Medicine & Therapy

Abstract
Attention deficient hyperactive disorder is a growing diagnosis among adolescents. Two main treatments are medication and behavioral therapy, or a combined treatment is also an option. Naturally there are debates on which treatment is more effective on treating the effects of ADHD. This report provides you with background information about ADHD, the types it’s broken down into, whom it affects, the percentage of adolescents taking medication. Also information on what behavioral therapy is provided. Two studies that have tested a group of children, affected by ADHD, and the types of treatments in order to find out which treatment provides the best results on reducing the effects of ADHD.

Introduction
Attention deficient hyperactivity disorder is a growing behavioral disorder among America’s adolescents. ADHD is a growing mainly among children from ages 4 through 17. According to the Center for Disease Control and Prevention 9.5 percent of children ages 4 through 17 have been diagnosed with ADHD as of the year 2007. The CDC also reports that on average the rate of ADHD diagnoses has increased 5.5 percent per year from 2003 to 2007. Boys are about twice as likely to have been diagnosed with ADHD than girls according to the CDC, and diagnoses increase among older teens than among children. ADHD was formerly referred to as Attention Deficient Disorder, ADD, but in 1994 the disorder was classified into three subtypes based on different behavioral patterns and was renamed (Kingsley). The three subtypes of ADHD include a hyperactive impulsive type, an inattentive type, and a combined type (Kingsley). Each subtype of ADHD differs in symptoms. The hyperactive impulsive type includes fidgeting, squirming and problems with interrupting, the inattentive type includes listening problems, organizational problems, distractibility and forgetfulness, and the combined type, which is the most common type, displays a mix of symptoms from both other subtypes (Kingsley). There are two main ways to treat ADHD medication, behavioral therapy. Another treatment option is a combination of the two. Medicating ADHD with medications like stimulants, antidepressants, or nonstimulants are the most common treatment. In 2007 66.3% of children diagnosed with ADHD were treating it with medication, as stated by the CDC. An alternative to medication there is behavioral therapy, which consist of several different types of therapy. Behavioral therapy deals with changing the child’s ways of thinking and coping with difficult situations or everyday tasks, psychotherapy helps children with ADHD deal with accepting themselves regardless of their disorder, social skill training develops new behaviors like asking for help or learning to other’s facial expressions, support groups which connect families dealing with the same issues in order to share experiences, and parent skills training which gives parents the proper techniques to handle their child’s behavior (Schoenstadt). Should parents choose only one treatment option for their child? Is there a benefit to combing the two treatment options? I believe that medication will be the most favored treatment option of ADHD, because it seems to shows the fastest signs improvement. I believe in the combination of the two treatment options will in the long run show better results then the two treatment options separately.

Methods
When researching this topic I initially searched for scholarly journals and reports based on trail experiments comparing medication treatment versus medication and behavioral treatment. The scholarly journal and report proved to be reliable. They also showed thorough work, which added to their reliability. The studies provided me results to base my recommendations off of. I also searched for information in psychology field in order to see how the behavioral therapy and medication treatment affected the attitudes, academics, and symptoms of children with ADHD. I researched background information on ADHD and any other additional information needed through Google and personally evaluated the sources to ensure the provided information was reliable.

Studies
One study included fifty children between the ages 8 through 12 participating in testing medication treatment alone versus combined treatment (Oord). The only requirements for the children participating in this study were to be diagnosed with ADHD and to have an IQ of or higher than 75 based on a short version of “Wechsler Intelligence Scale for Children-Revised” (Oord). The groups of fifty children were randomly split into two groups (Oord). On group was given a medication alone to deal with the effects of ADHD (Oord). The other group was given a medication and also had behavioral therapy to deal with the effects of ADHD. Over the course of ten weeks both groups received their designated treatment and were measured on scales such as inattention, and hyperactivity/impulsivity (Oord). The medication treatment consisted of finding appropriate dose of medication for each child and then consistently taking medication. The medication and behavioral therapy treatment consisted of finding the correct dose of medication and a variety of therapies. The therapies included 90 minutes parent therapy sessions where parents where taught skills such as positive attending skills, effective behavioral commands, and 10 weekly 75 minute group cognitive-behavioral therapy where children worked on problem solving and relaxation skills (Oord). Each child was given personal target problems to work on in the sessions to ensure they were fully utilizing the therapy sessions (Oord).

