What treatment, psychopharmacological, psychotherapeutic, or both, would be significant for a child or adolescent diagnosed with ADHD?

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What treatment, psychopharmacological, psychotherapeutic, or both, would be significant for a child or adolescent diagnosed with ADHD?

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Due: Facilitating group to post by Day 1; all other students post to discussion prompt by Day 3 and one other peer initial discussion prompt post by Day 6

Initial Post: Created by Facilitating Group ( I am not in the facilitating group)

This is a student-led discussion.

· The facilitating group should choose one member from their group who will be responsible for the initial post.

· On Day 1 of this week, the chosen group member will create an initial post that is to include the group’s discussion prompts, resources, and the instructions for what your classmates are to do with the resources.

· During this week, each member of your group is to participate in the facilitation of the discussion. This means making certain that everyone is engaged, questions from students are being answered, and the discussion is expanding.

· It is the expectation that the facilitating group will address all initial peer response posts by Day 7.

Reply Posts: Non-Facilitating Students

· If you are not a member of the facilitating group, you are to post a discussion prompt response according to the facilitating group’s instructions by Day 3. Your reply posts should include substantive reflection directed to the presenters.

· You are also expected to respond to at least two other peer’s initial discussion prompt posts.

Group Facilitated Discussion Plan: Attention Deficit Hyperactivity Disorder

Yanisleidy Mondeja and Laura Richard

NU664C Family Mental Health I

Attention Deficit Hyperactivity Disorder

This post entails an alliance of ideas and research blended to inspire a lively discussion entailing Attention Deficit Hyperactivity Disorder (ADHD) among children and adolescents. ADHD is one of the most common mental disorders affecting children and adolescents. Thomas et al. (2015) affirm that it is a common neurobehavioral disorder, with approximately 11% of children aged 4 to 17years being diagnosed in the United States alone. The presence of geographical differences affects the rate of diagnosis and treatment in which prevalence has increased over time. Considering the fifth edition of DSM-V, for an individual to be diagnosed with ADHD, one must meet six out of nine possible inattentive symptoms such as failing to give close attention to details or being easily distracted. This is alongside the six out of nine possible hyperactivity or impulsivity symptoms such as being on the ego or difficulty for an individual to wait for his turn. Moreover, symptoms need to be present for at least six months, occur in two different settings, be present before 12 years of age, and not be better explained by another disorder (Painter & Scannapieco, 2021).

Attention Deficit-Hyperactivity Disorder has three presentations: predominantly hyperactive/impulsive, predominantly inattentive, and a combination of the two based on how many symptoms in each diagnostic category a person meets. ADHD does not precisely fall into the three categories is regarded as ADHD-Not Otherwise Specified. Lavigne et al. (2012) note that individuals with the most impulsive-hyperactive ADHD usually have both hyperactivity and impulsivity symptoms, which implies that an individual acts without thinking about the consequences. In contrast, hyperactivity implies an individual who fidgets and moves about constantly. An individual with the most inattentive have issues paying attention as they are easily distracted. Those that have combined have a combination of impulsivity, hyperactivity, and inattentiveness. According to Meere (2005), ADHD is more common among boys than girls.

Reducing distractibility, enhancing sustained attention, reducing impulsive behaviors, and enhancing activity level psychostimulants are regarded as effective (Kemper et al., 2018). Nonpharmacologic therapies such as psychotherapy, behavioral therapy, complementary and alternative medicine interventions, and psychosocial interventions potentially address primary symptoms of ADHD or the long-term impairments related to the disorder. Comprehending the function of nonpharmacologic therapies is challenging since they entail a wide range of methods to care, ranging from highly structured behavioral interventions to complementary medicines. According to Feldman and Reiff (2014), regardless of growth in research on treatment for ADHD and awareness of the condition’s course of illness, significant queries remain regarding ADHD diagnosis and management. A primary issue for clinical practice regarding ADHD is ensuring an appropriate diagnosis and avoidance of misdiagnosis. For therapy, primary questions include how effective to structure a therapy to individuals based on their characteristics and how effectively and efficiently monitor an individual with ADHD over time.

