Download Alternative Therapies for Treating ADD and ADHD by Lee Ann

Society’s Duty to Consider Alternative Therapy when Facing the Symptoms of Attention Deficit
Disorder and Attention Deficit Hyperactivity Disorder in Children
Lee Ann Molinaro
ISS 4935
Dr. R. Johns
April 25, 2012
0
In 2010, the number of children aged three to seventeen diagnosed with Attention Deficit
Disorder (ADD) or Attention Deficit Hyperactivity Disorder (ADHD) reached 5.2 million
(Bloom, Cohan & Freeman, 2010). Nine out of every ten children diagnosed with ADD or
ADHD are treated with harmful prescription medications that result in devastating long-term side
effects. The other ten percent are treated by alternative means that are safe and are nonprescription based, such as behavioral modification therapy (Sleator & Pelham, 2010). ADD and
ADHD are disorders that affect the focus, attention and overall behavior in a child. If the
symptoms of these disorders are ignored, they can be detrimental to the child’s success and will
only worsen as the child matures. It is the duty of caregivers to provide their children with the
most beneficial method of treatment to ensure that they will have a healthy and successful future.
Attention Deficit Disorder (ADD) and Attention Deficit Hyperactivity Disorder (ADHD)
are medically defined disorders and the research herein will provide evidence based medical data
to describe the disorders and explain their diagnosis, prognosis and treatment. ADD and ADHD
classifications and standards will be outlined using medical dictionaries along with the
Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) which is the
customary classification of mental disorders used by medical professionals in the United States
and put forth by the American Psychiatric Association. The DSM-IV is used in many ways by
clinicians and researchers because it provides current public health statistics and up to date
diagnosis criterion used by qualified medical professionals.
I will also include a comprehensive qualitative analysis of the opinions and knowledge of
several medical professionals and scholars who are educated on the topic. The conclusions that I
will draw are based on the knowledge gained from professionals who have a great understanding
on the subject at hand. All the research for this paper has been gained by a review of secondary
1
literature which will provide a well-rounded and objective examination of the social issue in
question.
Although ADD and ADHD are true medical disorders, the diagnosis, and in particular the
treatment, of these disorders are causing more and more controversy every day. Research shows
that children are diagnosed with ADD and ADHD when they do not truly have a disorder. This
unfortunately results in an improper diagnosis and consequently unneeded treatment. It has
become apparent that the required diagnosis criterion over the years has become negligent. With
this negligence there has been a rise in children receiving treatment with harmful prescription
medications. These medications are harmful but they are effective for those who have ADD and
ADHD.
Unfortunately, the medication effects are also extremely beneficial to authority figures
that have trouble tolerating children’s behavior that has been mistaken for ADD and ADHD. In
other words, it is easier for adults to give children a pill that will adjust their behavior than it is
for authority figures to work on the behavioral issues present through other means. All in all,
medication treatment methods are warranted although not needed simply because they are easier.
Undoubtedly, this sort of negligence on behalf of adults will not go unnoticed and it is not
surprising that there is controversy.
Throughout this paper a history of ADD and ADHD and
the problematic present day matters that society faces because of the above-mentioned
carelessness of society will be discussed.
As previously mentioned, ninety percent of children diagnosed with ADD and ADHD are
being treated by the means of prescription medication (Sleator & Pelham, 2011). This fact
demonstrates that the majority of society’s caregivers are condoning the quickest method of
treatment for their children and yet also choosing a method that is not the safest or the most
2
beneficial. Studies have shown that alternative methods such as behavioral modification are
more beneficial to the future health of children. Medications used to treat ADD and ADHD do
not cure the disorders (Purtie, Hattie & Carroll, 2002). “Medication does not make up for skills
that children have never mastered nor does it address learning problems” (Powell, Welch, Ezell,
Klein, Smith, 2003). These medications simply mask the symptoms by altering the stimulants in
the brain that effect behavior.
Alternative methods of treatment like behavioral modification are not as quick as
prescription medications; however, this type of intervention is far more beneficial to the child.
Behavioral modification employs tools that allow children to work through their behavioral
problems and find healthy solutions. This type of treatment involves steady therapy and must
include all authority figures in the child’s life. This treatment gives children a chance to fix their
behavior before they are immediately labeled with a disorder like ADD or ADHD and treated
with hazardous medicine. Caregivers should implement safe and effective methods first and
foremost to treat symptoms before any diagnosis or medication is given.
