Attention-Deficit Hyperactivity Disorder: Treatment and Financing

Abstract

Attention-Deficit Hyperactivity Disorder (ADHD) is a common and widespread neurobehavioral disorder among minors. It is a debilitating condition that is long term in nature. In the United States alone, about 5.5 million minors below the age of 17 have already been diagnosed with this condition. Since the figures are not constant, prevalence estimates have also reached an all-time high of about 7 percent. So far, the school-going children are among the most segment if the population.

From the observations made in this research study, ADHD has a higher prevalence rate in boys than girls. The true gender difference and selection bias may also account for this huge difference. An estimated US$12000-US$17000 is used yearly per child as part of medical costs in the United States alone. Although ADHD has been perceived as a childhood problem, close to 60 percent of childhood cases progress into adulthood.

Introduction

According to Boles, Adair, and Joubert (2009), sustained attention and spatial deficits are major characteristics of Attention-deficit/hyperactivity disorder (ADHD). The frontal lobe and the right parietal lobe are among the most affected regions among individuals suffering from ADHD. Nevertheless, the authors argue that there is insufficient scientific information on attention processes and lateralization changes. It is apparent that there is limited data on the impacts of widespread lateralization disorder. Worse still, it is still unclear whether lateralization transforms itself with the passage of time.

It is against these backdrops that the authors have attempted to explore lateralized processes through the examination of numerous tasks. In an attempt to obtain the best and most reliable results, specific age ranges have been used to study particular lobes within localized positions. Individuals aged between 18 and 26 years, as well as those within 11 to 14 years, were used as part of the study parameters. It is crucial to mention that the two age ranges were fully comprised of both controlled and unmedicated participants.

From the findings, lines were significantly bisected by ADHD minors contrary to the case of controlled children. This is a vivid indication that the parietal lobe located on the right is affected by altered spatial attention. Young adults did not have this medical challenge according to the survey results. Hence, this suggests some form of developmental resolution. In addition, decrements in sustained attention are evident among the lower and higher age groups who took part in the research design. It is the left hemisphere that is affected according to the findings of the research study. Besides, ADHD-related challenges were categorically associated with attention processes according to the preliminary research data.

Peer-mediated intervention and functional analysis were used in this experimental study. Minors diagnosed with ADHD often demonstrate disruptive behavior, and unless they are taken through a rigorous therapeutic process, the symptoms cannot decrease. An afterschool program can be put in place as part and parcel of reducing the impacts of disruptive tendencies experienced by ADHD children.

Grauvogel-MacAleese and Wallace (2010) are emphatic that off-task behaviors among children diagnosed with ADHD can be minimized through differential reinforcement. The latter can be implemented through peers. In this case, behavior change agents are peer groups.

Individuals who suffer from Attention-Deficit Hyperactivity Disorder are largely ignored by extended-release therapies (Gunter, 2013). The latter encourages children to carry their drugs along when going to school. The ability to control symptoms throughout the day has been a major need for ADHD patients. Therefore, a transdermal delivery system was recently developed to solve this problem. It can assist in the process of monitoring and understanding symptoms throughout the day. In other words, the system is highly flexible. Transdermal therapy and oral therapy present unique strengths and weaknesses. For instance, the study by Lloyd et al. (2011) addresses parental preferences of both types of therapies.

In their methodology section, Lloyd et al. begin by exploring a qualitative literature review in a less systematic manner. In addition, the authors use in-depth interviews targeting medical doctors and parents. The aim is to determine salient treatment attributes. Administering drugs according to the diverse needs of patients, duration of medication, speed of onset, and the mode of administration were some of the treatment attributes pursued in the research study. A convenient study sample was used during the experiment. It comprised of 200 children who had already been treated against the condition. A recruitment agency was used to recruit children. Generalized estimating equations were used to analyze the raw data.

The results indicated that oral therapy undertaken once per day is highly preferred by most parents. The latter also mapped into a confidence interval of 95 %. The experiment also revealed that parents whose children have been found to be suffering from Attention Deficit Hyperactivity Disorder (ADHD) choose different preferences.

