I. Topic
The topic for this term paper focuses on Children with ADHD, the topic is being chosen due to the fact that there are several cases of ADHD indication in children such as in the United States and almost everywhere recognized and unrecognized by such community as well as social support groups that go together in providing awareness programs to those affected parties such as the school as well as well as family environment and also those involved in health care services. I wanted to realize and learn a lot from ADHD cases affecting the children and knowing and assessing how such individual and groups provide different therapeutic modalities as can be reflected through cognitive therapy and psychotherapeutic treatments with useful and relevant explanations and discussions regarding certain medications use for children with ADHD, is it effectively manifested or not?
Thus, there allows students like myself, to have better concern of the community, being a citizen-driven individual who has a heart for such issues and problems visible within the cycle of his/her own milieu set-up. However, the goal of being motivated to truly take part and be serious in every endeavors and decisions made to be a strong advocate in such health as well as social campaigns in fighting against abuses and misconceptions about prevalence and incidence of ADHD in children. Then, as much as possible offer supporting interventions to reduce such serious cases and help children cope up with problems and for the parents to keep involve and not lose hope in everything that is happening with their child.
II. Research concerning the topic
Ideally, several proponents/writers of ADHD topics mostly, concerning on children may have their different views and opinions regarding children having ADHD but in a way, these proponents share some similarities with regards to their views and beliefs incurring ADHD cases in children. Then, in dealing with differences in opinions for quite a general condition can be tough but what is imperative here is to be able for the researcher to arrived at fair and justifiable judgment of such assumptions and theories involved, trying as much as possible any biases of objective as well as subjective judgment and have an equal control over various arguments made by the proponents in achieving a more balanced context of ADHD cases affecting and hitting the children, especially those within the school environment and classroom set up. Aside, the use of relevant references will have to be up to date so that, there may have applications of such recent development of ADHD knowledge to be inculcated and imparted to the students and the general public as a whole. The information below shows any basis for concerns in research signifying ADHD in children.
Accordingly, ‘Attention Deficit-Hyperactivity Disorder’ – ADHD, is illustrated by developmentally abnormal levels of sustained attention, impulse control, and excessive activity. The Diagnostic and Statistical Manual of Mental Disorders, 4th edition ( 1994, 2000) defines three subtypes: predominantly inattentive type, predominantly hyperactive-impulsive type, and combined type. Thus, predominant therapy for children exhibiting ADHD could be psycho-stimulant medication, primarily methylphenidate (Ritalin) but one survey of physicians, there are only about 88 percent of the children diagnosed as ADHD had received methyphenidate. Although one study shows that there is about 60 percent to 80 percent of school-age children respond to stimulant medications but such side effects are common as some patients taking stimulant medication experience such decreased in their appetite and the difficulty to sleep and others thus, growth velocity can diminish when stimulant medication is used for over a period of time. Ideally, children having ADHD, display difficulties with attention in contrast to normal children of same mental age and sexual preference. ADHD children have maximum difficulties with sustained attention or effort to tasks. Difficulties are most evident in situations requiring the children to sustain attention to repetitive tasks such as in school as ADHD children have difficulty following instructions, make careless errors in school work, fail to reflect upon the consequences of negative behavior and engage in risk-taking. In addition, the understanding places restrictions on types of therapeutic modalities and interventions strategies that will be most efficacious in treating ADHD.
The successful approach to ADHD treatment must normalize the underlying brain abnormalities, while reducing risk factors and strengthening protective factors. Such an approach should enhance resilience, the ability to adapt despite prior or continued exposure to risk factors. Prescription medication rates for ADHD are increasing in usage dramatically in the United States, with certain geographical areas tripling or quadrupling the number of prescriptions written ten years ago. Although increasing medication rates may be related to improved awareness and diagnosis, some professionals have different theories. Some researchers speculate that increasing ADHD prevalence and treatment rates may be related to changes associated with living in the digital age, such as decreased levels of physical activity and less exposure to the natural environment, which is thought to lead to increased amounts of restless and impulsive behavior. Furthermore, according to Diagnostic and Statistical Manual of Mental Disorders ( 2007) (DSM-IV-TR) that, there were such patterns of behavior that indicate ADHD.
