Intervention for Attention Deficit Hyperactivity Disorder - Report Example

Intervention for ADHD: Should it involve medication or is behavioral intervention is sufficient Introduction Attention Deficit Hyperactivity Disorderor ADHD is a neurobiological condition that is believed to be heritable and presents itself in children at an early age. It is typically characterized by symptoms of hyperactivity, inattention, impulsiveness or a combination of these symptoms (Miller & Hinshaw, 2012). According to the DSM – IV – TR, the onset of ADHD can be observed before the age of 7 years, and approximately 5 – 8% of all children demonstrate distinctive symptoms of ADHD (APA, 2000). The DSM – IV – TR recognizes three subtypes of the disorder – one that is characterized by inattention, one that is characterized by the combination of hyperactivity and impulsiveness; and one that combines all these symptoms (Miller & Hinshaw, 2012). A number of reasons have been proposed to explain the prevalence of ADHD. The present understanding is that the condition comes about through a combination of genetic, environmental and physiological factors (Barkley, 1997). As it is a chronic condition, a significant population of persons diagnosed with the disorder in childhood continues to exhibit symptoms into adulthood and many have to learn to live with these symptoms for all of their lives (Barkley, 1997). Given the disruptive nature of the condition, parents and educators are motivated to identify and treat ADHD at an early stage. Medication is usually recommended to control the symptoms of ADHD, and stimulant medications are popular among practitioners (Miller & Hinshaw, 2012). Although there is a widespread acceptance of the use of medication to treat and control ADHD, a growing concern is related to the side-effects of these medications (Barkley, 1997). Some thinkers also question the need for medication, and advocate behavioral and cognitive treatments in lieu of medication (Barkley, 1997). There is an increasing amount of support for the different interventions available to address ADHD (Miller & Hinshaw, 2012), and it can become difficult to choose the most appropriate measure in any given condition. The Case to Abstain from Medication The diagnosis and treatment of ADHD has always been controversial. Many believe that the diagnosis of ADHD simply involves putting a medical label on non-normative behavior seen in children (Schonwald & Lechner, 2006). All the major symptoms of ADHD are a part of normal childhood behavior and using medical treatment to control excesses in the same is not considered good practice by some thinkers. Although few believe that the diagnosis of ADHD is flawed in its essence, there is a growing concern about the use of medication to treat it (Schonwald & Lechner, 2006). Medication has been used to treat ADHD for a long time, and over time, it has become evident that there are a number of side effects associated with medical treatments available for ADHD. Typical symptoms in the use of stimulant drugs like methylphenidate and amphetamine often include mild to severe headaches, nausea, stomachaches, insomnia, decreased appetite and associated weight loss and irritability or low mood. There may also be small changes in blood pressure and pulse rates and some instances of sexual dysfunction in adults with ADHD who use pharmacological interventions (American Academy of Pediatrics, 2001). Over the last few decades, a number of non-pharmacological interventions have been suggested and tested with respect to ADHD. These include training, behavioral techniques, cognitive interventions and other holistic and lifestyle based interventions, although not all interventions have found empirical support, the use of behavioral and cognitive techniques have constantly found validation. Brown et al. (2005) reviewed a number of reports that described different treatment modes for ADHD and found that behavioral interventions showed consistently useful levels of efficacy. Fabiano et al. (2009) have also found in an independent review of over 114 studies that behavioral techniques are very effective interventions when used for ADHD in different age groups. The effect sizes observed by the researcher in the participants of different studies showed that these techniques were consistently effective and provided somewhat long-term results. Holmes, Gathercole, Place, Dunning, Hilton, and Elliott (2010) have found that children who experience a cognitive training program designed to improve the functioning of Working Memory showed significant gains in all aspects of working memory that lasted for approximately six months. They also found that similar children who were