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Michael Badon Children that are forced to live with ADHD are generally required to fit in with their

nondisabled peers. ADHD children have a hard time relating to their peers due to inattention, hyperactivity, and impulsivity (the core symptoms of ADHD). But is medicating the children really an optimal solution to solving ADHD problems? Children should only be medicated after first receiving behavioral treatment alone. Only if behavioral treatment does not show an increase of positive behavior, should medication be considered an option. (Research on the educational implications of attention deficit hyperactivity disorder: Exceptional Children) Attention-deficit/hyperactivity disorder (ADHD) is a serious mental health problem that is characterized by inattention, impulsivity, and hyperactivity and is associated with serious impairment. ADHD is not a disorder of attention. Rather, it is a function of developmental failure in the brain circuitry that monitors inhibition and self-control. Loss of self-regulation impairs other important brain functions, which are crucial for maintaining attention. (Attention-deficit hyperactivity disorder: Scientific American). It is still unclear what the direct and immediate causes of ADHD are. Researches suspect that the cause of ADHD is genetic or biological, although they acknowledge that the childs environment helps determine specific behaviors (Attention-deficit hyperactivity disorder: Scientific American). Children diagnosed with ADHD generally act without thinking, are hyperactive, and have trouble focusing. They may understand what's expected of them but have trouble following through because they can't sit still, pay attention, or attend to details. All children (especially younger boys) act this way at times, particularly when they're anxious or excited. But the

difference with ADHD is that symptoms are present over a longer period of time and occur in different settings. They impair a child's ability to function socially, academically, and at home. (Attention Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment). ADHD can negatively affect social relationships with peers. Developing healthy peer relationships is critical for the normal development of an ADHD child. Peer relationships are an important predictor of positive adult adjustment and behavior. Around 60% of ADHD children suffer from peer rejection. It is difficult to determine all the factors that make a child likely to be neglected by their peers, but children who frequently display aggressive or negative behavior tend to be rejected. ADHD children tend to be more impulsive and aggressive than other children, and behave inappropriately in social contexts. For example, ADHD children are more likely to yell, run around, and talk at unsuitable times. (Social Behavior and Skills in Children). The classroom setting is a very difficult setting for ADHD kids. They are told to sit still, remain quiet, pay attention (to boring worksheets), and stay on task until the work is finished or using time wisely. It is not easy for an ADHD child to operate under these conditions, but they have no choice except to attend school day after day. (Joshua A. Lutz, Ed.S., NCSP). ADHD is most often recognized and diagnosed in the third grade. In third grade, students are required to do more in-class work on their own, and more homework. ADHD Students who are not able to maintain the classs average pace tend to separate from the pack. Every week they just get a little farther and farther behind. They lose their homework assignments, despite the hours spent working on them. They study all night only to perform poorly on a test the next day. Third grade is the usual time that ADHD students hit a wall and fall behind in academic progress. (Joshua A. Lutz, Ed.S., NCSP).

There is no cure for ADHD, but there are a few treatment options that have proven to be effective for some children. Effective strategies include behavioral, pharmacological, and [a mixture of both] multimodal methods. (Identifying and Treating Attention Deficit Hyperactivity Disorder: A Resource for School and Home) Behavior approaches represent a broad set of specific interventions that have the common goal of modifying the physical and social environment to alter or change behavior. They are used to provide structure for the child and to reinforce appropriate behavior. (Clinical practice guideline: Treatment of the school-aged child with attention deficit/hyperactivity disorder). Types of behavioral approaches include: behavioral training for parents and teachers (in which the parent and/or teacher is taught child management skills), clinical behavioral therapy (training in problem-solving and social skills), and cognitive-behavioral treatment (e.g., self monitoring, verbal self-instruction, development of problem-solving strategies, self reinforcement). (Handbook of Attention Deficit Hyperactivity Disorder). The effectiveness of behavioral techniques is controversial. . A review conducted by McInerney, Reeve, and Kane (1995) confirms that the most effective behavioral techniques for children with ADHD require modifications to academic instruction, behavior management, and classroom environment. Behavior therapy has been found to be effective only when it is implemented and maintained (Clinical practice guideline: Treatment of the school-aged child with attention deficit/hyperactivity disorder). Behavior therapy is difficult to implement and sustain throughout the many different environments in which children encounter. For example, Jimmys parents and teachers (Jimmy is a child who has recently been diagnosed with ADHD) have done what

seems like everything possible to implement behavioral techniques into all of Jimmys surroundings (sports, home, school). One weekend jimmy attends a sleepover party hosted by a friend from school. The group of hellions at the sleepover party were up all night, running all over the place making messes, breaking things, and wrestling with one another. Jimmys mother had no idea she was letting her son shatter his behavioral therapy progress. Jimmys behavior therapy was not maintained throughout the entire process; therefore his behavior may cease to improve. Behavioral approaches towards the treatment of ADHD are used most commonly when parents do not want to give their child medication, or their child has an adverse reaction or side effects from the medications. In general, these approaches are designed to use direct teaching and reinforcement strategies for positive behaviors and direct consequences for inappropriate behavior. (Identifying and Treating Attention Deficit Hyperactivity Disorder: A Resource for School
and Home).