The end results showed in both groups improvement in ADHD symptoms and social skills. The study did not find any significant difference between the two treatment methods over a ten-week period of time (Oord). The only difference found between the two groups was over a longer period of time, months after the conclusion of the study, the doses of medication being taken by the combined treatment group was lower (Oord).

A different study included 579 children, boys and girls between the ages of 7 to 9, in the first through fourth grades from different races (Jensen). Each child participating in the study had the combined subtype of ADHD, were from different home settings (Jensen). Also the children must have tested above the 90th percentile “standardized teacher rating scales” and were found from primary care practices, schools, mental health settings and advertisements (Jensen). The qualifications of each child were important “to assure that the final sample would be broadly generalizable to the types of children with ADHD found in usual settings” (Jensen).

Each of these children was randomly assigned a treatment medication, behavioral, combined, or community comparison (Jensen). The medication treatment consisted of one month of “blind titration” with medication in order to find the dose appropriate for each individual (Jensen). After effective dose of drug regimen was found monthly visits were maintained (Jensen). During visits the drug regimen was monitored and adjusted as needed (Jensen). The behavioral treatment included therapy sessions, 27 group sessions and 8 individual sessions (Jensen). This treatment also included parent training, 20 structured teacher consultation sessions, 8-week full-time summer treatment program, 12-week half-time paraprofessional aide, and phone calls between these events (Jensen). The combined treatment was a combination of the first two treatments but included “more extensive data bases” from behavioral therapist to help with medication adjustments and information from pharmacotherapist to assist in adjustment of behavioral interventions. Community Comparison treatment consisted of family choosing and seeking treatment within their community, or given a list of referrals to community agencies options where treatment could be found (Jensen).

Over a period of fourteen months the results of the children’s treatments were measured over six topics ADHD symptoms such as hyperactivity and inattention, oppositional/aggressive symptoms, social skills, internalizing symptoms, parent-child relations, and academic achievements (Jensen). After the fourteen-month period the study found that there was little difference between the medication treatment and the combined treatment but both of those treatments were significantly better than the behavioral treatment and the community comparison treatments (Jensen).

Discussion
Though the first study did not show immediate results of the behavioral therapy along with medication. It does show that the combined treatment in the long run provides adolescents with less dependence on medication and gives them new ways to controlling their behavior, and a new way to processes situations. There was never complete withdraw from the medication even after a year but it lowered the doses and was dealing with the effects of ADHD. This information shows that they can be less dependence on medication to treat ADHD.
Though again, in the second study there was no significant difference found between the medication treatment and the combined treatment there still was some difference found. The combined treatment does prove to have some added benefit.

Conclusion and Recommendations
ADHD is a growing diagnosis among America’s youth. This disorder affects behavior and attention of the children it affects. There are two main treatment options for this disorder medication or behavioral therapy. Many parents would initially decide to medicate their child to treat ADHD, but is this the right choice? The studies showed that there is so significant difference between medication treatment alone versus medication and behavioral treatment, but in the long run there is a difference. The combined treatment allowed for the children to depend less on the medication and also gave them the skills to control their behavior and problem solve for situations they can face. I recommend that before parents decide to only medicate their children to control the symptoms of ADHD they should look into adding behavioral therapy to the treatment.

Work Cited

Saskia van, der Oord, et al. "Does Brief, Clinically Based, Intensive Multimodal Behavior Therapy Enhance the Effects of Methylphenidate in Children with ADHD?" European child & adolescent psychiatry 16.1 (2007): 48-57. ProQuest Research Library. Mon. 22 Oct. 2012.

Jensen, Peter. Findings from the NIMH Multimodal Treatment Study of ADHD (MTA): Implications and Applications for Primary Care Providers. Diss. Developmental and Behavioral Pediatrics, 2001. Print. <http://data.psych.udel.edu/abelcher/Shared Documents/5 Psychotherapy and Preventive Intervention (42)/Jensen 2001.pdf>.

Kingsly , Richard . "What Is ADHD?." Kid's Health. N.p., n.d. Web. 22 Oct 2012. <http://kidshealth.org/parent/medical/learning/adhd.html

United Staes. Centers for Disease Control and Pervention. Attention-Deficit / Hyperactivity Disorder (ADHD). Atlanta : , 2011. Print.
Schoenstadt, Arthur. "Behavior Therapy for ADHD." EMed . N.p., 25 2011. Web. 22 Oct 2012. <http://adhd.emedtv.com/adhd/behavior-therapy-for-adhd.html>.