Treatments for ADHD in Children - Case Study Example

Treatments for ADHD in Children Attention deficit hyperactivity disorder (ADHD) is a chronic behavioral disorder of childhood onset (by age seven). Children with ADHD have trouble paying attention in school, at home or at work. It is characterized by behavior that is hyperactive, impulsive, and/or inattentive. ADHD is the most commonly diagnosed childhood disorder, affecting an estimated 3 to 5 percent of school-age children. It occurs more often in boys than girls, in some studies by a 5:1 ratio (Stern 20). Since they are overactive and impulsive, children with ADHD often find it difficult to fit in at school. They may also have troubles in getting on with other children of the same age group. These difficulties can persist as they grow up, particularly if it is not properly diagnosed and treated. Children with ADHD may appear functionally impaired in many areas and may engage in a broad array of problem behaviors that frustrate and disrupt family, school, and peer relationships. Their inability to sit still and pay attention in class may lead to school failure, truancy, and dropping out. However, ADHD is not related to intelligence and children with all levels of intellectual ability can have ADHD. Overactive behavior: If a child is characterized by races around the classroom, may wander around the room, restless, or repeatedly tap a pencil, interfering with other children’s activities, and may be seen as mischievous and unwilling to learn, then these behavioral disorders can be classified as overactive behavior. Hyperactive children seem to be constantly in motion. Impulsive behavior: Children with ADHD may be impulsive in many ways, such as saying or doing the first thing that occurs to them. In other words they do not think about the consequences. They are also easily distracted by irrelevant things. These children find it difficult to carry out everyday jobs which involve patience. They will find it hard to do any activity which involves waiting to give an answer, or in which they have to take turns. Impulsive children tend to act without thinking and often seem unable to control their immediate reactions to people, events, or even their own thoughts and feelings. As a result, they may speak without thinking or dash into the street without looking for traffic. Most children experience transient episodes of these symptoms, perhaps due to stress or in response to certain medications. Attention problems: Children with ADHD have a short attention span. They find it difficult to concentrate and therefore hard to learn new skills, both academic and practical. Research from the USA suggests that 90% of children with ADHD underachieve at school and 20% have reading difficulties. Children with ADHD may themselves be quite distressed, because they do not mean to behave badly in class but do not know how to change. Social problems: Children with severe ADHD may be rejected or disliked by other children, because they disrupt their play or damage their belongings. It is easy for a child with ADHD to become labeled as troublesome, or for parents to think it is their fault for not controlling their child. In fact children with ADHD do not realize how their behavior affects other people. They may want to make friends, but have no idea how to go about it, having never picked up the basic rules of social behavior which most children learn naturally (Borrill 1-22). Causes of ADHD Children with ADHD do not make enough chemicals in key areas in the brain that are responsible for organizing thought. Without enough of these chemicals, the organizing centers of the brain dont work well. This causes the symptoms in children with ADHD. Research shows that ADHD is more common in children who have close relatives with the disorder. Recent research also links smoking and other substance abuse during pregnancy to ADHD (Familydoctor.org). ADHD has conventionally been viewed as a problem related to attention, originating from an inability of the brain to filter competing sensory inputs such as sight and sound. Recent research, however, has shown that children with ADHD do not have difficulty in that area. Instead, researchers now believe that children with ADHD are unable to inhibit their impulsive motor responses to such input. It is still uncertain what the direct and immediate causes of ADHD are. Although most researchers acknowledge that the child’s environment helps determine specific behaviors, they suspect that the cause of ADHD is genetic or biological (Identifying and Treating Attention Deficit Hyperactivity Disorder 1-15). Research suggests that the condition may have a genetic component because ADHD is diagnosed more frequently in children who have close biological relatives with ADHD than in the general population. The effects of untreated ADHD carry on into adolescence and adulthood. As they grow older, children with untreated ADHD often in combination with oppositional-defiant and conduct disorders may abuse drugs or alcohol, engage in antisocial behavior, and suffer physical injury at higher rates than the general population. Later impairment can include vocational and social problems, low self-esteem, and a higher incidence of automobile accidents. Boys with ADHD are at increased risk for engaging in delinquent and antisocial behavior. Researchers know less about the long-term consequences of ADHD in girls because of a lack of relevant longitudinal