Attention Deficit Hyperactive Disorder ADHD

Executive Summary
Attention-deficit hyperactive disorder (ADHD) is a rare psychiatric complication, which is diagnosed among children. To children who grow into adolescence without proper diagnoses, there is a huge difference in presentation compared to patients who are diagnosed early in their childhood. They depict major challenges to the guardians and teachers attempting to cope with their condition. In most cases, the challenge is often reported late to medical practitioners (Muhammad et al, 2011).
This is a case of an adolescent with school truancy presented to a primary care clinic. At first, he was treated for depression and subsequently defiant disorder, as well as sibling rivalry. It is only after a keen and procedural follow up of the medical history that ADHD was correctly diagnosed. Further investigation was necessary because there was positive improvement after the use of methylphenidate for his condition. Escitalopram was prescribed alongside the medication to cater for his depression. The use of behavior therapy and parenting interventions played a key role in ensuring success of his management. There still remains a need to raise knowledge of ADHD through public awareness forums aimed at many parents as well as teachers exposed the children. In such a case, the changes can be instituted early (Muhammad et al, 2011).
Introduction
ADHD is a neurodevelopmental disorder, which emerges in children especially during their preschool and early school years. The disorder affects between three to five percent of ages six to nine years. According to Khemakhem et al., (2015), boys are more prone to the disorder than their female counterparts. Diagnosis remains difficult because the symptoms can be seen in all children occasionally. In most cases, accurate diagnosis is determined by the age of seven years. At this time the symptoms are obvious and may increase as the children mature. Up to sixty per cent of patients grow with the symptoms into adulthood (Khemakhem et al, 2015). A picture below depicts the prevalence of ADHD among the young people of different races.
Some of the most vivid and unmistakable characteristics of the disorder include; dif?culties with paying attention, impulsive behavior, and over-activity. Children living with this condition will not find it easy to manage their immediate reactions and often act impulsively as if they did not think ?rst. ADHD causes significant changes in the children’s activities seen when they fail to finish what they are doing. Most children with this impairment have dif?culty concentrating and remembering instructions. Those with hyperactivity often seem to talk too much and behave noisily. These children appear to be always ‘on the go’ and depict restlessness especially when they are expected to calm down. The patients may also show carelessness dangerous situations putting them at risk of harm. ADHD causes the children to constantly interrupt, and intrude on others. This challenge means they have dif?culty taking turns in games or sustaining long conversations. When they grow older, the adolescent patients are often unable to make reliable plans or get themselves organized (Khemakhem et al, 2015).
Previous Models
While there may still be no cure for ADHD to date, there are multiple treatment options available, which have proven effective for some of the patients. The most effective strategies include; behavioral, pharmacological, and multimodal methods (Henderson, 2003).
Behavioral Approaches
Effective behavioral approaches provide a wide range of specific interventions designed to achieve the common goal of manipulating physical and social environment to alter, and change behavior. These options are used in the treatment of ADHD, as they provide a structure for the child to enhance appropriate behavior. For the best outcome, it is necessary for parents to work alongside other professionals, from psychologists, school personnel, to community mental health therapists, and primary care physicians. The common types of behavioral approaches are; clinical behavioral therapy, behavioral training for parents and teachers, a systematic program of contingency management, (training in problem-solving and social skills), and cognitive-behavioral treatment (This includes; self-monitoring, verbal self-instruction, development of problem-solving strategies, self-reinforcement) (Henderson, 2003).
Generally, the available approaches utilize direct teaching and reinforcement strategies for positive behaviors and direct consequences for inappropriate behavior. Among the options available, the most effective interventions proven to provide adequate solution are the systematic programs of intensive contingency management conducted in specialized classrooms and summer camps with the setting controlled by highly trained individuals. Recent studies show that two approaches, (classroom behavior interventions and parent training in behavior therapy) have proven useful in changing the behavior of children with ADHD. Moreover, most home-school interactions support a consistent approach, and are critical to the success of behavioral approaches (Henderson, 2003).
Pharmacological Approaches
Pharmacological approaches to treatment remain among the most effective and reliable alternatives to ADHD. Although common, it is still an extremely controversial form of ADHD treatment. The most important issue to note is that the decision to prescribe any medicine remains under the jurisdiction of medical professionals. Consultation with the family are therefore, necessary before making an agreement on the most appropriate treatment plan. The treatment includes; the use of psychostimulants, antidepressants, anti-anxiety medications, antipsychotics, as well as mood stabilizers. Many stimulants are known to predominate in clinical use hence useful in treatment of patients with 75 to 90 percent success rates. They include; Methylphenidate (Ritalin), Dextroamphetamine (Dexedrine), and Pemoline (Cylert). More types of medication outside of the main medication include; are given mainly to patients who fail to respond to stimulants, or those who have coexisting disorders (Henderson, 2003).
