The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) recognizes three forms of ADHD; inattentive, hyperactive and combined inattentive hyperactive (Lavoie, 2008). The inattentive type is characterized as an individual suffering from an inability to concentrate along with being highly distractible (Lavoie, 2008). While not generally being disruptive in the classroom, these children have great difficulty concentrating or performing sustained acts of high mental activity (Lavoie, 2008). The hyperactive type is characterized by an individual who has great difficulty controlling impulses but few struggles with distractibility (Lavoie, 2008). The combined form of ADHD is the most common with 60 percent of individuals suffering from ADHD falling into this category (Lavoie, 2008).
Stimulant medication whether MPH or amphetamines generally comes in two forms, immediate release or extended release (Findling, 2008).
Robert Findling (2008) conducted an empirical research on the long-term use of stimulant medications, specifically MPH on children (Findling, 2008). His research found that both rapid release and extended release formulas were effective in combating the symptoms in ADHD and didn’t pose long-term tolerability problems (Findling, 2008). Additional research performed on the effectiveness of stimulant medication showed an increase in motivation for ADHD children (Chelonis et al., 2011).
In a research study conducted by Powell, Thomsen, Frydenberg and Rasmussen (2011) to evaluate the effectiveness of medication long-term they made use of the naturalistic observational method (Powell et al., 2011). After following 410 patients over the course of several years they found that stimulant medication was extremely efficacious in the treatment of ADHD (Powell et al., 2011). What they also found however was that the diversity between patients was great with many suffering from comorbid disorders along with variability in the intensity of ADHD symptoms (Powell et al., 2011). They discovered that the dosage required for patients could vary widely and that over time some individuals could require an increase or decreased dosage with others remaining static (Powell et al., 2011). They concluded their study by advocating for the need to take each individual case and the surrounding circumstances separately in order to best treat individuals (Powell et al., 2011).
Stimulant medication has long been a controversial topic as detractors don’t believe kids should be medicated with such powerful drugs. There is also a substantial amount of black market distribution of these drugs. Additionally there is the potential for abuse especially with rapid release formulas.
According to Miranda and Presentacion (2000), “In other words, the problem with hyperactive children seems to stem from a deficiency in the activation of planned and systematic thinking, and not from active but distorted thinking” (Miranda, Presentacion, 2000, p. 1).
CBT makes use of behavioral contingency plans for children to use in order to alter behaviors and suppress normal response to impulses (Miranda, Presentacion, 2000). Modeling is the imitation of behaviors observed from some form of role model or authority figure (Miranda, Presentacion, 2000). In this case, children will observe the acceptable behaviors of their peers or elders and attempt to imitate them in order to gain social acceptance.
Research performed by Miranda and Presentacion (2000) was centered around the effectiveness of combining traditional ADHD centered CBT with anger management in reducing aggressive behaviors from children with ADHD (Miranda, Presentacion, 2000). The research was performed on 32 children split into 4 groups, an aggressive group and a nonaggressive group receiving the anger management, and 2 of the same groups not receiving anger management (Miranda, Presentacion, 2000). All four groups showed significant improvement with the aggressive group receiving anger management showing the most improvement of the groups (Miranda, Presentacion, 2000). Yet another study on the use of CBT for ADHD was conducted over the course of an eight week long summer treatment program with 19 adolescents participating (Sibley et al., 2010). This program was designed specifically to address and treat symptoms or problems associated with adolescents diagnosed with ADHD (Sibley et al., 2010). These issues included conduct problems, defiance, social functioning, attention problems, organizational deficits, temperament and academics (Sibley et al., 2010). The participants were rated both before and after treatment by parents, teachers and researchers on an ADHD rating scale (Sibley et al., 2010). The results of the study had all but the Science/Health teacher reporting major improvements in all areas of functioning (Sibley et al., 2010).
Research for the combined use of CBT and stimulant medication is rare and especially with regards to such research on children. One research study however performed on adults consisted of 86 adults who had been receiving medication for treatment but still showed considerable symptoms (“Cognitive Behavioral,” 2010). The patients were randomly assigned to either receive CBT therapy or simple education and relaxation courses (“Cognitive Behavioral,” 2010). Out of the initial 86 patients 79 completed treatment and 70 participated in follow up assessments (“Cognitive Behavioral,” 2010). The participants were assessed on an ADHD rating scale conducted by doctors with those receiving CBT scoring considerably higher than those who did not (“Cognitive Behavioral,” 2010). This successful research should lead to an increased interest in this method of treatment and hopefully further research.
