You are on page 1of 6

Pack 1

Chelise Pack
Professor Dursema
English 1010
31 July, 2015
Putting It Together: Complete ADHD Treatment
The prognosis for untreated children with Attention Deficit Hyperactivity Disorder
(ADHD) is bleak. Instances of drug abuse, criminal activity, accidents, poor work performance,
and relationship challenges are more prevalent in those with this disability when they are left
unaided to struggle with symptoms, such as hyperactivity, problems with self-behavioral control,
and an incapability to focus on tasks (Hardman 397). Few question the need for proper treatment
of ADHD; however, disputes exist over the most effective and appropriate methods for the
management of the life-altering condition. Medication has long been considered an effective
therapy by many, though its use has not been without controversy. Conversely, a firm argument
exists that ADHD should be addressed strictly through the use of behavioral interventions. The
solution lies not in one therapy alone; rather, studies have revealed that the most appropriate
treatment for individuals with ADHD is a multimodal method combining both psychosocial
approaches and medication interventions.
On the frontline of ADHD intervention is the use of medications. Stimulants, such as
methylphenidates and amphetamines, are used most frequently because they work relatively
quickly and have proven to produce positive results in from 50-95% of children treated. These
drugs function by enhancing the action of chemicals in the brain that serve to direct behaviors
involved in supporting self-control (Barkley 293). Russell A. Barkley, a renowned pioneer in the

Pack 2
study of ADHD, asserts that stimulants are the only treatment to date that normalizes the
inattentive, impulsive, and restless behavior in at least 50-65% of children with ADHD (296).
Because stimulants are not effective in every case, non-stimulants, such as atomoxetine (a
norepinephrine reuptake inhibitor) and guanfacine XR (an electrical signal enhancer) may be
prescribed. These have been found to be less effective than stimulants, but have still proven to
have some positive effect on approximately 75% of children taking the medication (Barkley
315). Additionally, other medications which are not FDA approved have been employed with
some success. These include antidepressants and antihypertensives (Barkley 319).
ADHD medications impact the symptoms of the disability by improving executive
function, increasing the ability to focus for sustained periods of time, and decreasing restlessness.
To a limited extent, the effects of these improvements in executive function often reach into the
areas of behavior, social function, emotional adjustment, and academics. However, medication
as a standalone treatment is deficient in its ability to positively modify all domains in the childs
life (Barkley 302). This deficiency leaves gaps in the care of children and adolescents with
ADHD.
Second in line in symptom management is the psychosocial approach. According to
Marian W. Roman, PhD of the University of Tennessee, College of Nursing, Psychosocial
therapies alone, without pharmacotherapy, have been reported to help up to 30% of the
recipients (616). Non-pharmacological interventions are available from the pre-school level
throughout adulthood, and take the form of parent training, academic involvement, social
coaching, cognitive instruction, and behavioral therapy, such as Cognitive Behavioral Therapy
(CBT) (Young 123).

Pack 3
Parents often choose to pursue these methods due to concern about the possible side
effects of medications, which may include insomnia, decreased appetite, increased heart rate and
blood pressure, and very rarely, temporary psychosis. Additionally, many experience
apprehension about reports of increased drug abuse or adverse long-term effects of the drugs
(Harper 399). Still other children may be either unable to tolerate the medications or have a
physical condition which precludes the use of such drugs. For these families, managing behavior
through support, training, and therapy produces some positive outcomes in diverse areas that are
affected by ADHD. However, these methodologies alone, according to Roman, offer limited
value for core symptoms, although they can improve functioning (616).
The purpose for treating children with ADHD is to improve the everyday lives of those
who live with the disability by reducing the symptoms of the condition (Harper 399). While the
above mentioned modes of treatment both have proven successful in helping to alleviate the
symptoms of ADHD, each exhibits significant disparities in its ability to adequately influence
every facet of the complex diagnosis. Thus, in instances where medication is safely tolerated, a
comprehensive or multimodal approach is the most effective treatment for children and
adolescents with ADHD.
The Multimodal Treatment Study of Children with ADHD (MTA), was conducted in
order to explore the effectiveness of the combined approaches of medication and behavioral
psychosocial therapies. The study is the largest of its kind in the field of ADHD. Its findings
indicate clearly that the joint methods demonstrated greater success in progress development
than the individual therapies alone. A later follow-up study showed that these children displayed
fewer instances of drug abuse than those initially treated with a solitary treatment. A further
study conducted by a group of psychologists led by Saskia van der Oord found that children and