Before delving any further into the preventative measures, the diagnosis and the
treatment of ADD and ADHD it is imperative to review the details of these disorders and the
reasons behind why millions of children are diagnosed. ADD is a neurological syndrome,
usually in childhood, characterized by a persistent pattern of impulsiveness, and a short attention
span that interferes with academic, occupational and social performances (American Heritage
Medical Dictionary, 2007). ADHD is a neurological disorder similar to ADD that unveils
excessive movement, irritability, immaturity and inability to concentrate or control impulses
(American Heritage Medical Dictionary, 2007). ADD and ADHD (AD/HD) are ultimately one
in the same disorder because the root cause of the problem is neurological and involves an
3
attention insufficiency.
The difference is that children with ADHD as opposed to ADD
demonstrate more hyperactivity along with their inability to sustain their attention. Most medical
research tends to group both ADD and ADHD (AD/HD) together due to the similarity of their
characteristics and also because the diagnosis criteria is the same.
From here forth, ADD and
ADHD will be discussed together for purposes of research and analysis.
According to the DSM IV, to diagnose AD/HD, the symptoms such as inattention,
hyperactivity and impulsivity must be present for at least six months and also be displayed
before a child is seven years old. Inattention is demonstrated when a child is not able to give
close attention to details, makes careless mistakes, has difficulty sustaining attention in playful
activities, is unable to follow through with instructions, has difficulty organizing tasks, avoids
tasks that require mental effort, frequently loses items needed for scheduled tasks, is distracted
by extraneous factors or is forgetful in daily activities. Hyperactivity can be determined when a
child frequently fidgets in his or her seat, frequently leaves his or her seat when asked to stay,
runs or climbs excessively in inappropriate situations, has difficulty playing in activities quietly,
tends to be “on the go” or “driven by a motor” or talks excessively. Impulsivity is determined
when a child frequently blurts out answers to questions before the question is completed, has a
difficulty waiting his or her turn or habitually interrupts others. (American Psychiatric
Association, 2000)
In general a child’s caretaker first observes the symptoms of AD/HD yet it is normal for a
teacher or another unattached authority figure to mention when the symptoms start to become
troublesome. When this occurs, a caretaker usually seeks the help of a medical professional to
assess if there is a problem in need of an intervention. Medical professionals that are qualified to
give a diagnosis for AD/HD are pediatricians, neurological physicians, psychologists,
4
psychiatrists and in some cases clinical social workers (Guevara & Stein, 2001). As previously
stated it is required, as outlined by the DSM IV, to observe the symptoms of inattention,
hyperactivity or impulsivity for at least six months before a diagnosis occurs and to see the
prolonged symptoms before the age of seven. Clearly, a standard visit to one of the qualified
professionals does not provide any ability to observe a child for six months and may occur after
the child is seven years of age. Therefore, medical professionals are accepting the observation
by the child’s authority figures to make the decision that a diagnosis is in order. Along with the
six month observation reported by the caretakers the medical professionals are using several
types of Attention Tests that have been created to also point out symptoms of AD/HD. (National
Institute of Mental Health, 2009). However, after review of several studies, these tests do not
prove to have any true validity to them which concludes that there is extreme difficulty in
assessing behavior by the means of a test. Behavior is circumstantial and not something that can
be summed up from a set of questions or by a single doctor’s visit. Ultimately, for a true
diagnosis to occur, a thorough investigation of a child’s behavioral history is necessary.
In the past twenty years, the percentage of children diagnosed with AD/HD has
dramatically increased by about 500% (Center for Disease Control and Prevention
(CDC), 2010). Dr. Lawrence Greenberg is a child pediatrician and child psychologist
who also created one of the Attention Tests called The Tests of Variables of Attention
(TOVA). Dr. Greenberg states one reason as to why the diagnosis rates are increasing is
because society has become more aware of AD/HD. He claims that any symptoms of
AD/HD, even if the symptoms are temporary, results in a diagnosis of a child to have
AD/HD even when they do not actually have a disorder. Dr. Greenberg verifies that the
problem of over-diagnosing children with AD/HD has been a result of society’s
5
eagerness to control children’s behavior and get any problematic behavior treated as
quickly as possible. (Greenberg, Shaughnessy, Martin & Rivera, 1999)
Jaak Panksepp, another child psychologist, claims that society has become intolerant to
children’s behaviors and that the behaviors that used to be considered playful are now being seen
as disruptive (Panksepp, 1998).