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Comparing the Effectiveness ofCognitive-Behavioral Therapy toStimulant Medication for ADHD Kyle McNamara Argosy University Online
What is ADHD?• ADHD is a biological development disorder with three hallmark symptoms;• Inattention• Hyperactivity• Impulsiveness (Lavoi, 2008).
Continued• The DSM-IV classifies three separate subtypes in the diagnosis of ADHD;• Predominately Inattentive• Predominately Hyperactive• Combined Inattentive/Hyperactive
Stimulant Medication• One of the most common treatment options for ADHD is stimulant medication.• The two main forms of medication used are Methylphenidate (MPH) and amphetamines (Findling, 2008).
Efficacy of Stimulant Medication• Research studies have continually shown both immediate release and controlled release MPH to be effective and tolerable long-term.• Studies have shown the use of stimulant medication to be extremely effective in combatting the symptoms of ADHD.
Need for Individually Specific Dosage• The type and intensity of ADHD and its symptoms varies greatly between individuals (Powell et al., 2011).• Comorbid disorders may also develop such as depression, anxiety or substance abuse (Powell et al., 2011).• These issues dictate a need to take each individual case separately in order to provide proper dosage and medication option (Powell, et al., 2011).
Weaknesses of Stimulant Medication• The major problem with stimulant medication is the potential for abuse or illegal distribution.• There has long been a stigma associated with its use for children and questions regarding its safety.
Cognitive-Behavioral Therapy• Cognitive-Behavioral Therapy (CBT) is another commonly used treatment option for ADHD.• Advocates for CBT view ADHD as a cognitive deficiency that prevents a child from thinking properly before acting on an impulse (Miranda, Presentacion, 2000).
Continued• CBT consists of teaching kids methods of self- control to alter behavior and cognitive functioning (Miranda, Presentacion, 2000).• Modeling is a technique used to help teach children acceptable behavior (Miranda, Presentacion, 2000).
Efficacy of CBT for ADHD• CBT was found to be effective in reducing aggression when paired with anger management (Miranda, Presentacion, 2000).• Research on CBT for adolescents with ADHD showed significant reductions in problem areas specific to this age group (Sibley et al., 2010).
Combined medication and CBT• Combining CBT with stimulant medication may be the most effective method of treatment• Research on adults with ADHD showed tremendous improvement when combining CBT with stimulant medication (“Cognitive Behavioral,” 2010).
Conclusion• Both stimulant medication and CBT are effective forms of treatment for ADHD.• It is important for doctors or therapists to take into account all the extraneous variables and issues particular to each individual in determining effective treatment and dosage options.• Further research needs to be conducted on the effectiveness of combined treatment especially with regards to children.
ReferencesChelonis, J. J., Johnson, T. A., Ferguson, S. A., Berry, K. J., Kubacak, B., Edwards, M. C., Paule, M. G., (2011). Effect of methylphenidate on motivation in children with attention-deficit/hyperactivity disorder. Experimental and clinical psychopharmacology, 19(2), 145-153. doi:10.1037/a0022794Findling, R. L., (2008). Evolution of the treatment of attention-deficit/hyperactivity disorder in children: a review. Clinical Therapeutics, 30(5), 942-957. doi:10.1016/j.clinthera.2008.05.006Lavoie, T. (2008, Part 1: Introduction and overview to ADHD. The Exceptional Parent, 38(3), 74-74-75. Retrieved from http://search.proquest.com/docview/223497621?accountid=34899
ContinuedMiranda, A., & Presentacion, M. (2000). Efficacy of cognitive-behavioral therapy in the treatment of children with adhd, with and without aggressiveness. Psychology in the Schools, 37(2), 169. Retrieved from EBSCOhost.Powell, S. G., Thomsen, P. H., Frydenberg, M., & Rasmussen, H. (2011). Long-term treatment of ADHD with stimulants: A large observational study of real-life patients. Journal of Attention Disorders, 15(6), 439-439- 451. doi:10.1177/1087054710368486Sibley, M. H., Pelham, W. E., Evens, S. W., Gnagy, E. M., Ross, M. J., Greiner, R. A., (2010). An evaluation of a summer treatment program for adolescents with adhd. Cognitive and Behavioral Practice, 18(4), 530-544. doi:10.1016/j.cbpra.2010.09.002