Pack 4
adolescents who received the combined treatment ultimately used less medication and presented
a substantial reduction in hyperactivity and opposition (Van der Oord 271).
The unique needs of each child must be taken into consideration when tailoring a
treatment plan. The cognitive abilities and age of each individual must be regarded when
determining the best plan of action because, as the child ages, the most suitable mode of
intervention changes. For instance, during the pre-school years, the most appropriate
intervention is thought to be parental training which educates parents about behavioral
management and empowers both parent and child by assisting them to build proficiencies in
relationships (Young 117-119).
As the child reaches school age, outside behavior therapies and educational intercession
become more appropriate. CBT may be added at this age, but as Young reports, it may only be
effective for the treatment of ADHD when provided in combination with medication (122).
Additionally, social skills training (SST) proves to be beneficial in consideration of the fact that
nearly half of children this age report a lack of social acceptance. Young also asserts that
integrated treatment packages are more likely to be successful than standalone treatments
especially in addressing comorbid problems and broad domains of impairment (124).
Adolescence is a time when a pointed decrease in continued medication intake is seen.
Unfortunately, this is not indicative of the absence of symptoms in all of these youth. This is a
time when ADHD drugs should be the principal choice of treatment. Academic intervention
continues, and at the same time, parent training proves to be less effective. Finally, it is
recommended that both CBT and SST be incorporated at this age when the child is beginning to
emerge into adulthood. These helps provide the adolescent with tools of self-regulation and
social health (Young 124-125).

Pack 5
The purpose of the treatment of Children with ADHD is to enhance their lives and enable
them to thrive in social situations, the work environment, the classroom setting, and in
relationships (Hardman 399). Studies have confirmed that despite the benefits of each treatment,
no single approach is far reaching enough to extend to every symptom of the condition. Every
child with ADHD is unique in his or her needs, and those requirements must be extensively
assessed through the proper modes of treatment. Although medication may not be an option for
every individual, it should be utilized when appropriate to do so. This, in combination with the
most fitting psychosocial courses, provides the most suitable and effective treatment for children
and adolescents with ADHD.

Pack 6
Works Cited
Barkley, Russell A. Taking Charge of ADHD: The Complete, Authoritative Guide for Parents.
3rd ed. New York: The Guilford P, 2013. Print.
Hardman, Michael L., Clifford J. Drew, and M. Winston Egan. Human Exceptionality: School,
Community, and Family. 11th ed. Belmont, CA: Wadsworth, Cengage Learning, 2014.
Print.
Roman, Marian. Treatments for Childhood ADHD Part II: Non-Pharmacological and Novel
Treatments. Issues in Mental Health Nursing 31:9 (2010): 616-618. Web. 23 July 2015.
Van der Oord, S., et al. The Adolescent Outcome of Children with Attention Deficit
Hyperactivity Disorder Treated with Methylphenidate or Methylphenidate Combined
with Multimodal Behavior Therapy: Results of a Naturalistic Follow-up Study. Clinical
Psychology and Psychotherapy 19 (2012): 270-278. Web. 27 July 2015.
Young, Susan and J. Myanthi Amarasinghe. Practitioner Review: Non-pharmacological
Treatments for ADHD: A Lifespan Approach. Journal of Child Psychology and
Psychiatry 51:2 (2010): 116133. Web. 23 July 2015.