The 5.2 million children that are diagnosed with AD/HD
represent a 500% increase since 1990. We can now conclude that this rise is due to society’s
expectancy for children to behave in a certain manner. Although this may not have been the
intention, society has evolved to expect a certain type of human order that pressures children to
act more mature than ever before. Behaviors that were once considered just ordinary childlike
behaviors are now considered to be bothersome and annoying and must be a result of a disorder
like AD/HD. Subsequently, society has latched on to the medicines that change children’s
behaviors instead of just allowing kids to be kids.
Symptoms of AD/HD are symptoms that all human beings experience, especially
children. The reason that the diagnosis criterion has a six month observation guideline is
because the symptoms are relatively common, especially in children (National Institute of
Mental Health, 2009). Therefore, to consider these symptoms worthy of a diagnosis they would
need to be present for an extended period of time. A child’s diet, health, exercise, family, and
social circumstances can severely affect how he or she will behave on any given day, thus to
diagnose a child with AD/HD for showing symptoms of hyperactivity, inattention or impulsivity
you must take a look at all factors affecting the child’s life. A six month observation is vital to
ensure that these symptoms are not just circumstantial and they are truly a real cognitive problem
which is affecting their behavior. It has become apparent that the diagnosis criterion is being
6
overlooked and a majority of the children diagnosed with AD/HD are diagnosed improperly and
even worse are now being treated.
As the rate of children diagnosed with AD/HD has increased, so has the rate of treatment
for these disorders.
The most common form of treatment for children with AD/HD is
prescription medications like Adderall or Ritalin. Adderall, commonly used for children with
ADD is a combination of dextroamphetamine and amphetamine. The combination of these two
drugs can produce severe side effects such as nervousness, restlessness, difficulty sleeping,
shaking, headache, dry mouth, stomach pain, nausea, vomiting, diarrhea, constipation, decreased
appetite, weight loss, heart attack, stroke and death.
Ritalin commonly used in children with
ADHD is a similar drug that contains methylphenidate. The side effects from using this drug
include nervousness, difficulty sleeping, dizziness, nausea, vomiting, decreased appetite,
stomach pain, diarrhea, heartburn, dry mouth, headache, muscle tightness, uncontrollable
movements, restlessness, numbness in hands and feet, painful menstruation, heart attack, stroke
and death. (US National Library of Medicine, 2011).
A study conducted in 1995 by Hedges, Frederick, Reimherr, Rogers, Strong and Wender
found that the severe side-effects of AD/HD medications occurred in 39% of AD/HD patients.
The most common side effects reported were fatigue, confusion and dizziness. Many of these
patients had trouble staying on the medication. This study also found that 50% of patients
experienced nausea and 17% experienced “lowered energy, gas, diarrhea, insomnia, tremor,
muscular tension or teeth grinding”. Although these medications are meant to sustain focus, the
negative side effects have had adverse effects on “fine motor skills, weight, appetite, blood
pressure, heart rate, and sleep”. (Purdie, Hattie & Carroll, 2002)
7
It is uncertain the total number of deaths that have occurred from AD/HD medications;
however, due to 12 sudden deaths in American children in 2005 from AD/HD medications,
Canada suspended its distributions of the drugs. Drug representatives have publically stated that
the drugs can cause death and they are now required by law, under the guidelines of the Food
and Drug Administration (FDA), to place a warning label on the prescriptions. These same
representatives justify the deaths in stating that in 1990 the chance of death occurring was about
1 in 100,000. Of course, this statement referring to a 1990 consensus was just before the 500%
increase in distribution of the drugs and it is common sense that if the distribution increases the
death count will rise as well. (DeNoon, 2012)
Adderall and Ritalin are also habit forming drugs and are even more dangerous for
anyone with an addictive type personality, have other mental issues such as depression or for
those who have a genetic history of addiction or drug abuse.
These drugs are psychotropic
stimulant medications that alter the state of mind and although they work to subdue hyperactivity
they also work to stimulate the mind and speed up the central nervous system (Powell, et al. ).
These drugs do not cure AD/HD and a child must take the drugs forever to maintain the effects
that they produce (Purdie, Hattie & Carroll, 2002). The longevity of taking a drug this powerful
makes it nearly impossible for an individual to stop taking it and attempt to live without it.
