Pluralized TherapyThe Logical Approach To Add Essay

Pluralized Therapy-The Logical Approach To Add Essay, Research Paper

Pluralized Therapy-The Logical Approach to ADD

Attention deficit disorder, in earlier times, was given a variety of names including: minimal brain dysfunction, minimal brain damage, hyperkinetic syndrome and hyperactive child syndrome. DSM III (1980), published by the American Psychiatric Association describes two subtypes of attention deficit disorder: attention deficit disorder with hyperactivity (ADD-H) and attention deficit disorder without hyperactivity (ADD). The child with ADD/ADD-H is described as one who shows signs of a short attention span, inability to concentrate and impulsivity. This impulsivity often causes the ADD/ADD-H child to act before thinking, which in turn leads to social friction, academic failure and self-esteem issues, which can lead to further problems such as suicide.

Attention deficit disorders can be treated in a number of ways: psychotherapy, family systems therapy, parent training, biofeedback and medication (both stimulant and anti-depressant) are some of the most widely used treatments. Proper diagnosis is important to the outcome of any of the above treatments. Whalen (1983) cautions against diagnosing children who are overactive, rambunctious and even a bit distractible as ADD/ADD-H as many young children tend to display these symptoms at one time or another. Because of the overlap of symptoms between ADD and ADD-H, DSM IV (1987) has three subcategories: 1. For children whose difficulties are primarily from hyperactive-impulsive behavior, 2. For those whose difficulties are primarily those of poor attention, and 3. For those who have both sets of problems. Barkley (199) suggests that ADD/ADD-H should be treated as two separate, but related disorders. Presently, the majority of the research combines ADD and ADD-H when studying different treatments.

Currently, treatment of children diagnosed with ADD or ADD-H largely involves the use of medication. A few studies suggest that family therapy is the best cure for this disorder. A more comprehensive and more logical theory is a combination of medication and family therapy.

Treatment of ADD/ADD-H with either a stimulant or an antidepressant does have positive effects on the patient; however, there are many side effects and there is a risk of abuse and dependence (Goyer et al., 1979). Also, there is proof that a majority of adolescents dislike taking stimulants and therefore, do not comply with the treatment regimen. In a study which was conducted to determine normal drug usage patterns in ADD children, Firestone (1982) found that about 20% of his patients had stopped taking their medication by the fourth month and by the 10th month, only 55% of his patients were still taking the medication.

Methylpehidate (Ritalin, a stimulant) is perhaps the most popular and common therapy for children with ADD, whether or not it is paired with hyperactivity (Klorman et al, 1990). Ritalin therapy has shown positive effects in some studies. One study (Rapport et al., 1986) utilized several different testing methods and compared scores of children between the ages of six and ten years who were split into two groups; the first group was given a placebo and the second group was given Ritalin. The children involved in the study met certain criteria, including their pediatrician s evaluation according the DSM III and a parental rating of behavioral problems. Children were seen once per week at the Children s Learning Clinic (CLC) at the University of Rhode Island, for individual testing. During each weekly session, a number of tests were administered, one being the Continuous Performance Test (CPT). The CPT (Rosvold et al., 1956) is an experimenter-based test designed to detect deficits in attention and impulsivity. A child s behavior was categorized as either on task or off task. Off task behavior was defined as visual non-attention to one s materials for more than two consecutive seconds within each 15 second observation interval, unless the child was involved in some other on-task behavior, such as talking to the teacher of sharpening a broken pencil. Significant overall effects were found for children s percentage of on-task behaviors and for CPT omission.

In another study by Gastfriend, Biederman and Jellinek (1984), children with ADD/ADD-H were treated with Despiramine, an antidepressant. The twelve children involved in the study ranged from 12-17 years of age. Eleven of the 12 adolescents had previously received Ritalin as a form of treatment and had either experienced inadequate results or side effects such as insomnia, weight loss, loss of appetite, dry mouth or occasional tremors. Participants in this study were rated on the Clinical Global Impression (CGI) and the Parent-Teacher Rating scales and showed much improvement in attention level as well as lower levels of hyperactivity and impulsivity as a result of taking the Desipramine. Antidepressant medication also has side effects: drowsiness, dizziness, weight loss, decreased appetite, insomnia and racing thoughts. The advantage of antidepressant use is the single-dose administration, which would prevent the child from having to take medication while in school, as opposed to Ritalin which usually requires a morning and an early afternoon dose.

Aside from the many side effects of both stimulant and antidepressant treatment, and the