This article will explore the disorder Attention Deficit Hyperactivity Disorder (ADHD) while providing the common symptoms associated with ADHD and the neurophysiological underpinnings of ADHD. Three different treatment options, family therapy, Ritalin, and video games will be compared and contrasted. Last the Powers will share what she thinks the best treatment option is for people who suffer from ADHD.
Common Symptoms Associated with Attention Deficit Hyperactivity Disorder
Attention is a cognitive process that enables humans to process incoming information. This information can be smells, objects people see, sounds, and things that are felt. Attention is a set of process in which people focus on information they are receiving (Robinson-Riegler and Robinson-Riegler, 2008). Attention is a cognitive process that is, “strategic and actively manipulated as we attempt to examine, consider, manage, and respond to events appropriately” (Robinson-Riegler and Robinson-Riegler, 2008, p. 120). Attention is a flexible process, and a person can shift his or her attention back and forth (Robinson-Riegler and Robinson-Riegler, 2008).
People can perform tasks like changing the radio station while driving a car or participate in a conversation while walking down the street. Even though attention can be divided and flexible attention is limited and humans cannot process all of the information senses pick-up (Johnston & Heinz, 1978) . In order for humans to function there is a regulatory mechanism, attention is strategic (Johnston & Heinz, 1978) . According to Johnston and Heiz attention is flexible because of the multimode theory of attention (Johnston & Heinz, 1978) . This theory suggests that people shift from early modes of attention, which entails only focusing on the physical details of stimuli to late modes, which entails processing the meaning of the incoming stimuli (Johnston & Heinz, 1978) . ” Given that we have voluntary control over how we deal with incoming information, we are capable of determining the basis on which we select information for further processing (an early or late processing mode)” (Robinson-Riegler and Robinson-Riegler, 2008, p. 120). Each stage of attention has consequences, the later point in the processing takes more mental energy; attention can operate in two modes and each mode has a cost (Robinson-Riegler and Robinson-Riegler, 2008). Attention is a key component for a person’s survival and ability to function in everyday tasks.
Attention Deficit Hyperactivity Disorder (ADHD) according to the “DSM-IV-TR” (The Diagnostic and Statistical Manual of Mental Disorders, 4th edition text revision), ADHD is the most common psychiatric disorder identified during childhood (Chuang & Chen, 2010). Attention is a key component for survival and the ability to function completing everyday tasks but children who suffer from ADHD display symptoms that include impulsive behavior, they are easily distracted, hyperactive, and in general struggle paying attention (Chuang & Chen, 2010). “Moreover, children with ADHD usually also have problems with inside behavior: cognition, emotion, learning, behavior and deficit of relationship” (Wicks-Nelson & Israel, 2000, p. 2). ADHD is a serious disease and can greatly impact an individual’s life in a negative manner, especially if untreated. ADHD is a complex disorder that often requires input from the affected children or adolescents, teachers, parents, and physicians in order to being diagnosed correctly and treated successfully (McGough & McCracken, 2000).
Neurophysiological Underpinnings of Attention Deficit Hyperactivity Disorder
The exact cause of ADHD has not been discovered but researchers have found that people who suffer from ADHD have less activity in the areas of the brain that control attention and an individual’s activity level (Mayo Clinic, 2011). ADHD also tends to run in families but the specific genes or gene that cause ADHD have not been discovered yet (Mayo Clinic, 2011). Some studies have found that women, who smoke, drink alcohol, or use other drugs during pregnancy increase the likelihood that her baby will develop ADHD (Mayo Clinic, 2011). Preschool children exposed to toxins, especially lead, are at an increased risk of developing ADHD (Mayo Clinic, 2011). Last some food additives have been found, especially food coloring or preservatives, contribute hyperactive behavior (Mayo Clinic, 2011).