Considering the outcome of the Multimodal Treatment Study (MTA), which are discussed in further detail in the next section, there is adequate confirmation of research findings on the use of this type of treatment for patients with ADHD. In detail, the study determined that using medication was as significant as the multimodal treatment of medication and behavioral interventions. Henderson (2003) found that the most appropriate medication stimulates these under functioning chemicals to produce extra neurotransmitters, thus increasing the child’s capacity to pay attention, control impulses, and reduce hyperactivity. For effectiveness, this medication needs multiple doses throughout the day. This means that each individual dose of the medication lasts for a short time (1 to 4 hours) (Henderson, 2003).
Multimodal Approaches
Multimodal approaches have recently become the most reliable in treatment, according to recent research. There are many studies, which indicate that a combined technique worked for many cases where youngsters displayed early ADHD indicators. For example, a recent study conducted by the NIMH, on the Multimodal Treatment Study of Children with ADHD (MTA), followed 579 patients between ages seven and 10 years. This study is one of the longest and most thorough assessments of the effects of ADHD interventions. The researchers focused on six Canadian cities and compared the effects of four interventions (behavioral intervention, medication provided by the researchers, a combination of medication and behavioral intervention, and no-intervention community care). The most reliable being medical care provided in the community (Henderson, 2003).
New Findings
Psychosocial Involvement
While most of the medications may lead to improvements in behavior for most of the subjects living with the condition, it is not a guarantee. There are a few who may not show favorable responses to medication or may have intolerable adverse effects as a result thereof. For this reason, some of the parents may choose not take the risky medication. As a result, behavior intervention has an added significance to medication. Moreover, the approach could be based on the fact that all children with ADHD require psychosocial intervention to boost their self-observation or coping skill. It is also helpful in enhancement of skills, which are often compromised by their ADHD (Tresco, Lefler & Power, 2010).
There are only a few studies, which are related to the impact of intervention in ADHD in comparison to those on stimulant treatment in ADHD. The advancement in the main symptoms of ADHD especially in academic performance, social skills, defiant and aggressive behavior was realized using behavior intervention techniques. They include; response cost for unwanted behavior and positive reinforcement. On the hand, this advancement has been short term in nature (Tresco, Lefler & Power, 2010).
Considering the psychosocial treatments, the most widely researched option was parent behavior management training. These studies focused on the option for school age children, and also those with comorbid oppositional defiant disorder. According to Tresco et al., (2010), conduct disorder and has been shown to substantially impact behavior and compliance. Parent behavior management training involves taking the parents through a tutoring process. The aim is to implement behavior therapy programs beginning in the home, enabling to target both home and school behavior. Generally use of contingency management approaches has proven effective in such cases (Tresco, Lefler & Power, 2010). Parents are taken through training in fundamentals such as positive reinforcement, and a functional behavior analysis. This knowledge is applicable to the negative behaviors, and specific behaviors are pinpointed and their frequencies tracked. Constant manipulation of behavioral targets and reinforcements is necessary to make the most out of the training sessions. Since the approach depends on parents as the agent of change for child behavior, it is most appropriate to pre-school and school age children across the board (Tresco, Lefler & Power, 2010).
There has been much focus among researchers over the role of parental behavior training. Most of the available and most commonly used techniques include training them in general contingency management tactics. They include; contingent application of reinforcement or punishment following appropriate and inappropriate behaviors. Using a parent training model, the tutorial can achieve high rates of success rate with approximately 64% of families, which are experiencing clinically significant change of their child's disruptive behavior and other symptoms (Tresco, Lefler & Power, 2010).
There has been considerable increase in pharmacogenomics research sprouting with some preliminary findings on patient-treatment matching. There has been a major detection in the interaction effect between the presence of the G allele and treatment with methylphenidate after a long time. Moreover, more findings show that individuals with T allele as one of the alleles (A/T or T/T genotypes) at the -3081(A/T) polymorphism respond better to methylphenidate treatment than those with the A/A genotype (Tresco, Lefler & Power, 2010).
Different Treatment
There is no prevailing research done which sides with any substantial advantages of substituted forms of ADHD treatment. These substitute treatments comprise of physiological brain monitoring methods, non-drug treatment in which patients voluntarily learn to control physiological processes, use of large vitamin doses in treatment, natural remedies, control of the physical anatomy, the process of organizing one’s sensations from the brain as well as particular dietary products which enhance nutrition in the body (Verma, Balhara & Mathur, 2011).
