of severity of DSM-IV-TR symptoms and measures of clinical global improvement. Response rates to methylphenidate are somewhat lower than those seen in children, and have ranged from 37-70% in controlled studies (Solanto, 2011). Although stimulant and non stimulant drugs are effective in treating adults with ADHD, there are limitations connected with drug treatment for this disorder (Steele, Elkin & Roberts, 2008). First, efficacy in largely determined on the basis of the core symptoms of ADHD, and there exists limited information concerning the impact of drug treatment on specific variations of functional impairment, like ineptitude or time-management difficulties (Solanto, 2011). Clinical experience indicates that because of the likely lack of development of meta-cognitive skills in these critical areas in childhood drug treatment alone could be insufficient to remediate these deficits and that some explicit skills in training in these fields in adulthood maybe necessary (Pliszka, 2011). Second, significant subgroups (30-50%) of ADHD patients are non-responders or adverse responders to drug treatment, which also necessitates the use of alternate interventions. Notably, response in pharmacological studies typically refers to those individuals who demonstrate at least 30% reduction in symptoms, even many of those considered to be “responders” do not achieve full remission of symptoms, leaving room and need for improvement through psychosocial intervention (Solanto, 2011). Solution So far, it is clear that use of medication is not an ultimate solution to ADHD as it does not guarantee a long-term solution to the condition. Besides, medication is mainly based on the idea of suppression which means that once the effects of the medication wear out the child resumes normal disruptive behavior. This calls for a better long term solution which focuses on modifying behavior and getting the child to control their activity levels (Steele, Elkin & Roberts, 2008). Notably, it is not lost that an absolute abandonment of medication is impossible as a non-medication solution is slowly impacted on the child. This means that medication can be employed as a safeguard to the child’s hyperactivity especially before the child learns to adopt constructive approaches to containing their activity levels (Pliszka, 2011). Additionally, the solution discussed herewith is not one that completely dispels the effectiveness of medication but one that seeks to mitigate the effects of medication discussed within this study. Most importantly, it seeks a healthy and long-term solution to the problem of medication by focusing on an individual’s capacity to determine and regulate their behavior. This study considers that an effective solution, oriented to both the short-term and the long-term is one that combines pharmacological interventions with psychosocial interventions. Psychosocial intrusions comprise of behavioral treatments such as contingency management and home-school notes, individuals or group therapy for the child, parent training, and family therapy (Ellison & Semrud-Clikeman, 2009). Combined therapeutic interventions have been more thoroughly researched with ADHD than with other childhood disorder. Early studies showed that medication combined with parent training and behavior management was more effective than either medication or behavior management alone for “normalizing” children with ADHD (Ellison & Semrud-Clikeman, 2009). Minimal doses of medication (methylphenidate) can be considerably enhanced with combined behavioral interventions. An important result of a combined approach to treating ADHD is that maximal improvement in behavior may be reached without resorting to high dosages of stimulant medication a factor that mitigates the enumerated adverse effects of medication (Ellison & Semrud-Clikeman, 2009). Additionally, combined behavioral-medication interventions for children with ADHD appear to complement the shortcomings of either treatment alone and add incremental effects that do not occur with either intervention alone. In regard to psychosocial treatments, there are mainly three types, psycho education, cognitive-behavioral therapy and other approaches such as couple’s therapy. Amongst these three, psycho education has been identified as the most fundamental component of all psychosocial therapies (Tuckman, 2008). It entails teaching the patient and family about the disorder, its symptoms, its typical course, and its treatment (Tuckman, 2008). The patient’s understanding of ADHD and its implications is an essential first step of any treatment modality. A host of patients and support groups have pointed out that understanding the disorder is the most important contributor to the success of their own treatment (Steele, Elkin & Roberts, 2008). The main aspects in psychoeducation are instilling hope, optimism, and motivation to improve the understanding of the condition and be more inclined to engage in and follow through with a multimodal treatment plan (Barkley, 2010). Secondly, aiding the patients view their disorder from a perspective that empowers them to believe that their lives can be different, and encourages their active and enthusiastic involvement in treatment. In discussing this mode of treatment or intervention the study identifies that it is almost impossible to come up with a solution that avails an absolute solution without a number of adverse effects (Pliszka, 2011). In this case, these effects are likely to result from the recommendation that slight doses of medication can be administered jointly with the psychosocial interventions. The exact effects of these “rationed” doses are not definite but this study considers that the effects must be lesser than those evidenced in a purely pharmacological approach/intervention. Obstacle The biggest obstacle in psychosocial education and in extension adopting a combined pharmacological approach is information. Most adults suffering from ADHD and those handling children suffering from the condition remain inept in the importance of various interventions. This is mainly because they lack constant access to clinicians or specialists with access to the right information on the best approaches to ADHD as discussed in this study (Tuckman, 2008). Secondly parents, or individuals in the lower income segments (199% and below) consider these approaches as resource intensive and thus avoid them citing inability to afford these interventions. These obstacles create an immediate need to equip clinicians and nurses with comprehensive knowledge on how to handle ADHD (Tuckman, 2008). This will increase the chances of patients and caretakers accessing the right information and thus helping reduce prevalence rates. Conclusion In conclusion, it is of concern that the past decade has recorded increased ADHD prevalence rates irrespective of greater research on the condition and more sophisticated means of communication that would help avail the right information on the condition. This has pointed to laxity among various medical bodies, clinicians’, specialists and all health stakeholders in addressing the condition and finding the best solutions to the condition. This study has sought to bridge this eminent bridge by looking at existent research and information on the condition and best means of treatment. Through extensive research the study has concluded that a combined approach, enlisting psychosocial and pharmacological approaches would be best suited in addressing the ADHD among both children and adults. The study has also found out that the success of this intervention is hinged on the ability of medical personnel handling ADHD patients to understand both the importance and administration of the combined approach which underlines the criticalness of education of ADHD therapies for pediatric nurses. References American Psychological Association. (2013). ADHD. Retrieved April 28, 2013, from American Psychological Association: http://www.apa.org/topics/adhd/ Barkley, R. A. (2010). Attention deficit hyperactivity disorder in adults: The latest assessment and treatment strategies. Sudbury, Mass: Jones and Bartlett Publishers. Barlow, D. H., & Durand, V. M. (2009). Abnormal psychology: An integrative approach. Australia: Cengage Wadsworth. Centre for Disease Control and Prevention. (2012). Attention Deficit Hyperactivity Disorder (ADHD)-Data and Statistics Retrieved April 28, 2013, from Centre for Disease Control and Prevention (CDC): http://www.cdc.gov/ncbddd/adhd/data.html Ellison, A. T., & Semrud-Clikeman, M. (2009). Child neuropsychology: Assessment and interventions for neurodevelopmental disorders. New York, NY: Springer. National Institute of Mental Health. (2013). How is ADHD Treated. Retrieved April 28, 2013, from National Institute of Mental Health (NIMS): http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder/how-is-adhd-treated.shtml Pliszka, S. R. (2011). Treating ADHD and comorbid disorders: Psychosocial and psychopharmacological interventions. New York: Guilford Press. Solanto, M. V. (2011). Cognitive-behavioral therapy for adult ADHD: Targeting executive dysfunction. New York: Guilford Press. Steele, R. G., Elkin, T. D., & Roberts, M. C. (2008). Handbook of evidence-based therapies for children and adolescents: Bridging science and practice. New York, NY: Springer. Tuckman, A. (2008). Integrative treatment for adult ADHD: A practical, easy-to-use guide for clinicians. Oakland, CA: New Harbinger Publications. Read More