Choosing the Most Effective Treatment for Attention Deficit/Hyperactivity Disorder (ADHD)
Sabra Serreyn
PSYCH3002 Developing a Psychological Perspective
Controversies in Psychology Position Paper
Capella University
December, 2015

Abstract
This paper discusses the most effective treatment for children with Attention Deficit/Hyperactivity Disorder (ADHD). Increasing research has been recommending a combination of both pharmaceutical and psychotherapy treatments. DuPaul and White (2006) state that both the disruptive behavior and genetic aspects need to be addressed, therefore recommending treatment of both medication and behavioral intervention. There has also been a spike in psychiatrists suggesting alternative options in place of medication. Block and Smith (2015) express concern for the side effects of medication and should focus on the behavioral modification aspects. With that being said, the authors do state that medication may help in conjunction with behavioral therapy. Others argue that medication is the answer to resolving symptoms of ADHD because it can repair gray matter in a certain part of the brain. The conclusion comes together stating that all symptoms and treatments need to be taken into consideration in developing a combination therapy strategy. This is the most advantageous and ethical manner of working with a diagnosis.

Choosing the Most Effective Treatment for ADHD Diagnosing children with Attention Deficit/Hyperactivity Disorder (ADHD) has been on the rise at an alarming rate and is the most common diagnosed mental illness disorder for kids in the U.S. Although there is an abundance of disagreement as to what is the best treatment is for ADHD, such as medication and/or behavioral therapy, we need to focus on the aspects of the benefits in using both pharmacological and behavioral treatments and not just one or the other. To understand the reasons behind providing essential treatments of ADHD, there must be a clear understanding of the definition of what this debilitating illness entails. ADHD is a disruptive behavior disorder which has symptoms of inattentiveness, hyperactivity and impulsiveness. This is a broad description of ADHD and there needs to be an understanding that it entails many other aspects as well as particular details within each symptom and biological factors. The most common treatment used to be prescribing medication to “control” symptoms, but with the growing research of treatments for ADHD, there is an overwhelming response with the recommendations of both medication and behavioral intervention. Reviewing the research and data regarding the most effective treatments should provide a better understanding of the specific reasoning behind the strategy of using both pharmacological and behavioral therapies.
Understanding ADHD Symptoms As previously mentioned, Attention Deficit/Hyperactivity Disorder is a disruptive behavior disorder which promotes inattentiveness, hyperactivity and impulsiveness; however, there are also biological issues involved. The first step in addressing treatments for children is to recognize the signs and symptoms. First we will look at the behavioral factors of ADHD. In accordance with the National Institute of Mental Health (n.d.) ADHD has three subtypes:
• Predominantly hyperactive-impulsive. Hyperactivity may include fidgeting, trouble sitting still, and difficulty completing tasks.
• Predominantly inattentive. Inattention may include difficulty focusing, easily distracted and easily confused.
• Combined hyperactive-impulsive and inattentive. Impulsivity may include being very impatient, difficulty waiting for things and showing emotions without restraint. Secondly, we look at the genetic and biological factors that come into play, such as:
• Abnormal brain structure showing a lower volume of gray matter in certain parts of their brain (basal ganglia).
• Operation of brain components, such as prefrontal cortex.
• Chemical imbalance (neurotransmitters). Psychiatrists need to take into consideration all of the above information, as well as any other specific symptoms that may differ from child to child, and determine the best treatment plan based on each individual patient.
Why Combination Treatment is the Best Medicine
According to DuPaul and White (2006) both biological and environmental influences play a part in ADHD, therefore “indicating medical and psychosocial treatments could be helpful” (pg. 58). This also includes prescribing stimulants for the central nervous system and behavior modification procedures. The focus should not merely be directed towards the ADHD-associated behaviors, but the behavioral function of the child. The combination of treatments could be helpful in controlling symptoms and side effects of ADHD. Each child has different reactions to medication and behavioral therapy, hence the treatment plan may differ for each person. Medication should always be applied in conjunction with behavioral therapy as to acquire the benefit of all aspects of the treatment plan.
Behavioral intervention and medication therapy has been the most recommended treatment for ADHD in current research. A behavioral treatment plan, along with medication, can promote improvement in children with ADHD and help them have a healthy and successful life.
Positive Effects of Pharmacological Treatment The most common part of an ADHD treatment plan is prescribing stimulant medications that have a calming effect and reduces hyperactivity, impulsiveness, better focus and less disruptiveness. Antipsychotic medication may also be appended to the pharmacological treatment for children with extreme hostility.
