Mental Health and Adhd

¶ … Program-Evaluation -- Evidence-Based Practice: Case Study Review There is growing recognition that the used of evidence-based practices promotes improved clinical outcomes and can help guide clinicians in their respective disciplines. This paper draws on the Clinician's Guide to Evidence-Based Practices: Mental Health and the Addictions to provide a description of a salient case study and the identification of the critical elements that require the review of published research to guide professional practice. In addition, a summary of a research study by Spengler, P. M., White, M.

J., Egisdottir (2009) that informs evidence-based counseling practice related to the selected case study as it would occur in a specialization area is followed by a discussion concerning relevant ethical, legal, and socio-cultural considerations that apply to the case and research article selected. Finally, a summary of the research and important findings concerning the need for evidence-based practices to guide professional practice today are presented in the conclusion.

Description of a Salient Case Study: "Jonathon, an engaging and rambunctious 8-year-old white boy." This young learner is a middle child of married, working parents who live together but who experience ongoing marital strife characterized by a pattern of separation and reconciliation. Although the case study makes no mention of Jonathon's kindergarten teacher, the point is made that due to his unspecified classroom behaviors, both his pre-school and first-grade teachers believed this young man suffered from attention deficit hyperactivity disorder (ADHD).

Moreover, even Jonathon's mother concedes that he is "smart as a whip but a real handful" (p. 12). Based on an evaluation by a school psychologist when Jonathon was in the first grade, a diagnosis of ADHD (mixed type) and mild to moderate oppositional defiant disorder (ODD) accompanied by family tensions.

Despite an offer from Jonathon's pediatrician (who ordinarily treats his asthma) to prescribe psychostimulants for these diagnosed disorders, the young man's father is strongly opposed; however, both his mother and father are concerned about Jonathon's condition and both are amenable to participating in "a few family meetings" only due to their heavy working schedules and ongoing marital discord which preclude extensive outpatient treatments.

Analysis of Need for Evidence-Based Practice in Jonathon's Case Prior to 1968 when the American Psychiatric Association first included a mention of hyperkinetic impulse disorder in the second edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM), there were no children in the United States diagnosed with ADHD because the condition simply did not exist formally (Holland & Higuera, 2015). Just a half century later, though, between 5% and 11% of all children and adolescents in the U.S.

are being diagnosed with ADHD which makes the disorder one of the most commonly diagnosed conditions of young people in clinical settings in the United States today (Qureshi & Schofield, 2014). These statistics means that approximately 6 million American children are currently diagnosed with ADHD (Understanding ADHD in children, 2016).

While the potential exists that the increased diagnosis of ADHD is attributable, at least in part, to growing awareness of the disorder on the part of educators, parents and clinicians, the possibility also exists that this heightened awareness has translated into a tendency to diagnosis all children who engage in disruptive behaviors as suffering from ADHD.

The nonspecific diagnostic symptoms of ADHD, however, are commonly associated with a number of other childhood-onset disorders including mood and anxiety disorders as well as the various types of normal "rambunctious" behaviors that Jonathon has routinely exhibited (Qureshi & Schofield, 2014). Indeed, Elik and Corkum (2015) emphasize that young learners who engage in ADHD-type behaviors tend to exacerbate teachers' stress levels, giving them a powerful incentive to have these young people medicated to allow easier classroom management.

Not surprisingly, then, there is growing concern among clinicians that many young people are being misdiagnosed with ADHD due to the vagaries of the DSM diagnostic guidance and the fact that many young learners, especially males, tend to engage in disruptive behaviors as a natural part of the maturation process (Toplak, 2015). Indeed, many young people tend to react to the types of home environment being experienced by Jonathon in ways that resemble ADHD.

For instance, Toplak (2015) emphasizes that, "Anxiety problems, a reaction to a traumatic event, and a change in family constellation such as divorce can also result in ADHD symptoms" (p. 53). Further, it is reasonable to posit that most children exhibit one or more of the symptoms of ADHD such as fidgeting at their desks, losing their lunch money, talking out of turn, or an inability to concentrate from time to time and over time.

Simply exhibiting one or more of the symptoms of ADHD on a transient basis, though, is insufficient evidence to support a diagnosis of ADHD and the administration of powerful psychotropic drugs to young people (Toplak, 2015). Therefore, the application of appropriate evidence-based practices for the diagnosis of ADHD is absolutely essential (Qureshi & Schofield, 2014). In this regard, Dodson (2007) emphasizes that, "ADHD is too complex for any set of guidelines to address every situation" (p. 82).

In order to make the diagnosis of ADHD as accurate as possible, Dodson (2007) and like-minded clinicians recommend the use of clinical practice guidelines to supplement the diagnostic criteria set forth in the DSM. For instance, Dodson (2007) advises that, "Clinical practice guidelines for the diagnosis and treatment of ADHD in children and adults represent a consensus on the minimal standards and most reasonable, evidence-based practices" (p. 83).

While clinicians tend to become more accurate in their diagnostic abilities as they gain education and experience, this improvement is only moderate, meaning that the potential for misdiagnosis always exists, particularly with less experienced and educated practitioners confronting ADHD for the first few times (Spengler, White & Egisdottir, 2009). This point is also made by the experts at Duke University Medical Center who point out, "Evidence-based practice is the integration of clinical expertise, patient values, and the best research evidence into the decision-making process for patient care.

Clinical expertise refers to the clinician's cumulated experience, education and clinical skills" (Overview of evidence-based practice, 2016). Conclusion Assuming that the diagnosis of ADHD made by Jonathon's school psychologist was accurate (this remains uncertain), there are evidence-based practices for his treatment that are consistent with his school and family circumstances. Besides psychotropic medications (which Jonathon's father opposes as well as many young people who are.