Abstract
Great deal of children all over the world suffers from Attention Deficit Hyperactivity Disorder. Symptoms of ADHD include hyperactivity, emotionalism and difficulty of staying focused. Children with ADHD usually have the lack of comprehension skills, poor study results and problems with following instructions as a result, they are more likely to conflict with coevals and teachers.
There are different types of ADHD treatments, the most common one is academic interventions which include manipulating antecedent conditions, parent tutoring, homework management programs, instructional modifications, self-monitoring. Self- monitoring technique is crucial for children with ADHD, as teaches them not only to regulate their performance but also control and evaluate it. Academic intervention appeared to be more successful in the long run compare to drag intervention that proven to have effect on symptoms of ADHD, however, fail to stabilized behavior of children with ADHD. Despite the fact that drugs treatment is less time consuming it may cause plenty of negative consequences like headaches, medication addiction, irritability, suicidal feelings.
Extremely effective treatment is proven to be behavior interventions which involve modifications of the patient environment. Because of its time and effort consumption, only a small number of families can provide this treatment for their kids. On the other hand, classwide interventions are an alternative and are cost effective and efficient. These interventions are based on supporting positive behavior, peers monitoring each other and grope activities. Behavior interventions are unique because not only child with ADHD can remain anonymous but whole class can benefit from such activities.
Frequently children get misdiagnosed of ADHD because kids who are gifted and children with ADHD show the same behavior patterns. Such misdiagnose often has harmful consequences, as it not only effects children vision of themselves, but also inappropriate stimulant medication treatment may cause serious health and mental problems in the future.
Introduction
ADHD or Attention Deficit Hyperactivity Disorder is a neurological condition that involves problems with inattention and hyperactivity-impulsivity that are developmentally inconsistent with the age of the child. (U.S. Department of Education, 2003) When a child is diagnosed with AHDH he or she is more likely have the history of learning disabilities, placement in a special education program, or academic tutoring. Research shows that children with ADHD are more likely to be retained and are more likely to drop out of school. Some red flags of ADHD diagnosis are failure to complete homework, poor comprehension skills, poor study skills, low test scores, disruptive behavior, and conflict with peers and teachers. Children who diagnosed with ADHD are usually extremely hyper and excessively verbal. Because children with ADHD are considered to have deficits in nonverbal working memory, they may forget to complete homework, have difficulty planning ahead for long term projects, and are unable to prioritize what is important. (Raggi & Chronis, 2006)
In the modern world, ADHD is a widespread neuropsychiatric disorder. In 2011, estimated 9% of US children in the age of 3-17 years were diagnosed with ADHD. (Bloom, Cohen, & Freeman, 2011) Children with ADHD are often misdiagnosed by specialist and require extra attention from parents and teachers in order to overcome their conditions or at least reduce it effect. That is why, to my mind, this topic is very significant for modern society and future generations. During my research on this subject, I have realized that it is extremely important to choose the correct type of intervention in order to help children with ADHD overcome their condition.
In this research, my focused was on based characteristic and school performance of children with ADHD, different types of treatment and misdiagnose of Attention Deficit Hyperactivity Disorder among kids. In each section I explored different interventions, procedures and experiments that were conducted in this filed. I have tried to represent opposite points of views of various scientists who explored ADHD. This research concludes with an idea why ADHD became a common thing among modern kids.
