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Comparison of Therapies for children Diagnosed with ADHD

Barbara Maclure

10/03/22

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Comparison of Therapies for children Diagnosed with ADHD

Participants

This study's participants will consist of 100 children (N=100) aged 4 to 6 years. This study will be

conducted in the school where the children attend the class. The main reason behind selecting the

school setting is because, in this setting, all the factors that affect work ethic, social interaction, and

behavior will be considered. To conduct this study successfully, a class will be required to have 20-

25 students, their teacher, and our professionals. All the participants will be kindergarten children

with who ADHD has been diagnosed. We will ensure that the sample size is large enough so that

we will be able to collect data that will support or dispute the research question. Using one hundred

participants surpasses the threshold; therefore, the data to be collected will have a weight to

support or dispute the research question. We will use purposeful sampling criteria to find one

hundred students in the grade kindergarten aged 4-6 years. In qualitative research, it is essential to

use purposeful sampling to get valuable data despite the limited resources. The children's choice

will be based on pediatrician evaluations and diagnosis of ADHD. To get the participant, it will be

ensured that they have not gone a treatment therapy before the start of the study. This is to facilitate

the participant to be chosen randomly between methylphenidate treatment and behavioral therapy.

The study will ensure that the parent consent of the children is taken. The participant will involve

males and females.

Measures

In this study, the best research design is using qualitative experimental research. The main feature

of experimental design is selecting the participant randomly; therefore, the research has a

maximum control level. In much research for identifying a relationship between two or more

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variables, they embrace experimental research. This research amicably compares two or more

groups. Experimental research consists of both of experimental group and the control group. This

experimental group will consist of the children undergoing medication or behavioral therapy; on

the other hand, a control group entails children undergoing Methylphenidate. The experimental

group gives an independent variable of behavioral therapy. The research will relate behavior

therapy's effects symptoms of ADHD and the effect of Methylphenidate therapy on the same

symptoms.

Extraneous Variables

Many variables must be examined and recorded in observing and recording various issues related

to ADHD children. No factors present in the children's classroom that may not have an indirect

influence on the children's behaviors yet are not related to the ADHD symptoms. The presence of

distractibility and peer influence are some of the core aspects that are likely to influence children's

behaviors. The children can also be affected by the underlying situation related to ADHD and the

comorbidities resulting from ADHD. Some of these variables cannot be fully monitored but can be

closely checked concerning the study.

Instrument

The instrument used in this study to determine whether behavioral therapy is effective in

Comparison to Methylphenidate therapy in treatment of ADHD is a numerical rating scale.

Specifically, the study's scale will be the Children's Attentions deficit Evaluation scale. This scale

was developed by different researchers that used the current literature in neurology, psychology,

and education in modern practices of identifying other individuals' diagnoses. (Buyx, 2019). The

reliability of this scale is much dependent on the participant's faithfulness, but the validity of scale

studies is so promising.

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Using this scale in the schools and homes version plays an essential role in documentation of

ADHD features in schools and home settings of children aged 2-6 years. In most instances, the

ADHD scales is constructed for children’s symptoms who are older; thus, this scale will be used as

it evaluates the targeted age of the study. To some extent, this scale will be unique as it will enable

both parents and teachers to participate in the ADHD symptoms present in the numerical scale.

This scale will be part of the pre-diagnosis for ADHD and the accomplishing the research of the

parents and teachers with a repetition of a questionnaire. This will enable the comparisons of the

child questionnaire before behavioral and Methylphenidate therapy and provide answers if a

reduction of symptoms is noted concerning the administered treatment.

Intervention Description

Based on CDC, behavioral therapy is the first line of treatment for children under six years and

having been diagnosed with ADHD is behavioral therapy. Behavioral medicine is essential in

monitoring any negative behaviors resulting from ADHD. The principle used by behavioral

therapy is that the behaviors are usually learned, and destructive behaviors can be modified.

Psychologists can assist parents and children in focusing on the negative behaviors that arise from

ADHD and the role to play in changing those behaviors. Some forms of behavioral therapy entail

cognitive behavioral, aversion therapy, cognitive behavioral, and system desensitization. When

working with both the children and the parents, the therapist can use on-form therapy or combine

multiple of them based on their effectiveness

Data Collection Procedure

This study's participants will be based on the recommendation of pediatricians. The participant will

involve children aged 4 to 6 years diagnosed with ADHD who have yet to start the treatment.