There are myriads of health-related effects in the use of pyrethroid chemicals for eradicating insects. Children are the worst affected when they are exposed to this insecticide. However, Quirós-Alcalá, Mehta, and Eskenazi (2014) are of the opinion that there are limited data on the negative health effects of pyrethroid. Quirós-Alcalá et al. (2014) examine the link between pyrethroid exposure after birth and the learning feedback given by parents regarding respective school-going children. In particular, the researchers seek to obtain the learning report given by parents regarding the individual performance of their children. The cross-sectional association that exists between ADHD and poor learning ability has been discussed by the authors. Specifically, children between the ages of 6 and 15 years were examined in this experimental study.

The parental-reported academic performance of a child was associated with the ADHD alongside the exposure to the above insecticide. After employing a logical regression method in the analysis, Quirós-Alcalá et al. (2014) concluded that there was no relationship between parental reports on the academic performance of individual children and Postnatal pyrethroid exposure. Besides, ADHD cases were not a direct impact of exposure to this chemical. Although there is the widespread use of pyrethroids, it is necessary to carry out adequate research in order to establish the actual effects or linkage with ADHD. The crucial development stages in children are indeed fundamental as far as the development of ADHD is concerned.

In spite of the strong findings by Quirós-Alcalá et al. (2014), the learning feedback offered by parents is definitely prone to major errors. It is vital to mention that the individual performances of children in the class are unique. As a result, each parent is bound to respond according to the personal performance of the respective child. Hence, such feedbacks may be prone to bias and subjectivity and can hardly give accurate research findings.

Reduced intelligence has been suggested as one of the impacts of exposure to hazardous chemicals in the environment. Nonetheless, there is no adequate evidence on how intelligence is affected by exposure to lead-containing substances, especially when ADHD is not put into consideration. The past studies are also not very clear on the linkage between the symptoms of ADHD and inattention among school-going children (Hong et al., 2015).

The latter authors predicted mutually adjusted associations of the symptoms of ADHD and environmental exposure towards harmful lead components. In order to arrive at the desired results, the researchers a population sample of 1,001 children were used whereby their individual blood lead concentrations were taken. The age group of the sample size ranged between 8 and 11 years (Hong et al., 2015). A model known as multivariable linear regression, was used to analyze the blood samples and relate the outcomes to ADHD symptoms, IQ scores, as well as attention during class hours.

The results indicated that higher blood lead concentrations were responsible for poor attention in class (Hong et al., 2015). In addition, it was also evident that children with higher impulsivity had greater levels of lead concentrations in their blood samples. This implies that intelligence is adversely affected by immense exposure to lead exposure. However, it is vital to mention that the above results were obtained independent of ADHD. When the outcomes of the study were further investigated, the researchers established that the clinical features of Attention-Deficit Hyperactivity Disorder, as well as impulsivity among school-going children, were slightly aggravated by environmental lead exposure (Hong et al., 2015). By independently relating the health impacts of lead exposure to the retention ability of children, the results obtained may as well lack the much-needed accuracy because all factors have not been put into consideration.

Steiner et al. (2013) assert that children’s classroom behavior can be best analyzed using both clinical evaluations and research. There is always a need for objective data when observational measures are being carried out on a crucial psychological subject such as Attention-Deficit Hyperactivity Disorder (ADHD). Inter-rater reliability between observers is still a major challenge when gathering and analyzing raw data from the field.

Observing the behavior of learners in learning environments is a common practice and a major instrument that can be used to detect major flaws in the learning process of children. In particular, the symptoms of ADHD should be keenly observed among children with low retention ability in the classroom so that a better association can be developed. Steiner et al. (2013) observe that reliable research standards on the development of ADHD can only be reached after sufficient training. The authors mainly focus on how effective research study can be used to obtain relevant and most accurate data on ADHD.

Steiner et al. (2013) estimate that proficient reliability when carrying out research studies on ADHD, require about 30 training observations. Although the authors have outlined a research-based experimental study that can be used to improve the analysis of ADHD, the findings lack comparison with other past studies. Another gap in this study is the missing association of ADHD and learning ability among school-going children

Proposal for a new research study

What is ADHD?