Academic Intervention
Academic interventions for ADHD diagnosis include manipulating antecedent conditions such as the instruction and the materials used during the instruction. Although drug and behavior interventions have been used with these children, researchers have noted a greater need for interventions in the classroom that create addictive effects beyond those that medication creates. Teachers prefer academic interventions versus strict behavior interventions because of time efficiency. Direct targeting of academic impairment does reduce the risk of children having increased academic problems in the future. Some academic support includes peer and parent tutoring, instructional modifications, self monitoring, use of functional assessment, and homework management programs. Computer assisted instruction consists of specific instructional objectives, highlighting of important material, and the division of content into smaller parts. Computer assisted instruction also provides immediate feedback about response accuracy. Students using Computer assisted Instruction are more likely to be more actively involved in learning and have more confidence and motivation. In conclusion of article “Interventions to Address the Academic Impairment of Children and Adolescents with ADHD”, writers find out that stimulant medication has proven to be effective in improving the on task and disruptive behaviors in ADHD children, but academic interventions have proven to be more successful long term. These include classwide peer tutoring and parent tutoring, instructional and task modifications, classroom functional assessment procedures, self-monitoring, strategy training, and homework focused interventions. (Raggi & Chronis, 2006)
One’s ability to control his behavior is a based characteristic that uasually does not require any effort. When a student is able to control his behavior within a classroom setting, academic performance will be greatly improved. This is critical for a child’s development and learning. Children diagnosed with ADHD that exhibit inattention, impulsivity, inhibition, and overactivity need to have self -regulatory abilities in order to succeed in the classroom. Approximately 3% to 5% of elementary age students are diagnosed with ADHD. Children with ADHD often produce work at a slower rate, produce poorer quality work, and have difficulty maintaining on task behaviors or following through when given instructions. Their daily performance on classroom tasks and homework is below their peers, and 80% of students diagnosed with ADHD exhibit academic performance problems. (Harris, Friedlander, Saddler, Frizzelle, & Graham, 2005)
Academic behaviors to include completion and accuracy of homework and independent classwork. There are two areas of self monitoring: self monitoring performance and self monitoring of attention. Self-monitoring is a critical self regulation process and when students are taught to use SMP they are encouraged to assess, evaluate, and record particular aspects of their academic performance. When students are taught to SMA they assess, evaluate, and record attentional behaviors, concentrating on increasing on task behaviors. In the study of Harris, Friedlander, Saddler, Frizzelle and Graham, students were trained by their teacher to monitor the target behavior and peer feedback was provided during therapy sessions. The intervention decreased inappropriate talking out behavior in the students. (Harris, Friedlander, Saddler, Frizzelle, & Graham, 2005)
Classwide interventions
Most students diagnosed with ADHD have academic knowledge, but still struggle with the duty to complete assigned work, have poor test scores, and low report card grades. In order to prevent school drop out and school failure, it is important to develop effective cross domain interventions for students. Classroom modification and parent training are essential for skill building, and both of these have a positive impact on ADHD symptoms and academic performance (Pfiffner, Villodas, Kaiser, Rooney, & McBurnett, 2013).
Drug intervention
One of the less favorable, however, effective intervention is drug treatment. Some studies suggest that the behavioral inhibition is the most significant component of ADHD. Behavior inhibitions is a pattern of behavior characterized by shyness, timidity, withdrawal, and fear of the unfamiliar. Children diagnosed with ADHD will have four major functions that act as planning mechanisms affected. These are nonverbal working memory, internalization of speech, self regulation, and analysis synthesis processes. Although stimulant medicine is the treatment of choice for ADHD and it promotes the attentiveness. However it has not been proven that academic performance improves with the use of these psychostimulant drugs. “Simply medicating children, without teaching them the skills they need to improve their behavior and performance, is not likely to improve the children’s long term prognosis” because medication does not teach a child or promote cognitive reorganization. School age children spend a considerable amount of time in the classroom, and the classroom requires planning, control, and evaluation of procedures. (Miranda, Presentacion, & Soriano, 2002).
Although there is current evidence that shows, stimulant medicine has an effect on symptoms of ADHD, there is no evidence available to show that the medication has an effect on long term academic success. In fact, stimulant medication does not normalize behavior. (Raggi & Chronis, 2006) In many cases children with ADHD are being medicated with daily doses of methylphenidate, a dangerous and addictive drug to control normal-range behaviors. The drugs used to treat ADHD can produce severe withdrawal symptoms, irritability, suicidal feelings, headaches and Tourette’s Syndrome. Medication treatment is less time and effort consuming, however, not always consciences of such innervation paid off. (Stolzer,2007).
Contingency management and cognitive behavior modification interventions
Contingency management and cognitive behavior modification are two interventions that have been advisable in school settings for students diagnosed with ADHD. Cognitive behavior modification refers to cognitive modeling, self reinforcement, self monitoring and self instruction. Contingency management required training teacher in the use of techniques such as token reward, positive reinforcement, contingency contracting, time out and losing privileges great number of children, diagnosed with ADHD, mostly spend their time in mainstream classrooms even if they receive special education services. Teachers need all the information available to them regarding ADHD so they can learn teaching strategies for these children (Miranda, Presentacion, & Soriano, 2002).