When children begin taking drugs habitually, their brains develop with the drug and do
not learn to function without it. As a result, these children will be faced in their adulthood with
either long-term prescription drug use or serious personal battles to withdraw from the
medication. Adderall and Ritalin are commonly used recreationally in adolescents and adults
because of their strong effects on the mind. By prescribing children with behavior problems
these drugs we are entrusting that the drugs are only taken as prescribed and never abused.
8
Timothy Wilen, associate professor of Psychology at Harvard University and psychologist at
Massachusetts General Hospital, states that roughly 30% of youth with AD/HD report that they
abuse their medications for recreational use (Becker, 2011). This percentage reflects only those
willing to admit that they abuse their medications and it is easy to believe that this percentage is
far less from the actual truth.
Research consistently agrees that use of stimulant medication like Adderall and Ritalin
puts an individual at a higher risk for future drug addiction or abuse related problems. When an
individual is used to using medication to address a feeling or mask a problem, the use of
medication or other substances to cope with emotions that are uncomfortable becomes harder to
control or avoid. The use of Adderall and Ritalin has skyrocketed since the early 1990’s. The
production of these drugs in the United States increased significantly as the diagnosis percentage
rose. In 1995, 2.6 million children were taking these prescriptions medications for symptoms of
AD/HD and by 2003 that number rose to 4.4 million (CDC, 2010). Researchers along with Dr.
Timothy Wilens, followed 500 children treated with AD/HD medications over a ten year period
and found that they were one and a half times more likely to abuse drugs or alcohol and over two
times more likely to smoke cigarettes than other children. Dr. Wilens concluded that the reasons
AD/HD children were more likely to abuse drugs was not because of any cognitive factor in
these children but simply because there tends to be a prolonged “dysregulation” of mood or
affect in these children when they are medicated with AD/HD medications (Becker, 2011).
Again, when a child’s brain and body becomes accustomed to having a powerful medication
regulating their mood and behavior, they are unable to successfully deal with stressors that show
up throughout their lives. These children are used to having a medication to aid them in feeling
“normal”, therefore they are more susceptible to abuse drugs to cope with any uneasy feelings
9
that come along. In essence, they are never trained to deal with emotions during the stages of
life that they need to learn the fundamental coping mechanisms.
One parent of a child with AD/HD commented on an online commentary for the
Massachusetts General Hospital Study and said,
“My son was diagnosed ADHD at age 5. He was on ritalin until high school. He
then began to self medicate. We went to therapists and did all we could do.
He went through the usual highs of pot, then club drugs, cocaine, vicodin, and
finally heroin. He became addicted to vicodin after a painful surgery. A friend
turned him onto heroin. My son overdosed on heroin and vicodin and spent 4
days in intensive care. We thought that was enough to straighten him out. My
beautiful, loving, sweet, son passed away 6 months later. He died the day
before his 29th birthday. I belong to a support group for parents who lost
children to drugs it is called GRASP. A large number of our kids were
ADD/ADHD. We didn't need a study to tell us how ADHD contributed to their
addiction and in the end their deaths. My son never slept, he would joke and
say he was nocturnal. Not sleeping and impulsiveness add up to disaster. “
~PatsMom
Not all children diagnosed with AD/HD and treated by means of prescription medications
end up drug addicts or abusers; however, the likelihood increases and that is significant.
Because of the side effects that these drugs can create and the possibility of sudden death,
caretakers should try every method to avoid the prescriptions first. It is unfair to medicate a
child with a drug that produces troublesome side effects without knowing for sure that a natural
alternative, with no side effects could work. Children cannot speak for themselves and their
health is in the hands of adults; thus it is so important to provide the healthiest method before
imposing treatment that may cause problems. Also, many children are being falsely diagnosed
with AD/HD; therefore it must become the responsibility of adults to make sure children do not
become medicated for something that does not exist. Adults must seek alternative ways to deal
with problematic behavior that does not involve anything that could cause harm.
10
It is important to understand that when dealing with AD/HD symptoms we are dealing
with symptoms that effect behavior. These symptoms, if the child truly has AD/HD, are present
because of a cognitive ailment which prevents normal cognitive development which as a result
effects behavior.
However, because the symptoms are behavioral, because they can be
circumstantial and because they are found in every child in the world at some point, it is very
important to first employ tactics of behavioral modification to rule out the very notion that the
child has an actual disorder. If and when a child is born with an actual mental illness, typically,
there are not many effective ways to help the child without the intervention of some medications.