research; however, current studies suggest that ADHD can also have long-term negative effects on girls (Stern 20). Treatments for ADHD A combined effort, with parents, teachers and doctors working together, is the best way to help children with ADHD. Some children benefit from counseling or from structured therapy. Families may benefit from talking with a specialist in managing ADHD-related behavior and learning problems. Medicine also helps many children (Familydoctor.org). Although at present no cure for ADHD exists, there are a number of treatment options that have proven to be effective for some children. These treatments may either work individually or in combinations. Effective strategies include behavioral, pharmacological, and multimodal methods. Behavioral Approaches An important non-medical approach used in treating children with ADHD is known as behavior therapy or behavior management. The goal of behavior therapy is to increase the frequency of desirable behavior by increasing the childs interest in pleasing parents and by providing positive consequences when the child behaves. Inappropriate behavior is reduced by consistently providing negative consequences when such behavior occurs. Behavioral approaches correspond to a wide set of specific interventions that have the common goal of modifying the physical and social environment to alter or change behavior (American Academy of Pediatrics (AAP) 1033-1044). They are used in the treatment of ADHD to provide structure for the child and to reinforce appropriate behavior. Those who typically implement behavioral approaches include parents as well as a wide range of professionals, such as psychologists, school personnel, community mental health therapists, and primary care physicians. Types of behavioral approaches include: Behavioral training for parents and teachers, A systematic program of contingency management, Clinical behavioral therapy, And cognitive-behavioral treatment. In general, these approaches are designed to use direct teaching and reinforcement strategies for positive behaviors and direct consequences for inappropriate behavior. A study conducted by Pelham, Wheeler, and Chronis indicates that two approaches—parent training in behavior therapy and classroom behavior interventions—are successful in changing the behavior of children with ADHD (190-205). In addition, home-school interactions that support a consistent approach are important to the success of behavioral approaches. One of the draw backs of behavior therapy is that it is found to be effective only when it is implemented and maintained. Behavioral strategies can be difficult to implement consistently across all of the settings necessary for it to be maximally effective. Although behavioral management programs have been shown to enhance the academic performance and behavior of children with ADHD, follow up and maintenance of the treatment is often lacking (Rapport, Stoner, & Jones 334-341). Pharmacological Approaches Pharmacological treatment remains one of the most common, yet it is the most controversial forms of ADHD treatment. Pharmacological treatment includes the use of psychostimulants, antidepressants, anti-anxiety medications, antipsychotics, and mood stabilizers. Stimulants predominate in clinical use and have been found to be effective with 75 to 90 percent of children with ADHD. Stimulants include Methylphenidate (Ritalin), Dextroamphetamine (Dexedrine), and Pemoline (Cylert). Other types of medication (antidepressants, anti-anxiety medications, antipsychotics, and mood stabilizers) are used primarily for those who do not respond to stimulants, or those who have coexisting disorders. Researchers believe that psychostimulants affect the portion of the brain that is responsible for producing neurotransmitters. Neurotransmitters are chemical agents at nerve endings that help electrical impulses travel among nerve cells. Neurotransmitters are responsible for helping people attend to important aspects of their environment. The appropriate medication stimulates these under functioning chemicals to produce extra neurotransmitters, thus increasing the child’s capacity to pay attention, control impulses, and reduce hyperactivity. Medication necessary to achieve this typically requires multiple doses throughout the day, as an individual dose of the medication lasts for a short time (1 to 4 hours). However, slow- or timed-release forms of the medication may allow a child with ADHD to continue to benefit from medication over a longer period of time. Doctors, teachers, and parents should communicate openly about the child’s behavior and disposition in order to get the dosage and schedule to a point where the child can perform optimally in both academic and social settings, while keeping side effects to a minimum (Identifying and Treating Attention Deficit Hyperactivity Disorder 1-15). In selecting the appropriate pharmacological regimen, consideration should be given to the child’s daily school and after-school schedule, the presence of aggressive symptoms, and the risk of diversion. Controlled clinical trials consistently demonstrate that treatment with stimulants substantially reduces the characteristic symptoms and impairment of patients with ADHD. Stimulants result in a rapid improvement in the conduct, attentiveness, and academic performance of children and adolescents with ADHD. Approximately 70% of ADHD patients respond to stimulant medications in the short term and