ADHD Diagnosis

Diagnosis of ADHD is based on clinician assessment that evaluates if the approach described in the DSM-V is met. Rating scales that patients, teachers, and guardians can finalize are used to determine the presence of each of the 18 symptoms alongside the level of impairment that results from the symptoms. Rating scales must be integrated with a clinical interview to evaluate the onset, the course, duration, and impairment associated with symptoms. Moreover, screening and clinical assessment of possible comorbid psychiatric conditions is a primary part of the diagnostic process. Painter & Scannapieco (2021) affirm that the main challenge experienced when diagnosing ADHD is to differentiate from other conditions that appear similar such as to conduct disorder, anxiety, and other developmental disorders. Also, to determine if another condition may better explain ADHD symptoms or present comorbid diagnosis.

Discussion prompts and response instructions

Peers are requested to read each prompt and reply to any four of the six questions ( bold and italicized ). Everyone is requested to number the question as it corresponds with the initial post to avoid confusion.

Prompts

Prompt 1: What treatment, psychopharmacological, psychotherapeutic, or both, would be significant for a child or adolescent diagnosed with ADHD?

Prompt 2 : According to Kemper et al. (2018), affirm that previous research relied on interviews and rating scales for diagnosis, recently the US Food and Drug Administration (FDA) approved a new device, “the Neuropsychiatric Electroencephalograph (EEG)-based Assessment Aid (NEBA; NEBA Health, Augusta, GA). How effective is it at diagnosing ADHD?

Prompt 3 : When a child or adolescent is treated with pharmacotherapy, what medication will be the first-line choice and why? Will it be significant to add psychotherapy, and which one?

Related Resources for Review

Hammersley, D. (2016). The interface between psychopharmacological and psychotherapeutic approaches. The Handbook of Counselling Psychology, 259–275. https://doi.org/10.4135/9781529714968.n17

Kemper, A. R., Maslow, G. R., Hill, S., Namdari, B., LaPointe, N. M. A., Goode, A. P., & Sanders, G. D. (2018). Attention deficit hyperactivity disorder: Diagnosis and treatment in children and adolescents.

Kennedy, R., & Kingsley, E. (2013). The impact of attention-deficit/hyperactivity disorder in African-Americans; current challenges associated with diagnosis and treatment. Attention Deficit Hyperactivity Disorder in Children and Adolescents. https://doi.org/10.5772/54276

Painter, K., & Scannapieco, M. (2021). Treatment of attention deficit hyperactivity disorder. Understanding the Mental Health Problems of Children and Adolescents, 148–161. https://doi.org/10.1093/oso/9780190927844.003.0010

Prompt 4 : Why is it challenging to diagnose a child with ADHD, particularly under four years? Why is there is no test for ADHD?

Prompt 5: It is required that a clinician use standard and approved tools to screen and diagnose patients with ADHD. Is it significant to evaluate whether the instrument selected is consistent with the diagnostic criteria of DSM-V?

Prompt 6 : Considering the many available validated diagnosing instruments among children and adolescents, which one have you used in recent days? Contrast the instrument to the DSM-V. What have you learned?

Related Resources for Review

American Academy of Pediatrics. (2017, September 1). Diagnosing ADHD in children: Guidelines & Information for parents. HealthyChildren.org. Retrieved November 21, 2021, from https://www.healthychildren.org/English/health-issues/conditions/adhd/Pages/Diagnosing-ADHD-in-Children-Guidelines-Information-for-Parents.aspx.

Gupta, A., & Kashyap, A. (2021). Assessment of ADHD for children, adolescents, and adults. New Developments in Diagnosing, Assessing, and Treating ADHD, 117–131. https://doi.org/10.4018/978-1-7998-5495-1.ch007

Lavigne, J. V., Dulcan, M. K., LeBailly, S. A., & Binns, H. J. (2012). The importance of obtaining information from multiple informants when diagnosing and managing ADHD in children. PsycEXTRA Dataset. https://doi.org/10.1037/e610022012-026

NIH Publication. (2019, June 25). Attention-deficit/hyperactivity disorder (ADHD) in children. Mayo Clinic. Retrieved November 21, 2021, from https://www.mayoclinic.org/diseases-conditions/adhd/symptoms-causes/syc-20350889.

