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Problems with ADHD Treatment Research Paper

Joshua Rutledge

Delaware Technical Community College

NUR 340

Dr. Heacock

October 10, 2020

Introduction
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“Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder

characterized by symptoms of inattention and/or hyperactivity and impulsivity causing

impairment in two or more settings” (Elwin, 2020). ADHD is a mental disorder commonly

occurring in children or adolescents that is categorized as a set of behaviors exhibited that are

suspected to be results of neurotransmitter and hormone imbalances in the brain. Between 5%

and 10% of adolescents in the United States have attention‐deficit hyperactivity disorder

(Webster-Straton, 2011). Most common methods to treat this disorder are the use of stimulants

such as Adderall or Vyvanse to create a sedation effect on the central nervous system.

Responders to ADHD medications can still have significant residual symptoms and impairment

post-medication treatment (Sprich, 2016). Many patients currently living with this disorder are

susceptible to substance abuse, higher risk for having comorbid mental disorders, along with

social and emotional impairments even while using pharmacological treatments. The purpose of

this paper is to use literature from five supporting research studies or clinical practice guidelines

to accurately depict problems of this mental disorder and ways to better appropriately treat and

assess this population.

Problem Statement

Currently hundreds of thousands of adolescents, children, and adults are living with

ADHD. The most common form of ADHD treatment is long term dependence on stimulant

medications to minimize prevalence of ADHD associated behavior. The healthcare and mental

health system as a whole are ineffectively assessing and treating this population and failing to

appropriately attack this disorder. Nursing primarily is on the front line for acute care, mental
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health care, and ongoing care therefore having a large exposure to this patient population and a

large opportunity for education and therapeutic treatments.

Review of Literature

Article 1: “Do I Need to Become Someone Else?”

This research article by Schrevel et al., (2016) was published in a peer-reviewed journal

Health Expectations. The purpose of this research paper is to identify social, emotional, and

psychological burden of disease for currently treated patients. Researchers compared three

similar studies for differences and identified that similar qualitative studies failed to assess

perspectives, problems, and needs of adults with ADHD in daily life. Researchers proposed that

adults with ADHD experience higher rates of unemployment and underemployment,

underachievement in academic careers along with relational, marital and family problems. This

supports the theory that ADHD is a complex disorder and holds with it not only behavioral and

academic problems but social, emotional and relational problems as well, which are not

commonly treated pharmacologically.

Article 2: Symptoms and Level of Functioning Related to Comorbidity with ADHD

Elwin et al., (2020) study explored prevalence of ADHD in children under the age of 18

years old in conjunction to their overall level of functioning versus the level of functioning for

children with ADHD and other comorbid psychiatric conditions. They hypothesized a lower

level of functioning for patients with comorbidities in addition to ADHD and a strong correlation

for comorbid mental disorders and ADHD. Researchers referenced a similar study by Roy

Arnold; Predictive utility of childhood diagnosis of ICD-10 hyperkinetic disorder: adult

outcomes in the MTA and effect of comorbidity. Research by Roy Arnold was said in the article
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to be the opener to further research into the effect of comorbid conditions with mental disorders

and paved the way for this research study. This gave insight to the prevalence of comorbid

disorders and the ineffectiveness of current assessment standards for ADHD.

Article 3: Clinical practice guidelines for the assessment and management of ADHD

Guidelines proposed by Ruchita et al., (2019) begin by implementing a 13 tier

Comprehensive Assessment and Evaluation criteria. This was supported using the American

Academy of Child and Adolescent Psychiatry (AACAP) practice parameter for assessment of

patients with suspected ADHD. Ruchita et al., (2019) explore non-pharmacological alternative

treatments referencing “Non-pharmacologic treatments for attention deficit hyperactivity

disorder”(Ferrin, M. 2015) published by the Textbook of Child and Adolescent Mental Health.

Using supporting research from evidence reviews conducted by the National Institute for Health

and Care Excellence for pharmacological efficacy and sequencing of pharmacological treatment

Ruchita et al., (2019) established a proper medication guideline. Lastly Ruchita et al., (2019)

provided a treatment plan for managing ADHD setting a template for how treatment should be

conducted and proper follow up care procedures driven by diagnostic criteria for this disorder

using supporting evidence reviews conducted by the National Institute for Health and Care

Excellence: Diagnosis and Management. Over 50 references were used as supporting data for the

Clinical Practice Guidelines established by Ruchita et al., (2019), references ranging in diversity

including systemic reviews, evidence reviews, meta-analyses, and practice parameters.

Article 4: Cognitive Behavioral Therapy for ADHD

Sprich et al., (2016) used extensive literature to display the problem of current ADHD

treatment and the need for multi-tier combined treatment plans. Researchers point to data

suggesting that many teens on medication for ADHD discontinue the medication before
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graduating from high school. This reveals a huge question if pharmacological treatment is a

temporary fix why are we most commonly treating ADHD with solely medication? This

underscores the importance of psychosocial treatments but, according to researchers on 22

research studies have been conducted regarding Cognitive Behavioral Therapy for ADHD from

1999-2016. This research supports the general trend that pharmacological treatment alone is not

adequate in treating ADHD which has been shown to have social, emotional, and relational

impacts along with a high incidence of comorbid mental disorders. We are failing this

demographic of patients as healthcare providers when resources are available while updated

treatments are not.