ADHD can be controlled by the use of progressive psychotherapy treatment which combines diverse treatment techniques. This is a joint determination from the treatment specialist, caregivers as well as the patients. This is to be followed by a strict plan to manage the condition. Apart from progressive follow ups which are done when managing ADHD, it is imperative to consistently stick to the therapy. Suitable protocols of physical as well as social surroundings have to be integrated in the treatment. One can obtain information on the particular medicine to use when treating ADHD from the Texas Children’s Medication Algorithm Project. Likewise, the guiding principles laid down by the Global ADHD Working Group give suggestions on how to choose ADHD therapies (Verma, Balhara & Mathur, 2011).
Awareness and Proficiency to deal with ADHD
This entails creating awareness on ADHD using different platforms so that all stakeholders affected by ADHD are able to manage the condition regardless where they are. In the family setup, youngsters with ADHD together with their caregivers ought to undergo counselling in order to accept and deal with the condition. In learning institutions, awareness on ADHD needs to be crusaded across, by forming ADHD Club as well as bringing in ADHD experts to talk to teachers, students and administrators on how to deal with ADHD. Last but not least, forming communal support platforms will go a long way in enhancing coping skills both in the patients as well as their caregivers and those around them (National Institute of Mental Health, 2016).
Personal management of ADHD can be recorded in a sheet like the one below:
Conclusion
ADHD can be described as a collection of wide-ranging conditions of the brain in relation to certain mental processes as well as behaviors. In order for physicians to be able to identify the nature of this illness in youngsters as well as mature people, it is imperative for them to generate indicators for diagnosis which are custom made for each age group. Currently, the use of pharmaceutical drugs which offer a reprieve for ADHD include: modified drugs whose effects are gradually released into the system, drugs which are enteric-coated to prevent them from being inactivated by gastric juices, inactive drugs which are activated upon consumption, medicated adhesive patches as well as drugs which target the brain cells to improve attention (Vasconcelos et al, 2003).
Attention deficit hyperactivity disorder (ADHD) affects the behavior patterns in toddlers, teenagers as well as mature people. The key traits of ADHD are lack of concentration, too much activity as well as reacting at the spur of the moment. ADHD affects all factors of one’s life, from the domestic relations to poor performance in school. Managing ADHD requires tapping into various dimensions such as understanding the victim’s background and using treatment which involves the victim’s daily surroundings. While treating patients with ADHD, it is imperative to utilize the stated dosage to minimize any adverse outcomes (Virtual Medical Centre, 2017).
Continual integration of pharmaceutical medications as well as the victim’s physical and social surroundings are crucial in enhancing a normal lifestyle for ADHD victims (Vasconcelos et al, 2003).
Reference
Henderson, K. (2003). Identifying and treating attention deficit hyperactivity disorder: a resource for school and home. US Department of Education Office of Special Education and Rehabilitative Services, Washington, DC.
Khemakhem, K., Ayadi, H., Moalla, Y., Yaich, S., Hadjkacem, I., Walha, A. & Ghribi, F. (2015). Attention deficit hyperactivity disorder at schools in Sfax-Tunisia. La Tunisie Médicale, 93(5), 302-307.
Muhammad, N. A., Wan Ismail, W. S., Tan, C. E., Jaffar, A., Sharip, S., & Omar, K. (2011). Attention-deficit hyperactive disorder presenting with school truancy in an adolescent: a case report. Mental health in family medicine, 8(4), 249-54.
National Institute of Mental Health. (2016, March). Attention-Deficit/Hyperactivity Disorder. Retrieved February 21, 2019, from https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml
Vasconcelos, M. M., Werner Jr, J., Malheiros, A. F. D. A., Lima, D. F. N., Santos, Í. S. O., & Barbosa, J. B. (2003). Attention deficit/hyperactivity disorder prevalence in an inner city elementary school. Arquivos de neuro-psiquiatria, 61(1), 67-73.
Verma, R., Balhara, Y. P., & Mathur, S. (2011). Management of attention-deficit hyperactivity disorder. Journal of pediatric neurosciences, 6(1), 13-8.
Virtual Medical Centre. (2017, June 13). The Family Impact of Attention Deficit Hyperactivity Disorder (ADHD). Retrieved February 21, 2019, from https://www.myvmc.com/lifestyles/the-family-impact-of-attention-deficit-hyperactivity-disorder-adhd/
Tresco, K. E., Lefler, E. K., & Power, T. J. (2010). Psychosocial Interventions to Improve the School Performance of Students with Attention-Deficit/Hyperactivity Disorder. Mind & brain: the journal of psychiatry, 1(2), 69-74.