AttentionDeficit Hyperactivity Disorder
AttentionDeficit Hyperactivity Disorder
Attentiondeficit hyperactivity disorder ADHD, is a mental state that canbecome apparent among some children in the early school years.Children suffering from this disorder are unable to pay attention inthe class or even control their behavior(O`Connell et al., 2012).It is approximated that 6% of children in the United States sufferfrom Attention Deficit Hyperactivity Disorder. In the year 1902, SirGeorge F. published a series of lectures that described children whowere impulsive and had significant problems in the way they conductedthemselves. These behavioral problems were believed to have beencaused by a dysfunction in their genetics. These children today aredescribed to be suffering from Attention Deficit Hyper ActivityDisorder (O`Connell et al., 2012).
Itshould be noted that not every single person who is overlyinattentive, impulsive, or hyperactive is said to be suffering fromADHD. This is in consideration that most individuals may blurt outthings they do not mean to communicate. Others are disorganized andforgetful but they do not necessary reflect the symptoms of ADHD(Saul,2014).Since almost every person displays this kind of behavior at one timeor the other, it is required that the diagnosis be demonstrated to adegree that is not appropriate for an individual’s age. Theguidelines for the diagnosis avails specific requirements that helpin the determination of the common symptoms.
Inthe United States of America, ADHD is mostly diagnosed in childrenbefore they attain seven years. For the condition to pass as ADHD,the behaviors must appear during the school going years and prolongup to a period of six months (Saul,2014).Besides the demonstration of the tendencies, they must also result ina form of disability including difficulties in learning, antisocialbehaviors and inability to get along with other family members. Thesebehavioral challenges occur mainly at school and at home. Therefore,a person who displays some symptoms but whose friendships orschoolwork are not in any way impaired by these behaviors cannot besaid to be suffering from ADHD. Additionally, neither should a childwho is overly active in the field, but behaves normal elsewhere beperceived to suffer from ADHD (Saul,2014).
Studieshave been conducted to investigate children from different countrieson the prevalence of ADHD. The common studies are undertaken in USA,UK, New Zealand, Canada and Australia. In most of the studies,authors agree that that the descriptions being distractible and beingrestless forms a factor that is coherent and that corresponded tohyperactivity (Banaschewski,2015).This is distinct from other antisocial behaviors such asaggressiveness and defiance. A comparative study conducted byBanaschewski (2015) reveals that the prevalence of ADHD is fairlysimilar in different countries (Banaschewski,2015).
Availabledata suggests that ADHD, and almost all other psychological disordersand traits are caused by a combination of environmental and geneticrisk factors. However, none of these factors have been sufficient tocause ADHD to develop by itself. At the same time, it has beendetermined that interactions between these risk factors cancontribute to an individual being susceptible to ADHD (Millon& Millon, 2014).Other variables have been determined to moderate the relation betweenphenotypic manifestation and risk factors. For this reason, to fullycomprehend the etiology of ADHD, studies in the future will berequired to measure each environmental risk factor and type each ofthese genes in a single characterized sample of persons with ADHD. Inconsideration of ADHD etiology, different methods for the treatmentof ADHD have been considered (Millon& Millon, 2004).
Behavioraland pharmacologic approaches for the treatment of ADHD have beenfound to be effective, particularly if the treatment methods arecombined. The National Initiative for Children’s Healthcare Qualityhas developed a tool kit purposed to assisting physicians improve andmanage ADHD (Ries,2011).
Inpharmacologic therapy, physicians have been advised to be familiarwith the multiple medications that are available for the treatment ofADHD. Stimulant and atomoxetine medications have been considered tobe the first and second line agents respectively (Ries,2011).For pharmacologic therapy, treatment should be initiated at lowdosages, or titrate the it over four weeks until adequate responsesfrom the patients are achieved or adverse effects that areunacceptable occur. In the case that one stimulant is not effective,another should be tried out before considering second-linemedications (Ries,2011).
