Psychosocial Intervention Effectiveness in Treating Children ADHD

Introduction

ADHD has emerged to be one of the major mental problems in our children today. It has been the main reason behind our children shocking behavior change. Several parents find it hard to understand these behavior changes. For example, our children may become hyperactive in one area posing questions on their abrupt interest in that area. But how does ADHD exactly affect our children? Millichap and Gordon (2010) state:

Attention-Deficit Hyperactivity Disorder or ADHD is a common childhood condition that can be treated. It is the main cause of the cases of diagnosed psychiatric disorder in children. ADHD may affect certain areas of the brain that allow problem solving, planning ahead, understanding others’ actions, and impulse control. If a child seems too active on the playground but not elsewhere, the problem might not be ADHD. It might also not be ADHD if the behaviors occur in the classroom but nowhere else. A child who shows some symptoms would not be diagnosed with ADHD if his or her schoolwork or friendships are not impaired by the behaviors. Even if a child’s behavior seems like ADHD, it might not actually be ADHD; careful attention to the process of differential diagnosis is mandatory. Many other conditions and situations can trigger behavior that resembles ADHD. (p. 47)

From Millichap and Gordon’s view of ADHD, it is evident that the disorder is the reason of major behavior changes in our children. An understanding of the subject goes a long way in trying to solve untold behavior changes in the children. For example, there have been cases of reduced participation among a number of children when it comes to class work. However, such children are hyperactive in outdoor activities such as ball games and athletics. The disorder can also be used to explain the problem solving difficulties among a number of children. It is not a matter of them being bright academically. Some children’s performance in class has been seen to take un-explained about turn. Such children are the best examples of children whose attentiveness in class has been affected by the disorder (Hines 2004). They are characterized by reduced hours of attention; they are easily distracted when it comes to matters concerning class work. However, it is also important to note that not all changes in participation in different field are caused by ADHD. When a child is more attentive in class and not in the field does not necessarily mean that such a child has been affected by the disorder. Some of the problems may have been acquired at birth and may have nothing to do with Attention-Deficit Hyperactivity Disorder. Similarly, some character trait may be passed on from parent to child and so on so forth.

From the above overview, it is evident that indeed the disorder needs proper understanding. It is important to differentiate Attention-Deficit Hyperactivity Disorder from other possible causes of similar behaviors. It may be hard to accurately draw lines between ADHD and other causes. “However, causes of ADHD are characterized with hyperactivity, inattention and impulsivity as the main behaviors of the disorder.” (Swanson 1992, p. 43). As such, the symptoms of the disorder can be categorized in these key behaviors. Swanson (1992) classifies the symptoms as predominantly inattentive type (easily distracted, miss details, distracted attention, easily bored with task, daydreams, struggles to follow instructions etcetera) predominant hyperactive types (talk nonstop, constantly in motion, dash around, cannot seat still during meals, school, squirm in their seats etcetera) and impulsive type (very impatient, difficulty in waiting for things they like such as games).

The symptoms above show that the disorder indeed revolves around behavior changes. However, contrary to what most people may think, the disorder is not a permanent situation. Most of the changes can be reversed when appropriate measures are taken. That is to say ADHD is curative. Researches and discoveries have proved that the disorder has various cures ranging from stimulant medication, antipsychotic medication, other non-stimulant medications, behavioral interventions among others. The dissertation hereby looks at the behavioral intervention approach towards the treatment of ADHD. The main aim if this thesis is to analyze the effectiveness of psychosocial/behavioral intervention in treating children ADHD.

The dissertation looks at the current cases of ADHD in the United State of America as the context of the research. The United States is one of the regions that have registered high number of cases of the disorders in the recent years. Most of these cases have been recorded in the urban centers and other developed areas of the continent. However, several efforts have been made towards treating the disorder and control the situation. The dissertation looks at the psychosocial interventions that have made towards the case in study. The dissertation is structured to analyze the impact of behavioral interventions in the treatment of the disorder. Several data on the case study is collected through various methods and analyzed then conclusions made drawing arguments from the results and the discussions on the matter. The methodology chapter reviews literature on ADHD in the country as a research methodology in trying to answer the research question; has psychosocial/behavioral interventions effected the treatment of children ADHD in the United States?

Background of Attention-Deficit Hyperactivity Disorder in USA

Attention-Deficit Hyperactivity Disorder is a problem that has existed in the United States for a long period of time with the first cases dating back to the early 1940s. As stated earlier, 4 children out of every 100 children in the country are affected by the disorder in one way or the other. The disorder was not readily identified. In the 1940s, it was mistaken for unexplained behavior change among the children. However, when cases of the disorder increased in the country, there was need for fresh researches in to the matter. Various scientist and medical experts engage in a series of researches that lead to the discovery of the disorder.

Upon the discoveries several ADHD disorder were diagnosed and found to account for the tremendous behavioral changes among the children, a situation that followed then into adulthood in cases where they lacked treatment. The researches also revealed that most of ADHD cases were reported among male children. The early statistics show that two to four cases of the disorder were diagnosed frequently in boys than in girls. Several suggestions were proposed in the efforts of explaining these findings. Some experts argued that the cases of the disorder were more frequent in the male child due to his way of like. The male child seems to have little attention from the parents as opposed to the female child especially during the early stages in life. Some argue that in the learning institutions that are responsible with early childhood education tend to pay more attention to the girl child forgetting the male child. Such children are subjected to behavioral influencers such as peer pressure among other. However, not any of these theories have been accepted as the main reason behind the condition of the situation.

