Medication of Children with Attention Deficit Disorder - Research Paper Example

? Medication of children with Attention Deficit Disorder Attention Deficit Disorder (ADD) is a condition that continues toaffect many children and teenagers especially in the United States. The prevalence of the condition in children occurs highly during the early elementary school years. The disorder highly affects various aspects of a child’s life including social development and academic performance. The most important aspect of this condition is its medication. In the past years, there has been over use of stimulant medication as the core treatment procedure of the disorder. However, due increased research and concerns, treatment providers have embraced the use of behavioral interventions for treatment. This paper will examine the patterns of medication of children with this disorder to establish whether there is overmedication. It will first provide a general introduction of the disorder, explaining its prevalence, and history. It will also discuss the standard diagnosis criteria for the disorder as well as its effects and treatment options. Introduction Attention Deficit disorder (ADD) is a neuropsychiatric syndrome linked with major functional impairment, including patient and family distress, comorbid psychiatric and developmental conditions, and poor academic outcomes. The prevalence of ADD according to population-based studies estimate is about 4%. The diagnosis and identification of Attention- deficit disorder in children is usually during their early elementary school years making it one of the most frequent behavioral or psychological disorders of childhood (Rappley et al, 1999). Bedard et al (2003) asserts that Attention deficit disorder is among the most widespread developmental psychiatric disorders detected in childhood. One of the recent theory claims that the crucial impairment in this disorder is a deficit concerning response inhibition. He explains, “Response inhibition is part of the multidimensional construct of inhibition and is a self-generated, higher-order executive function that refers to the ability to stop a planned course of action.” According to prevalence studies carried out, boys are 2 times more prevalent to ADD than girls are. In addition, these studies have also reported on a positive link between ADD and academic problem. However, across studies there was a great variation on the degree of co morbidity ranging from 10% to 90%. Although research have not confirmed, there is an assumed link of ADD prevalence and the children’s background being more prevalent among children from minority and low-income populations (LeFever et al, 1999). It is in the late 1960s in the United States that the construction of ADD occurred with the acceptance that a variety of behavioral characteristics defined the medical disorder without a specific requirement to ascertain evidence of neurological or biological dysfunction. The rapid increase in the use of the diagnosis and treatment with medication globally occurred in the 1990s. In the United States and Australia, there is a significant increase in diagnosis although there has been an evident increase in other countries worldwide (Kean, 2004). Effects of the disorder and diagnosis Among the signs experienced by quite a numbers of children with ADD during the adolescent years includes, deficient problem solving skills, continued motor restlessness, delinquency and impulsive cognitive styles. In addition, the following characteristics are also very common, poor peer relationships, school failure and personality styles of immaturity, recklessness, impulsivity and drug abuse. It is evident that there are poorer results for those adolescents with learning disabilities or conduct disorders while they are concurrently suffering from ADD. Although ADD may hinder proper completion of adolescent maturational tasks leading to interpersonal, intrapsychic and adult vocational difficulties, it is clear that successful, clinical intervention during the adolescent years may have long-term advantages (Kutcher, 1986). Attention-deficit disorder (ADD) is the main reason for referral among school-aged children to mental health services. The great impairments in academic and social functioning across many settings among children with ADD are because of chronic and pervasive difficulties with hyperactivity, impulsivity and inattention (Chronis et al, 2006). A comprehensive interview between the parent and the clinician to identify about 18 ADD recognized symptoms remains the core of the most effective diagnosis. The clinician should establish the presence of each symptom as well as its severity, frequency, and duration. In addition, it is also important to assess the age of the patient when the symptoms first appeared. It is important for the patient to have a chronic course, the necessary number of symptoms, and onset of symptoms during childhood. The clinician should establish the circumstance at in which settings impairment happened after assessing all the symptoms. It is necessary to ask specific questions about academics since most ADD patients have academic impairment (Pliszka et al, 2007). For the past 10 years, there have been several revisions regarding the nomenclature and diagnostic criteria for ADD. It saddens that many primary care physicians do not use the standard criteria when diagnosing attention disorders. Consequently, it is hard to report the true prevalence of ADD in a study population since parent-reported history of a diagnosis of ADD is probably a poor surrogate (Rowland, 2002). Medication of Attention Deficit Disorder Stimulants, desipramine and bupropion are some of the pharmacological interventions considered effective. However, for use in the treatment of ADD, the Food and Drug Administration and other regulatory agencies endorse only the stimulants. Moreover, the generations of new non- stimulant pharmacologic treatments, which are non-restricted, have become an area of great interest since this would broaden the therapeutic options to both the patients and the clinicians (Michelson et al, 2002). However, the most effective treatments for ADD comprise both behavior modification and stimulant medication. Pharmacological treatment approaches only, fail to give the expected results for various reasons despite it being evident that stimulant medication in the treatment of ADD is very effective hence emphasizing the need for discovery of effective psychosocial treatments (Chronis et al, 2006). Although the United States National Institute of Mental Health (NIMH) in the United States have invested heavily in the ADD research, it has not evaluated effectively the benefits, risks, and threats linked with the drug treatments but have chosen to concentrate on short-term behavior change experiments using medications (Breggin,200l). NIMH in the 1990s financed the most expensive research experiment