Family therapy is one approach to treating ADHD and this is strictly a cognitive approach, this approach does not include the use of medication. ADHD is diagnosed between 3% to 7% of school-age children and is treated with a variety of psychosocial and psychoeducational interventions for parents and children (Bjornstad, 2010). According to Bjornstad’s (2010) discoveries about 10 to 13 percent of children prefer not to take medication. Family therapy without medication can be beneficial to patients because it assists the family in setting-up a structure within to the family to help manage the child’s behavior and assists family members with coping with the distress ADHD can cause in a family (Bjornstad, 2010). In the United States stimulant medications are the most common prescribed form of psychotropic medication for children who suffer from ADHD but the consequences of taking these types of medication are long-term are not known, which is why looking at alternatives is important (Bjornstad, 2010).
Family therapy and parent training (behavior management, communication training, and problem-solving) are the key components for successful treatment (Bjornstad, 2010). The therapy and training provides the tools parents need to communicate effectively and problem-solve while keeping in mind the child has ADHD (Bjornstad, 2010). Therapists also make it clear to parents that unreasonable demands of the child can cause a great deal of tension in the family and set the child up for failure (Bjornstad, 2010). Behavior management helps parents adjust the environment while providing structure to assist the child in behaving better (Bjornstad, 2010). The traditional talk therapy during family therapy sessions helps therapists find the gaps in the therapy, help assist in problem-solving, and address any questions or concerns the parents may have (Bjornstad, 2010). Family therapy is not a quick fix and takes significant commitment from the parents and any other family members that reside in the household (Bjornstad, 2010).
Bjornstad found in his clinical trials that the frequency of success depended on a few factors and every child is different (Bjornstad, 2010). Parents had to follow through with instructions and be active participants, parents who did not do this found the results to be unsatisfactory (Bjornstad, 2010). Parents who did follow through found that children respond well and symptoms were managed very well (Bjornstad, 2010). Parents who preferred this approach had to keep in mind that very rarely did symptoms disappear completely but parents did find life with their child was much more manageable and enjoyable (Bjornstad, 2010).
During Bjornstad’s (2010) research he discovered that most of his counterparts did not agree with this approach, his counterparts thought that the outcome and success of family therapy would be more consistent and better if he added medication to part of the treatment plann. Bjornstad found very few professionals that believed therapy alone was a good option (Bjornstad, 2010).
Ritalin is the most commonly prescribed medication for patients diagnosed with ADHD and is the most common treatment option patients and parents select (White & Rouge, 2003). Ritalin is classified as a mild central nervous system stimulant (White & Rouge, 2003). Ritalin stimulates the central nervous system, which aids in reducing the symptoms of ADHD (White & Rouge, 2003). Ritalin is a medication that can be prescribed by any doctor and the medication has to be taken at certain times of the day on a regular basis to help ease the symptoms of ADHD (White & Rouge, 2003). The rate of success with Ritalin is high; almost 90% of patients see some type of improvement (White & Rouge, 2003). Ritalin is a widely accepted treatment method and is the most prescribed medication for patients diagnosed with ADHD (White & Rouge, 2003). Doctors also remind parents that taking stimulants does not make a child smarter; it may ease the symptoms of ADHD, which enables a child to do better in school, education is the key to success (White & Rouge, 2003).
Like most treatments there are some downsides to Ritalin, it can be addictive and abused easily (White & Rouge, 2003). The long-term effects of Ritalin are not yet clear so patients are taking a calculated risk (White & Rouge, 2003). Ritalin should not be used alone; Ritalin should be part of a treatment plan and not the entire treatment plan (White & Rouge, 2003). Some research has found that stimulants may suppress a child’s growth (Butcher, Mineka, & Hooley, 2010). Research revealed that methylphenidate stimulates the daytime release of growth hormone, which disrupts the release of the nocturnal hormone (Butcher, Mineka, & Hooley, 2010). The interrupted release of the nocturnal growth hormone can interrupt growth and even sexual maturation (Butcher, Mineka, & Hooley, 2010). More research and studies need to be conducted to clearly understand how Ritalin effects growth.
Video games are everywhere and are very popular among adults and children. Some video games require players to become part of a new world or create a new world, video games can be simple or complex, and are even part of social media ,such as Facebook. Video games are readily accessible and can be found on computers, tablets, and cell phones (Game Console, 2011). Video game consoles have been available to consumers since 1970 and are part of American culture (Game Console, 2011). Lately there have been many studies that indicate that video games can have a positive effect on training and could be used as a teaching tool for students who had ADHD (Chuan & Chen, 2009).