Truly, ‘’children with ADHD may show signs of being inattentive. One could be the, hyperactive children which seem to be constantly in motion as such as they squirm and fidget in their seats and roam around the room meanwhile, impulsive children seem unable to curb their immediate reactions or think before they act. They will often blurt out inappropriate comments, display their emotions without restraint, and act without regard for the later consequences of their conduct. During the year 2002, researchers from NIMH Child Psychiatry Branch had studied 152 boys and girls with ADHD, matched with 139 age- and gender-matched controls without ADHD’’ ( 2007;2002).
Thus, ‘’as group, the ADHD children showed 3-4 percent smaller brain volumes in regions such as the frontal lobes, temporal gray matter, caudate nucleus and cerebellum. The study showed that the ADHD children who were on medication had white matter volume that did not differ from that of controls. Those never-medicated patients had an abnormally small volume of white matter. The white matter consists of fibers that establish long-distance connections between brain regions’’ ( 2007; 2002). Thus, based on the National Institute of Mental Health, there were several studies of treatments for ADHD in evaluating treatment of disorder such as the Multimodal Treatment Study of Children with Attention Deficit Hyperactivity Disorder (2007;1999). Then, for children with ADHD, no single treatment is the answer for every child. A child may sometimes have undesirable side effects to medication that would make that particular treatment unacceptable as well as if child with ADHD has anxiety or depression, treatment combining medication and behavioral therapy might be best as every child’s needs and personal history have to be considered well and carefully.
III. Treatment Modalities/Interventions
Several medications can ideally help those children with ADHD as the child can possibly take control over some behavior problems that will possibly caused trouble and conflicts with family members and parents in relationship with the other siblings. Thus, such health professionals can possibly do the counseling needed by the child and his/her family in helping them to develop and acquire such innovative skills, and attitude patterns as well as the ample ways of relating to each other. In individual counseling, the therapist helps children with ADHD learn to feel better about themselves. Thus, some of the social workers involved in the situation can amiably help those children and families as well in order for them to identify and build on their strengths, cope with everyday issues and problems in controlling some of attention and aggression cases and oftentimes only those children with ADHD needs a helping hand and an understanding heart for the needed counseling support.
Thus, psychotherapy works to help people with ADHD to like and accept themselves despite their disorder. It does not address the symptoms or underlying causes of the disorder. In psychotherapy, patients talk with the therapist about upsetting thoughts and feelings, explore self defeating patterns of behavior, and learn alternative ways to handle their emotions. As they talk, the therapist tries to help them understand how they can change or better cope with their disorder. While on the other hand, cognitive/behavioral therapy helps people develop more effective ways to work on immediate issues. Rather than helping the child understand his or her feelings and actions, it helps directly in changing their thinking and coping and thus may lead to changes in behavior. The support might be practical assistance, like help in organizing tasks or schoolwork or dealing with emotionally charged events. Or the support might be in self-monitoring one’s own behavior and giving self-praise or rewards for acting in a desired way such as controlling anger or thinking before acting. Thus, one of research conducted with children with ADHD regarding their medication suggests that most of them believe that medication made improvement in their lives; ability to gain clarity on their disorder has been enhanced by the improvements they experience with medication.
However, since ADHD is disorder that changes over time, it may be helpful to periodically stop the medication and observe the changes. The extent of ADHD problems, the availability of support services, and the likelihood of cooperation from school personnel and parents must be considered in the medication decision. Whether or not to medicate child from an uncooperative family who also desperately needs other resources like, psychotherapy is difficult decision for any doctor. The child’s school may provide mediating role by discussing treatment with the family, arranging for counseling on the school site, as well as administering medication at school. Furthermore, medication for ADHD should be taken according to the doctor’s orders. Parents and school personnel must often take an active role to ensure that children take their medication as prescribed. Few children with ADHD can assume full responsibility for their medication. Treatment compliance is important since the effectiveness of the medication depends on regular administration. If there is any question of unreliability or drug abuse potential in the patient’s home, the medication should be administered at school. Each school has different guidelines, but permission form is usually required for medication administration by school official.
Many children take their medication only on school days with the idea that it is best for them to have a couple of days per week to be medication free. These children might even have drug holiday for the summer and or during holidays in order to let their bodies function without the medication for a period of time. Other children, especially those with extreme symptoms, may take medication every day. The theory of this daily dosing technique is that the child may experience significant benefits from the calming influence of medication. Positive experiences with family and friends can have long-lasting beneficial effect that exceeds the concerns of taking medication daily. Closely evaluating medication effects is an essential part of treatment. Parents, teachers and the child, have a role to play in identifying whether or not the medication is effective in reducing ADHD symptoms.