given stimulant medication showed gains only in visuo-spatial functioning. Since neither treatment affected I.Q. scores, the results can be associated only with improved functioning of the working memory (Holmes et al., 2010). The authors of this study thus conclude that cognitive training is more beneficial in improving functioning in children as compared to stimulant medication. Miller and Hinshaw (2012) have observed that cognitive techniques and training for children and parents have slowly started gaining acceptance as they provide the child / adult with the skills required to cope with symptoms of ADHD on a regular basis. These researchers have also found that Behavioral treatments work best when combined with medication (Miller & Hinshaw, 2012). Young and Myanthi Amarasinghe (2009) have found that a number of different non-pharmacological interventions are useful for children with low to moderate symptoms of ADHD. They have found that parental train and classroom interventions work best with preschool and school age children with low to moderate impairments. As they grow, children are more likely to need multimodal treatment, and benefit from a combination of classroom, home based and social skills interventions (Young & Myanthi Amarasinghe, 2009). CBT has been found effective as a treatment measure for adults with ADHD (Young & Myanthi Amarasinghe, 2009). From these and other studies, it becomes evident that medication is not the only option available for people with ADHD. Other interventions that are evidence based and have found acceptance with the scientific community can be used without the side effects associates with medication. The Case For the Use of Medication Medication has become a popular intervention for ADHD because it is fast, effective and provides significant relief form symptoms. medication also helps children show improved functioning in a number of areas (Barkley, 1997). For example, children with ADHD who are given medication show improvement in motor activity and coordination, improved cognitive functioning, and improved social behavior (Barkley, 2006). Typically, soon after starting a child on medication, he/she is able to work consistently and accurately in school and at home. They show reduced impulsivity and distractibility, and are able to attend consistently to tasks (Brown et al., 2005). These children also seem less aggressive with interacting with peers and more able to participate in long duration group activities like sports and group projects (American Academy of Pediatrics, 2001). They are also able to control their emotions better, and thus, are less likely to experience anger and frustration as compared to before they were medicated. This also reduces the chances of defiant or non-compliant behavior which is often associated with the anger and impulsivity characteristic of children with ADHD (Barkley, 2006). The review conducted by Brown et al. (2005) demonstrated that although behavioral interventions were helpful, they were more useful when combined with medication. They also found a significant amount of support for stimulant medications in general. The findings show that across groups, children who were medicated showed significant improvement In core symptoms as well as in overall functioning (Brown et al., 2005). Also, Children who received combination treatment showed the most improvement with lesser medication. Thus, Brown et al. (2005) have concluded that the case for medication as a mode of treatment for ADHD cannot be rejected. The use of Medication to treat ADHD has been associated with change in behavior and improved functioning in people of all ages (Miller & Hinshaw, 2012). The main problem with medication is that these interventions do not reduce the core deficits seen in ADHD, but provide symptomatic relief. thus, they are only effective thrill the individual is taking the medications, and provide little long term change or improvement (Miller & Hinshaw, 2012). The concern associated with this observation is that an individual who is given only mediation as an intervention for ADHD will always be dependent on these medications. Although there is some support for non-pharmacological treatment modes, most reviews of treatment show that medication is at least one of many components in successful treatment plans (Young & Myanthi Amarasinghe, 2009; American Academy of Pediatrics, 2001; Brown et al., 2005; Fabiano et al., 2009). As the child grows, the need for medication as part of the overall management of ADHD becomes apparent. even young children with severe ADHD rarely respond to other modes of treatment unless they are given some medication (Barkley, 2006). unless the neurobiological