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Developmental Issue: Attention-Deficit/Hyperactivity Disorder (ADHD)
Sule Umit
Professor: Michael Gontarz
PSY-632-X4301 Developmental Psychology 24TW4
06/15/2024
Developmental Issue: Attention-Deficit/Hyperactivity Disorder (ADHD)
Section II: Research and Theoretical Foundation
Contemporary development psychology research
As a neurodevelopmental disorder, Attention-Deficit/Hyperactivity Disorder (ADHD) is characterized by persistent patterns of impulsivity, inattention and hyperactivity, which impair functioning significantly in multiple setting. As such, the contemporary development psychology research has attempted to search for the underlying pathways and mechanisms associated with ADHD and its evolution by drawing upon classic and contemporary theories. These research offer insight into ADHD evolution across lifespan, including ADHD symptoms developmental trajectories, associated outcomes and risk factors from childhood to adolescence and adulthood (Özkan & Haznedaroğlu, 2023). ADHD evolution nature encompass early identification and neurobiological underpinning in childhood, transition and persistence, comorbidity and risk factors in adolescence, continuity and change, and functional change in adulthood.
Developmental research highlight that ADHD pathophysiology from childhood to adulthood is shaped by complex interplay of psychosocial, genetic, neurobiological, environmental and psychosocial factors. According to research, there are multiple tested theories that explain ADHD evolution such the mismatch theory, executive dysfunction, neurobiological factors, dopamine regulation hypothesis, and delay maturation of brain development, environmental influences, and genetic factors. For instance, based on a study by Esteller-Cucala et al, (2020), mismatch theory is a contemporary theory that proposes that ADHD traits are maladaptive in structured environment and modern sedentary but in earlier evolutionary contexts, they were adaptive. The theory focuses on natural selection of specific traits to people with ADHD.
Developmental Psychology core themes
There are three core themes of developmental psychology, which provide a lens to examine ADHD. These core themes include; nature vs nurture, continuity versus discontinuity and stability versus change.
· Nature Vs Nurture: Nature perspective involves genetics/biological influence on human traits or personality. Research estimates that ADHD has a heritability ranging from around 60% to 90%. In ADHD, genetic predispositions plays a significant role as several genes associated with the condition such as COMT, DRD4 and AAT1 have been identified. For instance, based on a genome-wide associated research studies by Demontis et al., (2019), numerous ADHD associated genetic variants, especially in genes related to neuronal signaling pathways and dopamine regulations were identified. These finding indicates that genetic or biological predispositions take part in ADHD symptoms development. In contract, nurture focuses on environmental and learning influences on human traits. In ADHD context, research indicates that prenatal exposure to certain toxins such as alcohol can increase ADHD risk. Additionally, psychosocial stressors such as family dysfunction and maternal stress associated with symptoms of ADHD (Tistarelli et al, 2020). As such, genetic vulnerabilities and environmental influences interact to shape and develop ADHD symptom’s expression and severity.
· Continuity Vs Discontinuity: Continuity perspective view development as continuous process. According to research, symptoms of ADHD often persist over time, indicating disorder continuity. Song et al, (2021), indicates that research have observed that ADHD persist from childhood into adulthood for majority of people. For instance, multiple prospective longitudinal studies have indicated at two-thirds of adults with ADHD have had it in childhood. In contrast, discontinuity perspective view development as a process that occur a series distant stages. There are evidence of heterogeneity in ADHD developmental trajectories, where some people may experience attenuation or remission of the onset ADHD. For example, in a study by Pedersen et al (202o) subgroups of persons with ADHD symptoms trajectories from childhood was identified, indicating discontinuity in the disorder course for some people.
· Stability Vs Change: Stability refers to traits that remain less or more constant throughout an individual’s life. In ADHD, the condition is characterized by a behavior pattern that is relatively stable over time. According to longitudinal studies, people that are diagnosed with ADHD in childhood have a higher risk of persistent functional impairments and symptoms both in adolescence and adulthood. For instance, study found that around 60% of children with ADHD continue to fully meet ADHD criteria as adults (Song et al, 2021), On the other hand, change involves behaviors and traits that are flexible or more fluid throughout one’s life. In ADHD, evidence suggest that some symptoms and outcome change over time. For instance, with environmental modification and some intervention, some changes in functional outcome or symptom severity might occur. A study report of 23 studies that included children and adolescence with ADHD suggested that symptoms fluctuate over time (Pedersen et al, 2020).