Psychotherapeutic Treatment
As with treating ADHD in children, the combination of medication and other psychotherapeutic strategies produces the most positive outcome. One of the first priorities is to help newly diagnosed individuals understand and accept their disorder. Adults with ADHD have lived for many years with their symptoms, and have likely developed combination of helpful and not-so-helpful coping strategies to deal with their disorder. Negative coping skills may have become so deeply ingrained that they are seemingly automatic patterns of behavior and thinking. Therapeutic goals then include symptom management, as well as increasing coping behaviors that are healthy and decreasing behaviors that are not. Relaxation training, anger management and stress management skills can also be incorporated into therapy sessions. Group therapy can often be extremely helpful for addressing interpersonal skills deficits. Group treatment can provide support and reassurance that the individual is not alone in coping with the challenges of ADHD, as well as offering new ideas for dealing with symptoms. The group then also provides more safe environment in which to learn and practice new interpersonal behaviors, obtain recognition for improvements, and an opportunity to help others who are struggling with similar issues.
Cognitive Behavior Therapy
Cognitive behavioral workers assist children identify the symptoms created by their disorder, as well as the specific thoughts and behaviors that interfere with school, family and peer functioning. The theory behind is that changing thoughts can lead to changes in mood and behavior. Once the target behaviors have been identified, the therapist will help the child develop a series of connected thoughts to begin using when problem situations arise. These scripts are usually accompanied by specific behaviors that gradually replace the problem ones. Once skilled in the use of these scripts, child with ADHD can demonstrate increasing behavioral control and have choices instead of showing only impulsive automatic responses to environmental events. Then, the cognitive therapist will help the child identify individual thinking patterns and tendencies and once identified, these individual thoughts and cognitive processes can be examined and evaluated for accuracy and helpfulness. If these tendencies seem to contribute to the identified problems, they will become a focal point of therapy. Therefore, the therapeutic goals evolve as one goal is met and others are identified as the areas of treatment focus include the development of skills in:
- Understanding and accepting the diagnosis of ADHD
- An honest appraisal of one’s own strengths and weaknesses
- Setting up realistic, attainable goals
- Planning and strategizing skills, including how to prioritize goals and behaviors
Cognitive therapy group programs are somewhat similar to social skills training classes. Social skills training focuses on the development of an awareness of the impact of ADHD behaviors on others and the self-management skills needed to limit associated disruptions. Cognitive therapy also pursues the development of awareness of disruptive behaviors and ADHD symptoms, but focuses on self-awareness rather than environmental awareness. Guided by cognitive behavioral theory, specific self-management skills, such as self-soothing behaviors and positive self-talk techniques, are taught. Cognitive behavioral therapy groups can be quite beneficial to children with ADHD. Not only is the associated cost less than that of individual therapy, but the child has an opportunity to interact with other children who have similar types of challenges. The group therapy environment provides a structured setting in which children can discuss their unique feelings and situations, develop an understanding of the feelings of others and realize that they are not the only ones who face challenges. The development of a sense of belonging to a group, in a structured, safe environment, can be particularly helpful to ADHD children. Another benefit is the opportunity to practice newly evolving social skills in the safe environment of a therapeutic group. Although children with ADHD do care about other people, they are simply unaware of the need to consider the perspective of others. Thus, certain social skills training classes are designed to improve peer relationships, and teach interpersonal interaction skills that facilitate success in the classroom or at home. These classes differ from individual or group therapy in that the focus is primarily on interpersonal interactions rather than managing emotions or personal change.
Treatment Options for ADHD
Individual therapy
Although the management of ADHD primarily targets the alleviation of children’s problems in the classroom and at home, a child’s difficulties often range well beyond these two settings. In fact, poor self-esteem and difficulty with peer relationships can cause even greater emotional pain for the child. While medication, environmental changes and educational interventions address the core symptoms of ADHD, they are not always sufficient to alleviate the damage done to the child’s internal sense of mastery and competence. Moreover, individual therapy can address children’s unique response to the problems created by ADHD in their life, and focus on related emotional issues. Although such topics can be addressed in a group setting, depending on the child, a group might not be the best entry point into therapy. Even though individual work is more time consuming and costly, it is often highly beneficial. The first thing to consider when looking for an individual therapist for a child with ADHD is whether or not the therapist has experience with this population. Both children and the disorder itself present unique therapeutic challenges, so it is best to work with a specialist who is knowledgeable about children with ADHD. Next, consider the therapeutic orientation of the therapist. Given the physiological origins of the disorder and the subsequent disruptive behavior problems, problem-focused approaches are more likely to be helpful. A therapist trained in cognitive behavioral techniques will have the therapeutic tools most likely to be helpful to an child with ADHD.
