Attention Deficit/Hyperactivity Disorder (ADHD) is a common disorder that is related with difficulties in behaviour and academic life (Sherman). There are various treatment options that are available to the children with ADHD, for example, medication and behavioural therapy, nutritional supplements etc. However, there are many other factors that can have significant psychological effects for a child with ADHD.
In this report, we are going to discuss the reasons for over diagnosis and over medicating of ADHD, the alternative treatment methods for ADHD and how educators and families can help with psychological effects of ADHD.
Reasons for over diagnosis and over medicating of ADHD
When patients are diagnosed with a disease, which eventually will not cause symptoms or early death, is what is known as overdiagnosis (Quebec Medical Association).
According to the review performed Connor, the number of school children diagnosed with ADHD was very low for school children and the number was close to zero for adolescents and adults before 1970. In the United States, number of ADHD cases increased almost eight times from 1980 to 2007 when compared to the number of cases 40 years ago. The data from the National Survey of Children's Health showed that 7.8% of young population between 4 to 17 years of age was diagnosed with ADHD and 4.3% used medication for the disorder.
Figure 1: Four Groups that contribute to overdiagnosis (Quebec Medical Association)
Some of the studies also showed overprescribing and underprescribing depending on various regions of the United States. For example, the study conducted among children in western North Carolina found that although 3.4% of children were diagnosed with ADHD, 7.3% of children received stimulants.
In general, it is hard to evaluate mental conditions, and so a condition like ADHD takes time to be evaluated properly and a multi-method assessment should be in place for the proper diagnosis of this condition.
Physicians’ clinical time constraints and payer constraints can lead to overdiagnosis of ADHD. When the diagnosis of ADHD is confirmed, treatment plans should be determined on a case-by-case basis. Some children with ADHD may not need medication, for many behavioral therapy or nutritional supplements can alone do the necessary work. For many children with mild ADHD psychological therapy and educational and family support can be effective (Connor).
It can take time to make the right diagnosis of ADHD. Filling out a standardized form and knowing a few symptoms is not an effective way to diagnose. There are other conditions that physicians may need to consider that have ADHD-like symptoms, for example learning disabilities, anxiety etc. A child’s environment along with any educational or family situation needs to be considered as well (Newman).
Other studies like QMA (Quebec Medical Association) have used a classification system of the different factors that contribute to overdiagnosis that was presented by Parmar, M. and Parmar K. (2013). These factors divided into four groups (figure 1). These groups are dependent on each other. For example, it’s possible that attitudes and needs expressed by patients’ influences the behaviour of the health care providers. Compensation methods or the organizational structure can also have an effect in the health care system.
The behavior of the patients during patient-physician interaction is also influenced by the expectations that that they have from the health care system. And last but not the least, the nature of physicians’ training is also an important factor that can influence their behavior.
Alternative treatment methods for ADHD
Many studies have been conducted research on alternative treatment options. Here we are going to discuss the review conducted by Hurt et al. Mainly, two nutritional treatments were discussed that are worth consideration for the majority of patients diagnose with ADHD. These are: Recommended Daily Allowance/ Reference Daily Intake (RDA/RDI) multivitamin or mineral supplementation and essential fatty acid (EFA) supplementation. These are described in detail below,
Recommended Daily Allowance/Reference Daily Intake Multivitamin/Mineral Supplementation
Although this alternative nutritional treatment has not been specifically evaluated in patients diagnosed with ADHD, other studies have shown that children who received RDA/RDI multivitamin supplementation improved in non-verbal intelligence, concentration and continued attention, and improvement in motor behavior.
Essential Fatty Acids (EFA)
Our neuronal membranes have phospholipids that contains large amounts of polyunsaturated fatty acids, omega-3 and omega- 6 acids. Long-chain (≥20 carbons) n-3 EFAs are found in fish, seal, etc. Both the n-3 series (progenitor α- linolenic acid) and the n-6 series (progenitor linoleic acid) have been reported to be significantly lower in children with ADHD. That is why a nutritional treatment plan with EFA may be helpful for a child with ADHD.
How can educator and families help with psychological effects of ADHD?
Educators and families can have significant impact a on the behavior and psychological effects among children with ADHD.