The disorder in the country has been attributed to a number of causes (Hines 2004). However, the one seen to be predominant cause of the spread of the disorder is the lack of knowledge on the matter among its citizens. Most people have inadequate information about the disorder and fence mistake it for other medical conditions making it take root in the country. This ignorance especially among those parties that are directly associated with the disorder such as parents and teacher has been the main reason why several children have fallen victims of the disorder.

The main cause Attention-Deficit Hyperactivity Disorder in the United State remains a misery. However, several factors have been linked to the condition as key contributors to the disorder. Genetic has been highlighted in various scientific researches as a cause of ADHD. It is believed that disorder is heritable and that genetic account for ever cases of ADHD reported now in the United States. Children with disorder show similar traits as those of the parents or a person in their lineage in one way or the other. How genetics affect ADHD is not explained. Some experts argue that combination of genes that affect dopamine transporters may lead to cases of ADHD. However, the issues of genetics and ADHD have been complex as it does not follow the genetic disease model. As such, it is believed that indeed genetic and ADHD is an example of the complex interaction between the environmental and genetic factors.

In the efforts of other causes of the disorder, several theories have been highlighted to be among the major factors that contribute to the disorder. Evolutionary theory is an example of the theories that have been suggested to explain the origin of ADHD. It is a theory suggested by Thom Hartmann in which he argues out that some cases of the disorder develop as a result of evolution. When one is subjected to certain conditions and situation, he may develop some behavioral changes that are later passed on to offspring as ADHD. Others argue that the disorder develop as a result of environmental factors. These include non-genetic environmental factors such as alcohol, tobacco and other drugs. It is believed that when one is exposed to these factors during the early stages in life like during pregnancy, the child can react to the stimuli resulting into ADHD.

Beside non-genetic environmental factor ADHD has also been found to have a relationship with the diet the children are subjected to during the early stages in life. This is according to the research done by Southampto University on the relationship between ADHD and diet. According to the research, it was found out that some cases of hyperactivity in children had something to do with various artificial food colors and other artificial food supplements. These supplements and food colors were stated as some of the causes of the disorder. As a result, the United States bureau of stands has since put in place mechanisms to control the manufacturing of the commodities. On top of these ADHD was also found to have a relationship with the social aspects of life one is subjected to in his or her early stages in life. Example of these aspects includes various caregivers. Parents and early childhood teachers play a key role as far as ADHD is concerned. They determine some cases of the disorder especially in children under the age of 7 (Hines 2004).

Having stated various causes of the disorder, the dissertation reviewed some of the efforts that have been made towards the treatment of the disorder in the study country. According to the researches America has made tremendous efforts as far as control of the treatment and the spread of ADHD is concerned. However, some of the treatment and diagnosis have been controversial as seen by a number of experts. This is because there is no definite dosage for the disorder. As such, various suggestions have been made towards the cure of the condition. The United States government has embraced a number of these suggestions due to their positive impact in controlling the disorder.

In the midst of all the controversies in the treatment of the disorder, the United States settled for a number of methods to control the problem. However, all the methods are aimed at impacting positive behavior modification to the ADHD patients. Among the methods adopted by the nation include the stimulant medication, antipsychotic medication, other none-stimulant medications and the behavioral interventions. Stimulant medication involved administration of stimulants to ADHD patients that help in alteration of their neurotransmission dopamine. On the other hand antipsychotic medication uses antipsychotic drugs to manage the disorder while none-stimulant medication depends on Atomoxetine (Strattera) and Guanfacine (Intuniv) as the main drugs to cure ADHD.

There has been more emphasis put on behavioral interventions as the best way in treating ADHD in children. This is because most of stimulant and none-stimulant medications do not offer a long term solution for the problem. Medications have only been seen to offer short term solutions with no significant effect on the long term outcomes. As such, behavioral interventions have been seen to be the best methods of treating ADHD due to is ability to offer long term solutions and has no side effects as opposed to stimulant medications (Hines 2004).

Methodology

From the background information on Attention-Deficit Hyperactivity Disorder in the United States it is clear that the problem has persisted in the country for some time now. Similarly, the background information on the setting of the context shows that several efforts have been made towards sensitizing people on ADHD and treating those affected by the disorder. The efforts range from stimuli medications to behavioral interventions. As stated earlier, the aim and objective of this dissertation is to review the effectiveness of behavioral interventions as the key method of treating ADHD among children. The dissertation presents an extensive research done on the subject matter. The United States is a big country. As such, the thesis an extensive research had to be done on the vast country so as to present a cross-section of the issue as it affects the country as a whole (Creswell 1998). In so doing, the methodologies used in the research involved a lot of literature reviews on the subject matter. This was seen to be the most effective research methodology. This research methodology tends to reflect the situation as it is on the ground. By reviewing other literatures on the subject matter, one gets to know how the problem exists in other contexts. It is therefore easier to make solid judgments based on the comparisons of the findings.

Literature review

The literature review research methodology reviewed literatures that were carefully selected. Not any article on the subject matter was selected. Instead, the literature articles used had to meet some qualifications. The objectives of the dissertation were to produce highly researched work with dependable information and factual conclusions and arguments. Among the qualifications of the article used was the accuracy of the article. All the articles used in this dissertation were of high levels of accuracy as they were drawn from dependable sources. The sources from which the articles were borrowed include renowned scientific plants, high profile hospitals, national research finding among others. Another factor considered for the articles was the dating of the article. The selected articles clearly showed how ADHD has affected the United States from the time of discovery to date (Creswell 2003). The articles also showed the gradual changes in the disorder from time to time. In addition, relevance of the articles also largely influenced the decision to include a particular article and ignore the other. There are many methods of treating ADHD in children ranging from medication to psychosocial interventions. All these methods have been used in the United States to treat the disorder. However, the aim of the dissertation was not to research on ways of treating ADHD in children, but to research on behavioral intervention as a method of treating the disorder. As such, most of the articles used were on behavioral interventions as an independent method in the treatment of children ADHD. Most of these precautions were made so as to produces a solid research.

