Contemporary approaches to treating children’s and adolescent’s attention-deficit hyperactivity disorder

The author is a parent of a kid who was diagnosed with attention deficit hyperactivity disorder (ADHD). Instead of following the doctor’s advice she researched the topic and identified alternative ways to successfully combat the disorder. According to the data collected by National Health Interview Survey ADHD is among the most common disorders among the younger generation especially among adolescents. 8% of children and 15% of adolescents (“General Prevalence of ADHD”, 2020) suffer attention-deficit hyperactivity condition (ADHD). It is described by damaging levels of inattentiveness, impulsivity and hyperactivity. ADHD negatively impacts school performance, causing kids to repeat grades or even drop out of school. This disorder also makes establishing the social relationships difficult. Though treatment can be an operational cure for persons of all ages who have ADHD, further efforts are required for those with the syndrome. Responders to ADHD treatments, can also have important remaining signs and impairment postmedication management. As clinicians evaluate the advantages and disadvantages of lasting prescription use for every child or adolescent they mention about the importance of the corresponding medications. Drugs are not the only option for treating ADHD.

Kids who have attention-deficit hyperactivity condition (Sprich and al, 2016) demonstrate impairing levels of inattention, hyperactivity, and impulsivity. This disorder is usually first detected in childhood and regularly continues into adulthood. It is common for kids to have trouble concentrating and performing at one time or another. Nevertheless, children having ADHD never mature from these manners causing problems at school, home, or when they are with friends. ADHD in teens can place them on a line to negative results such as drug abuse, dangerous driving (Sprich and al, 2016). ADHD is categorized into three groups, they are determined based on the type of the strongest symptoms. First is the Predominantly Inattentive Presentation. For a person with this sort of ADHD it is difficult to establish or end an assignment, to be attentive to information, or to follow directives or dialogues. The other type is the Predominantly Hyperactive-Impulsive Presentation. An individual with this sort of disorder plays and talks more. It is difficult for him / her to be still for long time. The individual feels impatient and has problem with impulsivity. The third type of ADHD Collective Presentation when symptoms of the above two types are both present (“What is ADHD?” 2020).

From the neurobiological stand point the dysfunction in the corticostriatal-thalamic-cortical loops have remained related with ADHD. Catecholamine (dopamine and noradrenaline) dysfunction has similarly been involved in ADHD. The best normally used prescriptions act on this structure. Neuroimaging studies have shown that the stimulant medications have corrected hindered brain development, minor basal ganglia, cerebellum plus frontal lobes (Bhat, 2016). Stimulating medications act on dopamine and noradrenaline reuptake inhibitions, and presynaptic release. Methylphenidate is a dopamine reuptake blocker, dexamphetamine gets almost dopamine blockade and presynaptic relief. Various medications are accessible in generic and patented drugs and contain immediate release (IR), slow release (SR), extended release (ER), and long lasting (LA) inventions. Ritalin (methylphenidate formulation) is the most common medication for treating ADHD. It is available in 3 forms with the longest duration action of 5-6 hours (Ritalin SR). Biphentin is another methylphenidate formulation lasting up to 8-10 hours. Different chemical formulations have a range of side effects including decreased appetite, weight reduction, initial insomnia, and headache and rebound irritability. Recently there has been a rise of interest towards alternative ADHD treatments.

Cognitive behavioral therapy (CBT) remains a problem-specific, goal-oriented tactic that requires the person’s lively participation to succeed. It is a form of psychotherapy that emphases on their present-day encounters, opinions, and actions. Frequently, a sequence will consist of 20 one on one gatherings, however this is not an every time the case. CBT is a cooperative therapy, demanding the person and therapist to work together. Agreeing to the American Psychological Association (APA), the individual finally acquires to be their own counsellor. CBT is based upon a number of beliefs: starting with unsupportive conducts, learning unhelpful behavior and learning more advantageous ways of reasoning and acting are some of the aspects people consider can cause psychological issues. New habits can also release signs of mental and physical situations and let people act in enhanced ways. Physicians base CBT on the philosophy that difficulties arise from the denotations people provide to events, together with the events themselves. CBT can have a beneficial influence on how people feel, act and provide them with managing policies that help them cope with encounters. Even though CBT is a potential therapeutic solution for treating ADHD medical treatments represent a traditional approach.  

ADHD is adversely associated with a variety of educational achievements. The researchers applied Danish managerial record data to examine the influence of medical treatment of ADHD on children’s educational performance (Keilow, Holm & Fallesen, 2018). The grade point average (GPA) was used as a performance criteria. By use of organizational register statistics on children, who start medical usage, the researchers conducted an ordinary experiment to assess the outcome of medical usage on school-leaving GPA. This study evaluated a very significant number of cases which exceeded 550,000. The researchers sampled all kids detected with and cured of ADHD out of the overall number of kids, those finished Danish compulsory schooling from 2002 to 2011. To discover kids who were psychologically cured, they choose children, who redeemed one medicine for any sort of ADHD prescription (atomoxetine, methylphenidate, and modafinil) amid teenage and about to school-leaving examinations. To define the influence of medical cure of ADHD, the investigators used the longitudinal data and defined three types of pharmacological treatment patterns: Discontinued Pharmacological Treatment (DPT), Continuous Pharmacological Treatment (CPT) and Ambiguous Pharmacological Treatment (APT). The variance amid the three types of management allowed the researchers to assess the influence of treatment. DPT was defined as having acquired prescription for extreme three months inside the statistics window that only permitted the original medicine test and dosage titration. Similarly, the description of continuous treatment (CPT) was limited to kids, who possess a consistent and unwavering application of medication with procurements being not further than three months spaced out. The designs of the residual category, the APTs, were unclear as they could not be persuasively kept in either one of DPT or CPT group. These are kids, who recurrently come in in and out of medical usage. Totally the three groups were equally limited. In every evaluation, CPT was a reference cluster, where the researchers investigated other treatment influence of DPT and APT (termination and uncertain treatment) related to CPT (constant treatment). The substantial influence of treatment on both exam and teacher estimated GPAs was observed. The data showed the drop of the both types of the GPA’s for kids from part or full treatment discontinuation groups. It was found that amplified efficiency of the medication of ADHD might ease part of the GPA gap amid children detected with ADHD and their peers. The results also demonstrated that medication might control the undesirable social outcomes of ADHD. Worth mentioning that the contemporary medical industry also offers alternative ADHD treatments.