In other words, medications have been a medical miracle for those with true mental illnesses
because they have provided a quality of life for the mentally disabled that could not have
previously existed. However, when a child is mentally healthy but is experiencing the symptoms
of a disorder, like AD/HD, it is only right that society works with these children to adjust their
behavior so that they do not become diagnosed with AD/HD and then further treated with drugs
that are harmful.
Behavior modification should be given as the first intervention to all parents and
caretakers of children with symptoms of AD/HD (Thompson, 1996). Behavior modification is
defined as the use of basic learning techniques, such as set conditions, biofeedback, positive
reinforcement, engaged education and aversion therapy to teach simple skills or alter undesirable
behavior. Behavioral modification is a therapeutic approach that focuses on modifying the
patient’s observable behavior by addressing the conditions that influence the undesirable
behavior (Powell, et al). Some conditions that influence undesirable behavior are lifestyle
conditions like the child’s diet or the amount of exercise that is being done. Other conditions
that may influence behavior could be extraneous factors like a parent’s divorce or sibling rivalry.
11
Behavioral modification uses therapeutic tools to work on the issues affecting the child’s
behavior and it teaches proper coping skills if and when the conditions present themselves again
in the child’s future.
Behavior modification can include a number of different approaches. One approach
according to the Widmeyer Group & Chesapeake Institute involves a type of behavior
modification that involves education. This practice engages children in an active learning setting
that incorporates a lot of motor activities (Powell, Welch, Ezell, Klein & Smith, 2003). Several
behaviors associated with AD/HD tend to come about when a child is bored or not stimulated
enough. When a child is in a situation that is boring it is difficult for a child to sit still or behave
in a socially acceptable way. Also, if a child is more intellectually developed than the other
children around, he or she will ultimately become agitated and fidgety while waiting for their
peers to catch up. This can result in a demonstration of problematic behaviors of inattention,
hyperactivity and impulsivity. Therefore, these children should be placed into situations that will
keep them stimulated and focused.
It is not any surprise that children are affected by their surroundings. If a child is
experiencing difficulty coping with a problem in their home such as a divorce, a death in the
family, sibling rivalries, etc., the child may display undesirable behavior which can be confused
as AD/HD. In these sorts of cases behavioral modification uses tactics to help the child work
through their emotions and find healthy solutions to let out their frustration or express their
feelings. For example, Hospice is an organization devoted to individuals and their families when
they are facing a terminal illness or have experienced a sudden death.
Since Hospice’s
foundation in 1977, they have employed tactics of behavioral modification in children that are
affected by the deaths of close family members. Hospice members found that children have a
12
difficulty coping through traumatic experiences and they need individualized treatment plans that
are relative to their own level of development and age. Hospice’s program for children is called
Stepping Stones and it employs behavioral therapy techniques to encourage healing, healthy
expression and bereavement to ensure that children do not find themselves suffering further.
Children that are a part of Stepping Stones express their grief in a healthy manner and learn how
to cope so that their feelings of despair do not manifest into problematic behaviors. (Suncoast
Hospice, 2012)
“Factors such as poverty, abuse, or neglect, and disturbed family relationships
are known to in-crease the risk of emotional dysfunction and mental disorders
in infants and young children. Yet their obvious consequences are not always
documented until children's learning or behavioral problems are noticed
when they reach preschool or school. The emotional and mental disorders of
early childhood need to be addressed before they lead to school failure and
behavioral problems.”
A. Novello, MD, MPH, C. DeGraw, MD, MPH & D. Kleinman, MD, MPH
Conditions that are out of a child’s control will occur frequently as they grow up and they
mature. It is inevitable that the child will face some uneasy emotions as they grow up and the
adults around them are calling the shots. Educators Jane Ann Morrison and Beth Fouse believe
that reading children’s books is a useful type of behavioral modification for the purposes of
treating AD/HD. The premise here is to involve children in reading children’s stories that
address stressful situations and end in healthy outcomes. This practice stimulates children
because they are unknowingly empathetic to the characters in the books. Children can relate to
the situations in the stories, learn from the endings and improve their cognitive reading skills and
attention. Children have a difficult time listening to adults as they try and give advice, especially
when the adult may be the reason causing their frustration to begin with. Children’s books bring
13
real life situations down to a simple manner of understanding that children grasp onto and learn
from. (Fouse & Morrison, 1997)
When a child is behaving in an undesirable manner it is important for people to recognize
that they are children and need to be taught proper behavior before they are punished or
improperly diagnosed with AD/HD. Positive reinforcement is a type of behavioral modification
that has proven effective and is a useful technique for children having difficulty behaving
properly. Positive reinforcement rewards children when they behave well and disregards them
when they act poorly. Children begin to start associating good behavior with rewards and bad
behavior as creating no attention at all. Ultimately these children begin to choose to act in a
manner that is beneficial to them, which gives them attention and awards. Also, a common
practice in positive reinforcement is to provide the child with a designated time that they can do
something that is out of the normal day’s activities that they enjoy. As long as the child behaves
appropriately, the time is given and as a result the child will continue to work to behave well to
deserve the extra activity. (Powell, et al, 2003)
Taking control of children’s diet and exercise is also another behavior modification
strategy because it addresses conditions that are extremely influential to a child’s behavior.