Need for literature review

Researches involving medical issues require high levels of accuracy. As such, intensive research has to be done before any conclusions are made. When the research involves a problem solving research question, the dissertation should be aimed at providing a long lasting solution that should consider the long term consequences of the research. With all these factors in mind, appropriate methodologies should be employed for every research carried out. The methodology should be compatible with the resources available for the research. Similarly, it should not be too complicated especially for the people expected to work with it.

The dissertation uses literature review as the appropriate methodology for the study. The decision to settle for the literature review as the main methodology for the study was because of its advantages. As stated earlier, the dissertation is a medical study. As such, it requires high levels of accuracy. Literature review offer high chances for accurate dependable output. The literature review entails analyzing articles on the same problem recorded by different people and organization (Creswell 2003). This offers the chance to review how the same problem exists in other contexts. In so doing, the researcher gets to understand the subject in the case study better. Similarly, showing how the problem exists in other context provides room for comparison. The researcher can compare the problem as it relates to it different contexts. Some of the elements of the problem that can be compared include causes of the problem, its effects on different parties in the society and how the problem has been controlled in different contexts. Reviewing literature on the effectiveness of behavioral interventions in the treatment of ADHD in children largely helped in the research. From the review the problem was analyzed how it existed in the different state of the United States. Similarly, various causes of the disorder in the different states were compared to find the predominant ones. Several measures and methods of treating the disorder in different parts of the country were also reviewed. This comparison of contexts helps in drawing conclusions that tough across all contexts. Similarly, it helps in identifying the most hit areas at the same time identifying those areas where recommendable efforts have been made. When it comes to making recommendations, one can recommend interventions that have worked in different areas as seen in the literature review.

Literature review is an easy methodology. This is another factor that was considered when choosing it as the appropriate research methodology. It is les involving when it comes to finances as compared to other methods such as questionnaires and experiments among others. Issues of money have been the major hindrances of many activities including experiments and other researches especially the scientific ones (Creswell 2003). Literature review involves minimum movements thus becoming a cost effective methodology for the research. On the other hand, the methodology is less time consuming as it involves little movements and contact with other people. The fact that the method involves little contact with other people or organizations increases its levels of accuracy. Whenever there are many people involved there tends to be manipulations of the research to fit different views and expectations. Other methodologies such as interviews and questionnaires are prone to external interferences. Similarly, the accuracy of such methods depends on the knowledge of the interviewee on the subject matter, who may give false information deliberately or either due to ignorance. All these advantages plus other minor merits of literature review were the main reason why it was chosen as the appropriate methodology for this dissertation.

Having come up with the literature review as the appropriate methodology for the study, it is important to note that searching for the right literature should be methodical (Guba & Lincoln 1989). Being methodical helps the researcher remain focused on the case study. It also gives guidelines for the research from writing down research proposal questions, highlighting key topics in this case the effectiveness of behavioral interventions in treatment of children ADHD, making a list of alternative terms and above all creating a mind map to help think around the subject. A mind map is a very important especially in formulating hypotheses for the study. These hypotheses guide the study giving a rough idea on the expected results (Patton 2002).

In the efforts of searching for the right literature articles, search terms should be carefully selected the best research terms. These are the key terms that direct the search most efficiently.

Literature reviews involves a lot of data analysis. The methods of analysis used are selected according to its effectiveness in answering the research questions. In the dissertation various ways of analysis were used to evaluate other people’s research findings. Quantitative analysis was used in comparing the figures of other people findings. Among the figures analyzed included the number of cases of the disorder reported in various parts of the country. Another method of analysis used was qualitative analysis. This method was used in the needs assessment and other findings that required high levels of accuracy (Barkley 2005). Logic analysis as a method of analysis was used to assess the logical sense in the claimed patterns of causality.

Today we live in the global world characterized by multicultural communities. As such, ethical implications are key factors that should be considered before settling for any research methodology. “Ethical implication is how the possible outcomes of a situation will affect everyone’s best interests, how the issue affects people’s well-being” (Hartmann 2003, p. 52). Literature review is compatible with most of the people as a research methodology. As indicated earlier on, literature review as a method of data collection involves minimum contact with people. As such, it becomes the best research methodology as far as ethical implications are concerned.

Method

The first step after identifying the research question is to select the appropriate search methodology. For this dissertation, literature review was selected as the most appropriate research methodology. That meant that the right and relevant literature should be carefully selected for the study. As stated earlier, accuracy of the literature articles was one of the criteria used to determine which article to be used. Among the other determinant included the relevance of the literature material (Faraone 2003). Not all articles on ADHD were reviewed but only those touching on the effectiveness of behavioral interventions in the treatment of ADHD in children.

For choosing the appropriate research methodology, the researcher should decide of the most appropriate research databases. Databases are important components of literature review as a research methodology. Hartmann (2003) explains, “Research databases are the online tools you should use to search for articles on your topic. These databases include information about articles that have been published in journals, magazines, and newspapers.” (p 68). Databases are the most preferable for this research as compared to the World Wide Web. This is because with the databases more information can be retrieved. Some important articles such as journals and article can not be readily accessed on the web because such articles are not free (Hanna 2006).