Pharmacological treatment remains one of the most common, yet most controversial, forms of ADHD treatment. (Identifying and Treating Attention Deficit Hyperactivity Disorder: A Resource for School and Home). Pharmacological treatment includes the use of stimulants, antidepressants, anti-anxiety medications, antipsychotics, and mood stabilizers (The Multimodal Treatment StudyQuestions and Answers). Keep in mind, parents should not administer medications to their children without first consulting a medical professional. Stimulants are a class of psychoactive drugs that increase brain activity, and theyre the most commonly prescribed medication for ADHD. Stimulants include Methylphenidate

(Ritalin), Dextroamphetamine (Dexedrine), and Pemoline (Cylert). Other types of medication (antidepressants, anti-anxiety medications, antipsychotics, and mood stabilizers) are used primarily for those who do not respond to stimulants, or those who have coexisting disorders. Neurotransmitters are chemical agents in the brain that are important for helping people to attend or pay attention to important aspects of their environment. Stimulants increase the brains production and capacity of neurotransmitters, thus increasing the childs ability to pay attention, control impulses, and reduce hyperactivity. Medication necessary for this process typically requires multiple doses throughout the day. An individual dose of the medication lasts for a short time (1 to 4 hours). However, slow- or timed-release forms of the medication (for example, Concerta) may allow a child with ADHD to continue benefitting from medication over a longer period of time. (Identifying and Treating Attention Deficit Hyperactivity Disorder: A Resource
for School and Home). Stimulants, like all medications, have varying side effects. Changing the dosage amounts can diminish some side effects. The most common side effects produced by stimulants include insomnia, nervousness, headaches, and weight loss. In fewer cases, subjects have reported slowed growth, tic disorders, and problems with thinking or with social interaction (Efficacy of methylphenidate for attention-deficit hyperactivity disorder in children with tic disorder). Stimulant medicines do not normalize the entire range of behavior problems, and children under treatment may still yield higher levels of behavioral problems than their peers. Medication also can be expensive, depending upon the medicine prescribed, the frequency of administration, and the subsequent frequency of refills. (Childrens responses to stimulant medication and two intensities of a behavioral intervention: Behavior Modification)

The American Academy of Pediatrics (AAP) finds that at least 80 percent of children will respond to a stimulant if administered systematically. The AAP also reports that children who do not respond to one medication may have a positive response to an alternative medication. Under medical care, children who fail to show positive effects or who experience intolerable side effects on one type of medication may find another medication helpful. (Clinical practice guideline: Treatment of the schoolaged child with attention deficit/hyperactivity disorder: Pediatrics)

The results of the Multimodal Treatment Study confirmed the use of medication was almost as effective as the multimodal treatment of medication and behavioral interventions (Journal of Mental Health Counseling). Multimodal Approaches are a combination of behavioral and pharmacological approaches, and are considered the most effective way to mitigate the symptoms associated with ADHD. The Multimodal Treatment Study of Children with ADHD (MTA) groups studies in 1999 indicate that multimodal treatments were especially effective in improving social skills for students coming from high-stress environments and children with ADHD in combination with symptoms of anxiety or depression. Researchers found improvement in the following areas after using a multimodal intervention: child anxiety, academic performance, oppositional behavior, and parent-child interaction. Positive results also were found in school-related behavior when multimodal treatment is coupled with improved parenting skills, including more effective disciplinary responses, and appropriate reinforcements (Journal of Abnormal Child Psychology). Parents should first try the behavior approach to treat their childrens ADHD symptoms. If the behavior approach alone does not affect the child positively (increase in appropriate behavior), medications may be needed. If medications are going to be used, combining the

behavior approach along with the use of medication is highly advised. Research indicates that multimodal approaches have a higher success rate in treating symptoms of ADHD than the pharmacological approach alone. The dosage amount of any medicine (including stimulants) can affect the severity of side effects. If the only option left is to medicate your child, be cautious and do not over medicate!

Work Cited
Barkley, R. A. Attention Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment. Barkley, R. A. Attention-deficit hyperactivity disorder: Scientific American, page 279, volume3 Matson, J. L. Social Behavior and Skills in Children, page 49 U.S. Department of Education, Office of Special Education and Rehabilitative Services, Office of Special Education Programs, Identifying and Treating Attention Deficit Hyperactivity Disorder: A Resource for School and Home National Institute of Mental Health, NIMH Research on Treatment for Attention Deficit Hyperactivity Disorder (ADHD): The Multimodal Treatment StudyQuestions and Answers. Edwards, J. H. Evidenced-based treatment for child ADHD: Real world practice implications. Journal of Mental Health Counseling Abramowitz, A. J., Eckstrand, D., OLeary, S. G., & Dulcan, M. K. ADHD childrens responses to stimulant medication and two intensities of a behavioral intervention. Behavior Modification American Academy of Pediatrics. Clinical practice guideline: Treatment of the school-aged child with attention deficit/hyperactivity disorder. Pediatrics Hazelwood, E., Bovingdon, T. and Tiemens, K. (2002), The meaning of a multimodal approach for children with ADHD: experiences of service professionals. Child: Care, Health and Development Hinshaw, S. P., Owens, E. B., Wells, K. C., Kraemer, H. C., Abikoff, H. B., Arnold, L. E., et al. Family processes and treatment outcome in the MTA: Negative/ineffective parenting practices in relation to multimodal treatment. Journal of Abnormal Child Psychology Joshua A. Lutz, Ed.S., NCSP. UWF PowerPoint Presentation Working with the ADHD Student in the Classroom :Current Trends and Treatments