Before the participant's placement, it will be ensured that the parent's consent is obtained. Once the

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recommendation is made, and the parent signs the consent, the research will go to IRB to seek

approval. The researcher will search the group using random means. Once the IRB verifies the

approval, the participant will be grouped into two. Group A acts as control group, and group B acts

as treatment group.

1. Group A

a. There will be the prescription of the methylphenidate dosage of the participant by the

Physicians

b. The participant will be required to take Methylphenidate dosage every morning at 7 am

before school. They will be taking the dosage at the same time

c. It will be ensured that all the participants do not miss the dosage of medication

d. All side effects of Methylphenidate will be closely monitored

2. Group B

a. In two months, the participant and parents will undergo eight behavioral therapy sessions

with a well-trained psychologist.

b. The teachers and parents will provide the positive behaviors identified

c. The teachers and the parents will be required to have similar behavioral systems in the

classroom and at home to have a consistency of participants.

d. It will ensure that the participant has a consistent discipline band adequate structure.

Data Analysis

The research will be conducted in different demographics to have diverse participant groups.

Male and females will be included in the study aged 4-6 years. The study will ensure that the

participants are from different ethnic groups having the fulfillment of being diagnosed with

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ADHD yet not started the treatment. Descriptive studies will be implemented to analyze the

demographic, as shown IN the table below.

Race Age Gender Grade

Central Tendency

Mean

median

Mode

Standard Deviation

Distribution

Variance

Dispersion

In the analysis, ADHD symptoms score will be determined by ACADDES educators and

parent questionnaires. The questionnaire will use a scale that ranges from 0 to 4. Zero indicates

no sign of ADHD, and four exhibits ADHD behavior. The trial participants in the two available

groups' scores will be done before that treatment when completion of the trial process is done.

The analysis is supposed to run through ECADDES computer system that will convert scores

from raw to standards and percentiles, thus making the score to be more efficient. The

descriptive statistics will consist of standard deviation, Variance and inference methods will be

a t-test used to analyze data collected from the questionnaire. Comparison will be made in both

groups to examine whether experimental group participants in the behavior therapy outcomes

differed from the stimulant Methylphenidate control group.

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Results

The study is aimed at investigating the effectiveness of the treatment symptoms of ADHD

between behavioral and Methylphenidate therapy. This research was guided by the hypothesis

that stated non-pharmacology therapy is an appropriate therapy for ADHD compared to

Methylphenidate stimulant therapy for children aged 4-6 years. Based on the literature review,

we can predict the real expectation of the results. For example, the CDC's study in 2018

indicated that less than 50 % of the children practicing stimulant therapy had initially practiced

behavioral therapy. Of the children aged between 4-5 years, only one out of five was taking the

medication to treat ADHD instead of recommending the use of behavioral therapy. This study

also identified variations in the use of behavioral treatment from State to State. (Thyagarajan

(2019) The study showed that all those states that opted to utilize behavioral therapy as the first

line of treatment had decreased the number of children on the stimulate therapies. Most studies

have put a lot of emphasis on combining behavioral therapy and stimulant medication. The

current research also shows that pharmacological therapy is an effective method of treatment of

the symptoms.

The figure below shows the expected results of the side effects of the different therapies.

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1 2 3 4 5

0

0.5

1

1.5

2

2.5

3

3.5

4

Group A

Group B

Comparison of the Two Groups

Group A Group B

This indicates that the method B score is higher than A, thus more effective in treating ADHD.

Discussion

Ethical Issues

In conducting any research, there are incidences of ethical issues to arise, especially when

using minor children. When performing the study involving children, it is essential to identify

what the targeted population will benefit from the research. The central issue that requires to be

addressed is whether the investigation will bring harm to children. (Freitag & Buyx (2019). In

this research, the participant in the control group will receive Methylphenidate therapy which

cannot endanger the participant or put them at risk from the medication. The parents will be

well informed of the side effect through consent, and if the side effects arise, the pediatrician

will check the patient. Despite the research being conducted in a school setting, it will be

ensured that confidentiality and privacy will remain intact. The researcher will not require to

expose the information on the progress of the teachers who is part of the evaluation process.