Research dating back to the 1970’s has shown that food additives such as dyes and colorings
have been linked to the behaviors in children with AD/HD. Also, a lack of fatty acids or omega3 enriched foods, like tuna and salmon has proven to be a cause of inattention. Foods enriched in
omega-3 nutrients have been proven to positively enhance the way the brain functions and when
there is an insufficient amount of these nutrients the brains cognitive ability is weakened.
(Harvard Health Publications, 2012)
14
Proper nutrition is essential for good brain development and for good physical health.
Inadequate diets can manifest symptoms of AD/HD in children which will negatively affect their
social and academic performances. Dr. Novello, the former Surgeon General of the Public Health
Service, Dr. DeGraw, the former Coordinator of Children and School Programs at the Office of
Disease Prevention and Office of the Assistant Secretary for Health, and Dr. Kleinman, the
former Deputy Director of the National Institute of Dental Research agree that the collaboration
between health and education is vital. These reputable doctors claim that healthy children are
eager to learn and educated children are eager to be healthy. Children, who become educated on
their health and comply with necessary health standards, will be enthusiastic to learn and become
more focused on their education because they will feel physically better and be more motivated.
(Novella, DeGraw & Kleinman, 1992)
Exercise also plays a large role in the way that children behave because it stimulates
dopamine levels in the brain. Dopamine is a natural chemical that is a neurotransmitter which
enables the body to feel emotions like joy and happiness. It arouses sensors in the brain that
influence mood and keep the body in motion because it also effects the central nervous system.
Dopamine controls how we think, sleep, handle stressors and emotional episodes that arise
throughout our lives. AD/HD medications are formulated to increase dopamine levels, however
exercise is a proven safe way to increase the levels of dopamine and keep them regulated.
Furthermore, a lack of exercise can be a cause of attention disorders and compulsive behavior.
(Sorenson, 2010) Overall, exercise provides positive benefits to children with symptoms of
AD/HD and it is also something that children should grow up doing for preventative purposes.
Schools across the nation have been minimizing the time allotted for recess because of
budget cuts.
Several scholars argue that this is detrimental to children because recess is
15
necessary in keeping a child focused. It is not logical to expect a child to sit in a classroom for
several hours and pay attention.
Studies have shown that children who are in learning
environments that consistently involve ten minute breaks within forty minute periods have better
attention and overall academic performance than those that do not have recess at all. Studies
have proven that children are more academically successful when there is a break in between
prolonged cognitive tasks. Today, students typically move from cognitive task to cognitive task
without any non-cognitive break. Five minutes between classes is not sufficient time to rest the
mind and relax. A good recess period between cognitive learning tasks actually promotes less
interference and more attention during cognitive assignments (Pellegrini & Bohn, 2005).
There are so many children diagnosed with AD/HD today due to symptoms that are quite
normal for children. It seems only necessary to involve all children in activities that lessen their
chances of ever getting labeled with AD/HD. Preventative measures include ensuring children
have proper exercise and a good healthy diet. For the children that are experiencing troubles
outside of their control, they are at a high risk for undesirable behaviors because their focus is
not where it needs to be. Adults should take the initiative to assess a child’s personal situation
before allowing the child to be diagnosed with AD/HD. Symptoms of AD/HD are treatable
through methods of behavioral modification and these symptoms can be adjusted in a healthy
way. Only ten percent of the children diagnosed with AD/HD are reported to have tried the
tactics of behavior modification before prescription medications are considered (Sleator &
Pelham, 2010). With this minimal percentage there is minimal data on the efficacy of behavioral
modification; however, this form of treatment has consistently shown a benefit on the behavior
in children with AD/HD (Guevara & Stein, 2001).
