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ADHD can occur in any population. The data from 175 research studies globally on children 18 years and under indicate 7.2 percent of the worldwide population in this age group or 129 million individuals have ADHD (Children and Adults with Attention-Deficit/Hyperactivity Disorder, 2018).
Initial ADHD treatment was primarily aimed at schoolchildren in the United States. Although ADHD is diagnosed globally, the diagnostic criterion differs among countries, and is not specifically targeted to ethnicity, gender, or race. France was resistant to even diagnosing French schoolchildren with ADHD as social and medical culture determined that ADHD was an “American construct” with a diagnostic rate of less than two percent (Frances, 2014).
As mentioned previously, pharmaceutical treatment of ADHD has primarily consisted of methylphenidate or Adderall, which consists of amphetamine and dextroamphetamine (Katusic et al., 2005). Sociocultural differences can be shown by the approximate percentage of all school children prescribed pharmaceutical medication for ADHD in the United States (2.0-2.5%) and Europe (<1.0%) (Singh, 2002). The United Nations International Narcotics Control Board reported that 85 percent of the world’s pharmaceutical medications are taken by Americans (Singh, 2002). Data collection on medication management and behavioral treatment of ADHD continues worldwide, particularly in the United States.
Researchers with the Centers for Disease Control and Prevention (CDC) considered data from a national sample of children with special health care needs, ages 4-17 years, collected in 2009-10. They determined that just before the release of the 2011 guidelines, a majority of children studied with ADHD received either medication treatment or behavioral therapy; however, many were not receiving treatment as outlined in the 2011 best practice guidelines (Visser, Bitsko, Danielson, Gandhour, Blumberg, Schieve, Holbrook, Wolraich, & Cuffe, 2015). This was attributed to the possibility that socioeconomic factors, such as financial cost and treatment availability, were barriers with state of Tennessee reporting only a 33 percent treatment rate among those diagnosed (Visser et al., 2015).
Intervention strategies were not delineated in regard to divergent cultural or ethnic groups in the United States. Stimulants are the best-known and most widely used ADHD medications. Between 70-80 percent of children with ADHD have fewer ADHD symptoms when they take these fast-acting medications (Centers for Disese Control and Prevention, 2018). Behavior therapy, parent training, and specifically-based educational plan have shown positive results in improving classroom behavior, improving positive peer interactions, and organization skills (Centers for Disese Control and Prevention, 2018).
The strengths of these programs lie in the involvement of the natural and family supports of the children studied. In addition, parents can directly work with evidence-based interventions from the child’s teachers to design an Individual Education Plan (IEP) to predict and ensure an increase in positive outcomes.
One the main limitations can be found in those families who cannot afford the cost of these programs. ADHD was strongly related with an array of indicators of social and economic disadvantage in a Millennial Cohort Study (N = 19,519), including poverty, housing tenure, income, and lone parenthood, particularly involving young mothers (Russell, Ford, Rosenberg, & Kelly, 2014). As a result, appropriate treatment modalities, including school attendance, were barriers to positive outcomes. Meta-analysis across multiple studies will be required to authenticate the extent of any positive correlational associations across cultures (Russell et al., 2014).
Core Developmental Themes
ADHD treatment appears to be aligned with the nature, nurture, and continuity core development themes of developmental psychology. Recent ADHD research has shown the brains of those with ADHD may differ with respect to the equilibrium of certain neurotransmitters, as well as the scope and process of specific brain components, such as the prefrontal cortex (Moon, 2011).
Classroom tasks and behavior management styles at home and school could affect the expression of ADHD. Social skills’ training was regarded as a very important alternative treatment to teach children how to read others’ reactions and how to behave more acceptably in the classroom, as well as in the community (Moon, 2011). Singh (2008) suggested the need for additional resources, such as improved classroom environments, supplementary special educational services, and reduced class sizes to decrease the need for more ADHD diagnoses and stimulant drug use in the classroom.
The continuity theme is also represented as ADHD can, and often does, persist into adult life. However, diagnoses and symptoms have been known to decrease after late adolescence, many diagnosed with ADHD as a child exhibit and report symptomology throughout their lives (Brown University, 2016).
ADHD uses a contemporary theory of development for implementing assessment, treatment, and intervention strategies. Person-centered therapy, also known as Rogerian therapy an off-shoot of Humanistic Theory, originated in the work of the American psychologist, Carl Rogers. He held the belief that every individual is different, and therefore, their individual worldview, and capacity to manage it, should be trusted, encouraged, and guided (Psychology Today, 2018). Rogers suggested that every person has the power to find and determine the best resolutions for ourselves, and construct proper changes in their lives (Psychology Today, 2018). He understood that for a person to achieve their goals or overcome a behavioral deficit, he or she needed an environment that offered them validity, acceptance, and empathy.
The original intervention for children with ADHD consisted of primarily medication treatment. The U.S. Food and Drug Administration (FDA) approved Benzedrine as a medicine in 1936. Dr. Charles Bradley stumbled across some unexpected side effects of this medicine the next year. Young patients’ behavior and performance in school improved when he gave it to them (Healthline, 2018).
An increased number of research over the past 20 years have examined the efficacy of non-medication interventions for adults with ADHD, including cognitive–behavioral treatments (CBTs), which comprise of training clients in cognitive and behavioral skills to address symptoms, often in conjunction with pharmacological strategies (Knouse, Teller, & Brooks, 2017). The research indicates that a combination of both evidence-based interventions provides individuals with ADHD an increased efficacy for recovery than the original medication-only treatment afforded.