Limitation of the study

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The environment in which the research is conducted may become prone to biased results. The

classroom environment may be subject to high stimulation from the children. It may be a rise

in distractions that may result in poor results during the evaluation process. In addition, the

person collecting the data may affect the performance. The teacher may score the students

differently basing the criteria used, while the parents see them differently. The teacher and the

parents can skew the score since they know the initial performance. To provide a resolution to

this, it is essential to ensure that the participants are taken to classrooms where they are not

familiar with their teachers.

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References

Shellenberg, Stoops, Lile & Rush (2020). An update on the clinical pharmacology of

Methylphenidate: therapeutic efficacy, abuse potential, and future considerations. Expert

Review of Clinical Pharmacology, 13(8), 827.

Jayamaha, Perera, Herath & Rodrigo (2018). A cross-sectional survey of adherence, perceived

efficacy, and side effects of Methylphenidate among children at a teaching hospital in Sri

Lanka.

Masi, Fantozzi, Villafranca, Tacchi, Ricci, Ruglioni & Cortese (2019). Effects of melatonin in

children with attention-deficit/hyperactivity disorder with sleep disorders after

methylphenidate treatment. Neuropsychiatric disease and treatment, 15, 663.

Sierawska, Prehn-Kristensen, Moliadze, Krauel, Nowak, Freitag & Buyx (2019). Unmet needs in

children with attention deficit hyperactivity disorder—can transcranial direct current

stimulation fill the gap? Promises and ethical challenges. Frontiers in psychiatry, 10, 334.

Ghasemi, Nori & Abdi Zarrin (2019). The effect of parent management training (PMT) on the

reduction of behavioral symptoms in children with attention deficit hyperactivity disorder

(ADHD). Quarterly Journal of Child Mental Health, 6(2), 9.

Bussalb, Congedo, Barthélemy, Ojeda, Acquaviva, E., Delorme & Mayaud (2019). Clinical and

experimental factors were influencing the efficacy of neurofeedback in ADHD: a meta-

analysis. Frontiers in psychiatry, 10, 35.

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Proposal: Effectiveness of non-pharmacological in Comparison to

Methylphenidate Stimulant Therapy

Barbara Maclure

9/18/2022

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Effectiveness of non-pharmacological in Comparison to

Methylphenidate Stimulant Therapy

Introduction

Attentive–deficit hyperactivity is a psychological disorder that is well known, affecting

both children and adults. Some of the associated symptoms that are associated with ADHD include

inattention, hyperactivity, impulsivity, and difficulty in focusing. It is reported that in the United

States, about 8.5% of children are affected by ADHD. In the treatment process, several ways have

been put into place. Despite the treatment, many studies reported that some treatment methods

have side effects. Therefore, knowing the method that least has the side effects is crucial. This

research proposal will play an essential role as it will identify whether non-pharmacological

intervention, behavioral therapy, and stimulant therapy have the same results in children aged 4 to

8.

Background of the study

Dr. George first identified ADHD when he was a pediatrician. He noted that his patients

had uncontrollable impulsive behavior. There was an introduction of the drug Benzedrine, which

was approved as it showed to improve ADHD symptoms in children. In 1950 there was the

introduction of Ritalin drugs which were used in ADHD treatment in both children and

adolescents. (Holland & Higuera (2017). The drug that is used in the treatment of ADHD to date is

Ritalin. Despite the doctors treating patients with ADHD symptoms from the 1930s, there was no

actual definition of ADHD. Still, it was given much attention in 1987 when the American

Psychiatric Association (APA) redefinition of the disorder.

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By 2020, approximately 7.1 million young children aging between 2-17 years with ADHD

had been diagnosed. (Garbe (2018). Despite the prevalence of the disorder among children and

adolescents, ADHD is also present in adulthood. In most cases, this disorder is noted when the

child gets into the class and starts issues of failing to focus on the classroom. There are different

forms of ADHD which entails hyperactive/impulsive type, inattentive type, or a combination of the

two. There is a criterion that is customarily utilized in the treatment of ADHD. The parents and the

teacher are required to document the children's symptoms for a period of six months. Research

shows that ADHD is more common in males than women. One of the interventions utilized is

stimulant therapy, considered standard treatment for children after reaching an appropriate age.