Based on research compiled by Cortese, Holtmann, Banaschewski, Buitelaar, Coghill, Danckaertz, et al. (2013) it is perceived that although there may be adverse events with ADHD medication, they are manageable and easily tolerated. The side effects are rare and not severe enough to discontinue medication if managed effectively. Recommendations were provided to clinicians based on the above research, which was a SIGN grading system. Grades for recommendations (A-D) follow the level of evidence (1++ to 4) of specific areas of side effects, including, but not limited to, appetite, growth, cardiovascular system and sleep. Furthermore, according to Kings College London (2011), a meta-analysis of structural imaging studies demonstrated that the abnormal brain structure (basal ganglia) may be repaired by long-term use of stimulant medication.
Medication has many benefits to reduce some of the symptoms of ADHD, but it should be reiterated that pharmaceutical therapy alone cannot assist patients with the behavioral and social facets of the disease. According to Block and Smith (2015), medication may be helpful but it is more of a tool than a cure, therefore, if medication is used it will be more beneficial conjoined with behavioral therapy. We should not rule out medication all together, but consider alternative behavioral methods in combination with pharmaceutical treatment.
Positive Effects of Behavioral Intervention Since children with ADHD often times have self-esteem issues, social awkwardness, depression and anxiety, therapy should not only concentrate on pharmaceutical treatment, but also on improving their behavioral functioning. According to Block and Smith (2015), medications may help with concentration and other physical symptoms, but not improving school achievements, relationships or behavioral issues, which is where behavioral intervention comes into play. This type of intervention may help children balance out the behavioral side effects caused from ADHD.
Although behavior interventions seem to be the biggest aspect of therapy, DuPaul and White (2006), suggest that the most effective treatment is using a combination of both medication and behavior modification procedures due to ADHD having both genetic and disruptive behavioral aspects. Although the behavioral intervention may have the best treatment success, this should be in addition to pharmaceutical therapy. He does fit in that behavioral aspects such as organizational factors, family environment, and school environment greatly affect those with ADHD. However, he still recommends we focus on both ADHD-associated behaviors and the actual behavior functioning of the child.
Discussion of Oppositions
It may be true that medication has positive effects on ADHD, but research compiled in Kings College London (2011) argue that the basal ganglia returned to normal with or without medication as a person ages. They are stating that long-term stimulant medication promotes repair, but yet they say it also repairs with age without medication. This indicates that they are assuming medication does not promote repair of the brain or control the symptoms of ADHD. Many researchers argue that medication is more like a short-term fix and if a person stops taking their medication then the benefit from that medication stops working.
Although there are adverse consequences by applying pharmaceuticals, the positive effects of taking stimulant medication for ADHD outweighs the negative side effects. Using medication alone may help with physical symptoms but without the behavioral intervention, it may not address the child’s learning skills that they require to be successful in dealing with this disorder.
It is also becoming more common for professionals to research a broad variety of nonpharmacological interventions to treat ADHD with systematic reviews and meta-analyses. The analysis conducted by Sonuga-Barke, Brandeis, Cortese, Daley, Ferrin, Holtmann, et al. (2013) was based on a number of aspects including diet, psychological neurofeedback (cognitive training), and behavioral interventions. It showed positive effects on the symptoms in children when aware of the treatment allocation but neither neurofeedback and cognitive training trials had sufficient identification on whether either approach was better.
This analysis is suggesting that the only behavioral intervention is the only treatment needed to enable children to succeed without the use of medication. Although behavioral therapy helps with the behavioral aspects of ADHD, medication is still a vital component of the treatment plan for the patient as it can help with the neurological symptoms.
Furthermore, the research shows that the neurofeedback, cognitive training, and controlled diet as alternative methods to medication therapy, need to be further evaluated by a blinded study before they would be supported as an ADHD treatment.
On a positive note, most physicians agree that behavioral treatment helps parents, teachers and psychiatrists to develop a program to work on discipline, focus, social skills and more.
Summary and Conclusion “If you use only medication to try and treat ADHD, you’re likely to only get a partial response that does little to help the child or adult with all of the effects of living with ADHD” (Martin, 2013). Physicians first need to determine if a child has ADHD by looking at all the symptoms and characteristics of the child, not only the obvious ones such as inattentiveness, hyperactivity and impulsiveness, but also any neurological issues they may be having. As research evolves and methods improve, we will have a better understanding of ADHD and potentially provide more factual evidence of the correct treatments and/or a cure for this disorder.
There are numerous types of ADHD disorders which researchers are discovering including those with anxiety and depression, as well as physical conflicts that might differentiate one type of ADHD from another. With each type of disorder, the symptoms and environment needs to be researched to determine the appropriate discourse for treatments. It should be noted that since the typical symptoms of ADHD are not wholly inclusive, some kids may be misdiagnosed if they show signs of one or more of these traits.
“Piece by piece, through studies of humans and animals, scientists are beginning to understand the biological nature of attention disorders. New research is allowing us to better understand the inner workings of the brain as we continue to develop new medications and assess new forms of treatment” (Martin, 2013).