The Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-V; American Psychiatric Association, 2013) defines Attention Deficit Hyperactive Disorder (ADHD) as persisting and age-inappropriate behavioural patterns of inattention or hyperactivity and impulsivity. These impediments halt a person’s ability to function across multiple domains such as social, academic and/or occupational. The DSM-V acknowledges three presentation styles of ADHD which include primarily hyperactive-impulsive, primarily inattentive or combined. In order for a diagnosis, symptoms must arise before the age of 12 and persist for more than six months. Another criterion for diagnosis is that at least six symptoms of inattention, hyperactivity or impulsivity listed in the DSM-V be met. As ADHD continues to have its biggest impact and prevalence (3-7%) in children and adolescents aged 17 and under (Polanczyk et al., 2007), this essay will primarily focus on this age group. Although the exact cause of the disorder is not yet known, Rickel and Brown (2007) found that a majority of health care professionals agree on multiple factors within the span of human genetics and the environment; thus methods of treatment address these contributors.
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The main medications used in Drug or Combined Therapy are stimulants (Methylphenidate and Amphetamine) which cause dopamine and norepinephrine levels to become liberated in the central nervous system. Non-stimulants such as Atomoxetine boost norepinephrine levels in the same region (Mash & Wolfe, 2016). Behavioural Therapy (BT) on the other hand is an umbrella term used to describe different interventions which involve restructuring a child’s environment and their internal thought patterns, used alongside reinforcement and model behaviours to extinguish unwanted conduct whilst retaining desired ones (Developmental Psychopathology, 2012; Chronis, Jones, & Raggi, 2006). Examples include Parent Management Training (PTP) and Summer Treatment Program (STP). Combination Therapy where the above treatments are used interdependently are also commonly employed (Mash & Wolfe, 2016). Comorbidities occur when a child presents with more than one psychopathological disorder at once (Mash & Wolfe, 2016), and are quite prominent in ADHD with almost 2/3 of children meeting diagnoses for other disorders (Elia, Ambrosini, & Berrettini, 2008). Thus treatment plans need to take this into consideration for them to be effective. Parenthood is a difficult feat in its own right, Now imagine having your child diagnosed with ADHD. You still want a bright future for them but are not sure on what steps to take next. On one hand you are prompted to use combination therapy, and on the other you are told that the sole use of behavioural intervention will suffice and that ADHD medication is ill-advised. Thus the objective of this essay is to discuss specific treatment options within the behavioural therapy category as well as reviewing combination therapy, presenting several literature analyses on the two approaches and comparing their efficacy. From this we hope to conclude on whether the sole use of BT will suffice when it comes to treating children with ADHD, or whether medications play too important of a role to create future treatment plans devoid of them. Behavioral Therapy Is Sufficient A small review on the past 15 years of research into pharmacological (stimulants) and behavioural therapies for ADHD was conducted by Sibley, Kuriyan, Evans, Waxmonsky, and Smith (2014). The authors compared the size of therapeutic effects on ADHD symptoms as well as impairments commonly presented by adolescents. The 22 behavioural treatment studies included; after-school programs such as STP, counselling and PTP. A majority of which employed robust methodology and multiple informants for valuable and accurate results. The findings indicated a small to medium effect size in the reduction of symptoms (.34-.49) and for impairment, a small to large effect (.31-1.20). The same study analysed 17 controlled pharmacological trials, effect sizes found were small to medium for symptoms (.22-.64) and impairment (.21-.56). Sibley et al. (2014) concluded that although both treatments had …show more content…
It is not to say that Atomoxetine is a drug without accompanying side effects either. Eli Lilly, the creator of Atomoxetine has issued Black Box Warnings related to increased rates of suicide risk in the first month of consumption in children and adolescents (Finks, 2012). Other side effects include small but a significant rise in mean diastolic blood pressure in children and adolescents (Wernicke et al., 2003) as well as the common side effects which accompany
The main medications used in Drug or Combined Therapy are stimulants (Methylphenidate and Amphetamine) which cause dopamine and norepinephrine levels to become liberated in the central nervous system. Non-stimulants such as Atomoxetine boost norepinephrine levels in the same region (Mash & Wolfe, 2016). Behavioural Therapy (BT) on the other hand is an umbrella term used to describe different interventions which involve restructuring a child’s environment and their internal thought patterns, used alongside reinforcement and model behaviours to extinguish unwanted conduct whilst retaining desired ones (Developmental Psychopathology, 2012; Chronis, Jones, & Raggi, 2006). Examples include Parent Management Training (PTP) and Summer Treatment Program (STP). Combination Therapy where the above treatments are used interdependently are also commonly employed (Mash & Wolfe, 2016). Comorbidities occur when a child presents with more than one psychopathological disorder at once (Mash & Wolfe, 2016), and are quite prominent in ADHD with almost 2/3 of children meeting diagnoses for other disorders (Elia, Ambrosini, & Berrettini, 2008). Thus treatment plans need to take this into consideration for them to be effective. Parenthood is a difficult feat in its own right, Now imagine having your child diagnosed with ADHD. You still want a bright future for them but are not sure on what steps to take next. On one hand you are prompted to use combination therapy, and on the other you are told that the sole use of behavioural intervention will suffice and that ADHD medication is ill-advised. Thus the objective of this essay is to discuss specific treatment options within the behavioural therapy category as well as reviewing combination therapy, presenting several literature analyses on the two approaches and comparing their efficacy. From this we hope to conclude on whether the sole use of BT will suffice when it comes to treating children with ADHD, or whether medications play too important of a role to create future treatment plans devoid of them. Behavioral Therapy Is Sufficient A small review on the past 15 years of research into pharmacological (stimulants) and behavioural therapies for ADHD was conducted by Sibley, Kuriyan, Evans, Waxmonsky, and Smith (2014). The authors compared the size of therapeutic effects on ADHD symptoms as well as impairments commonly presented by adolescents. The 22 behavioural treatment studies included; after-school programs such as STP, counselling and PTP. A majority of which employed robust methodology and multiple informants for valuable and accurate results. The findings indicated a small to medium effect size in the reduction of symptoms (.34-.49) and for impairment, a small to large effect (.31-1.20). The same study analysed 17 controlled pharmacological trials, effect sizes found were small to medium for symptoms (.22-.64) and impairment (.21-.56). Sibley et al. (2014) concluded that although both treatments had …show more content…
It is not to say that Atomoxetine is a drug without accompanying side effects either. Eli Lilly, the creator of Atomoxetine has issued Black Box Warnings related to increased rates of suicide risk in the first month of consumption in children and adolescents (Finks, 2012). Other side effects include small but a significant rise in mean diastolic blood pressure in children and adolescents (Wernicke et al., 2003) as well as the common side effects which accompany