ADHD: Treatment with drugs or therapy?

boy on trampolineby Kresimir  Mijaljevic

Attention deficit hyperactivity disorder (ADHD) is a “problem with inattentiveness, over-activity, impulsivity, or a combination” beyond what is normal for a child’s age and development.1 It is more commonly diagnosed than any other behavioural disorder in children, affecting approximately 3-5% of school aged children; it is more common in boys than in girls.1 In Canada, 35% of all children referred to mental health clinics are diagnosed with ADHD.2

A prominent form of treatment noted in clinical settings was with the administration of Sertraline – marketed as Zoloft. Issued in 1996, Zoloft was developed by Pfizer for the purposes of treating Obsessive Compulsive Disorder (OCD). It is the Food and Drug Administration’s obligation to make certain that the therapeutic agent must ensure safety and efficacy.3 Hinshaw argues that “medication is the only viable option for treating children with ADHD, and that behavioural intervention strategies are not important for treating the core symptoms of ADHD”.4 A significant problem that arises with the administration of any drug is the problem of physiological dependence and proper adherence to the regimen. By offering a medicinal form of intervention for the treatment of a psychological disorder, new conditions and challenges arise in evaluating the efficacy of the treatment. Furthermore, the initial concern becomes a problem at the regulatory level.

On the contrary, The National Initiative for Children’s Healthcare Quality supports a chronic care model that accounts for teens and adolescents, and their families requiring supports in addition to an individualized and appropriate clinically based program.5 Lilienfield examines the treatment of ADHD in the psychosocial domain.7 She notes that cognitive-training therapy programs help enrich a child’s way of expressing an underlying psychological barrier that cannot be otherwise expressed in communicated words. The play therapy was based on the notion that integrating toy props such as dolls and other inanimate play objects to help the child express an underlying psychological conflict. In reality, these programs help highlight the child’s self-control problems by communicating self-instructional skills to advance their ability to ‘stop, look, listen’. Lilienfield highlights the fact that some controlled studies mainly focus on school-based behavioural interventions which focus on the positive reinforcement of attention sustainability.6 This exemplifies the simplicity in treating a complex disorder, in that the elementary constructs of the child’s mind are examined and manipulated in such a way to highlight undeveloped or repressed parts of the psyche. Similarly, Chronis and colleagues, examined both behavioural parent training and classroom behaviour management, in a study evaluating psychosocial treatment for children and adolescents with ADHD in a school setting.8 The study was directed toward teaching parents and teachers to implement behavioural modification principles supported by social learning principles, targeting deviant behaviours, using praise and positive attention, as well as rewarding exemplary and improved behaviour. Thus, Chronis highlights a potentially successful redirection in treatment of ADHD, which can serve as a model for many other mental disorders.7 This model highlights the importance of improving behavioural treatment and implementing it as a guide for enhancing the training of caregivers, educators, and parents working with children plagued by this disorder.

It is clear that medicinal interventions have significant immediate effects on mediating and controlling psychosocial disorders, but for the health and well-being of the child treatment models must be re-examined. Similarly, behavioural models demonstrate the positive implications upon the child’s psychological framework as well the child’s overall well-being. Truly, positive implications on the individual will lead advocates to encourage various collaborative programs to help treat and possibly reduce the prevalence and future incidence of these disorders in our society. However, this will likely be a constant battle against the pharmaceutical industry since the best interests of the child will ultimately compete with the marketing of medicine in our society.

References

1. MedlinePlus Medical Encyclopedia. Attention deficit hyperactivity disorder (ADHD); n.d. [cited 2010 February 25]. Available from: http://www.nlm.nih.gov/medlineplus/ency/article/001551.htm
2. ADHDCanada. What is ADHD?; n.d. [cited 2009 October 02]. Available from: www.adhdcanada.com/what.html
3. Internet Drug News. FDA Information; n.d. [cited 2009 September 09]. Available from www.coreynahman.com/FDA_Page.html
4. Hinshaw SP. Treatment for children and adolescents with attention-deficit/hyperactivity disorder. In: Kendall PC, editor. Child and adolescent therapy: cognitive-behavioral procedures. 3rd ed. New York: Guilford; 2006. p. 82-113.
5. Wolraich ML, Wibbelsman CJ, Brown TE, Evans SW, Gotlieb EM, Knight JR, Ross EC, Shubiner HH, Wender EH, Wilens T. Attention-deficit/hyperactivity disorder among adolescents: a review of the diagnosis, treatment, and clinical implications. Pediatrics 2005 Jun;115(6):1734-46.
6. Lilienfeld SO. Scientifically unsupported and supported interventions for childhood. Pediatrics. 2005 Mar;115(3):761-4.
7. Chronis AM, Chacko A, Fabiano GA, Wymbs BT, Pelham WE Jr. Enhancements to the behavioral parent training paradigm for families of children with ADHD: review and future directions. Clin Child Fam Psychol Rev. 2004 Mar;7(1):1-27.

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