week 4 peer review

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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 required to grade the critical factors while determining the

effectiveness of the independent variables.

The nature of the study is qualitative experimental based. It will involve random selection

of the participants so that the researcher will have maximum control. In the experimental study,

only two variables are used to show their relationship. There is an experimental group and a

control group. In this regard, the experiment group is children treated with behavioral therapy,

while on the other hand, the controlled group is children undertaking Methylphenidate. The

experiment group that is exposed to independent variables is behavioral therapy. The research will

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be able have a comparison on the effects behavioral therapy symptoms of ADHD and the impact of

behavioral treatment compared to Methylphenidate therapy.

Study significance

The paramount significance of this study is identifying whether non-pharmacological

behavioral therapy is of the same effects on ADHD symptoms compared with stimulant therapy,

Methylphenidate. Implementing non-pharmacological interventions such as behavior therapy in the

first line of medication in preschool and school-aged children can play an essential role in reducing

stimulant use. Suppose the symptoms can be managed using non-pharmacological therapy such as

behavioral therapy. In that case, the children cannot be at risk of the side effects associated with the

use of the drugs. Many side effects result from the use of stimulant therapy. Some of these side

effects are long run. It has come to my attention that most of the therapy have a short-term follow-

up after the therapy. This research will not only help identify some of the short-term side effects of

the use of the therapy on ADHD symptoms but also track the individual's progress. Some side

effects which are said to be a result of the stimulant therapy will be looked at and dealt with

amicably. This study is also essential since it will allow adolescents to speak their minds regarding

the different therapies. Since the technology keeps improving, this study will look at the cheapest

and most economical treatment.

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References

Attention-deficit/hyperactivity disorder (ADHD). (2018).

Baum, Newman, Weinman, McManus, & West, (Eds.). (2018). Cambridge Handbook of

Psychology, Health, and Medicine.

Behavioral Therapy: Definition, Types, and effectiveness. (2016, November 14).

CDC: AAP guidelines on behavioral therapy and ADHD in young children are not followed by

most patients. (2015). Brown University Child & Adolescent Psychopharmacology

Charach & Fernandez (2013, May 28). Enhancing ADHD Medication Adherence: Challenges and

Opportunities. Current Psychiatry Reports, 15, 371.

Helseth, Washbush, Gnagy, Onyango, Burrow-MacLean, Fabiano, Nicols-Lopez, K. (2015, April).

Effects of behavioral and pharmacological therapies on peer reinforcement of deviancy in

children with ADHD-only, ADHD and conduct problems, and controls.

Holland & Higuera (2017). The history of ADHD: A timeline.

Khajehpiri, Mahmoudi-Gharaei, Faghihi, Karimzadeh, Khalili, & Mohammadi (2014). Adverse

reactions of Methylphenidate in children with attention deficit hyperactivity disorder:

Report from a referral center. Journal of research in pharmacy practice, 3(4), 130-6.

Kholi, R(n.d.). The Early Childhood Attention Deficit Disorders Evaluation Scale (ECADDES)

[Scholarly project].

Kraut, Langner, Lindemann, Banaschewski, Petermann, Petermann, Garbe (2018). Comorbidities

in ADHD children treated with Methylphenidate: a database study. BMC Psychiatry, 13.

Lynch, A. (2016, August 19). Identifying Knowledge Gaps in ADHD Research. Journal of

Childhood & Developmental Disorders,

McCarney, S. (1995). Early childhood attention deficit disorders evaluation scale (ECADDES).

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Palinkas, Horwitz, Green, Wisdom, Duan & Hoagwood (2015, September). Purposeful sampling

for qualitative data collection and analysis in mixed method implementation research.

Thyagarajan (2019). A case study using cognitive-behavioral therapy-management of ADHD.

Indian Journal of Health & Wellbeing, 7, 471-477.

Vigliano, Galloni, Bagnasco, Delia, Moledo, Mana & Cortese (2016, May). Sleep in children with

attention-deficit/hyperactivity disorder (ADHD) before and after 6-month treatment with

Methylphenidate: a pilot study. European Journal of Pediatrics, 175.