16
Studies on treatment for AD/HD consistently mention behavioral modification as a useful
tool for parents and teachers to try on their children or students when they are observing
problematic behavior. After further research it seems that the reason there is very little reported
use of behavioral modification or support for its benefits is possibly because it requires
consistency among all people in the child’s life. This could be relatively difficult, especially in
today’s working society and the overpopulation in schools. The effectiveness of prescriptions
medications is also so great that caretakers find it easier to use medication than put forth the
effort to help their children. In 2007 and 2008 the average student to teacher ratio for public
elementary schools was 20 to 1 and for public secondary schools was 23.4 to 1, since then the
ratio has risen as budget cuts have forced the extinction of valuable educators (National Center
For Education Statistics, 2008). This ratio makes it difficult for teachers to give the necessary
extra time to their students whom are experiencing AD/HD symptoms. Although teachers may
not agree with medication, they feel they do not have the ability to implement behavioral
modification strategies in their large classrooms.
Currently, there are so many children taking AD/HD medications that there is a shortage
of medicine available. Children are now facing the dilemma of possibly having to cease taking
their medication. Due to the fact that these medications do not cure AD/HD we are going to be
right back where we started before the treatment even began. The children that have taken
medication for several years will have the same problems that they had before. Hopefully these
children will be fortunate to find methods of behavioral modification to continue on with a
successful future. The projection, unfortunately, is that these children will now be even further
behind because they will now have to try and adjust to a life without the enhancement of
stimulant medication. For those who have been taking the prescription medications for several
17
years, their brains are now reliant on the drugs and they will face serious battles to get their
brains working properly off of the medication.
Behavioral modification may be more difficult in the beginning when treating a child
with AD/HD or when treating the symptoms associated with AD/HD.
Also, behavioral
modification may not work in every case because AD/HD is a real cognitive disorder. However,
because the diagnosis of AD/HD seems to be handed out negligently it is only necessary to first
try a method of treatment that will ensure there is not any hazardous side effect in the child’s
future. Authority figures of all kinds should set aside their personal reasons for not finding the
time to work with children with behavior problems and realize that with a collaborated effort we
can help children using safe methods. Behavioral modification not only addresses the symptoms
of AD/HD but also teaches children coping skills that will forever be useful in their future.
Caretakers should also involve their children in public schools that have programs set
aside for children in need of extra attention. Many schools around the nation have programs for
children when they are not gaining the most effecting education in a regular classroom. In some
cases, children may not be up to par with other children their age. These children will need extra
attention to get caught up to their age level’s capabilities. In other cases, children are over par
with other children their age and they too will need extra attention to stimulate their minds.
When a child is not stimulated by a regular classroom or if he or she is behind and does not
understand a concept they will start to become inattentive, hyperactive and impulsive. Instead of
diagnosing them with AD/HD it is important to assess the child and see if he or she would be
better in another program.
It would also be beneficial for caretakers to take a look at their children’s school lunches
and exercise or recess practices. Parents can do everything in their power to feed their children
18
with the right nutrition; however, if the school is not providing the same nutrition it is
counterproductive. Students may leave the home eager and ready to learn but then get to school
and have a snack time that involves cookies and soda. When a child is used to eating well at
home and then eats high fat and sugar foods in school, their behavior in the classroom may be
disruptive. Some schools are cutting recess and if you have a child that needs time to exert
energy in order to focus; these schools are not for your child. Many families cannot afford
extracurricular sport activities so it is important to find a school that has a sport program to make
sure your child is getting proper exercise.
Most importantly, caretakers need to assess the environment in which their child is living
in. Although caretakers may find themselves in the midst of a serious personal problem they
need to realize that their personal issues may have serious effects on their children. There are so
many programs around communities that help children when there is a traumatic event in their
home taking place. Many of these programs are volunteer-based and the expense is minimal.
Hospice, for example, uses a sliding scale and assesses each family different depending on what
they can afford (Suncoast Hospice, 2012). Prescription medications are expensive and if a parent
can afford those on a monthly basis, more than likely, they can afford some extra help involving
behavioral modification.
AD/HD is a serious disorder and many children that have been diagnosed are not really
victims of the actual syndrome. Although society is faced with now rescuing the children that
are heavily medicated, society now also has the opportunity to prevent further improper
diagnosis and treatment. When a child is showing symptoms of AD/HD society must first
embark on the tactics of behavioral modification. If this type of intervention does not have any
result it may then be safe to test the child for cognitive problems and possibly diagnose AD/HD.