ever carried out into ADD (Kean, 2004). Coghill (2003) indicates that it is evident that medication can play a major role in the ADD management. However, it is difficult for clinicians to decide whether to give a generally pharmacological treatment package or a more-expensive and time-consuming package of combined psychosocial and pharmacological treatments to their ADD patients. In the United States, majority of children with ADD get stimulant medication, with about 90% getting methylphenidate (Ritalin). Consequently, methylphenidate can be a clear indicator of the ADD prevalence in the United States. Reports have shown that since 1990, there has been a 3- to 6-fold increase in the number of prescriptions for methylphenidate, the per capita distribution of methylphenidate, and the number of ADD patient visits. There is evidence that the change in ADD diagnostic criteria improves the disease diagnosis hence the noted increase. In addition, there have been changes in medical guidelines that encourage the use of stimulant medication into adolescence and adulthood. However, the National Institutes of Health recently admitted that the likely over diagnosis and overtreatment of ADD in the United States was a significant public health problem (LeFever et al, 1999). Although the differences in treatment rates between boys and girls may suggest the difference in the prevalence of ADD between the two sexes, it could also reflect referral bias. However, it is encouraging that once diagnosed with ADD, boys and girls get medication in similar proportions despite the sex difference in treatment rates. On the contrary, studies indicate that only a smaller proportion of African American and Hispanic children with ADD were getting medication treatment compared to the White children (Rowland, 2002). According to other studies, Children who underwent through the behavioral intervention only experienced results similar to or greater to those who received medication on 25 of 30 dependent measures. Moreover, there is a 10% increase in following rules, good sportsmanship, and peer relationships on the medication use (Kean, 2004). It is evident that there has been an increase in both stimulants treatments and office visits for ADD in recent years. The increase in patients looking for treatments signifies the fact that there can be successful ADD treatment. It is evident according to more than 200 controlled studies that stimulant medications and specific behavioral interventions are effective for children and adolescents with ADD. Moreover, there have been marketing of a number of new medications in the past several years. Although most of these are new types or formulations of stimulant medications, there has been approval by the US Food and Drug Administration of some non-stimulant drugs for the treatment of ADD such as Atomoxetine (Bukstein, 2004). It is clear that there is need for effective psychosocial treatments to fight the numerous shortcomings of pharmacological treatments despite the large literature supporting the efficiency of stimulant medication in the treatment of ADD. For instance, there is a huge support foundation for various behavioral interventions. These include school and parent training interventions, which emerges as practically authenticated treatments. Moreover, other significant interventions in the treatment of ADD include exhaustive summer intervention programs and social skills training with simplification elements. All these alternative interventions may replace stimulant medication adequately and produce better results. Children with ADD undergo unceasing impairment across manifold spheres of functioning. For this reason, multimodal interventions are essential to regularize the behavior of these children (Chronis et al, 2006). Majority of children in the 1980s diagnosed with the disorder between the ages of seven and nine since the diagnosis of the disorder and treatment with medications typically takes place in early childhood. There has been an attempt through the 1990s, which tried to identify the disorder early hence helping in early administration of various medication and mainly amphetamine-type drugs usable by children as young as 2 years of age. There is a likelihood of damaging effects of the drugs on social, behavioral, educational, and neurological development in early childhood (Kean, 2004). There are reports that ADD just as other learning, mental and developmental health disorders are more prevalent among children from minority and poor environments. The administration of ADD medication is twice to the Whites than to minority students even after controlling factors for example median household income and sex. On the other hand, it is possible that ADD is more widespread in minority populations than in nonminority populations, but the parents’ decision to fill the prescriptions and/or make prescribed medication available to their children brings about the significant difference. According to studies, there is recommendation of methylphenidate to ninety percent of the children who take ADD medication at school; five percent receive a combination of methylphenidate and other drugs while 10% receive other drugs alone. In addition, there is rise of use of stimulants and antidepressants to treat ADD children with multiple medications (LeFever et al, 1999). There is a controversy, however, surrounding the use of stimulant medications for the treatment of ADD. The groups against the use of stimulants medications urge that the characteristics seen in children with ADD is as a result of stimulants while on the other hand the use of stimulants increases the level of substance abuse. While it is true that some children may have suffered harmful effects because of overmedication there is a revelation in the recent studies that there are neuropsychological deficits in children with ADD even if there is no earlier exposure to psycho stimulants or other psychoactive medications. The rise of these problems is because of the short half-lives of stimulant medications and their short duration of action when given as immediate-release preparations. Although the long-acting preparations of stimulant medication have been available in the USA for over 10 years, clinicians have used them much less than was expected because these have not proved to be as effective as the immediate release preparations. The wax-matrix-based preparations have a delayed onset of action, resulting to lower peak plasma levels and entail a tailing off in plasma concentration after peaking at 3 hours (Coghill, 2003). There has been an augmented use of stimulant medication in diagnosis and treatment of ADD. For this reason, most professionals in the field of psychology as well as the public have raised constant sentiments concerning this issue. These concerns have also prompted further investigation in to the issue, which have become more and more complex. However, the