Searching for the articles in the databases or the World Wide Web can be a tedious task when some key elements of searching the web or the databases are not put into consideration. The task can also be time consuming especially when one uses generalized search terms. For quick and more accurate results, one has to devise search terms that are more specific (Millichap & Gordon 2010). Such help in retrieving an article that is more related to the topic in the case study. The dissertation used ‘effectiveness of behavioral interventions in the treatment of ADHD’ as the main search terms in trying to search for articles that would help in the research. Other search terms such as ‘counseling and ADHD’ ‘lifestyle and children ADHD’ among others were also used in analyzing the extend to which psychosocial interventions have inimpacted the treatment of children ADHD in the United States.

For medical researches to be of significance and positive ethical implication, patients of the problem should be included in the study in one way or the other. As such, the dissertation derived inclusion and exclusion criteria to help in the process. Joubish (2009) states,

Inclusion criteria are the criteria for including a patient in the study, and it is important that these criteria be clearly defined in an objective manner, so that anyone involved in the study (or anyone attempting to replicate the study) can reproduce patient inclusion decisions precisely. Exclusion criteria are the criteria for excluding patients from the study. (p. 57).

Inclusion and exclusion criteria help in convincing other people with similar professional knowledge to include the same patient as those include in the dissertation (Southall 2007). From the review of the various literature materials, the assumption was the behavioral intervention is twice effective in the treatment of ADHD in children as compared to medical treatments. It also proved to offer a long term solution as seen in the patients included.

Various methods of data analysis were used including qualitative analysis for the data that required accuracy. Quantitative analysis on the other hand was used to analyze figures of the findings. Other methods used included thematic and logic analysis.

Results

The research used literature review as the main search methodology. Various articles were reviewed before the appropriate once were decided on. The articles cut across all medical felids that are related to Attention-Deficit Hyperactivity Disorder both in children and the adults. It was important to review article on ADHD in adults so as to analyze how the disorder has the ability to carry on within the patient to affect him or her even in their adulthood when proper measures are not taken when the patient is still young. It also helped in the analysis of how the disorder contrasted or related to that of the children. Could the treatment methods used among the adults apply in children is the other factor that was determined by reviewing both ADHD in the adult people and in children (Gold, Siegel, Russell & Weinstein 1996).

Several papers were reviewed in the effort of selecting the most appropriate articles for the study. Among them were surveys done on the case study. These surveys provided vital information that helped in the placing of the topic of the case study into different contexts. It also revealed how the disorder had been dealt in different parts of the country. On the other hand the survey provided various treatment methods that had been used in the different contexts. People’s research papers were also used in the literature review. These were among the key contributors to the findings and recommendations of dissertation. The research papers presented the disorder as researched on by other researchers. It showed how the problem has persisted in the country as seen in the sequence of the research findings by other researcher. From the analysis, it was evident that the problem had become part of the country’s epidemic with several measures having failed in the efforts of controlling the disorder. The research papers also presented the problem as it existed in other part of the country, highlighting various methods of treatment used in those states. The papers were also helpful in drawing conclusions and making recommendations (Drummond & Pang 2001). Some behavioral intervention as a method of treating the disorder had proved to work in a number of contexts as revealed by the research papers. As such, some of the recommendations were made with reference to the research findings by other people. In addition, it provided various views of different researchers towards the problem. In addition to the research papers and surveys, articles on ethnographic study on the case study were also reviewed. Ethnographic study entails analysis humans and their behaviors. As such, being a research that involved the effectiveness of behavioral intervention in the treatment on ADHD in children, ethnographic study was important in trying to understand human behavior and how it affects the disorder.

The articles used

Having reviewed a number of articles on Attention-Deficit Hyperactivity Disorder in children, six articles were selected to form the basis of the research. The six articles included surveys, ethnographic study papers and the research papers showing various research findings on the topic as presented by other researchers. The six articles were carefully selected because they were to form the basis of the study, meaning the accuracy and relevance of the dissertation entirely depended on them. The need for accuracy resulted in close scrutiny of all the articles so as to come up with the six (Joubish 2009). There are various reasons that influenced the selection of the articles. For example, the research articles selected presented extensive researches that had been done on the topic. The researches were also done by recognized bodies and qualified personnel suggested that their accuracy was dependable as far as the basis of the study was concerned. Surveys on the other hand presented relevant statistics to the topic. Appendix A presents the URLs to the articles

Summary of the findings

From analysis of the above articles various findings were made. According to Betsy Hoza’s journal of Pediatric Psychology vol. 32 titled Peer Functioning in Children with ADHD, the treatment of Attention-Deficit Hyperactivity Disorder has been debated over ages now. Hoza argues out that peer influence plays a major role both in causing ADHD and its treatment as well. In his article, he insists that the fact of peer influence as far as ADHD treatment is concerned is a critical issue that needs to be clearly thought over. The success of any method employed to treat the disorder is directly proportioned to the peer influence to which the patient is exposed to. As such, even though the article advocates for behavior therapy as the most effective way of treating ADHD among children especially those under the age of 9, recommendable efforts should be made towards ensuring that these young ones are not drawn back in the disorder due to negative peer influence around them (Hoza 2007).

The article “The Effects of a Stress-Management Program on Self-Concept, Locus of Control, and the Acquistion of Coping Skills in School-Age Children Diagnosed with Attention Deficit Hyperactivity Disorder” by Lois O, Gonzalez and Eric W. Sellers analyses behavioral interventions as methods of treating children ADHD. In the article, the authors analyze various aspects of behavioral intervention method of treating ADHD. According to the article, stress management is an important element of treating the disorder. As such, the behavior modification process should take into consideration managing stress especially among the patients. This is because some of the procedures in the modifications process are demanding for the patients who find them stressful to cope with. The article therefore highlights a number of coping skills that can be used by school-age children especially suffering from ADHD (Gonzalez and Sellers 2002).