ADHD treatment impacts communities by delivering research, educational support, and answers to educators, doctors, and parents where developmental psychology is practiced. This has produced a robust sociocultural impact by increasing awareness, tolerance, and empathetic understanding for those afflicted with ADHD, including families, friends, and entire communities. Successful treatment or adaptive strategies promote increased financial opportunities for individuals, businesses, and communities as a direct result from the supportive relationship of healthcare providers, including therapists and parents. As a result, an increase in positive behavior leads to improved functioning at school, home and in relationships (Centers for Disese Control and Prevention, 2018).
The combined ADHD treatment modality utilizing evidence-based person-centered behavioral interventions with pharmacological strategies have been shown to be effective in reducing symptomology and problems associated with those diagnosed with ADHD. Individuals with ADHD, and those with co-occurring disorders such as anxiety and major depressive disorders, were evaluated by parents and educators with both indicating a reduction in ADHD symptomology, along with “real-world” measures such as grades, social interpersonal skills, and attendance (Antshel, Faraone, & Gordon, 2014). Another finding indicated that throughout CBT sessions, lesser dosages of medication were required to sustain the adolescent’s functional advances (Antshel, Faraone, & Gordon, 2014). In addition, a combined treatment study for 43 adults with ADHD, using simultaneous pharmacotherapy was published. The CBT involved 16 individual therapy sessions over a six month period, and every participant received medication. The results validated that the combination of pharmacotherapy and CBT is an effective treatment for ADHD, as well as, an extensive array of ADHD-related symptoms, such anxiety, depression, and an increase in global functioning (Kolar, Keller, Golfinopoulos, Cumyn, Syer, & Hechtman, 2008).
- Antshel, K. M., Faraone, S. V., & Gordon, M. (2014). Cognitive behavioral treatment outcomes in adolescent ADHD. Journal of Attention Disorders, 18(6), 483-495. doi:10.1177/1087054712443155
- Brown University. (2016, December). Brown University Child and Adolescent Psychopharmacology Update. Retrieved April 1, 2018, from Brown University Web site: http://web.a.ebscohost.com.ezproxy.snhu.edu/ehost/pdfviewer/pdfviewer?vid=1&sid=0110905a-e06b-48bc-a98c-de31d2a54d8e%40sessionmgr4009
- Centers for Disese Control and Prevention. (2018). Attention-deficit/hyperactivity disorder(ADHD). Retrieved April 1, 2018, from CDC Web site: https://www.cdc.gov/ncbddd/adhd/treatment.html
- Children and Adults with Attention-Deficit/Hyperactivity Disorder. (2018). Mission and history. Retrieved March 4, 2018, from CHADD Web site: http://www.chadd.org/About-CHADD/Mission-and-History.aspx
- Frances, A. (2014). The globalization of ADHD. Psychiatric Times, 31(12), 1-3.
- Healthline. (2018). What is ADHD? Retrieved April 1, 2018, from Healthline Web site: https://www.healthline.com/health/adhd/history
- Katusic, S. K., Barbaresi, W. J., Colligan, R. C., Weaver, A. L., Leibson, C. L., & Jacobsen, S. J. (2005). Psychostimulant treatment and risk for substance abuse among young adults with a history of attention-Deficit/Hyperactivity disorder: A Population-based, birth cohort study. Journal of Child and Adolescent Psychopharmacology, 15(5), 764-76. doi:http://dx.doi.org/10.1089/cap.2005.15.764. Retrieved from ProQuest http://search.proquest.com/docview/204605397?accountid=34574
- Knouse, L. E., Teller, J., & Brooks, M. A. (2017). Meta-analysis of cognitive–behavioral treatments for adult ADHD. Journal Of Consulting And Clinical Psychology, 85(7), 737-750. doi:10.1037/ccp0000216
- Kolar, D., Keller, A., Golfinopoulos, M., Cumyn, L., Syer, C., & Hechtman, L. (2008). Treatment of adults with attention-deficit/hyperactivity disorder. Neuropsychiatric Disease and Treatment, 4(2), 389–403.
- Moon, S. M. (2011, November). Cultural perspectives on attention deficit hyperactivity disorder: A comparison between Korea and the U.S. Journal of International Business and Cultural Studies , 6, 1-11. Retrieved from http://www.aabri.com/manuscripts/11898.pdf
- Psychology Today. (2018). Person-centered therapy. Retrieved April 1, 2018, from Psychology Today Web site: https://www.psychologytoday.com/us/therapy-types/person-centered-therapy
- Russell, G., Ford, T., Rosenberg, R., & Kelly, S. (2014). The association of attention deficit hyperactivity disorder with socioeconomic disadvantage: alternative explanations and evidence. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 55(5), 436–445. http://doi.org/10.1111/jcpp.12170
- Singh, I. (2002). Biology in context: Social and cultural perspectives on ADHD. Children & Society, 16(5), 360-367. doi:10.1002/CHI.746
- Singh, I. (2008). ADHD, culture, and education. Early Child Development & Care, 178(4), 347-361. doi:10.1080/03004430701321555
- Visser, S. N., Bitsko, R. H., Danielson, M. L., Gandhour, R., Blumberg, S. J., Schieve, L., Holbrook, J., Wolraich, M., Cuffe, S. (2015). Treatment of attention-deficit/hyperactivity disorder among children with special health care needs. Journal of Pediatrics. Published online April 1, 2015, DOI: http://dx.doi.org/10.1016/j.jpeds.2015.02.018
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