The Attention-Deficit Hyperactive Disorder (ADHD) affects 3-5 percent of school age children and of them 50 percent that are referred to clinic tend to have symptoms that pursuit till adolescence (Brown, 2000; Sales, 2000). Children diagnosed with AHDH are at greater possiblities of having learning, behavioral and emotional difficulites throughout childhood and adolescence. Resulting in lower occupational staus and higher chance in being diagnosed with psychiatric problems such as anti-social personalty disorder or substance abuse.
Children diagnosed with ADHD have difficulty with social interactions and family members (Kollins et al. , 2001; Miranda and Presentacion, 2000). Thus, effective treatment is required due to the adverse outcomes. This study focuses on examining an efficacy intervention focusing on three approaches such as drug therapy, behavioural/psychosocial therapy and the combination of both the therapy.
Various scientific studies that have been conducted over the years have tried to determine the most efficient intervention. Purdie et al. 2002) conducted a meta-analysis of 74 studies over years and concluded that medical intervention had a higher effect size compared to behavioural intervention. But drug therapy had its own side effects thus showing that each approach has it’s own weakness (Purdie et al.
, 2002). Though educational intervention a better cognitive outcome was produced than the use of medical or psychological approach (Purdie et al. , 2002). The use of medication as a suggested treatment for ADHD created a controversy, especially on the side effects and pharmacological use.For example, the long term use of drugs throughout childhood could lead to an increase in risk of substance abuse by 50 percent (Sales, 2000).
Drug therapy having either a positive or negative long-term effect has yet to be unresolved. The purpose of this study is to understand if behavioural intervention is sufficient and drugs are not necessary for ADHD (Sales, 2000). The study would cover on the risks of children diagnosed with ADHD, drug therapy, behavioural intervention and education intervention (Sales, 2000).Children with ADHD tend to be socially withdrawn, timid, perform poorly in both academic and sports. They are also more likely to be diagnosis with other learning and behavioural disorders.
Teachers report that ADHD children being more inactive and slow in movement related skills (Erk, 2000). Hynd et al. (1991) stated ADHD children tend to be self-conscious, have lower intellectual process and higher chance of suffering from learning disorders such unable to do basic maths, experiencing language delays (Erk, 2000), or having difficulties with reading (Piseccoet al. 2001).
Of these children, 30-50percent suffer with behavioral disorders (Erk, 2000; Kendall et al. , 1980; Sales, 2000), 60 percent are diagnosised with oppositional-defiant disorder, almost 50 percent with mood disorder (Brown, 2000) and as many as 60 percent of them suffer from depression, anxiety, and convulsions (Kollins et al. , 2001). Usually children with ADHD, as many as 60 percent of them come from a household whose parents are most likely to have this co-existing disorder or come from an abusive family background.
A combination of certain genetic and environmental factors creates a higher risk of an ADHD diagnosis leading to learning disabilities (Sterman, 2000). The availble drug therapy helps to reduce symptoms of ADHD and the functioning of the child rather than a cure. The common medication taken is called “stimulant”. Stimulant is rapid in its action and the side effects are generally considered mild.
The most popular stimulant is Ritalin followed by Dexedrine and Cylert. 2. 8 percent of school-aged childern that suffer from ADHD use Ritalin.Few other medications are non-stimulant and works differently, reducing hyperactivity and improving physical coordination (English et al. , 2009). These might not work for all children with this disorder thus need to be closely monitored.
The most commonly used is aromoxetine, a selective non-repinephrine reuptake-inhibitor. While atomoxetine rarely normalizes behaviour, symptom improvement is often reflected in social and behavioural function (English et al. , 2009). To understand exactly how the medicines help improve ADHD we have to look into the neurogenetics of ADHD.Research at Vanderbilt University Medical Center identified that there is a genetic variation that affects the brain chemical, thus contributing to ADHD (Kerig, 2012). Three different brain chemicals are affected which makes it easier to differeniate the the three types of attention deficit hyperactivity disorder: Predominantly hyperactive-impulsivness like figeting and doing things without thinking, Predominantly inattentivness like experiencing difficulty to pay attention and Combined hyperactivness-impulsiveness that shows symptoms of both (Kerig, 2012).
Specifically, variation on the transporter genes, which allow drugs to enter cells or in some cases act to keep them out have been show to differenaite the three different adhd subtypes, thus the transporter would allow the supply of another brain chemical in the synaptic gap so as to receive proper signalling (Kerig, 2012). Children with predominantly inattentive ADHD have changes to their noreprinephrine levels in their brains.Those with predominantly hyperactivity impulsive adhd have changes to their dopamine transporter gene, which affects the the dopamine level in the brain (Nikolas et al. 2010). In support of these findings, medication in the market for ADHD, both stimulant (Ritalin) and non-stimulant (Strattera), target these particular neurotransmitters blocking its transporter (Nikolas et al. , 2010).
For example, predominantly hyperactive-impulsivness is treated with drug Ritalin usually as it is thought to act mostly as a blocking dopamin transporter thus increasing the supply of dopamine in synapse (Nikolas et al. , 2010). Choline transporter gene is related with the combined hyperactive- impulsiveness (Gromisch, 2010).Being the precursor to acetylcholine, choline along with norepinephrine and dopamine sends messages between the gaps of the nerve cells. Importantly, no medication exists for this specific neurotransmitter, which may go some way to explaining why medication is less effective in those with the combined type (Nikolas et al.