References

American Academy of Pediatrics. (2017, September 1). Diagnosing ADHD in children: Guidelines & Information for parents. HealthyChildren.org. Retrieved November 21, 2021, from https://www.healthychildren.org/English/health-issues/conditions/adhd/Pages/Diagnosing-ADHD-in-Children-Guidelines-Information-for-Parents.aspx.

Feldman, H. M., & Reiff, M. I. (2014). Attention deficit–hyperactivity disorder in children and adolescents. New England Journal of Medicine, 370(9), 838-846.

Gupta, A., & Kashyap, A. (2021). Assessment of ADHD for children, adolescents, and adults. New Developments in Diagnosing, Assessing, and Treating ADHD, 117–131. https://doi.org/10.4018/978-1-7998-5495-1.ch007

Hammersley, D. (2016). The interface between psychopharmacological and psychotherapeutic approaches. The Handbook of Counselling Psychology, 259–275. https://doi.org/10.4135/9781529714968.n17

Kemper, A. R., Maslow, G. R., Hill, S., Namdari, B., LaPointe, N. M. A., Goode, A. P., & Sanders, G. D. (2018). Attention deficit hyperactivity disorder: Diagnosis and treatment in children and adolescents.

Kennedy, R., & Kingsley, E. (2013). The impact of attention-deficit/hyperactivity disorder in African-Americans; current challenges associated with diagnosis and treatment. Attention Deficit Hyperactivity Disorder in Children and Adolescents. https://doi.org/10.5772/54276

Lavigne, J. V., Dulcan, M. K., LeBailly, S. A., & Binns, H. J. (2012). The importance of obtaining information from multiple informants when diagnosing and managing ADHD in children. PsycEXTRA Dataset. https://doi.org/10.1037/e610022012-026

Meere, J. (2005). State regulation and attention deficit hyperactivity disorder. Attention Deficit Hyperactivity Disorder, 413–433. https://doi.org/10.1385/1-59259-891-9:413

NIH Publication. (2019, June 25). Attention-deficit/hyperactivity disorder (ADHD) in children. Mayo Clinic. Retrieved November 21, 2021, from https://www.mayoclinic.org/diseases-conditions/adhd/symptoms-causes/syc-20350889.

Painter, K., & Scannapieco, M. (2021). Attention deficit hyperactivity disorder. Understanding the Mental Health Problems of Children and Adolescents, 134–147. https://doi.org/10.1093/oso/9780190927844.003.0009

Thomas, R., Sanders, S., Doust, J., Beller, E., & Glasziou, P. (2015). Prevalence of attention-deficit/hyperactivity disorder: A systematic review and meta-analysis. Pediatrics, 135(4). https://doi.org/10.1542/peds.2014-3482

Peer Post 1 (To be replied)

Attention Deficit Hyperactivity Disorder

Jessica Murphy

November 29, 2021

Attention Deficit Hyperactivity Disorder

Group 5,

You have done a great job presenting the topic of attention deficit hyperactivity disorder (ADHD). As most know ADHD is the most common neurodevelopment disorder diagnosed in children and typically last well into adulthood (CDC, 2021). As you stated in your presentation, there are several types of ADHD including predominantly hyperactive, predominantly inattentive, and combined, when a child has an equal presentation of both inattention and hyperactivity. Although the causes and risk factors are unknown, there are several studies that have indicated genetics play a major role, with other possible causes such as brain injury, environmental risk factors, alcohol and tobacco use during pregnancy, as well as other pregnancy and birth complications (CDC, 2021).

Prompt 1: What treatment, psychopharmacological, psychotherapeutic, or both, would be significant for a child or adolescent diagnosed with ADHD?