CBT can be efficiently applied for treating ADHD in kids and adolescents taking psychiatric drugs. 46 adolescents between ages 14 and 18 participated in the study performed by S. E. Sprich and colleagues (Sprich and al, 2016). The adolescents had a principal ADHD diagnosis through a Clinical Global Impression Severity Rating of 3 or more which is equivalent to moderate or more severe form of ADHD. Other criteria of the participant’s selection was a constant dosage of an FDA-approved prescription. Every participants finished seven units of medication over 12 sessions, 10 of which were one psychotherapist to one teen, and the remaining two involved the parent as well. The majority of the ratio of 1:1 sessions were devoted to psych education, planning, organization, distractibility and adaptive reasoning. The parent-adolescent conferences were focused on educating parents about ADHD with the goal of extending the treatment upon completion of the formal part. The researchers used the extensively evaluation scale to determine overall anguish and damage related to ADHD signs. CBT resulted in the reduction of the adolescent symptoms severity. CBT-targeted therapy for adolescent ADHD may serve as a much-needed alternative or complement to medication.

Important to mention that CBT can be efficiently applied for treating ADHD in kids and adolescents not taking psychiatric drugs. The Spanish researcher A. Mirada conducted the study to investigate the influence of the medication program of a cognitive-behavioral coordination for overactive kids and if the influences of these medication endure over any span of time (Miranda, 2000). 42 kids aged 9 to 12 years old participated in the study. The participants met a number of criteria including ADHD diagnosis based on 2 worldwide acceptable mental disorders scales. “Stop and Think” interference program published by Kendall and his team in 1980 was utilized with minor adjustments. This cognitive-behavioral self-discipline therapy comprised reasoning and acting techniques (modeling, self-instruction, and behavioral contingencies) used to solve numerous difficulties. Its major objective was to advance attentiveness and thinking. The kids were taught to use self-instructional approaches through the procedure of problem-solving to deliberate possible options of action, to mirror on potential consequences, and to make choices about preferences. The message of self-instructions included five stages: one is the problem definition (“What do I have to do?”); then the problematic approach (“I have to think of all possibilities”); third, concentrating attention (“I have to concentrate and think of nothing else”); fourth, choosing an answer (“Having considered all possibilities, I think this is the correct answer”); fifth, self-test/self-reinforcement for precise performance or rectification of mistakes (“I have worked well. Or I have made a mistake. I’ll do better next time if I remember to slow down”). To enable the attainment of self-instructions, kids accomplished numerous psych educational responsibilities (word puzzles, or tangram puzzles, arithmetic problems) during 12 sessions. In the beginning of every session the counselor displayed the steps of self-instructional process while acting the first assignment of this session. She also established the use of managing approaches after an improper reply, designed to substitute overly bad reports with more suitable reports. Then she requested the kids to apply self-instructions to alike tasks. There were three conferences debating personal problem-solving responsibilities where the kids got trained to identify personal plus other’s opinions and moods, to recognize signals that show what the others are reasoning and feeling, and to determine the possible reasons of such emotions. Lastly, the therapist educated them to use self-instructions to theoretical problems and afterward with real-life problems. The intervention program was used in 22 sessions for a period of 3 months. Then the trials applied to assess the effectiveness of the courses comprised of teacher plus parent forms selected to get facts concerning the youngsters’ overactive characters also about the difficulties kids undergo at home as well as school. Evaluation was completed at three time periods: past cure, just after cure, and about two months after the cessation of medication (follow-up valuation). Results of the tests post hoc indicated that children recorded expressively better in each variable throughout the posttest stage than the phase before test. The variables included the mental disorders evaluation, antisocial, school problems, psychopathological disorders and internalization criteria. The noteworthy differences were likewise preserved in the follow-up stage.

References

Bhat V., Hechtman L. (2016). Considerations in selecting pharmacological treatments for attention deficit hyperactivity disorder. Clinical Pharmacist, Feb 2016. Retrieved from: https://www.pharmaceutical-journal.com/research/review-article/considerations-in-selecting-pharmacological-treatments-for-attention-deficit-hyperactivity-disorder/20200602.article?firstPass=false

Centers for Disease Control and Prevention. (2020). What is ADHD? Retrieved from: https://www.cdc.gov/ncbddd/adhd/facts.html

Children and Adults with Attention-Deficit/Hyperactivity Disorder. (2020). General Prevalence of ADHD. Retrieved from: https://chadd.org/about-adhd/general-prevalence/

Keilow M., Holm A and Fallesen P. (2018). Medical treatment of Attention Deficit/Hyperactivity Disorder (ADHD) and children’s academic performance. Plos One. Retrieved from https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0207905