Ida Kellison, Regina Bussing, Lindsay Bell and Cynthia Garvan present an article on “Assessment of Stigma associated with attention-deficit hyperactivity disorder: Psychometric evaluation of the ADHD stigma Questionnaire” In the article they talk about the stigma that comes with the disorder. In the United States various cases of ADHD associated stigma have been reported. Most of these cases have been reported in schools where teachers tend to discriminate students along ADHD lines. These teachers ignore or look down upon students diagnosed with ADHD. This discrimination has seen these students feel stigmatized for their condition. In their article, Ida Kellison and her team assess this stigma that comes with the diagnosis of the disorder. Even though they agree that teaching children on how to avoid or stop bad behavior is one of the main ways of dealing with children ADHD, they note that the effort should not seize at modifying ADHD children’s behavior. It should go a step further to protect them from the stigma by harmonizing the whole society on the subject matter (Kellison, Bussing, Bell and Garvan 2010).

The “Social Skills Intervention for Student with Emotional/Behavioral Disorders” article written by Kaili Chen has a social approach to the treatment of the disorder. In the article Kaili advocates for behavioral interventions as the most appropriate method for ADHD treatment. He notes antecedents, behaviors and consequences as the components of behavior modification. However, he goes a head to state that social skills are the most vital in the whole modification process. These social skills include skills on how to cope with peer influence, stress management among others. As such, equipping students with behavioral disorder with these skills goes a long way in the overall treatment of the disorder. The skills help them in vital activities such as decision making (Chen 2006).

On the other hand Marina Danckaerts, Edmund J.S. Sonuga-Barke and Tobias Banaschewski present an article titled “The quality of life of children with attention

deficit/hyperactivity disorder” giving a systematic review of the plight of a child diagnosed with Attention-Deficit Hyperactivity. In the article the authors give an overview of the disorder as it affects people in different ages. They then analyze the type of life ADHD children go through. The quality of this life has been compromised by various factors such as stigma associated by the disorder. The authors note that indeed there is need that an effective action be taken towards the same. In their article they also suggest behavioral intervention as the most appropriate method of treating ADHD among children. Appendix C shows the table of the critiques of the articles (Danckaerts, Sonuga-Barke and Banaschewski 2010).

Analysis

Reviewing different literature materials on Attention-Deficit Hyperactivity Disorder in the United States revealed various factors about the disorder. From the review it was evident that not only the common causes of ADHD were responsible for the high number of cases of the disorder in the country. Similarly, the causes differed from one area to the other. However, there were some that seemed to be predominant in almost all contexts. The difference in the causes resulted from different conditions under which every context was subjected to. In some of the reviewed literature materials, authors tried to account for how ADHD was related to the context. Similarly, some highlighted a number of causes that have emerged due to changes in the environment.

With the above overview of across-section of what the different literature sources presented, several themes emerged suggesting otherwise or in accordance with the background of the problem. According to the review, the three main themes that emerged were as follows.

Social and children ADHD is a theme that is clearly shown in most of the articles. The theme suggests the environment which the child is subjected to in his or her early the fate of ADHD on him/her. There are various elements that form up this social environment. One of the key components of the environment is the parents (Towse, Pritchard & Devlin 2002). Parents play a vital role as far as ADHD is concerned. These are the people that are closest to children in their early life. As such, how the parents decide to bring up the children may determine the extend to which the children are exposed to the disorder. Parents are the basis of parental training. Most of the character in children shapes up according to this parental influence. There were cases of ADHD among children especially in California that were greatly influenced by the lack of parental training due to irresponsible parents. When it so happens, such children are subjected force of external interferences such as peer pressure and negative media influence. Other groups of people that form children’s environment are the family, society and childhood teachers. Children tend to shape their behaviors according to the influence they get from these people who form their social environment. It should be noted the parental training is a collective responsibility of all parties that form the children’s environment. Therefore, when one party lives up to its duties and one fails to do so will be neutralizing the general efforts of all other parties and at the same time exposing the child to the avoidable causes of ADHD (Fernando 1995). A number of the articles reviewed stated that a number of international children adopted developed one or more cases of ADHD. This further proves the effects of the social environment as far as ADHD is concerned. Such children developed different cases of the disorder due to change of the social environment. They are presented into a whole different environment with that of their birth place. When it comes to behavioral modification as a method of treating the disorder, such children may take more time due to adaptation issues.

Another theme that stood up in the research is the theme of technology and ADHD. Even though not article clearly illustrated the relationship of technology advancement and ADHD in children, there are many ways in which these two can affect each other in one way or the other. Today we live in a global world characterized by advanced technology and scientific discoveries. In addition, the United States of America is one country that has advanced levels of technology. The discovery and creation of the World Wide Web and the Internet are one of these advancements in technology. As stated earlier, Attention-Deficit Hyperactivity Disorder is more of a mental disease. In the efforts of treating the disorder especially in children, the internet can be a very big obstacle. Children in the United States are exposed to any kind of information courtesy of the civilized nature of the country and technological advancement. The internet has addictive products such as social networks as well as addictive literature material such as cartoons for children under the age of 9 and pornographic material for the teenagers. These addictives may lead to behavior change. For example, a teenager addicted to pornographic material may have reduced attention in class or be hyperactive to pornographic topics. On the other hand the addictives acts as obstacles when enacting behavioral modifications to children affected by ADHD. Children find it hard to abandon such characters that they are already addicted to. Not only does internet affect the children but also affects the adults as well. In fact several researches on internet addiction shows that the group of people who are greatly affected by internet addiction lie between the age bracket of 15-30 years of age (Sheppard 1991). In other word, internet and other products of technological advancements are factors that affect both children and adults as far as Attention-Deficit Hyperactivity Disorder is concerned.

