Evidence-Based Practices and ADHD
The diagnostic term Attention Deficit / Hyperactivity Disorder, or ADHD applies to
children with three primary symptoms: hyperactivity, impulsivity and poor
attention control.
Current estimates suggest that between three and five percent of all school age
children meet the criteria for ADHD. This is equal to about one child per
classroom. The National Institute of Health identifies ADHD as the most
common psychiatric disorder that presents itself in children. ADHD tends to affect
2-3 times more boys than girls, and symptoms usually start to appear during
preschool or early elementary years.
The most common signs of ADHD that will appear early in childhood include:
- A child is unable to stay focused on a task
- A child is unable to sit still
- If a project or chore is started, the child is unable to finish
- The child is very impulsive - seems to act without thinking
The key to identifying these symptoms is whether or not these behaviors are
persistent. Most children experience these behaviors because of abnormal brain
development. An area of the brain located in the frontal region is responsible for
decision making. This includes decisions regarding behavior control. The front
portion of the brain helps children to:
- Pay attention when asked to focus, or choose to focus
- Stop talking when asked, or refrain from interrupting
- Choose not to take things that belong to someone else
- Refrain from hitting another child when angry about something
This same part of the brain helps control emotions. In a healthy brain, people
remain calm enough to complete responsibilities, even if excited or upset. The
front brain also works to help understand and follow rules and set goals. Children
with ADHD struggle with all of the frontal brain activities, and research is ongoing
to verify the best possible treatments and therapies.
Although mental health research in children is ongoing, some current theories
are providing researchers with better insight in how to tackle the problems
associated with ADHD. Using EEG's (measures electrical activity) and PET
scans (visualizes activity using electrons); research completed in 1995 indicates
these children experience:
- Less electrical activity in the frontal brain
- Less blood flow in frontal brain
- Less brain activity in frontal brain and surrounding connected brain areas
The Role of Evidence-Based Therapies
The goal of evidence-based therapy for children with ADHD is to help them learn
to control their behavior. Researchers propose that biologic abnormalities reduce
the child's ability to adjust their behavior in response to rules and commands.
Because children spend the majority of their time at home with their parents,
training the parents becomes the key to successful therapy.
Using an evidence based treatment manual, parents are trained to 1) use explicit
and consistent methods of communicating rules and instructions; and 2) provide
clear and powerful consequences when rules and instructions are not followed.
The goal is to create an environment organized by the parent that contains
appropriate cues and alternatives. In time, this will help the child behave more
appropriately and avoid the negative behaviors in spite of their biological deficit.
Evidence-based therapies are treatments that have been scientifically proven to
lead to positive results. Using specific treatment manuals outlining the methods
used to train parents, therapy will be administered consistently. The most
common form of therapy today for children with ADHD is medication. However,
medication alone is not enough. With additional research on children, the role of
the parent is proving to be a key to this behavior therapy. Once adequately
trained, parents may be able to alleviate many of the social and behavioral
problems associated with ADHD.