bulk of these concerns accrue from to major developments. These are the constant use of stimulants for a long time and proper identification of ADD among earlier under represented groups of children, adolescents and adults. Moreover, there is much evidence to suggest that over 3decades, there has been substantial increase in the use of psychotropic medication for children younger than age18years. The collection of psychotropic medications and the extremely diverse manner of their usage, indicate a lack of direction for treatment of very young children with these medications. This is clear evidence that there is overmedication of very young children with attention deficit disorder. Moreover, the use of stimulants for children younger than 18 years, suggest lack of enough research before administering these medications, which may ultimately produce negative consequences (Rappley et al, 1999). According to estimates, at least 85% of children diagnosed with ADD receive stimulants medication. Moreover, there is much evidence to support that stimulant medication has been very effective in the treatment of ADD cases in children. In fact, these medications prove to result in positive outcomes for many of the children with ADD. For example, it is evidence that stimulants lessen classroom disturbance and augment conformity, on-task behavior, and educational performance. In addition, studies have shown stimulants as very effective in reducing anti-social behaviors, such as unsuitable peer contacts, hostility and negative parent–child relationships (Chronis et al, 2006). Despite the extensive use of stimulant medication for ADD treatment in the U.S., parents generally regard stimulant medication as a hard modality to reflect on and embrace for their children. Generally, parents regard behavioral interventions as more suitable than stimulant medication when treating ADD. Precisely, they consider such interventions as constructive behavioral approaches and daily report cards, as much more satisfactory than stimulant medication. Moreover, teachers have the same positions concerning the suitability of behavioral approaches over stimulant medication. These parallel sentiments indicate that parents and teachers do not embrace stimulant medication as a cornerstone for ADD treatment. This is because of the overmedication that follows these treatments due to the necessity of rapid and multiple interventions (Bukstein, 2004). Recommendations for effective medication of Attention Deficit Disorder on children For effective medication and treatment of this disorder, treatment providers should be conversant with consumer preferences and anticipations. Moreover, it is very possible for providers to modify such preferences through cautious, insightful psycho education approaches and informed approval. It is also very important for the providers to have the best knowledge and skills in dealing with ADD cases. This will ensure competency and accuracy in the diagnosis and treatment of ADD cases (Bukstein, 2004). In addition, interventions must be developmentally sensitive. This means that they must engage cautious contemplation of the child's level of cognitive development and his/her developmental necessitates and pressures. In line with this, behavioral interventions for younger children must comprise results that are concrete, provided regularly, and presented instantly following the behavior. This would help the children to understand the link between their behavior and the outcome. Similarly, treatments for teenagers must reflect on their yearning for independence, for instance, by making sure they participate fully in the intervention procedure. There should be clear choice of outcomes that are consequential and inspiring for the person at a particular stage of development across all age groups. For instance, loss of benefits or activities might be more helpful as punishments for adolescents rather than time out, which may be a less suitable at this stage. Likewise, there should be proper adjustment of treatments at developmental transitions using developmentally sensitive behavioral approaches to reveal the behaviors that are most harming at the time (Chronis et al, 2006). These strategies will clearly reduce cases of over diagnosis or overmedication of children suffering from ADD. The patient’s treatment program should consider ADD as a persistent disorder and might comprise psychopharmacological and/or behavior therapy. In addition, this program should consider and closely examine the latest proof concerning successful therapies and family preferences and concerns. This program should also include parental and child psycho education concerning ADD and its different treatment alternatives, connection with community supports, and extra school resources. There is a clear distinction between Psycho education and psychosocial treatments such as behavior therapy. Psycho education involves educating the parent and child concerning ADD. It also involves helping parents foresee developmental pressures that are complex for ADD children, and offering general counsel to the parent and child to help develop the child’s behavioral and academic functioning (Pliszka et al, 2007). Conclusion Attention deficit disorder affects children especially those in elementary school in diverse ways. It makes the child to have difficulties in problem skills. In addition, the disorder leads to overall poor per relationships and academic failure. In general, this disorder affects the social life and development of a child as well as educational achievement. Children having the disorder find it difficult to interact freely with other children. Treatment of the disorder is very crucial to the child, parent and the teachers. The continuous overuse of stimulant medication for treating the disorder is of great concern. This is because treatment providers often overmedicate the affected children. The reason for the overmedication is that the disorder requires multiple and rapid interventions. However, professionals and researchers have raised concerns over this issue. Consequently, this has facilitated the use of alternative treatment for the disorder such as behavioral interventions. There is much evidence that behavioral treatment is very effective and most parents and teachers prefer it to stimulant medication. This is because the behavioral approach does not lead to overmedication of the affected children. To curb the problem of overmedication effectively, providers should opt to use the behavioral interventions more than medication. References Bedard, A.C. et al. (2003). Selective Inhibition in Children with Attention-Deficit Hyperactivity Disorder off and on Stimulant Medication. Journal of Abnormal Child Psychology, 31, 3, 315-327. Bukstein, O.G. (2004). Satisfaction with Treatment for Attention-Deficit/Hyperactivity Disorder. 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