Inthe case that behavioral interventions are adopted in the treatmentof ADHD, focus is mainly on rewarding the desired behavior andenacting serious consequences for behaviors that are unwanted. Thisin turn reshapes the child’s behavior and thinking. For instance, achild can be given tokens for good behavior. Parental involvement canbe reinforced through interventions such as support groups. Theseteams connect and bring together parents who have kids with similarproblems where they are offered training on parenting skills (Ries,2011).
Comingup with a comprehensive for the treatment of ADHD in Florida, or anyother locale not only requires that the many complexities of thedisorder be addressed, but also to fully understand the unique needsof the patient (Curtiset al., 2013).The treatment plans for this disorder involve behavioral andpharmacologic therapy. The same treatment plans are practiced inother states as well to ensure that the patients’ needs are met.
ADHDhas been found to be a common psychiatrist disorder with an estimatedprevalence of 4%. The disorder is associated with high economic andsocial costs for both the families and the state (Rolex, 2016). Ifthe disorder is not treated, consequences are serious and they comein the form of poor academic related outcomes, relationship andfamily problems and increased association with the criminal justicesystem.
Thedisorder is more prevalent in children than in adults because schoolgoing children are diagnosed easily by the teachers (Rloex, 2016).Other factors including stigma associated with the general populationand other professionals due to negative perceptions associated withthe disorder. Therefore, adults have poor heath seeking habits unlessthey are refered to professional treatment by their caregivers. Lackof training and awareness has led to ADHD being mistaken for othermental health disorders. Adult ADHD recognition was first initiatedby NICE in 2008 that set out standards that were clear in regards tothe specific needs services for persons with ADHD. It also spelt outthe most effective approaches to deliver the services. Despite theseguidelines, USA has a myriad of services that are available but theremany policies being implemented to ensure that efficient services aredeveloped (Rolex, 2016).
Patientswith ADHD have continued to experience difficulties in accessing theright services in most parts of the United States of America. Thesechallenges have continued to perpetuate in spite of therecommendations offered by NICE. According to the framework, theservices adopted by health institutions should avail, as minimum, adiagnostic service, drug monitoring, and psychological supportservice (Thapar, 2015).
Theseguidelines make clear recommendations for the assessment andmanagement of ADHD for all persons, from children to adults. TheDevelopmental Disabilities Assistance and Bill of Rights Act of 2000DD Act is most concerned with families that have children sufferingfrom the disorder and seeks to ensure to the patients’ access thenecessary services regardless of their background (Thapar, 2015). Theact also provides assistance to families with patients suffering fromADHD for services from programs funded by the DD Act. In a nut shell,the two laws ensure that children diagnosed with the disorder canreceive special assistance in school.
Theprimary challenge that faces ADHD patients is discrimination andeconomic disenfranchisement of their families. Section 504 of theVocational Rehabilitation Act of 1973 also prohibits programs thatrecive funds from the federal government from discriminating childrenwith disabilities under any circumstances (Thapar, 2015). The lawalso requires the school districts to offer accommodation to childrenwith ADHD. In addition, the Individuals with Disabilities EducationAct (IDEA) outlines that children who are eligible for ADHD careshould be provided with special education and other related services.The regulation also stipulates that the services should be designedto meet the unique educational needs of these children (Thapar,2015).
Oneof the recent innovations in care that have been adopted in publicsettings in the US is the evidenced based practice. Improving servicequality and effectiveness in mental health services throughdissemination, development, and implementation of evidence basedpractice have been emphasized by policy and practice directives(Sturmey et al., 2012). The empirically tested protocols andinterventions have however not matched the effective implementationof these practices in community settings. Research has shown that theadoption and utilization of evidence based practice have beeninfluenced by both individual adopter characteristics andorganizational context (Sturmey et al., 2012).