Environment and children ADHD is another theme that clearly shapes up from the review of the literate. This theme may not have emerged in all the articles but in the few that it did, it carried a lot of weight with it. The question one is left asking is how environment is related to Attention-Deficit Hyperactivity Disorder in children and how it is related to behavioral interventions as a method of treating the disorder. To understand the theme better, it should be noted that the term environment in this context means chemical factors of the environment that the child is exposed to during early childhood or just before birth. Examples of these factors include alcohols and tobacco. These factors contain chemical substances that may affect the child at birth or during childhood. When a mother smokes heavily during pregnancy, the nicotine in the cigarette may be passed through to the fetus through the umbilical cord. A child borne under such conditions may develop some cases of ADHD as a result of the body reacting to the stimuli that were induced in his body by the mother. Alcohol has the same effect as smoking. The stimuli may also lead to premature births that too cause ADHD. Children who are subjected to such conditions may develop viral complications such as measles, rubella and varicella among others. Together with the environment is the diet the children are treated to. The diet may react chemically with the body of the child making him or her hyperactive in some areas as opposed to others. In other words, the diet has a reactive effect on the normal functioning of the body of children resulting into the disorder. Therefore, environmental factors may acts as obstacles during behavioral modification is being enacted to children already affected by ADHD if they are not dealt with properly.

Behavioral intervention force field analysis as method of ADHD treatment

The analysis of the themes from the literature review can be summarized into a force field analysis. The themes include the social and children ADHD theme, the technology and children ADHD theme and the environment and ADHD theme. The theme had several implications to the research question and the hypotheses that had been made before (Leathard 1994). Some of the implications confirmed the hypotheses while others went contrary to the research question.

The research question of the dissertation was how effective is behavioral intervention in the treatment of ADHD among children. The themes provide a number of factors that affect the behavioral intervention in one way or the other. There is need for treatment of the disorder. The need is driven by a number of factors that can be included on the force field analysis as factors for change. On the other hand, several factors hinder the efforts of treating ADHD among children through behavioral modifications. These factors are included on the force field analysis as the forces against change. At the centre of the force field analysis is behavioral intervention as the most appropriate method for treating cases of Attention-Deficit Hyperactivity Disorder among children in the United States.

With the theme of social and children ADHD, forces for change may include the efforts by parents to treat their children. These efforts have resulted from the sensitization of the public by the government and other none governmental organizations. It may also arise from the fear of increasing number of cases of ADHD among children below the age of 9. This fear tends to drive parents into wanting to know the status of their children as far as Attention-Deficit Hyperactivity Disorder is concerned (Berlo 1960). Another force for change may result from the call by the government and other organization on the importance of treating the disorder in children. This may be through evens like national ADHD day where free treatment is offered to children who are living with Attention-Deficit Hyperactivity Disorder.

On the other hand, the themes present a number of forces against change. These are the forces that act as obstacles towards the treatment of the disorder with behavioral intervention as the most appropriate method. Example of the forces includes internet addiction (from the technology and children theme). As stated earlier, behavioral modification can largely be hindered by addictions such as those of the literature readily found on internet. For such children to fully recover from ADHD they have first to fight the addiction, an issue that can be time consuming. In addition to internet addiction, social factors such as irresponsible parents/family/caretakers/teachers can also emerge as forces against change. Even if the caretakers play their part in training the children, they need support from parents, teachers and the society at large. Lack of this cooperation between involved parties amounts to forces against change. Environmental factors like drugs (alcohol and cigarettes) and poor diet too amount into forces against change thus further hindering the treatment of the disorder.

Bellow is a force field analysis diagram to map the themes.

A force field analysis diagram to map the themes

Discussion

From the background information of the problem in the United States we found out that the problem has existed in the country for quit sometime. In addition, the country had made several efforts to treat and control the disorder. However, the efforts were met by several obstacles. From the themes it is evident that various factors relate to the ideas that emerged in the background chapter.

The theme of the relationship between social environment and ADHD in children stated different causes of the disorder. From the theme, parents, family and the society at large form the social environment of the children during their early life. The theme suggests that some cases of the disorder are largely determined by these people who revolve around these children in their childhood. Parental care and treatment is an important component of behavioral modification as a method of treating ADHD in children especially those under the age of 9 (Wrench, McCroskey & Richmond 2008). The theme also suggests that behavioral modification requires participation of all parties that form up the social environment of the child. According to the theme, behavioral intervention cannot be effective if one party fails to live up to responsibility as far as behavior modification is concerned.

The theme highly relates to the situation as it exists in the country. The United States is a developed and civilized country. As such, behavioral modification has been affected by this situation of the civilized nature of the country. There are cases where the modification process has been left to caretakers and learning institutions. This suggests that some parents have failed to live up to their responsibility of training their children in their early states in life. Several factors have limited these parents from their responsibility in parental training. In the present competitive world, most parents find themselves enslaved by their day jobs to the extend of lacking time to spend with their families. When it so happens, the fate of their children is left to the caretakers and teachers that have direct contact with them on a daily basis.