basis for ADHD can be addressed, or until interventions that are effective with persons exhibiting severe symptoms become available, it is not possible to reject medication as an important intervention for ADHD. Conclusion The literature reviewed enables us to examine a variety of issues associated with the treatment of ADHD in children as well as adults. Medication has certainly been found effective, but is associates with a number of side effects – some of which can be difficult to manage in young children. These medicines also do not provide long term relief from the root issues; and thus, there is a concern about dependence of drugs to function normally. On the other hand, the non-pharmacological interventions that do find empirical support are not always applicable, and are associated with high costs, increased effort and involvement from parents and teachers, and do not deliver as effectively with persons having severe symptoms. Brown et al. (2005), Young and Myanthi Amarasinghe (2009), Fabiano et al., (2009) among others have demonstrated that when interventions are combined, there is a reduced need for medication as well as an enhanced improvement in functioning. The results of these and other studies Have demonstrated the value of combining medication and other techniques like behavioral, cognitive and training. Thus, at this point, it seems that the wise choice is to enable the child / adult by using behavioral and cognitive interventions, enable the parents and educators by training them to work with and help children with ADHD, and to simultaneously reduce the core symptoms using the minimum medication required. The medication becomes necessary with cases that are severe; but in the case of children with mild ADHD, it may be possible to detect them early and train them using behavioral methods. This could help them control their symptoms throughout life. Thus, an emphasis on multi-modal interventions seems more appropriate in the present circumstances rather than exclusively relying on only a single mode of therapy. It would also be good practice to ensure that the particular compound prescribed for any child / adult provides the maximum relief from symptoms with minimal side effects. Simultaneously, there needs to be more research into developing effective and long-term behavioral and cognitive techniques so that at least children with mild to moderate ADHD may not require medication. References American Academy of Pediatrics. (2001). Clinical practice guidelines: Treatment of the school-aged child with attention-deficit/hyperactivity disorder. Journal of the American Academy of Pediatrics, 108 (4), 1033-1044. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders. 4th ed., text rev. Washington, DC: Author. Barkley, R. A. (2006). Attention Deficit Hyperactivity Disease - A Handbook for Diagnosis and Treatment (3rd Ed.). New York: The Guilford Press. Barkley, R.A. (1997). ADHD and the nature of self-control. New York: Guilford Press. Brown, R. T., Amler, R. W., Freeman, W. S., Perrin, J. M., Stein, M. T., Feldman, H. M., Pierce, K., Wolraich, M. L. & Committee on Quality Improvement, Subcommittee on Attention-Deficit/Hyperactivity Disorder. (2005). Treatment of attention-deficit/hyperactivity disorder: overview of the evidence. Pediatrics , 115(6), 749-757. doi:10.1542/peds.2004-2560 Fabiano, G. A., Pelham Jr., W. E., Coles, E. K., Gnagy, E. M., Chronis-Tuscano, A. & OConnor, B. C. (2009). A meta-analysis of behavioral treatments for attention-deficit/hyperactivity disorder. Clinical Psychology Review, 29(2), 129-140. ISSN 0272-7358, 10.1016/j.cpr.2008.11.001. Holmes, J., Gathercole, S. E., Place, M., Dunning, D. L., Hilton, K. A. & Elliott, J. G. (2010). Working memory deficits can be overcome: Impacts of training and medication on working memory in children with ADHD. Applied Cognitive Psychology, 24, 827–836. doi: 10.1002/acp.1589 Miller, M. & Hinshaw, S. P. (2012). ADHD and treatment. Schachar, R., topic ed. In: Tremblay, R,E,, Boivin, M., Peters, R. (eds.). Encyclopedia on Early Childhood Development [online]. Montreal, Quebec: Centre of Excellence for Early Childhood Development and Strategic Knowledge Cluster on Early Child Development:1-6. Available at: http://www.child-encyclopedia.com/documents/MillerHinshawANGxp1.pdf. Accessed 29-09-2012. Schonwald, A. & Lechner, E. (2006). Attention deficit/hyperactivity disorder: Complexities and controversies. Current Opinion in Pediatrics, 18 (2), 189–95. Young, S. & Myanthi Amarasinghe, J. (2010). Practitioner Review. Non-pharmacological treatments for ADHD: A lifespan approach. Journal of Child Psychology and Psychiatry, 51, 116–133. doi: 10.1111/j.1469-7610.2009.02191.x Read More