19
Society needs to realize that children will act as children and behavioral problems will be
present. The intolerance to children’s behavior in today’s world is not an excuse to medicate
children so that they behave. It is the responsibility of society’s authority figures to work with
children to ensure their health and success. It is the duty of society to consider non-prescription
alternatives when faced with symptoms of AD/HD in children.
20
Bibliography
American Heritage Medical Dictionary. (2007). Houghton Mifflin Harcourt Publishing Company
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders
(4th ed., text rev.). Washington, DC: Author.
Becker, D., 2011. Study: ADHD may be primary factor in substance abuse. Boston NPR News
Station, 90.9, Retrieved 022512
Bloom B., Cohan, RA & Freeman, G. 2010. Summary health statistics for US children: National
Health Interview Survey. National Center for Health Statistics. Vital Health Stat 10(250).
Center for Disease Control and Prevention, 2010. Increasing prevalence of parent-reported
Attention-Deficit/Hyperactivity Disorder among children---United States, 2003 and 2007.
Atlanta, GA. Retrieved on 041112
DeNoon, D. 2005. Sudden death in 12 kids on ADHD drug Adderall: Adderall XR sales
suspended in Canada, FDA issues U.S. advisory. WebMD Health News. WebMD, LLC
2005-2012. Retrieved 040512
Diller, L. (1996). The run on Ritalin: Attention Deficit Disorder and stimulant treatment in the
1990s. The Hastings Center Report, 26(2), 12-18.
Fouse, B. & Morrison, J.A. (1997). Using children’s books as an intervention for AttentionDeficit Disorder. The Reading Teacher, 50(5), 442-445
Greenberg, L., Shaughnessy, M.F., Martin, J., & Rivera, H. (1999). An interview with Lawrence
Greenberg about attention defecit and hyperactivity. The Clearing House, 73(1), 43-46.
Guevara, J. & Stein, M. (2001). Evidence based pediatrics: Evidence based management of
Attention Deficit Hyperactivity Disorder. BMJ: British Medical Journal, 323(7323),
1232-1235.
Harvard Health Publications, 2012: Harvard Medical School: Diet and attention deficit
hyperactivity disorder. Harvard University, Retrieved 022512
Suncoast Hospice, 2012: Support for grieving children and families: Stepping stones. Retrieved
041012 from www.thehospice.org
National Center for Education Statistics. (2008). Fast facts: Teacher trends. IES Institute of
Education Sciences. Retrieved on 040512 from www.nces.ed.gov.
21
National Institute of Mental Health. (2009). Attention Deficit Hyperactivity Disorder. NIMI US
Department of Health and Human Services, Retrieved 040512 from www.nimh.nih.gov.
Novello, A., DeGraw, C., Dushanka, V. (1992). Healthy children ready to learn: An essent,ial
collaboration between health and education. Public Health Reports. Association of
Schools of Public Health, 107(1), 3-15.
Panksepp, J. (1998). Attention deficit hyperactivity disorders, psychostimulants, and intolerance
of childhood playfulness: A tragedy in the making? Current Directions in Psychological
Science, 7(3), 91-98.
Pellegrini, A. & Bohn, C. (2005). The role of recess in children’s cognitive performance and
school adjustment. Educational Researcher. 34(1), 13-19
Powell, SE, Welch, E, Ezell, D., Klein, C., Smith, L. (2003). Should children receive medication
for symptoms of attention deficit hyperactivity disorder?. Journal of Education, 78(3),
107-115
Purdie, N., Hattie, J., Carroll, A. (2002). A review of the research on interventions for Attention
Deficit Hyperactivity Disorder: What works best? Review of Educational Research,
72(1), 61-99
Sleator, E. & Pelham, W. (2010). Attention Deficit Disorder. Dialogues in pediatric
management. Appleton-Century-Crofts. East Norwalk, Connecticut. Chapter 5, pp 127162. Retrieved 022012 from http://www.cs.cmu.edu/~sleator/Esther/ADD-book/ADD5.pdf.
Sorensen, B. (2010). Dopamine & exercise. Demand Media, Inc. 2012, Retrieved on 040512
from www.livestrong.com
Thompson, A.M. (1996). Attention Deficit Hyperactivity Disorder: A parent’s perspective. The
Phi Delta Kappan, 77(6), 433-436.
22