Contingency management and cognitive behavior modification interventions
Contingency management and cognitive behavior modification are two interventions that have been advisable in school settings for students diagnosed with ADHD. Cognitive behavior modification refers to cognitive modeling, self-reinforcement, self-monitoring and self-instruction. Contingency management required training teacher in the use of techniques such as token reward, positive reinforcement, contingency contracting, time out and losing privileges great number of children, diagnosed with ADHD, mostly spend their time in mainstream classrooms even if they receive special education services. Teachers need all the information available to them regarding ADHD so they can learn teaching strategies for these children (Miranda, Presentacion, & Soriano, 2002).
Behavior interventions
Behavior intervention is also one of the most common and efficient types of intervention. ADHD symptoms cause a number of behavior difficulties and these children are more likely to be rejected socially and have more trouble with their peers. Children diagnosed with ADHD are perceived to be less intelligent, and these children are more likely to have poorer grades, lower scores on tests, and more likely to be identified for special education. They are more likely to be absent from school and have a high drop out rate. Although stimulant medication is used to treat this disorder, there are effective school based intervention strategies for these children. Some of these interventions include modifications to instruction and home school communication programs. Article by DuPaul, Weyandt and Janusis discusses six major interventions used when working with children diagnosed with ADHD. Behavior interventions for children include an antecedent and consequence based strategy. These interventions involve modifications to the environment that directly address the impairment. An example of this type of intervention would be a teacher posting and enforcing the rules of the classroom. Rules should be stated in a positive manner. Assignments and tasks can be modified by being shortened. Reducing the length of the assignment is great for children with short attention spans. The most popular intervention for behavior is in the form of teachers praise or token reinforcement. Token reinforcers can be stickers, chips, or points that are exchanged later in the week for a larger preferred activity. Self-regulation interventions encourage students diagnosed with ADHD to monitor, evaluate and reinforce their own behaviors. Academic interventions directly address the academic skills needed for students diagnosed with ADHD. Academic interventions can be directed through teacher mediated direct instruction, computer technology and classroom peers. Home-School Communication Programs is necessary for these children. A daily report card system is an example of communication for this type of intervention, and this is one of the most frequently implemented interventions for children with ADHD. Interventions addressing social relationship difficulties are needed due to the fact that children with this disorder experience social relationship difficulties. Lastly, collaboration consultation is very important. Collaboration allows for the positive relationship among school professionals and increases the likelihood of treatment success. School based interventions are critical in order for a child to receive the treatment plans and strategies he needs to be successful in the classroom (DuPaul, Weyandt, & Janusis, 2011).
ADHD misdiagnose
ADHD is the most common reason children are referred to mental health professionals where they are prescribed stimulant medication that has increased over the past decades. A child can be misdiagnosed with ADHD because the behaviors associated with ADHD are related to the trait know as Giftedness. Children who are gifted and children who are diagnosed with ADHD show the same behaviors. Both groups are extremely active, have difficulty paying attention, act out without thinking about their behavior first, and have difficulty following rules. Both groups also experience significant social difficulties and academic underachievement. When diagnosing children with ADHD it is very common to use a behavior checklist which only addresses the expressions of behavior and not the causes of the behavior that can lead to great confusion when recognizing the difference between ADHD and Giftedness. When a child is gifted, he or she may spend more time waiting on their classmates to catch up, which causes boredom. That boredom subsequently leads to behavior problems and inattention within the classroom. Gifted children struggle with social development just like ADHD children. These similarities are so great with Gifted children and ADHD children that is extremely difficult to tell the difference. Both gifted and ADHD children have heightened activity levels and impulse control problems. The diagnosis of ADHD and Giftedness can be a difficult one to make, and misdiagnosis has harmful consequences. Once a child is labeled ADHD it is difficult for individuals to view him or her in any other way, and this often leads to inappropriate treatment such as stimulant medication. The popular medications have many negative side effects such as impairment of cognitive performance, insomnia, irritability, anxiety, sadness, and nightmares. Counselors in the public school system are often relied upon to identify ADHD children and studies suggest that they do not have the credentials to make competent decisions when it comes to the distinction between ADHD and giftedness (Hartnett, Nelson, & Rinn, 2003).