Attention Deficit Disorder with Hyperactivity (ADHD) is a neurobiological disorder and genetic in nature. It appears in childhood and often accompanies an individual throughout his/her life. It is characterized by symptoms of inattention, restlessness, and impulsivity. In order to appreciate the causes and effects of ADHD in a better way, it is perhaps instrumental in exploring a number of questions.

Does ADHD exist?

It is officially recognized by many countries and by the World Health Organization (WHO). In some countries like the United States, ADHD children victims are protected by law in order to receive specialized treatment in school.

Is there any controversy about the existence of ADHD?

None. There is even an International Consensus published by the most renowned doctors and psychologists from around the world in this regard. The consensus is a scientific publication made after extensive discussions between researchers from around the world, including those who do not belong to the same group or institution and not necessarily share the same ideas on all aspects of a disorder. It is the most common disorder in children and adolescents. It occurs in 3-5% of children in several different parts of the world. In over half the cases, the disorder follows an individual into adulthood, although symptoms of anxiety are more lenient.

ADHD is characterized by a combination of two types of symptoms, namely inattention and hyperactivity-impulsivity. ADHD in childhood is generally associated with difficulties at school and in relationships with other children, parents, and teachers. Boys tend to have more symptoms of hyperactivity and impulsivity than girls, but all are inattentive. Children and adolescents with ADHD may exhibit more behavioral problems, such as difficulties with rules and limits.

There are already numerous studies around the world demonstrating that the prevalence of ADHD is similar in different regions, suggesting that the disorder is not secondary to cultural factors (the practices of a given society, and so on). Scientific studies show that people with ADHD have alterations in the frontal region and its connections with the rest of the brain. The orbital frontal region is one of the most developed in humans compared to other species and is responsible for behavioral inhibition (that is a control or inhibit inappropriate behavior), the ability to pay attention, memory, self-control, organization, and planning.

What seems to be altered in this brain region is the operation of a system of chemicals called neurotransmitters that pass information between nerve cells (neurons). Not all the causes and implications of ADHD have been investigated, and consequently, an alternative research design is necessary.

Additional evidence on the existence of ADHD

Heredity

Genes appear to be responsible for predisposition to ADHD. The participation of genes was initially suspected from observations that in the families of ADHD patients, the presence of relatives also affected with ADHD were more frequent than in families who had no children with ADHD. The prevalence of the disease among relatives of affected children is about 2-10 times more than in the general population (this is called familial recurrence).

However, as with any behavioral disorders that occur within families, environmental influences may be the cause. Other types of genetic studies are fundamental in confirming the role of genes.

Twin studies compare identical twins and fraternal twins alongside the different aspects of ADHD (presence or absence, type, severity, and so on). Knowing that the identical twins have 100% genetic similarity as opposed to fraternal (50% genetic similarity), if the conjoined posses more ADHD symptoms than fraternal, the only explanation is the participation of genetic components (the parents are equal, the environment is the same, diet and so on.). The more they agree in relation to those characteristics, the greater the genetic influence on the disease. Indeed, studies of twins with ADHD showed that monozygotic are much more alike than fraternal.

From the data on these studies, the next step in genetic research of ADHD should start by exploring what these genes could be. It is worthy that in ADHD, as in most behavioral disorders, we should never speak of genetic determination, but predisposition or genetic influence. What happens is that in these disorders, genetic predisposition involves several genes and not a single gene.

In addition, genes may have different levels of activity; some may be acting in some patients in a different way than in others; they also interact, further adding up environmental influences. There is also a higher incidence of depression, bipolar disorder (formerly called manic-depressive psychosis), and abuse of alcohol and drugs in the family of patients with ADHD.

Substances ingested during pregnancy

It has been observed that nicotine and alcohol, when taken during pregnancy, can cause changes in some parts of a baby’s brain, including therein the orbital frontal region. Research indicates that alcoholic mothers are more likely to have children with hyperactivity and inattention problems. It is important to remember that many of these studies only show us an association between these factors, but do not indicate a cause and effect.