Thetreatment if ADHD assumes a multi approach that includespharmacological and therapy strategies. Various institutions inFlorida have been critical in assisting children suffering from thecondition as well as giving their parents information on model caremethods. Florida Hospital is the single largest institutions thattreat ADHD. The facility employs experts who diagnose and offer thelatest treatment methods to ADHD clients. Patients can also seeksimilar services at Orlando Hospital that also offers caregivereducation.
Othersfacilities include Alachua, Altamonte springs, Apalachicola, AppoloBeach, Apopka, Atlantic Beach, Atlantis, Aventura, Bal Harbor,Baldwin, Bartow, Bellair Beach, Bellevew, Boca Grande and Boca Raton.Apart from these institutions, patients can opt to visit differentprivate institutions. Since ADHD is also a behavioral disorder, someparents decide to take their children to certified therapists in thetown. The practitioners also make referral for pharmacological andpsychiatric care.
Variousstakeholders are involved in the mitigation of ADHD in Florida.First, health institutions are instrumental in devising new methodsfor diagnosis and treatment. In the state, both private and publicinstitutions offer quality care. However, individuals from low incomefamilies sometimes shy away from the services due to the high feescharged in case they are not under any health insurance cover.Psychiatrists and psychologists have been on the frontline ofdevising conventional treatment methods. Currently, patients aretaken through a series of both pharmacological and psychologicaltherapy since the combination of the approaches has been recovered toyield desirable results.
Learninginstitutions also form a critical section of the stakeholder sincethey are mandated with molding the cognitive development of thechildren. Through the policies developed by the state and the federalgovernment, schools have adequate staff who are specifically trainedto deal with children with learning disabilities. Drawing from thecontemporary, curriculum developers have the mandate to develop ageappropriate curriculum for ADHD patients.
Floridais among the states that have experienced an increase in the numberof ADHD cases among children and adolescents. In 2007, 9.8% of thepopulation suffered from the condition while in 2011, the populationhad increased to 11.2% (Doshi et al., 2012). There are variousepidemiological evidence that needs to be identified for thecondition to be dealt with effectively. The available data on ADHDis not up to date.
Thecurrent information as indicated by the Center for Disease Controlwas collected in 2011. According to Doshi et al. (2012), theheightening levels of the condition among children between 4 and 13years should necessitate the health authorities to compile dataregularly. Recording the changing trends can be imperative indesigning care and focusing on the most susceptible population.Various aspects of epidemiological evidence in the state of Floridacan contribute to improved care.
Fisrt,it is worth noting that the heterogeneous nature of the communityresults in the in the condition having varying a gravity. Thecommunity living in Florida in made of people with differentbackgrounds including Natives, Latinos, African-Americans andAsian-Americans. The prevalence of the condition among all the racesin the region can inform health care providers on where to layemphasis. The rationale for this is that the state`s populations livein different poverty levels. For example, 26.9% of theAfrican-Americans and 13.1% of Asian-Americans live below the povertylevels (Florida & Mellander, 2016). In addition about 21.7% ofLatinos and 23.3% of Native Americans struggle to earn a living.Determining the prevalence of ADHD among them can be critical inmaking funding and awareness decisions. On average, children fromlow-income families are at risk of suffering severe ADHD since theyfail to access quality medical care at an early age (Florida &Mellander, 2016).
Secondly,it would be invaluable to determine the level of growth or decline ofthe condition in the population. Singling out the trends in thedifferent social stratifications can assist in noting differencesthat exist within the community. As noted, the data collected in 2011does not provide the correct pattern of the complication.
Acquaintinghealth stakeholders on the nature of the pattern would provide abasis for decision making. It is also noteworthy that blanketmitigation techniques cannot effectively deal with the burden thatcondition presents top different families. The unique needs of thedifferent classes of people should rule out any generalized efforts.Narrowing down to the formal social sections is a viable way to theequitable provision of services (Fullerton et al., 2012).
