Introduction
Attention deficit-hyperactivity disorder abbreviated as ADHD is a behavioral disorder that is very common among school going kids. ADHD affects approximately 10% of all school going children. ADHA is characterized by a series of behavioral traits or symptoms that include hyperactivity, impulsiveness and inattentiveness.
The symptoms of ADHD normally start to exhibit themselves form an early age. They particularly become more noticeable when the circumstances of the child change, for example when they start school. In school, the children who have this disorder normally have great trouble in focusing. They act on impulse and without really thinking in some situations. Although they may understand what is required of them, they still have trouble in following orders or instructions simply because they cannot pay attention, sit still or even attend to instructions or details.
A lot of research has been conducted on this field particularly on treatment techniques. Various treatment modes have been advanced and proposed. Some of the treatment methods that have been thoroughly researched include; Challenging Horizon Program; pharmacological intervention; treatment with methylphenidate; nutritional treatment; multimodal behavior therapy amongst others.
The purpose of this paper is to critical review these treatment methods. The review will include the discussion of the methodologies employed and the comparison and contrast of their findings. The effectiveness of the two treatment methods will also be explored exhaustively and general conclusions will be drawn. At the end of the discussion, the best treatment or intervention method will be established.
Summary of the Articles
First of all let’s start with the pharmacological approach as explored in the first article. Pharmacological intervention involves the use of several medical drugs to the people suffering from the ADHD disorder. These drugs include Antipsychotics, antidepressants, psycho stimulants, anxiolytics, antihypertensive and anticonvulsants. In this particular study, 1668 participants were used to evaluate the trends and status of the pharmacological intervention methods on ADHD patients academic functioning. Psycho stimulants are however the most popular of all these pharmacological drugs (Dulcan 1999).
There are very many benefits that normally associated with the pharmacological treatment or intervention method and these include task completion, higher attention span, and ability to adhere to instructions and directions and decreased levels of impulsivity, distractibility and hyperactivity. Additionally, homework completion and handwriting can also improve significantly and the fighting and general stubbornness displayed by these students also decrease dramatically.
Several articles published by various researchers were used to come up with a lot of valuable information about the pharmacological ADHD intervention program. The articles were chosen systematically as it will be shown later in the findings section, there was a lot of interesting information and data established.
The other type of intervention method that I am going to briefly describe is the nutritional treatment. The use of nutritional management as an ADHD intervention program is one that has been relatively neglected over time. It has been found that there are some nutritional aspects that are directly linked to the occurrence of ADHD. Such nutritional aspects include refined sugars, deficiencies of fatty acids and food sensitivities. Therefore most of research on this field has been directed at establishing the official link between ADHD and the diet. Although, great controversy surrounds the various effects that some food components have on the behavior of children who have ADHD, a lot of evidence is being brought up everyday. This evidence seems to suggest that there are specific types of foods that can be directly linked to hypersensitivity in children.
The various effects of nutrition and diet ADHD warrants larger recognition form practitioners present in this particular field. This is because nutritional treatment can actually prove to be one of the simplest intervention methods that can be conducted at very low cost. This inadvertently underscores the enormous need for medical practitioners to fully understand the role played by nutrition and diet in ADHD.
Another ADHD treatment or intervention method that has been studied is the Challenging Horizons program. This is an after school treatment model. Students in a particular learning institution stay behind after school and participate in a series of individual and group interventions that target their social and academic functioning.
This program is normally held 2-4 times. Each session normally takes about two hours and this is done for the whole academic year or for a portion of it. Parenting and family groups are usually part of the Challenging Horizon Program and all the interventions employed are aimed at helping the students to learn and master various skills that will help them to succeed independently both academically and socially.
A total of 49 students were used in this study. The students were selected form two schools in Virginia. A large proportion (71%) was made up of Caucasians while the other part was made up of African Americans, Latinos and Asians who made up 14%, 12% and 4% of the participants respectively. The participants were subjected to the Challenging Horizons intervention program for a particular period and results were recorded and tabulated.
Another intervention method of ADHD is the intensive treatment. This was actually conducted in a time period of 8 weeks during the summer. It was administered on 34 adolescents who had BEEN diagnosed with ADHD. The adolescents participated in the program for 9 hours daily from 8.00 am in the morning to 5p.m in the evening.
They participated in modules that were designed to be synonymous to the setting of a secondary school. This includes emphasis on things like study skills, writing skills, note taking and binder organization. This was accompanied by a lot parental involvement.
Another research conducted was focused on evaluating the factors that lead to satisfaction of both parents and patients when it comes to treating ADHD using medication. Here, the satisfaction psychometric properties were analyzed using the SAMS scale, which is actually the questionnaire that is item based and is used to assess satisfaction in relation to ADHD modification.
