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Critical Analysis and Evaluation

Critical Analysis and Evaluation: Increasing perceptions of self-worth in preadolescents diagnosed with ADHD

This aims to be a critical and objective appraisal of the research study, “Increasing perceptions of self-worth in preadolescents diagnosed with ADHD”, authored by Kathleen Frame, Lynn Kelly, and Elizabeth Bayley and published in the Journal of Nursing Scholarship in 2003.

Title

The title of this research, “Increasing perceptions of self-worth in preadolescents diagnosed with ADHD”, authored by Kathleen Frame, Lynn Kelly, and Elizabeth Bayley (2003), is precise but not quite indicative of the full scope of the study. Neither does it employ plain but forceful words to reveal the nature of the study nor does it identify the independent variable. However it does reveal the sampled group. The title also is not quite attention catching and is also a bit misleading because it supplies us with an inference that may not be accurate.

Abstract

The study contains an abstract that reveals the purpose of the research. It clearly states the outcome of the study and the conclusion.

Research Problem and Objective

1. According to Cavanagh, “A research problem is a question or a matter involving doubt, uncertainty or difficulty that is proposed for solution or discussion Key aspects of a research problem. It concerns: 1. A question 2. Something which is not fully understood 3. Something that has been deliberately chosen as the subject of inquiry.” (2007).The research explains the relevant backdrop and cogently describes the problem. The intention of the research is to boost self-confidence in students with attention deficit disorder (ADD) or attention deficit hyperactivity disorder (ADHD).

2. There is good reason for this inquiry. Children detected with ADD or ADHD are at an inconvenience in the school systems not only in the USA but also in the rest of the world and it has been succinctly highlighted. The purpose of this research was to examine the efficacy of a school- centered, nurse- assisted care group in fostering awareness of academic proficiency, social acceptance, agreeable conduct, and recognized universal self-esteem in preadolescents detected with ADD or ADHD.

3. The study also offers a brilliant piece on background knowledge that comprises collected facts on Attention Deficit Hyperactivity Disorder, preadolescence, and existing treatments. This specific problem was important to nursing based in educational institutes and not to the wide-ranging field of nursing. The objective did not confine the study.

4. There appears to be a gender bias in the study because male children constitute 70% of the students selected for the study. But according to Lesley Jamison, “ADHD is much more common among males than females. It is estimated that boys are two to three times more likely to have ADHD than girls. They are up to nine times more likely than girls to be referred for evaluation and treatment.” Hence the study is not actually biased.

5. The stated objective is quite unambiguous and precise.

Conceptual/Theoretical Frameworks

1. The authors have identified a theoretical model and its framework is founded on Roy's adaptation model, Murrell – Armstrong empowerment matrix and Harter's developmental perspective. This is an exceptional way of studying preadolescents and communicating with them.

2. The research model is unambiguously identified.

3. The framework is quite suitable for this study. Some other theories based on practical experiences and a selection of foundational concepts could also have been incorporated. The researchers have only pointed these out and have tried to establish a link between these theories and their study.

Review of Literature

This study has not included any review of literature. The authors should have essentially evaluated the accessible literature on ADD and ADHD. According to Hilton Obenzinger, a Literature Review affords a significant perspective of a research study within the realm of existing research. The Literature Review lays the foundation for the need to do further research after analyzing the strengths, flaws, bias and completeness of the reviewed works. (2005). Nevertheless the authors do cite some resources at the end.

Research Questions or Hypothesis

According to Marks et al, “The lack of a clearly stated research question is the most common reason that medical manuscripts are rejected by journal editors.” (1988, as cited by Dawson and Trapp, 2004)

In this research there are no clearly stated questions or hypotheses. The objectives of the research are mentioned but not as questions, however they seem to be linked to the rationale for the study.

Research Design

1. The researchers have preferred to employ an experimental design that lacks random assignment, somewhat similar to the analysis of covariance design. In its most basic structure it needs a pretest and posttest control and intervention groups. This study has used this design to assess the efficacy of the intervention. By opting for this specific design the authors could ascertain a pre-intervention baseline that made available a basis for scrutinizing what effects the intervention afforded to the two test groups. This design also assisted in augmenting the validity of research inferences. The authors opted to employ randomization, control group and an intervention group to boost the validity of the research.

2. The researches could have used a comparative experimental design. According to the authors, it was not possible to obtain random sampling and hence they employed convenience sampling by selecting students who simply were enrolled in the same school. If the research had not ignored students from other schools and communities with more diverse backgrounds and had included more females then the findings may not have been so promising.

3. By selecting the participating preadolescents - predominantly white (93%), middle and upper class suburbanite, males (70%) mostly from two-parent homes (85%) - in the way the authors have, the threats to the validity of the research have been offset. 42.6% of these participants receive counseling or coaching or both and 83.1% take medication for ADHD.