SinceADHD is more prevalent in school going children, it is imperative toidentify the graduation rates among the affected learners. Therationale for this is that the various stakeholders have implementeddifferent mitigation efforts inclusion Medicare, Medicaid, SocialSupport Groups, school physicians among others, and there is a needto determine their effectiveness. At this age, concentration lies inensuring that children learn smoothly in the most supportiveenvironment. This form of epidemiological evidence would advisepolicymakers and other workers in different cadres on the methods toimprove on and the ones to make obsolete. It would also act as anevaluation technique for the school and home-based techniques inreducing the intensity of ADHD.
Thereis a need for an investigation on ADHD among children aged four to13years who hail from families living below the poverty line. Thejuvenile patients are disenfranchised of quality health servicesunlike their counterparts in from high-income units. According to theCenter for Disease Control, the economic implication of ADHD has notbeen fully reviewed. However, the symptoms associated with theconditions exacerbate due to poverty. The antisocial tendencieshindered school performance, and the general quality of life are alsodependent on economic conditions of the families. Financially weakparents fail to prioritize the needs of their children, and sinceADHD is not an acute condition, they may take long before presentingtheir children for treatment.
Aninvestigation into this population will also lay insight on the costincurred by the parents. According to CDC, a patient suffering fromADHD spends approximately $14,576 annually if all the medicalrequirements are met. Low-income families lack information on theavailable benefits and it is, therefore, vital to identify thepayment methods that they embrace. Drawing from the 2011 data thatindicates an increase in the number of juvenile ADHD victims and theeconomic burden has also become heavier (Kataoka, 2016). Identifyingthe number of children under insurance schemes would be aninformative move in this population since it will inform funding andhealth education efforts.
Thegaps observed in care can be reduced through the implementation ofvarious corrective measures. First, there is a need to inform parentsof the need for early detection and treatment. Patients from lowincome families are prone to severe ADHD due to delayed treatment.This is caused by the lack of prioritization of health and qualityeducation. According to Fullerton et al. (2012), creating awarenesson the available treatment options is necessary for parents to seekthe services of the available professionals. Although schools may besupportive to the learners, it is imperative for the family to provea similar conducive environment for the children’s growth anddevelopment.
Secondly,dealing with the economic burden can assist in sealing the gaps inaccess treated and management services. Currently, more than 49million persons are not covered by any medical insurance scheme(Fullerton et al., 2012). The costs incurred in addressing the heathneeds of ADHD patients can be unrealistic for families living belowthe income level. However, with an insurance cover, it possible forthe children to access care at any given time. The move would allowparents to direct their resource to other needs that may improve theeconomic standards of the families.
Finally,creating liaison between the different stakeholders can be aneffective method of reducing the gaps. As a behavioral problem, ADHDcalls for the contribution of different players in the children’senvironment (Visser et al., 2015). For example, parents, teachers,psychologists, policy makers and the general public. Each of the keystakeholders has a role to play to revert the current trends of thecondition.
Accordingto Visser et al. (2015), parents must observe their children todetect early symptoms of the condition. In addition, teachers shouldaddress the specific needs of the learners and develop appropriatemilestones for their intelligence and cognitive capabilities. Moreimportantly, policy makers should make regulations that allow theinteraction of all the stakeholders by ensuring the creation ofawareness among the public, increase funding allocations and increasethe number of families covered by health insurance covers.
Themental health of children has become an issue for public concern.Several national reports underscore the significance of addressingthe adolescent and children emotional wellbeing from an approachbased on a continuum of services and programs ranging from promotionof health and prevention to treatment (Sturmey et al., 2012). Toaddress children’s mental health effectively, stakeholders in thecommunity who are involved in health promotion, prevention ofdiseases, and treatment should work in liasion (Sturmey et al.,2012). The inability to work towards a common goal results in pooraccess to services and the inability of the children to livefulfilling lives. They can also miss the opportunities for earlyidentification and treatment of their conditions.
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