There is a major debate regarding the question of whether ADHD is over diagnosed in children. In order to answer this very important question and to be absolutely certain, one would have to investigate whether professionals that are responsible for diagnosing children with ADHD diagnose ADHD in cases where diagnostic criteria for ADHD are not fulfilled, and this type of study has yet to be conducted. As stated above, the question remains: Why are more boys diagnosed with ADHD as compared to the number of girls diagnosed each year? It is known that therapists diagnose boys with ADHD more than girls even if they exhibit the same symptoms. Some therapists may not abide by the diagnostic criteria and; therefore, their clinical judgment is affected by certain biases. (Bruchmuller, Margraf, & Schneider, 2011)
Conclusion
Attention deficit hyperactivity disorder has become an epidemic in the United States with approximately 8-10 million children being diagnosed (mostly boys). With the overwhelming majority of cases of ADHD, one might wonder if this is just a clash between a normal developing child and the everyday requirements of his or her adult controlled environment. The world is a very different place than it was decades ago when humans lived as hunters and high activity levels were crucial to the survival. Today children are subjected to video games and televisions, and these have replaced outdoor play. Schools have even restricted movement by not allowing movement, creativity and unstructured play. Males evolved in an environment where hunting and high levels of activity in order to survive and take care of their family were required. So we ask the question: Is this Attention deficit hyperactivity or normal range male behavior? ADHD in America is a big business for pharmaceutical companies, doctors, and public school in that they have all vested an economic interest in promoting the phenomenon in America. (Stolzer,2007).
References
Bloom B., Cohen R.A., & Freeman G., (2012) Selected high lights. Summery Health Statistics for U.S. Children: National Health Interview Survey, 10(254), 5.
Bruchmuller, K., Margraf, J., & Schneider, S. (2012). Is ADHD Diagnosed in According With Diagnostic Criteria? Over diagnosis and Influence of Client Gender on Diagnosis. Is ADHD Diagnosed in Accord With Diagnostic Criteria? Overdiagnosis and Influence of Client Gender on Diagnosis, 80,128-138. doi:10.1037/a0026582
DuPaula G.J., & Weyandt L.L. (2006). School-based Intervention for Children with Attention Deficit Hyperactivity Disorder: Effects on academic, social, and behavioral functioning. International Journal of Disability, Development and Education, 53(2). 161-176.
DuPaul G. J.,. Weyandt L. L, & Janusis G. M. (2011) . ADHD in the Calssrom: Effective Intervention Strategies. Theory into Practice, 50.35-42.
Harlacher J.E., Roberts N. E., &. Merrell K.W. (2006). A summery of Teacher Options Beneficial for the whole class. Teaching Exceptional children, 39(2). 6-12.
Harris K. R., Friedelander B. D., Saddler B., Frizzelle R., & Graham S. (2005). Self-Monitoring of attention Versus Self-Monitoring of Academic Performance: Effects Among Students with ADHD in the General Education Classrom. The Journal of special Education, 39(3).145-156.
Miranda A., Presentacion M. J., & Soriano M.(2002). Effectiveness of a School-Based Multicomponent Program for the Treatment of Children with ADHD. Journal of learning disabilities, 36( 6). 546-562.
Nelson, J.M., Rinn, A.N., & Hartnett, D.N. (2006) The possibility of Misdiagnosis of Giftedness and ADHD still Exist: A Response to Milka. Roper Review, 243-248
Pfiffner L. J., Villodas M., Kaiser N., Rooney M., & McBurnett K. (2013). University of California, San Francisco, 28(1). 25-56.
Raggi V. L., & Chronis A. M. (2006) Interventions to Address the Academic Impairment of Children and Adolescents with ADHD. Clinical Children Family Psychology, 9(2).
U.S. Department of Education, Office of Special Education and Rehabilitative Services, Office of Special Education Programs (2003). Identifying and Treating Attention Deficit Hyperactivity Disorder: A Resource for School and Home. Washington, D.C., 20202. Retrieved November 16, 2005, from http://www.ed.gov/teachers/needs/speced/adhd/adhd-resource-pt1.doc
Williams J., Klinepeter K., Palmes G., Pulley A., & Meschan Foy J. (2004). Diagnosis and Treatment of Behavioral Helth Disorders in Pediatric Practice. Pediatrics,114(3)
Williams, J., & Taylor, E. (2006). The evolution of Hyperactivity, Impulsity and Cognitive Diversity. Journal of the Royal Society Interface, 399-413. doi: 10.1098/rs.2005.0102