Sample Population

1. The sampling method has been adequately described. The subjects were randomly selected from an eligible pool.

2. The sampling method was sufficient in quality and quantity to generate a representative sample of the group. By selecting the participating preadolescents – mean age 11.4 years, predominantly white (93%), middle and upper class suburbanite, males (70%) mostly from two-parent homes (85%) – a built in bias was created. The research is not a just representation of students who are not white and who are from lower income groups. CDC has reported, “Approximately 7.8% (4,418,000; 95% confidence interval [CI] = 4,234,000--4,602,000) of U.S. children aged 4--17 years had ever had ADHD diagnosed.” (2003).The authors do acknowledge the lack of representation as a constraint to the generality of the findings.

3. The norm used for selecting participants was that only students diagnosed with ADHD were included in the study and that norm is the most suitable for this research.

4. A Chi-square analysis was carried out for this research, on three groups comprising nearly equal number of students to determine if two variables are inter-linked or not.

5. According to Frame et al, “The study was independently reviewed and approved by an appropriate committee for the protection of human subjects. Permission to conduct the study was also obtained from the superintendent of the school district where the study took place. Letters were sent to all fifth- and sixth-grade students diagnosed with ADHD (n=92) and their parents. The letters contained a brief explanation of the study, an invitation to participate, and a form requesting written consent. As an incentive to participate, the letter stated that each participant would receive a $10.00 gift certificate to a local bookstore, as well as an opportunity to win a $100.00 gift certificate to the bookstore. All students who returned the informed consent form were eligible to participate (n=65).” (2003)

Collecting and Measuring Data

1. The authors made use of an analysis of covariance, ANCOVA, so as to cut down on errors or inconsistencies based on factors like appearance and athletic competence over which they had no control.

2. The research used the Demographic Questionnaire and the Harter's the Self-Perception Profile for Children (SPCC) Instrument for this study. Though the study does not mention about the reliability and the validity of the Harter's SPCC Instrument, they do state that Harter's Self-Perception Profile is designed to measure perceptions of scholastic competence, social acceptance, athletic competence, physical appearance, behavioral conduct, and global self-worth. “The SPPC is a 36-item scale that consists of five domain specific sub-scales (scholastic competence, social acceptance, athletic competence, physical appearance, behavioral conduct) and one global measure of self-worth. Each sub-scale is measured by six items.” (Shevlin, Adamson and Collins, 2003) The Cronbach alpha coefficients of the questionnaire ranged from 0.75 to 0.84. According to Dawson and Trapp, the study should cover an adequate period of time and the process of collection should be outlined (2004). Accordingly, there was a reasonable time period for administration and the process of collection was well detailed in the study.

3. The study effectively dealt with the objectives of the research.

Findings

1. The findings were painstakingly discussed with respect to the declared purpose.

2. The conclusions were discussed in context of other theories and research like that of Roy and Andrews were examined.

3. There were no accidental or unforeseen findings in this research. This research simply confirmed what the authors had presumed, and gave an alternative to the school nurses to encourage positive perceptions and behaviors among children with ADD and ADHD.

4. The conclusions are in sync with the findings from the study. The ANCOVA table is easy to read and understand. The groups are nearly similar on baseline measures. Actual values have been reported and the magnitude of differences can easily be made out. The limited number of P values makes it sure that there are no spurious findings. The authors have not extrapolated the findings beyond the time period and scope of the study.

Limitations

The authors recognize the limitations to the research – “(a) the lack of a pure placebo control condition to adequately control for the possible effects of attention; (b) the lack of specific detail of the STARS curriculum, thus precluding immediate replicability; and (c) the homogeneous characteristics of the sample.” (Frame, Kelly and Bayley, 2003) The authors dealt with the matter and proposed suggestions in an attempt to tackle all of these.

References

CDC. (September 2, 2005). Mental health in the United States: Prevalence of diagnosis and medication treatment for attention-deficit/hyperactivity disorder . Retrieved July 22, 2009, from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5434a2.htm.

Cavanagh, R. (n.d). From objectives to methods . Retrieved July 27, 2009, from http://hgso.curtin.edu.au/downloads/From%20Objectives%20to%20Methods%20(c)%20Research%20problem%20and%20questions.pdf.

Dawson, B., & Trapp, R. (2004). Reading the medical literature. In B. Dawson & R. Trapp (Eds.), Basic & clinical biostatistics . (pp. 334-345). Columbus, Ohio: The McGraw-Hill Companies.

Frame, K., Kelly, L., & Bayley, E.(2003). Increasing perceptions of self-worth in preadolescents diagnosed with ADHD. Journal of Nursing Scholarship, 35, 225-228.

Jamison, L. (April 1, 2000). Gender differences in ADHD children . Retrieved July 27, 2009, from http://cpancf.com/articles_files/art_57attached_file.asp.

Obenzinger, H. (2005). What can a literature review do for me? How to research, write, and survive a literature review. Retrieved July 27, 2009, from http://ual.stanford.edu/pdf/uar_literaturereviewhandout.pdf.

Shevlin, M., Adamson, G., & Collins,K. (2003). The self-perception profile for children (SPPC: A multiple-indicator multiple-wave analysis using LISREL. Retrieved 07/21/2009, from www.science.ulst.ac.uk/research/psychology/profiles/m_shevlin/sppc.pdf.

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