Combination therapy is indicated for most children and adolescents diagnosed with ADHD. Involvement of family, school, and medications will be necessary to manage this chronic condition. Treatment goals include improvement in academic performance, improvement in relationships with family, friends, teachers, as well as improvement in ability to follow rules whether at home or at school (Krull, 2020). It is recommended that children between the ages of 4-5 are treated first with behavior therapy. Medication is added if behavior therapy alone is not sufficient, and symptoms do not improve. Krull (2020) recommends medications as an adjunct to therapy when behaviors interfere with other therapies, risk of expulsion from preschool, severe risk of injury to others, as well as strong family history of ADHD. The recommendation for School-age children is combined therapy with a stimulant and behavior therapy, although there are non-simulant medications recommended for some children, stimulants are first-line choice. Children and adolescents diagnosed with ADHD also benefit from structure, maintaining a daily schedules as well as using charts and checklists, keeping distraction to a minimum, limiting positive behavior, limiting choices, and finding desirable activities such as sports (Krull, 2020).

Prompt 2 : According to Kemper et al. (2018), previous research relied on interviews and rating scales for diagnosis, recently the US Food and Drug Administration (FDA) approved a new device, “the Neuropsychiatric Electroencephalograph (EEG)-based Assessment Aid (NEBA; NEBA Health, Augusta, GA). How effective is it at diagnosing ADHD?

Wilkes (2021) affirms the US Food and Drug Administration (FDA) approved the use of Neuropsychiatric EEG-Based Assessment Aid (NEBA) as a tool in confirming the diagnose ADHD in 2013. It is not likely that it will be use as a sole determinate but will be used in combination with a complete medical assessment, as well as psychological assessment. It may also be used to guide further testing. NEBA measures the ratio between theta and beta brain waves which are said to be elevated in children with ADHD (Wilkes, 2021).

Prompt 3 : When a child or adolescent is treated with pharmacotherapy, what medication will be the first-line choice and why? Will it be significant to add psychotherapy, and which one?

There are several factors that need to be considered when choosing a pharmacological treatment. Krull (2021) recommends considering the child’s ability to swallow, length of desired treatment, the time-of-day symptoms will be targeted, whether the medication will be administered in school, potential adverse effects, co-existing conditions, history of substance abuse, and expense. Typically, first line treatment for ADHD is a stimulant medication such as methylphenidate. Stimulants are typically chosen as they have a rapid onset of action and are also safe and effective. Psychotherapy is used as an intervention directed at the child and is designed to work on the child’s emotional status and thought patterns, although, not always recommended as an adjunct to therapy unless there are comorbid conditions such as anxiety, depression, and social deficits (Krull, 2020). In children with ADHD without other co-morbid conditions, there is no significant data to support the use of psychotherapy and its interventions transferring into other areas of the child’s

Prompt 4 : Why is it challenging to diagnose a child with ADHD, particularly under four years? Why is there is no test for ADHD?

According to the CDC (2021) in 2016 388,000 children ages 2-5 years were diagnosed with ADHD. However, it is difficult to diagnose ADHD in children younger than four years of age because of their rapid rate of change. Children under 4 are usually quite active, have tantrums, have short attention spans, and are impulsive. Their behaviors and attention span may mimic that of a child with ADHD, however their behaviors may change as they get older. According to Legg (2018) children under 4 may be diagnosed, however, there is not set clinical guideline for this age group.

There is no set test for diagnosing ADHD and is often completed in several steps. One of the first steps include a full medical exam including a hearing and vision test (CDC, 2021). Once organic causes are rule out, there is a collaborative effort with the child’s parents, teachers, other medical professionals, and in some instances the child.