, 2010). Dopamin and norepinephrine does not control the emotional dysregulation but rather the reward processing behavior in ADHD (Nikolas et al. , 2010). Thus leading to the understanding that another gene is related to ADHD, which is the 5HTTLPR, a serotonin transporter gene. HTTLPR, consist of a “short” allelic variant and “long” allelic variant that is connected to ADHD which causes mood disorder in ADHD.
This alleles are due to either low or high serotonin transporter activity (Nikolas et al. , 2010). Neurotransmitters may not only identify the cause ADHD but may also be crucial in identifying the most appropriate medication to manage symptoms. However, it is important to highlight that genes wont be the only factor causing the onset of ADHD (Nikolas et al. , 2010).
Researches conducted showed that parents of childen with ADHD perferred behavioral intervention as a treatment before including medication (Kollins et al. , 2001). Futher researches also added counselling as a necessary treatment for the mood and anxiety disorder associated with ADHD (Barabasz & Barabasz, 2000; Brown, 2000). In a behaviour modification therapy, trains children with ADHD that positive attention is received with appropriate behavior, and that withdrawal, extincition or punishment comes for unacceptable behavior.Other such behavioural interventions are the monitoring antecedent behaviour, reinforcement plans and modelling behaviors.
This behavior therapy has its own limitations thus in need of a continued intervention, highly dependable on parents and teachers cooperation and is costly (Barabasz and Barabasz, 2000; Grantham, 1999). Kendall et al. (1980) started a course called “Stop and Think” that helps train to improve the concentration and reflection of children that are affected by ADHD. The program uses techniques that involve analysing, behaviour modeling and refinforcement.
Miranda and Presentacion (2000), included anger management tatics in the Stop and Think program for children with and without aggressiveness. The program helped the children understan the cues of anger and relaxation techniques. The combine therapy resulted in a long-term positve effect on anti-social behaviour. Combine approach was proclaimed better than just the Stop and Think; however the combine approach could not pull of the changes expected in school performance or scoial adjustment thus doubt ADHD as a pathological problem.Keirsey (1998) stated that different children possessed a different type of temperament that could resemble ADHD, assessing that the personality involves 40 percent of those elementary school population.
Keirsey (2002a) claimed that it was likely that the children wont interested in their acadamic thus included counseling technique, “abuse it-lose it”, which involved studets who habitually disrupted classes (Keirsey, 2002a).Alfred Adler, Erik Erickson, and Rudolph Dreikurs from whom this method was adopted off through the concept of logical consequences, thus the program Abuse it- Lose it, allows the child to understand the consequence of inappropriate behavior leads the child to a lost of privilege. Keirsey (2002b) states in his study that, a child would only understand a lesson depends on the way he or she is treated. Its through this the child is able to relate and learn to control over privileges. Levine (2003), criticized on the fact of labelling children.
He felt that ADHD was not a disability but rather a child who needed a different way to learn. He also mentioned that due to labeling it caused a child to be misguided and destructive instead it should be a specific learning problem. He futher argued that ADHD has been an excuse used for a general learning problem that’s due to a neurological malfunction that’s related to distraction, language processing or information sorting. Levine futher explained the possiblity to analysis a child’s attention issue as a psychological problem but rather just a neurocognitive without being judgmental.Levine (2002) created an evalution of a child’s learning that involved the parents, teachers and the child, called it “attuning” which created the learning profile of the child. Levine (2002) reasoned that with limitation of medication influencing learning performance, with the influences of teachers clarifying the difficulites the child has allows the child to be able to have control over their academic progress.
The theory of neurocognitive by Levin, hypothesed, that, the brain has the ability to provide the relative areas specfic tasks like cognitive and analytical.Thus, according to the theory, the teachers would be able to understand and thus help pinpoint to the student’s strength and weakness. Critics claimed the ideas protrayed by Levine were of the same as Gardner’s multiple intelligence theory. While others claim that his attuning method was of asking too much from the ADHD children (Reunzel, 2001).
A meta-analysis that was conducted stated a higher outcome proven in medical intervention than to behavioural intervention (Purdie et al. , 2002). With the requirment of high conclusive diagnositic ADHD requires a high incidences of existing disorders.Children affected by ADHD differ from normal children, physiologically and neurologically, but this doesn’t make them abnormal but rather having a normal variation. To improve learning, researchers have recently begun understanding the relationship between brain functions, temperament, and psychotherapy. Many researchers have claimed that its not been proven whether stimulant increases the chance of substance abuse or have long-term side effects.
Therapies shouldn’t have dangerous side effect.Not all ADHD children needs medication as per mentioned earlier, medication only helps reduce symptoms, thus if symptoms arent detrimental, other interventions can be taken into consideration. These days parents, teachers and doctors make decisions based on the requirment of combination of therapies including the in take of medication. As they consider that the drugs would help reduce difficulty in controlling the activeness of the child and through behavioural and education intervention helps educate and make the child understand the neccessity of displaying an appropriate behaviour that’s acceptable.