The final method was the treatment using a multimodal behavior therapy that was combined with titrated methylphenidate through a clinical trial that was randomized. The follow up assessments included ADHD symptoms, diagnostic status, conduct and oppositional behavior parenting stress and symptoms of substance abuse.
Comparison and Contrast of the Findings
The research on the pharmacological intervention program was able to come up with several findings. It was found out that the information on the participants was actually very limited. In reviewing the various articles published about this intervention program, it was revealed that very few studies had actually been done to investigate or examine the effects that psychotropic medications had on adolescent populations. It was also established that most research focused on very few medication types. Another phenomenal finding established was that most of the pharmacological intervention methods employed were actually used for short term intervention only and not as a permanent solution. This led to the emergence of another fact from the research: that the pharmacological interventions had relatively moderate benefits across various subjects of academics in adolescents and children who have ADHD.
It was also found out that the pharmacological intervention method is constantly becoming one of the most popular intervention programs. The psychotropic medications are becoming popular increasingly and are being used to address the various inappropriate that displayed by students. Despite the fact that only about 3% of all students who suffer from ADHD are under prescribed medication, the rates of medication among students who have been clinically diagnosed with ADHD actually has a higher rate that ranges form 52% to 71%. A recent studies compilation monitoring pharmacy audits, physician survey and methylphenidate production shows that there has been a n increase in the use of pharmacological method as a treatment and intervention method for ADHS patients.
There was also several findings established form the research on the nutritional treatment. It was generally found that diet modification actually played a very large role in ADHD management and thus warrants incorporation into ADHD treatment protocol.
The research found out that certain foods not only have an influence on the ADHD symptom-mology but also altered the electrical activity of the brain. As stated earlier, the main types of nutritional ingredients that were found to have a direct link with ADHD are food additives, food sensitivities/allergies, refined sugars and deficiency of fatty acids. However, no single food substance can be used as a direct attribute to hypersensitive behavior exhibited by children. Various studies suggest that not every child responds the same way to a particular offending substance.
Therefore, findings form this research suggest that there is need to conduct more research particularly on identifying individual sensitivities and allergens, determining susceptibility patterns in various individuals, understanding reaction mechanisms and devising efficient and effective treatment methods for food sensitivities.
This Challenging Horizons research was able to come up with several finding. The main benefits of this program were established. The findings of the research indicated that after administering the program for five months, there were some benefits realized. However, it was found that the general improvement was actually less when the program was administered for a full academic year. It was also found that various measures used for evaluating the academic functioning of the participants indicated an improvement trend. The ratings of the teachers about the classroom performance rose significantly. This means that there was some considerable improvement in the participant academic functioning. As indicated earlier, the program is usually not very effective if administered for a whole year and many students who participated in the program during the fall semester actually experienced significant failure. The findings of this research therefore suggest for the CHP program to fully and optimally beneficial to academic functioning, the program should be initiated at the beginning of the school calendar.
The findings from the intensive treatment indicate that the program was actually very successful. Adolescent who participated in the program showed an improvement across all domains. There was no evidence of any iatrogenic effects.
The results of the evaluation of parents and patients satisfaction with medication indicate that patient and parent satisfaction was particularly very high with medication and it was possible to assess it using the SAMS questionnaire. The ratings of patient and parent were correlated moderately and functional impairment and symptom severity were two of the most credible satisfaction predictors.
The findings from the methylphenidate study showed that there was significant decline in the ADHD although this was not to the entire sample population.
Conclusion
In conclusion, it is fairly safe to say that most of these techniques described above are actually very successful. There are not many methodological p[problems witnessed and most of these research are actually generalizable and can thus be applied to a larger population However, it seems that the most effective one is the pharmacological intervention method. This is because the results and benefit are actually realized very fast. The nutrition aspect is also an advisable method due to its simplistic nature. It is futile to conclude that any of these intervention methods can be employed for any patient. The best method or intervention that suits a particular method chose is carefully analyzed before it is embarked on.
Works Cited
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Evans, S. W., & Schultz, B. K. (2011). Effectiveness of the challenging horizons after-school program for young adolescents with ADHD. Behavior Therapy, 42 (3), 462-474. doi: http://dx.doi.org/10.1016/j.beth.2010.11.008
Gortz-Dorten, A., Breuer, D., Hautmann, C., Rothenberger, A. & Dopfner M. (2011). What contributes to patient and parent satisfaction with medication in the treatment of children with ADHD? A report on the development of a new rating scale. European Child & Adolescent Psychiatry, 20, 297-307. doi: 10.1007/s00787-011-0207-z
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