Introduction: Most people have heard of the term Attention Deficit Hyperactive (ADHD) disorder. "Attention Deficit Hyperactivity Disorder (ADHD) is a neuro biological disorder that interferes with an individual's ability to attend to tasks (inattention), inhibits one's behavior (impulsivity), and may interfere with a person's ability to regulate one's activity level (hyper-activity) in developmentally appropriate ways (Barkley 19) ." The most important job for teachers and parents is to separate fact from fiction, to clarify what we know and don't know. Properly diagnosing ADHD, medication choices, and behavioral interventions are the key focal point. Is medication truly worth the side effects? Diagnosing ADHD As the name implies, ADHD is typically characterized by two distinct sets of symptoms: inattention and hyperactivity / impulsivity. Although these problems usually occur together, one may be present without the other and still qualify for an ADHD diagnosis. Children are diagnosed with ADHD when they have met specific guidelines within these two categories.
A number of parents observe signs of inattentiveness, restlessness, and impulsivity in their child even before their child starts school. The child might lose attention while playing a game or watching TV, or the child might dash about totally unrestrained. Since children mature at different levels and vary in character, nature, and energy levels, it is critical to obtain a specialist's diagnosis of whether the behavior is suitable for the child's age, the child has ADHD or the child is simply immature or uncommonly high-spirited. To qualify as having ADHD, the symptoms must significantly affect a child's ability to function at home and at school.
A diagnosis is based on the guidelines provided in the "American Psychiatric Associations Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) published in 1994 (Barkley 133) ." In general, children are diagnosed with ADHD if they show at least six symptoms from each category. Dr. Berkley lists the following symptoms for each category: Inattention: o Often fails to pay close attention to details or makes careless mistakes in schoolwork or other activities o Often has trouble sustaining attention during tasks or play o Often doesn't seem to listen when spoken to directly o Often doesn't follow through on instructions and fails to finish schoolwork, chores or other tasks o Often has difficulty organizing tasks or activities o Often avoids or dislikes tasks that require sustained mental effort, such as schoolwork or homework o Often loses things needed for tasks or activities, such as books, pencils, toys or tools o Is often easily distracted o Is often forgetful Hyperactivity - impulsivity o Often fidgets with hands or feet or squirms in seat o Often leaves seat in the classroom or in other situations where remaining seated is expected o Often runs or climbs excessively when it's not appropriate, or, if an adolescent might constantly feel restless o Often has difficulty playing quietly o Is often 'on the go' or acts as if 'driven by a motor' o Often talks excessively o Often blurts out the answers before questions have been completely asked o Often has difficulty waiting his or her turn o Often interrupts or intrudes on others by butting into conversations or games (Barkley 133-134) Medications Medications have been utilized to treat the symptoms of ADHD for decades. The medications that appear to be the most efficient and most prescribed are a class of drugs branded as stimulants. The classes of medications such as Concerta (R), Ritalin (R) and Ritalin SR (R) /LA (R) are "nervous stimulants that help increase attention and decrease impulsivity in individuals with ADHD ("Prescription Medication Overview") ." Research done at Brookhaven National Laboratory has show that people taking stimulant medication in its prescribed form do not become addicted or abuse the medication. Concerta (R) is a time-release formulation with treatment lasting 12 hours.
Some of the side effects for this medication include headache, stomach pain, sleeplessness, and decreased appetite ("Prescription Medication Overview") ." Additionally, this mediation often takes up to four weeks to realize its full effect. Some benefits are only a single daily dose is required, it increases attention span, helps with on task work, and assists with controlling hyperactive symptoms. Ritalin (R) is given two or three times daily and is a fast acting medication that is quickly assimilated and used by the body. Ritalin SR (R) and Ritalin LA (R), have longer durations of approximately 8 hours and therefore requires only one dose daily. Side effects for the Ritalin line include "nervousness, stomach pain, sleeplessness, and decreased appetite ("Prescription Medication Overview") ." Benefits of the Ritalin (R) are a fast acting potential, increases attention span, help with on task work, and assists with controlling hyperactive symptoms.
Additionally, other side effects seen in, which is the active ingredient in both Concerta (R) and the Ritalin (R) line, may include; "nausea, vomiting, dizziness, tics, allergic reactions, increased blood pressure and psychosis (Prescription Medication Overview) ." The newest medication approved by The U. S. Food and Drug Administrations is not a stimulant. This new drug is Strattera (R).
Strattera (R) is a "selective norepinephrine, a neurotransmitter and re uptake inhibitor ("Strattera") ." This differs from the stimulants which predominantly work on dopamine. Both of these neurotransmitters are assumed to play a part in ADHD. Additional studies will have to be made to distinguish Strattera (R) from other medications that are already available. Evidence as of the present loosely suggests that children with ADHD using Strattera (R) have noteworthy progress in their symptoms.
