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This 8 page paper provides an overview of the basic behavioral interventions that can be used for children with ADHD (Attention Deficit/Hyperactivity Disorder) and for children who display significant aggressive behaviors. Bibliography lists 6 sources.

OR ADHD ], even if he or she does so consistently, do not draw the conclusion that the child has the disorder.

Trends in ADHD commentary paper - Progress Essays

We are not suggesting that prevention of ADHD is an impossible goal. For instance, some have suggested that reshaping the environments of young preschoolers, such as limiting television watching, might help to prevent some cases of ADHD (Christakis, Zimmerman, DiGiuseppe, & McCarty, 2004). However, we doubt this will prove effective given that there are serious questions concerning the direction of causality in such correlational findings (Barkley, 2004b) and that others have not replicated these initial results. Others have made a more compelling case for the reduction of environmental lead given the contribution of lead poisoning before age 3 years to the risk for later ADHD (Needleman et al., 1990; Nigg, 2006). Certainly the reduction of maternal use of alcohol and tobacco products during pregnancy would seem to be useful in view of the linkages noted earlier between these fetal neuro-toxins and risk for ADHD in the offspring of those pregnancies. This type of preventative research and related interventions should be encouraged. However, this is a course on treatment and by the time individuals meet diagnostic criteria for ADHD, we believe that they are on a chronic course and need to be treated accordingly. Therefore, the treatment of ADHD is actually symptomatic management as in diabetes. It is management of a chronic developmental condition and involves finding means to cope with, compensate for, and accommodate to the developmental deficiencies so as to reduce the numerous secondary harms that can accrue from unmanaged disorder. These means also include the provision of symptomatic relief such as that obtained by various medications.

Some of the psychosocial treatments for ADHD may have carry-over effects, mostly in the form of parents or teachers providing external structure that ameliorates ADHD-related symptoms. Ideally, these environmental adjustments will alter the developmental trajectory of the child or adolescent with ADHD. However, such interventions are not expected to produce fundamental changes in the underlying deficits of ADHD, rather they only prevent an accumulation of failures and problems secondary to ADHD. Thus, researchers and clinicians should anticipate that long-term studies are more likely to find treatment effects on problems secondary to ADHD than on deficits specific to ADHD.

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Another concern regarding the treatment research on ADHD has been that despite consistent findings of improvement in core symptoms of ADHD, there have been few reports of psychosocial treatment effects on key indicators of functioning such as academic achievement or social skills. For treatment of ADHD to be considered truly effective, there needs to be documentation of effectiveness on key ecological indicators of functioning in major life activities, such as school grades, sustained peer relations, etc. Again, this situation has been somewhat remedied by the MTA and, to a lesser extent, by the New York-Montreal multimodal studies.

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A major problem in the ADHD treatment literature is a lack of documentation of long-term treatment effectiveness. Almost all of the research has focused on short-term effects (i.e., within 3 months), with a few studies providing intervention for up to 14 months (Shelton, Barkley et al. 2000; MTA Cooperative Group, 1999a) with follow-up evaluations going on for several years thereafter (Barkley, Shelton et al., 2002; MTA Cooperative Group, 2004a). Thus, at the time of initial writing of this course, long-term effects beyond a few years had been largely unstudied. This situation has been remedied somewhat by the Multimodal Treatment Study of ADHD, commonly called the MTA study (MTA Research Group, 1999a, 2004a),which has now followed children for 8 years after receiving 14 months of treatment (Molina et al., 2009), and the New York-Montreal multimodal treatment study (Abikoff et al., 2004a, 2004b; Hechtman et al., 2004a, 2004b). These long-term studies have shed some important insight on treatment, especially regarding the efficacy of combining psychosocial and pharmacological treatment, yet they have also shown that treatment gains do not endure once treatment is discontinued (Molina et al., 2009). This does not mean one should abandon treatment but that one should approach it like a chronic medical illness, such as diabetes, in which treatment must be continued as needed to control impairing symptoms and reduce the risk for secondary harm from an unmanaged disorder.

ADHD is one of the most common neurobehavioral disorders of childhood

Research by Safer, Zito, and colleagues has documented dramatic increases in the overall rate of stimulant medication use among children and adolescents with ADHD (e.g., Zito et al., 2003) that have likely continued until 2009 or later. During the 1990s, stimulant prescription rates more than tripled. This was part of a general boom in the diagnosis and treatment of ADHD that probably occurred due to greater public awareness of the disorder as well as changes to special education regulations that encouraged the identification and treatment of the disorder in school settings. For example, surveys comparing physician practices in 1986 and 1999 found a three-fold increase in diagnoses of ADHD and a ten-fold increase in treatment services for ADHD. Comparing 1987 with 1997 records in the National Medical Expenditure Survey, Olfson and colleagues (Olfson et al., 2003) documented a marked expansion of access to treatment among children with ADHD, from 0.9 per 100 children to 3.4 per hundred receiving outpatient treatment. Despite this improvement in access to care, there was a decline in the intensity of treatment, as determined by number of visits and forms of treatment recommended other than medication. The authors interpret these changes as likely arising from increased access to special education services during this period, the growth of managed health care and its emphasis on brief visits and treatments, and increased public acceptance of medication use for the disorder. Such trends have likely continued to the present time.