Technology and children ADHD is another theme that greatly relates to the situation in the country as depicted in the background chapter. The situation in the background chapter is that the efforts of controlling the disorder had met several hardships. Behavioral interventions in particular suffered the challenges of addiction among the children. As such, the process is slowed down. The theme suggests that technological advancements have contributed so much in the cases of addiction among the children. In the world today one can get access to information upon the click of a button. In addition, the information provided by these technology assets has no restrictions and one can access it irrespective of their age, sex or even place. United States has the highest numbers of addictions in the world. Most of these addictions are courtesy of the internet. As stated earlier, the United States is a developed country characterized by advanced technology with fast internet services at fairly affordable prices. This has led a number of children to be drawn into internet addictions of various kinds (Baluska, Marcuso & Volkmann 2006). Among the addictions include cartoons, games and pornographic materials among the teenagers. These addictions have greatly affected behavioral modification among children in America. They distract children attention preoccupying their brains with irrelevant things. For example, a child addicted to computer games may have her minds distracted in class. Her productivity in class may be compromised by the addictions to the games she is exposed to on a daily basis. Such children are hyperactive when it comes to the games. Parents on the other hand are blamed for some cases of these addictions. From the background chapter it is revealed that some parents make these IT assets available to the children because such parents do not have the time to spend with their children. As such, they avail such assets so as to replace their presence since most children are attracted to the assets such as computers, play stations among others.

The theme of environment and children ADHD also emerges to relate in a number of ways to the ideas in the background chapter. The theme highlights a number of factors as the main causes of the disorder among children. These causes emerges in the background chapter as some the factors that have taken route in the country as far as children ADHD is concerned. Drug addiction is a problem that has been experienced in the country for a long time. Even though efforts have been made by the state government to sensitize people on the dangers of drug dependency, statistics show the problem is still experienced in the country with areas such as California, Las Vegas and New Orleans being among the most affected places. Behavioral modification as a method of treating children ADHD has been largely affected by this issue. A number of adults are addicted to drugs and stimuli such as alcohol and cigarette smoking. Such a society constantly exposes innocent children to the dangers of contacting the disorder. Behavioral interventions in such areas have to start with the adults in the efforts of reducing the risks of more exposure of the children to the stimuli (Schramm 1954). As such, the treatment becomes ineffective if the society is resistance to change. In the end, it acts a strong force against change as seen in the force field analysis chat in the analysis chapter.

From the above analysis of the themes emerging from the literature reviews it is evident that still much ahs to be done as far as Attention-Deficit Hyperactivity Disorder in children is concerned. The United States is a country with a big population comprising different kinds of people. The literature reviews also suggested that the cases of ADHD in children differ from place to place. In addition, different place have different causes for the disorder. The research question of this dissertation was how effective is behavioral modification in the treatment of the disorder. Reviewing the different literature material on the topic reveals that the efforts of using behavioral intervention in treating ADHD have been faced by a number of challenges. Most of these challenges live within the society while others are external to the society. From the background information it is also evident that most of the cases of the disorder are due to lack of adequate knowledge of how the child’s environment affects him or her i.e.; either exposes him to the risk of contacting the disorder or protects him from the disorder. As such, more research has to be done especially on how these different environments have affected the children as far as ADHD is concerned. The research findings will be of great importance in pin pointing where the major problems arises from. The researches will also help in understanding the effects posed by different parties of the child’s environment thus helping on knowing which party requires more sensitization on the matter.

The implications that will come with this are that the main problem of children ADHD will be appropriately addressed. It is important to note that behavioral modification is a collective responsibility for all the parties that are affiliated to the child. As noted earlier, when one party fails to live up to its responsibility, this neutralizes the efforts making the whole process a waste of time and resources. As such, when the appropriate researches are made, the main obstacles to behavioral modification as a method off treating ADHD in children will be addressed. The finding of this dissertation can be used in guiding on which areas should be researched on. For example, according to the dissertation, technology and ADHD are related in one way or the other. Technology assets affect the treatment of children affected by the disorder in one way or the other. As such, the issue of technology and ADHD needs to be adequately researched on. The research finings may help formulating research questions. For example, internet addiction has been highlighted in this dissertation as one of the technological obstacles to behavioral modifications. Therefore, the research question in this context can be; how does internet addiction affect behavioral modification among children affected by ADHD?

The above suggestions have various benefits especially to the parents of children affected by the disorder. Treatment of Attention-Deficit Hyperactivity Disorder is costly exercise. Much effort is usually put into the process irrespective of which method one decides to use. Therefore, knowing the exact cause of the disorder helps in knowing which type of treatment is the most appropriate. In this case where behavioral intervention is the decided method, it helps in knowing the exact kind of behavioral training the affected child needs. In the end the process becomes effective and pocket friendly as it is well planed for. The ethical implications with this are that the society will be sensitized on their contribution toward ADHD in children (Kelleher, Childs & Harman 2001). As state earlier, the society’s moral values largely count in how children grow up shaping their character traits as they tend to copy from their elders.

Limitations of the methodology

The research methodology used in the dissertation was reviewing of the literature materials on the topic as recorded by other people. The methodology had it own merits and limitations. Even though the merits exceeded the limitations, it is important to note that the accuracy of the dissertation entirely depended on that of the reviewed literature. Similarly, the methodology restricted the research to the materials used. In other words, there was no involvement of other sources such as interviews and questionnaires. All these were some of the limitations of the methodology.

Conclusion

Attention-Deficit Hyperactivity Disorder is a condition that has affected the United States of America in so many ways. It is a disorder that has cut a cross all generations affecting both children and the adults. In some cases the disorder is acquired during childhood and lives on to affect the person in his adulthood. The condition has affected the country in many ways. Its economic growth and general output has put on the line as the disorder has continued still off potential citizens especially the youth who have found problems with paying attention and hyperactivity among other consequences of ADHD. As such, there is need for addressing the problem effectively and with the shortest time possible. Several efforts have been made by the country towards controlling the epidemic that has robed off its once productive youth. It is important to note that contrary to what most people think, ADHD in children has an effective long lasting cure. Behavioral modification is an example of these effective ways of treating the disorder. It is a collective responsibility of all the parties involved ranging from parents to the family and the society at large. When effected properly, behavioral intervention can be a great force of positive change as long as treatment of ADHD in our children is concerned. It is a process that involves psychological therapies. “Psychological therapies used to treat ADHD include psychoeducational input, behavior therapy, cognitive behavioral therapy (CBT), interpersonal psychotherapy (IPT), family therapy, school-based interventions, social skills training and parent management training(Southall 2007, p. 45).