References

Centers for Disease Control and Prevention (2021). What is ADHD?

https://www.cdc.gov/ncbddd/adhd/facts.html

Krull, K (2020). Attention deficit hyperactivity disorder in children and adolescents: Overview

of treatment and prognosis. UpToDate. https://www-uptodate-

com.regiscollege.idm.oclc.org/contents/attention-deficit-hyperactivity-disorder-in-

children-and-adolescents-overview-of-treatment-and-

prognosis?search=ADHD%20treatment&source=search_result&selectedTitle=1~150&

usage_type=default&display_rank=

Krull, K. (2021). Attention deficit hyperactivity disorder in children and adolescents: Treatment

with medications. UpToDate. https://www-uptodate-com.regiscollege.idm.oclc.org

/contents/attention-deficit-hyperactivity-disorder-in-children-and-adolescents-

treatment-with-medications?search=Treatment%20for%20ADHD&source=search_result&

selectedTitle=3~150&usage_type=default&display_rank=3

Legg, T. (2018). What’s to know about ADHD in toddlers.

https://www.medicalnewstoday.com/articles/315518

Wilkes, M. (2021). Pediatric Attention Deficit Hyperactivity Disorder (ADHD) Workup.

https://emedicine.medscape.com/article/912633-workup#c7

Peer Post 2 (To be replied)

Deborah Penny

Yanisleidy and Laura,

Thank you for your well defined and focused presentation about attention deficit hyperactivity disorder (ADHD). As you stated, ADHD is one of the most common neurodevelopmental disorders of childhood and the process to reach a diagnosis requires several steps. Because there is no single test to diagnose ADHD, the process starts with a medical exam to rule out other problems that may mimic or produce the same signs and symptoms as ADHD. In addition, obtaining a history from various sources (collateral information) which could include but are not limited to parents, teachers, day-care providers, family members, and sometimes the child.

Here is a great snapshot of ADHD provided in this ADHD Fact Sheet

The purpose of my response post is to answer four out of the six questions presented by Group 5.

Prompt 1: What treatment, psychopharmacological, psychotherapeutic, or both, would be significant for a child or adolescent diagnosed with ADHD?

According to UpToDate, “Medications, with or without behavioral/psychologic interventions, are the first-line therapy for school-aged children (≥6 years) and adolescents who meet diagnostic criteria for ADHD” (Krull, 2020).

Treatment of ADHD may involve behavioral interventions, medication, school-based interventions, or psychologic interventions alone or in combination. However, regardless of the treatment, the outcomes must be realistic, achievable, and measurable and developed with the parents, child, and school personnel. It really does take a village to provide guidance, support, and to celebrate when a goal is reached.

“Nonpharmacologic treatments for ADHD encompass a range of care approaches from structured behavioral interventions to complementary medicines and despite wide use, there are significant gaps in knowledge regarding the effectiveness of ADHD nonpharmacologic treatments” (Goode, et al., 2018). A systematic review was developed by Goode, et al., to evaluate the comparative effectiveness and safety of nonpharmacologic approaches to ADHD. Behavioral interventions are preferred to medication as the initial intervention for preschool children and parent-child behavioral therapy is focused at improving parent-child relationships through enhanced parenting techniques.

Prompt 2: According to Kemper et al. (2018), affirm that previous research relied on interviews and rating scales for diagnosis, recently the US Food and Drug Administration (FDA) approved a new device, “the Neuropsychiatric Electroencephalograph (EEG)-based Assessment Aid (NEBA; NEBA Health, Augusta, GA). How effective is it at diagnosing ADHD?

“Neuropsychiatric Electroencephalograph (EEG) is essentially neurofeedback that uses an electroencephalograph (EEG) machine and a system of rewards to teach people to increase their conscious control over the electrical rhythms generated in the brain— a process called operant conditioning” (Fehmi & Robbins, 2001). “The treatment typically involves patients using a computer monitor that shows brainwave activity through EEG. In the neurofeedback process, patients are trained to adjust their attention and thereby their brainwave activity” (Kemper, et al., 2018). From a cognitive and developmental viewpoint, it would be difficult to expect a child to benefit from operant conditioning. “Brain-wave training may have the potential to be a first line of treatment for many physical, neurological, and psychological problems, but research is needed to determine for whom it will work best and why, and to improve its efficacy” (Fehmi & Robbins, 2001).