("ADHD"). Side effects often seen in patients taking Strattera (R) include upset stomach, decreased appetite, nausea, vomiting, dizziness, tiredness and mood swings ("Prescription Medication Overview") ." As with Concerta (R), Strattera (R) often takes four to six weeks to become completely effective. Unlike Concerta (R), Strattera (R) provides twenty-four hour treatment when taken daily. ("Strattera") When utilized under medical supervision, the stimulant drugs are frequently considered harmless. Stimulants are not capable of making the child feel 'high,' even though a number of children report that they feel different or funny.
However, these tend to be minor changes. Even though parents are often concerned that their child may possibly become addicted to the medication, currently there is no credible substantiation that stimulant medication, when utilized for management of ADHD, is proven grounds for drug abuse or dependence. A review of all long-term studies on stimulant medication and substance abuse, conducted by researchers at Massachusetts General Hospital and Harvard Medical School, found that teenagers with ADHD who remained on their medication during the teen years had a lower likelihood of substance use or abuse than did ADHD adolescents who were not taking medications (Wilens 179-185) The issues of triggered drug abuse by ADHD medications is still being studied and documented. While no single management is the answer for every child with ADHD, successful treatment is increased when medications are used in conjunction with behavioral therapy. Behavioral Interventions An important approach to treating ADHD, either in a non-medical or in conjunction with medication, is behavioral therapy or behavior management. Organization and positive reinforcement are key components to a behavioral treatment program.
Children with ADHD will require assistance in organizing. This includes the organization of everyday items, writing schedules down, writing down assignments, and keeping personal items in order. A good place to start is to have a place for everything and specify it in accordance to its location. This would include school supplies, bags, clothing and other personal items.
At home, parents should lay emphasis on the significance of assignments being written down and bringing home required books. The harder part of behavioral treatment or behavior management is developing a good behavior plan. Children with ADHD necessitate dependable and consistent regulations that they can comprehend and adhere to. Incentives are also recommended for rules that were followed. Children with ADHD are often susceptible to receiving criticism and they expect it; therefore it is vital to emphasize to them the importance of good behavior, and one of the best way to the importance to them is to praise good behavior. Although plans are as varied as the child they are designed for, Dr.
David Rainer provides several general principles that are important; Keep these in mind; o Be very clear about what behavior is expected of the child in order to earn the reward and make sure the child understands what is expected of them. o Make sure that the expectations set for the child are reasonable. Don't set the child up for failure by having expectations that are not appropriate for the child's age and ability. o Don't try to work on too many different things at one time.
o Let the child participate in choosing the types of rewards he or she can earn. o Design the program to the child has a good chance to experience some initial success. o Provide lots of social rewards in addition to more tangible rewards that can be earned. o Be consistent. ("Behavioral Treatment") In addition to a positive reward system, it is often necessary to establish using negative consequences to reduce misbehavior. It is important to have a game plan and be flexible with the guidelines.
Opinion: As a parent, one of the first questions that comes to mind is, "Why and what went wrong?" The ultimate question that almost all parents ask is, "Did I do something to cause this?" There does not seem to be very substantial evidence that ADHD occurs because of social factors or the method upon which the child was raised except for genetic and neuro biological factors. I have found substantial evidence of the validity of ADHD in children. While the information on medicating children with ADHD is overwhelming, I believe that some children simply require medication in order to function, learn, and grow. Major concerns are addictions and abuse problems as well as tolerating the daily side effects.
No compelling evidence was found to convince me that prescribing medications to ADHD children makes them more venerable to abusing drugs than anyone else. Children who are not medicated, but need to be, may turn to other alternative and illegal substances for relief. The side effects are also considered personal choices. I, for one, believe that if the child is not able to complete assignments, remember lessons, make friends, learn, and grow, then the child should be medicated.
The side effects are concerning however, with the proper dosage they can be minimized and therefore the gain far outweighs the risk. Conclusion: Diagnosis of ADHD in children is a crucial step in order to avoid medicating a child without ADHD. Medication can assist the ADHD child on a daily basis. Medication and behavioral therapy increase treatment success. In such cases, mental health professionals are capable of counseling the child and the family and facilitating them in the development of new skills, attitudes, and ways of relating to each other. The important step is proper diagnosis of ADHD.
It is imperative to know about any medication being prescribed for each individual child. Work Cited Page: American Academy of Physicians "ADHD: What Parents Should Know." Family Doctor, 10 April, 2005 Barkley, Russel A. Taking Charge of ADHD: The Complete, Authoritative Guide for Parents. New York: The Gilford Press, 2000. Eli Lilly and Company "Strattera." Strattera 10 April, 2005 McNeil Consumer & Specialty Pharmaceuticals, a Division of McNeil-PPC, Inc "Prescription Medication Overview" Focus on ADHD. 14 April, 2005 < web treatments.
j html>Rainier, David. "Behavioral Treatment for ADHD: An Overview." Health. 14 April, 2205 Wilens, Timothy E. Straight Talk about Psychiatric Medications for Kids New York: The Guilford Press, 1999. Wilens T. C.
et all. Does stimulant therapy of attention-deficit / hyperactivity disorder beget later substance abuse? A meta-analytic review of the literature. Pediatrics, (2003) 111: 1: 179-185.