The stimulus, for example, the medication, is said to have side effects which can be either mild or

severe. Some noticeable side effects include upset stomach, appetite change, heart abnormalities,

tics, and weight loss. Although the treated symbols are 70-80% treated, there can be the utilization

of other alternative therapies that do not require the use of stimulant medication and play an

essential role in minimizing ADHD symptoms.

The current research shows that approximately 9% of young children residing in United

States are affected by ADHD. Using stimulant therapy is the primary treatment method for the

symptoms. The current research also show that pharmacological therapy is an effective method of

treatment of the symptoms. Between 2013 and 2019, there were over 5873 articles written about

ADHD. The term “young children " was added to minimize the research and behavioral therapy

benefits and stimulants' side effects. In addition to this expression, the number of articles was

reduced to 500 and 200, while about fifty articles were related to the behavioral therapy treatment

of children.

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To identify the gap in the research conducted to date, we shall look at the importance of

behavioral therapy and Methylphenidate treatment.

Use of behavioral Therapy

Before the stimulant therapy initiative in children with ADHD, there was a

recommendation for using behavioral therapy, an idea embraced in American Academy of

Pediatrics (AAP). The main aim of behavioral therapy was to help the kids gain self-control, self-

instruction, problem-solving ability, and modeling. Children with that ADHD has been diagnosed

said to have a high likelihood of developing emotional problems in their life. Behavioral therapy

can help children in their initial stages cope with the symptoms not only in childhood but also in

their adult life. A study by Thyagarajan shows that involving the parent and provider in behavioral

therapy in school-based children is crucial. This becomes important for the parent to be taught the

behavioral therapy technique.

The study that CDC did in 2018 indicated that less than 50 %of the children practicing the

stimulant therapy had initially practiced the behavioral therapy. Of the children aged between 4-5

years, only one out of five was taking the medication to treat ADHD instead of recommending the

use of behavioral therapy. This study also identified variations in the use of behavioral treatment

from State to State. (Thyagarajan (2019) The study showed that all those states that opted to utilize

behavioral therapy as the first line of treatment had decreased the number of children on the

stimulate therapies. Most studies have put a lot of emphasis on combining behavioral therapy and

stimulant medication. A study done in 2019 in 170 elementary schools indicated that combining

both therapies improved results.

Methylphenidate Treatment

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This is the therapy that is most prescribed for children having ADHD. Several articles show

the adverse effects that are associated with the use of this therapy. One of the side effects that the

study indicates concerning this therapy is Insomnia. One study found a change in the sleep pattern

for the children who have undergone this treatment, especially when the therapy is done over a

prolonged period. In 2019 a study was conducted on seventy-one children who had gone the

treatment for six months. There was an indication that about 87% had a side effect. Some of the

recorded side effects included irritability, Insomnia, and anorexia. Most studies showed that

despite Methylphenidate being embraced, it had many side effects.

Gap in Literature

In most of the research that was done regarding Methylphenidate and behavioral therapies

in children, no information concerning pre-school children and prevalence of the treatment in this

age group. The research tends to show the presence of the symptoms that arise when a person

experiences school life. An article published by the childhood & development Disorder identified

several gaps. There is a gender gap when studying ADHD as the studies gravitate toward males in

the population. In availability of the voice of the children diagnosed with ADHD is also a big gap.

It is worth noting that children cannot make medical decisions; thus, their voices are not heard

based on their opinion. Listening to what they may feel after therapy could play a significant role

in treatment. After the therapy, few studies follow up with the children to see the lifelong impact.

Research Question and Hypothesis

Research Question

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The research to be conducted is to answer whether non-pharmacological therapy is the best

alternative in treating attentive deficit hyperactivity disorder compared to using Methylphenidate

stimulant therapy in children between 4-8 years.

Hypothesis: Research and Null

Using Behavioral therapy in treating school children between 4-8 years is as effective as

Methylphenidate stimulant therapy, evidenced by the behaviors of the teachers and the parents

grading the study participant. Null Hypothesis: No difference exists between behavioral therapy

and Methylphenidate interventions in the school children aged between 4 and 6 years.

Nature of the study

In this study, the dependent variables in the behaviors will be keenly observed in the group

participant on each treatment type. The qualitative independent variables present in the research are

non-pharmacological treatment and Methylphenidate. The variable of operationalized will become

the behavioral assessment to be completed by the teachers and parents regarding each participant's

progress. Teachers and parents are

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