Fetal distress

Some studies show that women who have had problems at birth that ended up causing fetal distress were more likely to have children with ADHD. The cause is unclear. Perhaps, mothers with ADHD are more careless and so might be more prone to problems in pregnancy and childbirth.

Lead Exposure

Young children who suffered lead poisoning may experience symptoms similar to ADHD. However, there is no need to perform any blood test to measure lead in a child with ADHD, since this is rare and can be easily identified by medical history.

Family issues

Some theories suggest that family problems (high degree of marital discord, low maternal education, families with only one parent, chaotic family functioning, and families with low socioeconomic status) could be the cause of ADHD in children. Recent studies have refuted this idea. Family difficulties may be more as a result of what causes ADHD (in children and even parents). Family problems can aggravate an ADHD frame, but do not necessarily cause it.

The objective of the study

The learning ability of a child may be impaired by this common psychiatric condition. In addition, ADHD impedes the capability of a child to coexist with others in a social manner. This study will explore the prevalence of ADHD among children, especially in learning institutions that operate special education. The paper will also examine the degree and estimators of service needs that are yet to be met as far as ADHD patients are concerned.

Methodology

In order to explore the condition and the extent to which it can affect school-going children, 2-4th grade students will be incorporated into the study. These students will be drawn from the special education program throughout the country. Thereafter, a two-stage-screening protocol will be carried out. This implies that the sample size of the population selected will be screened for ADHD. In order to facilitate the screening procedure successfully, standardized questionnaires will be used.

The questionnaires will be handy in obtaining vital information from both parents and tutors. The sample size will be 499. Out of the sample population that will take part in the survey, a total of 318 will be taken through the diagnostic evaluation of ADHD. However, the determination of how healthcare services are being utilized will be conducted in the entire sample size (n=499).

In the first phase of the research study, parents whose children will be selected for the study will be interviewed through the phone. In each school, a coordinator will play the role of dropping and picking interview papers. In order to be included in the second phase, the classification of children selected for the research study will be based on the risk of being diagnosed with ADHD. Children who will be classified to be under high risk are the only ones whose parents will participate in the survey. Hence, the interview involving parents will be structured in nature. In the case of the telephone version of the interview, only parents with children classified to be under low risk of contracting ADHD will be contacted. The interview phase will comprise of a random sample of these parents (Reisberg, 2013).

Measures

In order for the above research study to yield unbiased results, a number of measures will be taken. For example, the administrative offices of the school district will be the main source of exceptional student education records. Besides, all the races will be included in the study so as to present an objective report.

Computer-assisted interviews will be used by the participating families to provide data for the first phase of the research study. Measures that were developed sometimes back will also be utilized as a part of survey health questions. Vital health parameters that will be examined among the selected children include general health status, individual health history, and the present health status of each child.

The Diagnostic Interview Schedule for Children (DISC) research design will be used in the second phase of this research study. The model will assist in the clinical diagnosis of Attention Deficit Hyperactivity Disorder.

Hypothesis

It is anticipated that nearly 50 percent of children selected for the survey will merit for the ADHD diagnosis. A significant number is also receiving care in a number of healthcare institutions. In regards to unmet service needs, it is highly likely that boys tend to receive better services than girls. The unmet service needs are also contributed by organization coverage for health maintenance, low income, and minority status.

The expected results of the study and recommendations

Attention Deficit Hyperactivity Disorder will remain untreatable among children. However, the condition can be dealt with by establishing special education schools where children can be taught at the right pace with appropriate learning styles. The provision of general health care should be aligned or be in tandem with health services offered to children diagnosed with ADHD. The failure of attention and hyperactivity of some children may not be characteristic of temperament and personality, but symptoms of a disease that can be controlled. The need to develop some techniques to compensate for the difficulties of ADHD (schedule of use, fixed place to store objects, reminders placed in strategic positions and on bulletin boards, to-do list, and daily and weekly appointments) require much effort and discipline.

Parents and teachers should be kept informed about the characteristics of the disease and interventions that can help patients overcome their limitations. Finally, psychotherapy may represent an effective way to recover self-esteem, often compromised by feelings of failure and frustration from the difficulties of dealing with everyday situations.