Article 5: Combining Parent and Child Training for Young Children with ADHD

Webster-Stratton et al., (2011) did extensive research supporting the introduction of

parent and child training to ADHD treatment. Research collected by Webster-Stratton et al.,

(2011) gave information on the limitations of stimulant pharmacological treatments and the

potential for progression of symptoms into diagnosable disorders such as oppositional defiant

disorder (ODD) and conduct disorder (CD). Literature research also depicts a strong correlation

with (ODD) and bad parenting techniques using a study by Barkley et al. (2000) which

correlated parent teaching to positive (ODD) outcomes. Although there is a strong correlation

with parent teaching and (ODD) outcomes, parent teaching alone is not always effective in

preventing negative outcomes which suggests the need for both Parent and Child training for

young children with ADHD. This research supports the general trend that pharmacological

treatment alone is not adequate in treating ADHD which has been shown to have social,

emotional, and relational impacts along with a high incidence of comorbid mental disorders.
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Analysis

The four research studies and Clinical practice guidelines used the collection of research

data to answer research questions regarding treatment options for ADHD patients both children

and adults. Methodologies used in these research studies consisted of mixed methods such as

experiments, observations, controlled trials, and surveys. Clinical practice guidelines were

formulated using a variety of data from different research by the author including systemic

reviews, evidence reviews, meta-analyses, and practice parameters. Findings of the research

studies where consistent with the trend that ADHD has a high incidence of comorbid mental

disorders, pharmacological treatment alone is not effective, combination therapies and teaching

promote effective coping mechanisms, and that ADHD has manifestations outside of the

academic and behavioral confines which should be addressed in proper treatment.

Gaps in research lie largely in the demographics of subjects researched in regards to voluntary

selection bias due to the voluntary nature of the research studies. Additionally it can be

determined from the literature and supporting literature that age demographics have a major

influence on data in regards to children, adolescents, and adults.

Recommendations

Recommendations for future research would be to formulate holistic style treatment plans

including pharmacological and non-pharmacological treatments, psychosocial therapy, parent

teaching, both initial assessments for comorbid mental disorders and ongoing assessments to

ensure treatment adherence and collect data on patient outcomes. Additionally I believe that

demographic specific research should be concluded by age to better formulate treatment plans

for patients of differing ages. Future research can answer the question regarding pharmacological
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therapy is it necessary to put children on amphetamines to treat behavioral disorders? I believe

further research will reveal just how useful non-pharmacological therapies can prove for mental

disorders especially ADHD and will slowly veer away from stimulant medications. An effective

way to research the comparison of pharmacological vs. non pharmacological effectiveness in

producing positive outcomes for patients with ADHD would be a three-armed randomized

control trial using mixed methods for data collection on positive outcomes comparisons. Human

rights would be protected in the same ways they currently are in randomized trials through

HIPAA and informed consent. Implications for nursing could be the formulation of holistic style

nursing treatment plans including pharmacological and non-pharmacological treatments,

psychosocial therapy, parent teaching, both initial assessments for comorbid mental disorders

and ongoing assessments to ensure treatment adherence and collect data on patient outcomes.
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References

Schrevel, Samuel J. C., Christine Dedding, Jeroen A. Aken, and Jacqueline E. W.

Broerse. 2016. “‘Do I Need to Become Someone Else?’ A Qualitative Exploratory Study

into the Experiences and Needs of Adults with ADHD.” Health Expectations 19 (1): 39–

48. doi:10.1111/hex.12328.

Elwin, M., Elvin, T., Larsson, J.O. (2020). Symptoms and level of functioning related to

comorbidity in children and adolescents with ADHD: a cross-sectional registry

study. Child and Adolescent Psychiatry and Mental Health, 14, 30.

Ruchita, S., Sandeep, G., & Avasthi, A. (2019). Clinical practice guidelines for the

Assessment and management of attention-deficit/hyperactivity disorder. Indian Journal

of Psychiatry, 61, 176–193.

Sprich, S. E., Safren, S. A., Finkelstein, D., Remmert, J. E., & Hammerness, P. (2016). A

randomized controlled trial of cognitive behavioral therapy for ADHD in medication-

treated adolescents. Journal of Child Psychology & Psychiatry, 57(11), 1218–1226.

https://doi-org.libproxy.dtcc.edu/10.1111/jcpp.12549

Webster-Stratton, C., Reid, M. J., & Beauchaine, T. (2011). Combining Parent and Child

Training for Young Children with ADHD. Journal of Clinical Child & Adolescent

Psychology, 40(2), 191–203. https://doi-

org.libproxy.dtcc.edu/10.1080/15374416.2011.546044
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