Prompt 3: When a child or adolescent is treated with pharmacotherapy, what medication will be the first-line choice and why? Will it be significant to add psychotherapy, and which one?

“Methylphenidate, dexamphetamine and atomoxetine (a nonstimulant selective noradrenaline reuptake inhibitor) are recommended medical treatments for children and adolescents. Methylphenidate, has been used for longer fifty years for the treatment of children with ADHD” (Storebø, et al., n.d.)

It is important to add psychotherapy, specifically parent management training, to the treatment plan because training provides an understanding of the consistency and structure needed when parenting a child with ADHD.

Prompt 4: Why is it challenging to diagnose a child with ADHD, particularly under four years? Why is there is no test for ADHD?

It is difficult to diagnose ADHD in children younger than 4 years. This is because younger children have a much shorter attention span than older children. For example, a 2 year old’s attention is about two minutes in length, while a four-year-old child’s attention span is about double that time.

Although there is evidence that DSM criteria can be applied to preschool children, obtaining a diagnosis of ADHD in preschoolers and adolescents can be complicated depending on the age of the child and many of the signs/symptoms could be behavioral. “Before establishing a diagnosis of ADHD and initiating treatment in preschoolers, the American Academy of Pediatrics (AAP) recommends that parents of young children referred for ADHD assessment enroll in a parent training program. Such programs can help parents develop age-appropriate developmental expectations and specific management skills for problem behaviors” (Bélanger, et al., 2018).

There is no single test for ADHD because the process requires several steps and involves gathering a lot of information from multiple sources. The parent (s), the child, the child’s school, caregivers, and anyone who spends significant amount of time with the child should be consulted.

Hanging indent not maintained

References

Bélanger, S. A., Andrews, D., Gray, C., & Korczak, D. (2018). ADHD in children and youth: Part 1-Etiology, diagnosis, and comorbidity. Pediatrics & Child Health, 23(7), 447–453. https://doi.org/10.1093/pch/pxy109

Fehmi, L. G. & Robbins, J. (2001). Mastering Our Brain’s Electrical Rhythms. Retrieved from https://dana.org/article/mastering-our-brains-electrical-rhythms/

Goode, A. P., Coeytaux, R. R., Maslow, G. R., Davis, N., Hill, S., Namdari, B., LaPointe, N., Befus, D., Lallinger, K. R., Bowen, S. E., Kosinski, A., McBroom, A. J., Sanders, G. D., & Kemper, A. R. (2018). Nonpharmacologic Treatments for Attention-Deficit/Hyperactivity Disorder: A Systematic Review. Pediatrics, 141(6), e20180094. https://doi.org/10.1542/peds.2018-0094

Kemper, A. R., Maslow, G. R., Hill, S., Namdari, B., Allen LaPointe, N. M., Goode, A. P., Coeytaux, R. R., Befus, D., Kosinski, A. S., Bowen, S. E., McBroom, A. J., Lallinger, K. R., & Sanders, G. D. (2018). Attention deficit hyperactivity disorder: Diagnosis and treatment in children and adolescents. Agency for Healthcare Research and Quality (US). https://www.ncbi.nlm.nih.gov/books/NBK487766/

Krull, K. R. (2020). Attention deficit hyperactivity disorder in children and adolescents: Overview of treatment and prognosis. UpToDate. https://www.uptodate.com/contents/attention-deficit-hyperactivity-disorder-in-children-and-adolescents-overview-of-treatment-and-prognosis

Storebø, O. J., Ramstad, E., Krogh, H. B., Nilausen, T. D., Skoog, M., Holmskov, M., Rosendal, S., Groth, C., Magnusson, F. L., Moreira-Maia, C. R., Gillies, D., Buch Rasmussen, K., Gauci, D., Zwi, M., Kirubakaran, R., Forsbøl, B., Simonsen, E., Gluud, C., & Storebø, O. J. (n.d.). Methylphenidate for children and adolescents with attention deficit hyperactivity disorder (ADHD). Cochrane Database of Systematic Reviews, 11.

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