over periods up to 18 months. In addition to pharmacological treatments, which are the focus of the current review, behavioral approaches involving classroom behavior modification and academic interventions, parent training, contingency management programs, and special education placement are also established treatments for children with ADHD. For some patients in some outcome domains, medications in combination with behavioral psychosocial interventions may be more effective than either treatment alone (Olfson S117-S124). Although the positive effects of the stimulant medication are immediate, all medications have side effects. Adjusting the dosage of the medicine can diminish some of these side effects. Some of the more common side effects include insomnia, nervousness, headaches, and weight loss. In fewer cases, subjects have reported slowed growth, tic disorders, and problems with thinking or with social interaction (Gadow, Sverd, Sprafkin, Nolan, & Ezor 444-455). Stimulant medicines do not normalize the entire range of behavior problems, and children under treatment may still manifest higher levels of behavioral problems than their peers. However, according to the American Academy of Pediatrics at least 80 percent of children respond to one of the stimulants if they are administered in a systematic way. Under medical care, children who fail to show positive effects or who experience intolerable side effects on one type of medication may find another medication helpful and concludes that stimulants may be a safe and effective way to treat ADHD in children (American Academy of Pediatrics (AAP), 1033-1044). In January 2003, a new type of non-stimulant medication for the treatment of children and adults with ADHD was approved by the FDA. Atomoxetine, also known as Straterra, may be prescribed by physicians in some cases (Identifying and Treating Attention Deficit Hyperactivity Disorder, 1-15). Multimodal Approaches Research indicates that for many children the best way to mitigate symptoms of ADHD is the use of a combined approach. Improvements in the following areas after using multimodal intervention were predominantly noted by many researchers: academic performance, oppositional behavior, child anxiety, and parent-child interaction. Positive results also were found in school-related behavior when multimodal treatment is coupled with improved parenting skills, including more effective disciplinary responses, and appropriate reinforcements (Hinshaw, et al. 555-568). Conclusion Child-specific treatment plans in required for treating of ADHD whether it is behavioral, pharmacological, or multimodal. The process of developing specific positive outcomes requires cautious and coordinated input from parents, children, and teachers as well as other school personnel. All of them need to specify goals that should be realistic, attainable, and measurable. Most of the children respond positively towards stimulant medication in the management of the core symptoms of ADHD. For many children, behavioral interventions are helpful as primary treatment or as an addition in the management of ADHD. Some of them respond equally to both behavioral as well as pharmacological interventions. There is undoubtedly a great deal of progress still to be made in developing effective responses to ADHD. The complexity of the problem is such that it is unlikely that any single form of intervention will ever be appropriate for all cases of ADHD. It is therefore essential that child-specific treatment plan should be formed with the consultation of doctors, teachers and parents. Work Cited American Academy of Pediatrics (AAP). “Clinical practice guideline: Treatment of the school-aged child with attention deficit/hyperactivity disorder”. Pediatrics, (2001) 108, 1033-1044. Borrill, Jo, “All About ADHD” 1-22, 2000, Mental Health Foundation. 9 May 2006 Familydoctor.org, “ADHD: What Parents Should Know”, September 1999 American Academy of Family Physicians, July 2005, 9 May 2006 Gadow, K. D., Sverd, J., Sprafkin, J., Nolan, E. E., & Ezor, S. N. “Efficacy of methylphenidate for attention-deficit hyperactivity disorder in children with tic disorder”. Archives of General Psychiatry, (1995) 52, 444-455. Hinshaw, S. P., Owens, E. B., Wells, K. C., Kraemer, H. C., Abikoff, H. B., Arnold, L. E., et al. “Family processes and treatment outcome in the MTA: Negative/ineffective parenting practices in relation to multimodal treatment”. Journal of Abnormal Child Psychology, (2000). 28(6), 555-568. “Identifying and Treating Attention Deficit Hyperactivity Disorder: A Resource for School and Home” 2003, U.S. Department of Education 1-15, 9 May 2006 Olfson, M., “New Options in the Pharmacological Management of Attention-Deficit/Hyperactivity Disorder”, The American Journal of Managed Care, July 2004, Vol 10, No. 4, Sup. S117-S124. Pelham, W. E., Wheeler, T., & Chronis, A. “Empirically supported psychosocial treatments for attention deficit hyperactivity disorder”. Journal of Clinical Child Psychology, (1998), 27, 190-205. Rapport, M. D., Stoner, G., & Jones, J. T. “Comparing classroom and clinic measures of attention deficit disorder: Differential, idiosyncratic, and dose-response effects of methylphenidate”. Journal of Counseling and Clinical Psychology, (1986) 54, 334-341. Stern, Karen R. A “Treatment Study of Children with Attention Deficit Hyperactivity Disorder” OJJDP Fact Sheet, May 2001 #20. 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