Environmental behavior modification
There can be other options for treatment, such as techniques involving environmental behavior modification in lieu to changing the environment to reinforce desirable behaviors while punishing undesirable behaviors. These techniques can be used at home or in school settings. Reinforcements or rewards must be considered positive by the child in order to be effective. Token reward systems, behavioral system that provides tokens as a reinforcer for desirable behavior that can be exchanged for desired goods, can be an effective technique with children. Children with ADHD require clear structure and incentives in order to focus on behavioral change. In addition, such type of plan should be presented as loving, positive, and focused approach rather than way to caught up the child misbehaving. General behavioral modification principles that have proven effective with ADHD can include the following points:
- Establishing of precise rules and behavior expectations
- Writing of applicable contracts for specific behavior changes
- Establishment of useful routines
- Allowing such usual consequences to occur
- Providing better opportunities for liberation
- Reinforcement within the desired behaviors
- Utilizing the value of shaping to teach such desired behavior such as rewarding the child for getting close to some of the desired behavior
- Teach organizational skills for assisting children in organizing better study materials and ample responses
There can also be the use of pharmacological intervention as found effective, although not without problems due to side effects and parent-training methods were found to be effective in the home setting, but minimal information has been collected on generalization to school setting. Thus, children with ADHD demonstrate an inability to modulate their behavior in response to different situational demands ( 1998). Thus, children with ADHD can be described as careless, disorganized, carefree, and non-reflective, even as preschoolers. In addition, they have trouble remaining in their seats and are often physically and verbally abusive to peers and teachers (1990; 1991), thus, probably denying children the opportunity to practice academic skills, develop valuable social skills, and become acclimated to the structure of school and then failed to develop skills necessary for learning in school situation. Moreover, some professionals contend that children with ADHD should be treated with combination of interventions that includes stimulant medication along with behavior management in the home and at school ( 1998; 1994). Although some professionals are hesitant to medicate children with ADHD and instead recommend behavior management and parent training, we were able to find only one published study that examined the effects of a multi-component intervention package on young children with ADHD.
IV. Summary
Generally, social workers play a vital role in providing the needed support and care as well as enough understanding to those children with ADHD as such proponents only provide relevant concepts and ideas with regards to such useful medications and or treatment interventions for ADHD cases but possibly never did try to investigate further about its assumptions to children and further outcomes of such and or unfortunately some professionals was not able to execute them for research evidences and future studies. Then, the role of social workers take place and bound to happen as they function efficiently to the situation mostly those that are inclined with home evaluation and treatment set up, for instance, they are the ones executing the proper actions to be taken for the children with ADHD and giving parents and families of the affected appropriate support programs and activities that can be best alternative weapon for preventing serious indications of ADHD cases in children. I do believe and think that social workers inclusion is important in helping to shape my desired identity being a social worker in a way that I learned so many valuable things to continuously improve my choice of craft and be passionately into services that caters to humanitarian perspectives. Thus, the fact that children with ADHD experience myriad of chronic behavioral and academic difficulties further necessitates an expanded focus on community-based and collaborative treatment-outcome research with this population. Social workers and practitioners should combine components of previously reviewed studies and tailor each intervention to match the environment of the classroom and the needs of the child.
It is that behavior management for children with ADHD should be an important research priority, given the dearth of current studies. Future studies should focus on developing effective interventions through functional analysis of the child’s behavior and environment. Furthermore, investigations should be conducted across the preschool and home environments, with outcome data supplied from both settings respectively. Amicably yes, I do see myself making contribution to this area and also I feel that we as social workers should advocate more for children with ADHD by looking and assessing such types of medications that are given to those children with ADHD indicating crucial points that, not all children needs to require the process of medication that can be possible if observed that a child is doing bad in school due his/her behavior the teacher should immediately send these children to the child study team for ample evaluation if the child is prone to ADHD or not and if the child needs medication or just a simple guidance of the behavior showed.
CI
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