Section III: Program Selection
Target program
The identified exiting program for ADHD prevention or treatment is the Cognitive Behavior Therapy (CBT) developed by Aaron Beck in the 1960’s. This is an evidence-based and extensively researched method found effective in wide variety of psychiatric disorder’s studies including anxiety and personality disorder, substance use and depression. CBT program primarily falls under an actual effective treatment category for the AADHD treatment. The program aims at addressing cognitive distortions and habits impacting an individual’s emotional mindset and productivity. It aims at helping persons with ADHD develop coping strategies, manage symptoms effectively, and improve their self-regulation skills. Although it is an effective treatment for ADHD, it does not prevent the disorder or promote health development necessity, but it addresses challenges and symptom associated with the condition, thus facilitating better functioning and life quality.
Assessment and treatment method
CBT program assessment and treatment methods are ideally developed to address selected the disorder across diverse population. Individuals can access the CBT program through various ways. In many cases, health providers, mental health professionals and educators refer parents or individuals with ADHD to the program. Other times, referral maybe self-refer. The process of admission into the program involves initial assessment, which help to determine their suitability for the program and identify areas of needs. Individual’s assessment involves clinical interviews, behavior observation, and self-report measures including evaluation of symptoms, strengths and functional impairment through a standardized measures, including their readiness for the therapy. However, after being admitted to the program, program models may differ based on ethnic, cultural and socioeconomic factors, therefore efforts to ensure equitable access to support groups are made (Friedman & Pfiffner, 2020). Additionally, during admission, individual modality may be considered based severity of the child’s challenges.
The program’s admission policy that might be consider include language proficiency, cultural beliefs, and individual’s financial resources to ensure equitable access to the program or treatment. For instance, therapists are trained to accommodate and respect cultural differences, according to (Friedman & Pfiffner, 2020). Additionally, multiple languages material are also made available and group formats for families, which share similar challenges. This help provide accommodation for people with cultural background. Socioeconomic standing are also considered through financial assistance option or sliding scale fees to enhance accessibility. These are efforts put to accommodate individual differences within the program.
Cognitive Behavior Therapy intervention is mainly an evidence-based treatment for individuals with ADHD. Based on research, as a ‘global standard’ treatment method with large body of evidence support its effectiveness, CBT has proved to address cultural sensitivity and address different disorder for even ethnic minorities (Huey et al, 2023). As such, the program adopts cultural, socioeconomically and ethical sensitivity through including treatment material and training strategies that accommodate diverse cultural values and norms. For example, according to Huey et al, (2023), there is an emergency of multiple models such as the Pamela Hay’s ASSRESSING Model. Which aim at addressing culture and diversity within CBT context. Regardless of the modality of treatment, majority of CBT intervention employ cultural differences and sensitivity to accommodate all clients. This aims at engaging all families from different background while fostering inclusive and supportive environment. However, research also indicate that there is a concern regarding the appropriate application of the program to non-western clients and if tailoring is needed to optimize CBT treatment for the culturally diverse population. This is because CBT practices and theories are mainly grounded in the dominant western cultural models such as primary Vs secondary control.
Analysis of Program method
CBT program align with the developmental theory as it represents an integration of cognitive, behavioral, social learning and other developmental theories of human behavior and development. Additionally, the assessment done throughout the program consider individual’s development stages, environmental influences and individual differences on the symptoms of ADHD. This is important on addressing specific developmental need and areas of need for ADHD individual. For instance, Hamatani et al, (2023), indicates that some major components of the program are psychoeducation, psychological support, cognitive restructuring, problem-solving, and applied behavioral analysis. This can help with social skills, develop emotional connection with others and learn appropriate behavioral and cognitive patterns. These elements are central to developmental theories in ADHD.