Video games provide fun, motivation, and can promote learning all at the same time (Chuan & Chen, 2009). Chuan and Chen (2009) decided to investigate the effects of playing video games on children’s cognition; they used elementary aged children in this investigation. The results from the study provided evidence to support the use of video games to facilitate students’ cognitive learning process (Chuan & Chen, 2009). The three components that increased the motivation of patients are, ” (1) to increase a patient’s motivation to engage in learning the ins and outs of their condition and its treatment; (2) to use games as a tool in distraction therapy for pain and anxiety; and (3) to encourage young patients to continue with their treatments over longer treatment regimes” (Chuan & Chen, 2009, p. 102). Chuan and Chen (2009) found that students who used educational video games spent more of their learning time concentrated, and that was even more evident in students with attention problems. Video games can provide interaction and rise of mental power, using video games appropriately enhances stimulation and is used in behavior therapy in ADHD (Chuan & Chen, 2009).
Video games allow children who have ADHD to have fun when they are in training (Chuan & Chen, 2009). “It is hoped to improve ADHD children’s attention effectively while playing digital games. It provides an innovative approach to ADHD therapy” (Chuan & Chen, 2009, p. 103).
The success rate of this treatment varied, depending on the child, video game, video game console, age, and severity of ADHD (Chuan & Chen, 2009). More studies will be needed to grasp a better understanding, and this study is a solid launching point for further studies (Chuan & Chen, 2009). Chuan and Chen’s counterparts are unsure of this approach because it is so new and several types of professionals do not want children in front the computer or television playing video games (Chuan & Chen, 2009). The United States has an obesity epidemic among children and the use of television and video games are considered part of the problem (Chuan & Chen, 2009).
Powers Thoughts on Best Approach
All three therapies have pros and cons; video games and family therapy are a cognitive approach while Ritalin is a pharmaceutical approach. The degree of success for each therapy has many variables to consider and the success of a therapy really depends on the patient and his or her needs. The one common thread among all of the therapies is that medical professionals all agree that any type of therapy should be paired with another element of therapy, such as taking a pharmaceutical approach and combining it with a cognitive approach.
Powers believes that any illness, mental or physical, should be treated by creating a treatment that is multi-dimensional so that the patient has a better chance of feeling relief or being cured. Generalizations in regard to treatment with a mental illness are not a successful approach because one medication may benefit a patient while causing harm another to another patient. Each case has to be weighed, the risks looked at, and the patient along with medical professionals must decide if the calculated risk is worth the possible success. A good doctor will approach a problem in many ways and approach each new patient with an open mind. Each person is so different it is not possible to say that one particular approach to treating ADHD is best. Doctors have to look at a patient’s medical background, what kind of resources are available, if the parents are involved or not, religion, and other beliefs. Some individuals do not believe in talk therapy while others might not believe in medication. Once the factors are looked a doctor or even a team of medical professionals should decide on how to address the patient’s illness and if possible with the patient’s input or the parents’ input. The medication and therapy approach seems to be most recommended method to treat ADHD but Powers would be open to other therapies.
ADHD is a complex disorder that often requires input from the affected children or adolescents, teachers, parents, and physicians to be diagnosed correctly and treated successfully (McGough & McCracken, 2000). ADHD is being diagnosed more frequently among school-age children; it is difficult to know if the increased rates of ADHD are because of the awareness that surrounds the illness, if it is being misdiagnosed, or if more children are actually suffering from ADHD, but regardless if a child is diagnosed he or she should be treated. Family therapy, medication, and video games have been explored as possible treatments but all of the research suggests using more than on method of treatment. A multi-dimensional approach to treating ADHD seems to be the most successful method. Researchers, medical professionals, and parents should make sure to revisit treatment plans. As the understanding of the brain changes possible treatments could change too so it is important to revisit the concept of ADHD and the best methods of treatment.
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