A child’s emotional and physical health depends a lot on their parents and siblings. Parents can take measures to gain control over the factors that can reduce the psychological effects of children with ADHD. For example, children with ADHD can perform their tasks well if the tasks have predictable patterns. They perform well when they are focused and organized and they know exactly what is expected from them. Following a routine, setting clocks and timers, keeping home neat and organized, and simplifying children’s schedule etc. can help to achieve just that. If children with ADHD have a lot of free times in their hands, then their behaviors may become chaotic. So, a child with ADD/ADHD should keep itself busy, for example parents can sign them up for a sport or art class. Simple activities at home can also take up a child’s time (Smith).
These can include regular household chores or, playing chess with their siblings. However, parents should be careful about the use of television and video games as they may increase the symptoms of ADHD.
Setting clear expectations and rules can also help the symptoms of a child with ADHD. Rules should be in place for all kinds of activities or behavior; they might even include rewards and consequences. These rules should be simple, clear and easy to understand for the child. If they behave well and follow the rules, it should be rewarded or praised. Praises can have a significant impact on the psychological effects of a child with ADHD, because they are not very used to it. Most ADHD children receive a lot of criticism about their behavior, so it is important that they receive a positive attitude from their family members (Smith).
A simple smile, or just an encouraging statement can have a huge impact on the child’s psychology. It can even improve the attention and focus of the child. It is also equally important to give negative feedback for inappropriate behavior.
Getting better sleep and doing some kind of physical activity are also equally important. Most children with ADD/ADHD usually have a lot of energy. If they do not use this energy to focus on some activity they may become chaotic. So it is important that they are involved in some kind of physical activities and this way they can focus their energy on some kind of sports and related skills. This kind of physical activity can improve focus and concentration, reduce anxiety and improve brain function. As a result of physical activity it also becomes easier for tem to get better sleep. Parents can also help with the proper diet a ADHD child may need. All these factors can significantly change the behavior of the child with ADHD and in turn can help with their psychological effects (Smith).
Educators or teachers can use similar methods described above in the classroom. Parents and teachers of a child with ADHD can even work together and get support from each other to reduce the child’s psychological effects associated with ADHD. Teachers also have significant importance in determining the level of performance for the child. For example, gesture use by teachers can have an effect on the performance of academic puzzles by children with ADHD. Student behavior is also influenced by the teachers’ views and opinions about a specific treatment option. Teachers can have a positive influence on a child’s success if they are patient, and have a positive attitude (Sherman).
Conclusion
In conclusion, there is still need for research on the overdiagnosis and overprescribing medications for ADHD. There are various alternative treatment options available that might be useful for children with ADHD but more studies are need to be performed. In the end, families and educators can play a very important role in shaping the future of a child with ADHD and help them with their psychological effects.
Works Cited
Connor, Daniel F. "Problems of Overdiagnosis and Overprescribing in ADHD: Are They Legitimate?" Psychiatric Times. Aug. 2011: 14. Academic OneFile. Web. 24 Mar. 2016.
Hurt, Elizabeth, et al. "Dietary and Nutritional Treatments for Attention-Deficit/ Hyperactivity Disorder: Current Research Support and Recommendations for Practitioners." Curr Psychiatry Rep. (2008): 323-332. Web. 24 Mar. 2016.
Newmark, Sanford. “A True ADHD Epidemic or an Epidemic of Overdiagnosis?.” PsychiatryAdvisor. Psychiatry, July 2015. Web 24 March 2016.
< http://www.psychiatryadvisor.com/adhd/a-true-adhd-epidemic-or-an-epidemic-of-overdiagnosis/article/429034/>
Quebec Medical Association. Overdiagnosis: findings and action plan. Montréal, Québec, 2014. Print.
Sherman, Jody, et al. "The impact of teacher factors on achievement and behavioural outcomes of children with Attention Deficit/Hyperactivity Disorder (ADHD): a review of the literature." Educational Research. Dec. (2008): 347-360. Web. 24 Mar. 2016.
Smith, Melinda. “ADD/ADHD Parenting Tips.” Helpguide.org. Helpguide, March 2016. Web 24 March 2016. < http://www.helpguide.org/articles/add-adhd/attention-deficit-disorder-adhd-parenting-tips.htm.>