CBT program does not vary with developmental theory but generally in consistent with majority of what it would support or recommend. For example, Cognitive Behavior therapy often focuses on modifying behaviors and maladaptive thoughts (Hamatani et al, 2023), which align with theories that emphasizes with the significance and role of cognitive processes in an individual’s behavioral outcome, central to ADHD. In ADHD context, developmental theories often highlight the roles of attention regulation challenges, executive functioning deficits and impulsivity in ADHD symptoms manifestation across lifespan. Therefore, interventions within the programs aim at these core deficits through training people with ADHD various strategies to manage their behaviors, emotions and thoughts more effectively. For example, techniques such as cognitive restructuring incorporated in the program assist people with ADHD identify and manage patterns of negative thought that contribute to impulsivity. Such intervention align with developmental theories on significant of modifying behavioral and cognitive process to mitigate symptoms of ADHD. However, CBT may deviate from developmental theory in some cases such if the program overlook contextual factors that influence symptoms of ADHD. Sometimes the program might not fully address significance of environmental and social factors such as peer relations, especially in traditional approaches.
Development theory guides in both selection and use of treatment, assessment and prevention strategies, which are developed sensitively. Moreover, research indicates that the theories are used disorder treatment through helping determine cognitive and behavior problem, when initiating treatment and determining treatment goals. As such, in this case, program assessment, prevention and treatment strategies could be aligned with different development theories for its effectiveness. For example, through interventions that focus on improving family dynamics or social skills, the program resonate with social learning theory (Hamatani, et al, 2923). Additionally, as indicated in research, approaches that consider ecological prodder context of one’s life align with socioecological development theories.
References
Demontis, D., Walters, R. K., Martin, J., Mattheisen, M., Als, T. D., Agerbo, E., & Neale, B. M. (2019). Discovery of the first genome-wide significant risk loci for attention deficit/hyperactivity disorder. Nature genetics. https://pubmed.ncbi.nlm.nih.gov/30478444/
Esteller-Cucala, P., Maceda, I., Børglum, A. D., Demontis, D., Faraone, S. V., Cormand, B., & Lao, O. (2020). Genomic analysis of the natural history of attention-deficit/hyperactivity disorder using Neanderthal and ancient Homo sapiens samples. Scientific Reports.
Friedman, L. M., & Pfiffner, L. J. (2020). Behavioral interventions. In The clinical guide to assessment and treatment of childhood learning and attention problems (pp. 149-169). Academic Press. https://www.sciencedirect.com/book/9780128157558/
Hamatani, S., Matsumoto, K., Kunisato, Y., Okawa, S., Yamashita, M., & Mizuno, Y. (2023). Protocol: Dismantling cognitive–behavioural therapy components for attention-deficit hyperactivity disorder in adolescents and adults: protocol for a network meta-analysis. BMJ Open, 13(4). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10124286/
Huey Jr, S. J., Park, A. L., Galán, C. A., & Wang, C. X. (2023). Culturally responsive cognitive behavioral therapy for ethnically diverse populations. Annual Review of Clinical Psychology, 19, 51-78. https://www.annualreviews.org/content/journals/10.1146/annurev-clinpsy
Özkan, H. S., & Haznedaroğlu, D. İ. (2023). ADHD AND ITS EVOLUTION ACROSS THE LIFESPAN. https://doi.org/10.4274/tmsj.galenos.2023.2023-1-4
Pedersen, S. L., Kennedy, T. M., Joseph, H. M., Riston, S. J., Kipp, H. L., & Molina, B. S. (2020). Real-world changes in adolescents’ ADHD symptoms within the day and across school and non-school days. Journal of abnormal child psychology, 48, 1543-1553. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7805014/
Song, P., Zha, M., Yang, Q., Zhang, Y., Li, X., & Rudan, I. (2021). The prevalence of adult attention-deficit hyperactivity disorder: A global systematic review and meta-analysis. Journal of global health, 11. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7916320/
Tistarelli, N., Fagnani, C., Troianiello, M., Stazi, M. A., & Adriani, W. (2020). The nature and nurture of ADHD and its comorbidities: A narrative review on twin studies. Neuroscience & Biobehavioral Reviews, 109, 63-77. https://pubmed.ncbi.nlm.nih.gov/31838192/