In dealing with the disorder it is important to take note of the various factors that interrelated with the problem. From the themes it is evident that the existence of the problem in the United States is due to a number of factors. These factors should be put into consideration as far as treatment of the problem is concerned. They are the factors that limit behavioral modification in treating Attention-Deficit Hyperactivity Disorder in children. These factors are contributed by various parties. As seen earlier, the society at large is an important component of a child’s environment. From the themes it was also noted that other complex factors such as technology and stimuli form part of the same environment. Therefore, for behavioral interventions to yield fruits in treating children with ADHD, it is important to note that all parties should live up to their responsibility. Effecting behavioral modification can never take effect if the same child undergoing treatment is still subjected to the same causes of the disorder he is being treated of (Knapp 1997).

Recommendations

From the research finding several recommendations can be made in regard to the effectiveness of psychosocial/behavioral intervention in treating children with Attention-Deficit Hyperactivity Disorder. Several issue emerged in the research on the case study. Attention-Deficit Hyperactivity Disorder is a condition taken by many as a slight mental problem. However, the disorder is a serious condition that has seen even adult people get affected in one way or the other. The fact the disorder is looked down upon as a slight medical problem is the main reason behind attention problems among the adults now. This arose from untreated ADHD that they acquired during childhood and have lived with it to childhood. As such, Attention-Deficit Hyperactivity Disorder should be addressed with the seriousness that it deserves.

Addressing ADHD can not take effect when the society has inadequate information on the disorder or has none at all. As such, using behavioral intervention to treating the disorder should first start with sensitizing the society on the disorder. The sensitization should touch on how the society is involved in causing and treating the disorder. This can be through media houses or organized medical rallies. Information about ADHD as a disorder can also be taught in various learning institutions and medical centers. On the other hand, psychosocial/behavioral intervention as a method of treating ADHD in children is a collective responsibility that involves various parties. As such, there should be campaign for sensitizing people of their vital participation in the behavior modification process. The contribution of the family as part of the behavior modification initiators is equally vital to that of the parents, the school, caretakers and the society at large. Another recommendation is that there should be more involvement of the state government in the fight against the disorder. The government is the right body that should oversee all the activities of the fight against the disorder. In addition, some of the activities require large sums of money. As such, the government should step in financing such activities. In addition, the government is the right body in protecting the young children from stimuli and other drugs that have been highlighted in the dissertation as key causes of the disorder. It can formulate laws that protect these innocent young once from abuse of the drugs. They should also regulate the internet in the efforts of protecting them from addictive literature such as pornography.

All these recommendations are realistic as they are ways that have been used and worked in other contexts. The ideas behind the recommendation are practical suggestions that are cost effective and time conscious. Sensitizing the community on the involvement in the treatment of the ADHD in children via behavioral modification helps in finding long term solutions of the disorder. In prioritizing the recommendations, sensitization of the society should come first. This is because it is the main determinant of the success of the whole process. Government intervention is also an important step towards control of the disorder.

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Appendix

Appendix A: URL Locations of the Articles

http://www.medicinenet.com/attention_deficit_hyperactivity_disorder_adhd/article.htm

http://www.kidneeds.com/diagnostic_categories/articles/mental.htm

Appendix B: Article Critique

ARTICLE TITLE CRITIQUES
1 Peer Functioning in Children with ADHD The article emphasizes on behavior therapy as the most appropriate method of treating ADHD in children. However, it insists that peer influence is a vital aspect that needs to be properly handled especially among children diagnosed with the disorder. This peer function can both be advantageous and disadvantageous to the behavioral modification process.
2 The Effects of a Stress-Management Program on Self-Concept, Locus of Control, and the Acquistion of Coping Skills in School-Age Children
Diagnosed with Attention Deficit Hyperactivity Disorder
The article analyses behavioral intervention as a method of treating ADHD in children. In their article the authors evaluate the effectiveness of stress-management as an element of behavioral modification. They note that stress is one of the key obstacles to behavior change. As such, getting a way of controlling stress especially among children with ADHD is a superb way of addressing the disorder. Similarly, the article talks of several coping skills and how they are acquired.
3 Assessment of Stigma associated with attention-deficit hyperactivity disorder: Psychometric evaluation of the ADHD stigma Questionnaire The article presents an assessment of the stigma associated with ADHD. In the article, it is evident that indeed stigma related to the disorder has been reported to be an obstacle for change especially in the treatment of the disorder. Children with ADHD have been discriminated in schools and other places for their condition. This has seen them suffer the stigma resulting into low self esteem and lack of self confidence.
4 Social Skills Intervention for Student with Emotional/Behavioral Disorders The article advocates for behavioral modification as the most appropriate method of treating the disorder with more emphasis on social skills. Social skills in this context include all elements that help cope with challenges from our social context. These skills go along way in creating self confidence and a high self esteem. The articles also highlights a number of obstacles that acts as forces against change among them addictions and irresponsible parents, family society.
5 The quality of life of children with attention deficit/hyperactivity disorder The article is on ADHD as a disorder and the quality of life that children diagnosed with the disorder live. It explains what the disorder is, how it is caused and which group of people it affects most. It analyses the disorder from a medical perspective giving facts on how the disorder affects the life of the young children. In relation to the United States, the article suggests that several factors are reasons for the wide spread of the disorder. Among them are the irresponsible parenthood and addictions.