TREATMENT AND MANAGEMENT OF ADHD 14
Running head: TREATMENT AND MANAGEMENT OF ADHD 1
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Utilizing exercise and behavioral therapies for the treatment and management of ADHD
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ABSTRACT
The paper purposed to investigate the value of physical activity and behavioral therapy as a means of means for managing and treating ADHD. The researcher conducted a systematic review of known studies from PubMed and Cochrane databases and selected 30 sources as primary sources. An analysis was performed on the selected studies, and the results revealed that behavioral therapies and the use of exercise were very critical in the enhancement of the condition of ADHD patient. The methods were also proved to possess many benefits when adopted as the primary management method for the ADHD condition.
INTRODUCTION
Background
Every medical researcher has explored the different ways of treating and managing Attention Deficit Hyperactivity Disorder (ADHD). Based on the nature and development of the ADHD condition, the majority of the medical personnel have always recommended the use of exercise and behavioral approaches as the most preferred treatment and management methods (Wigal, Emmerson, Gehricke & Galassetti, 2013). First, the implementation of regular exercise is a significant way of managing the condition. Medical research has proven that adequate and specific activities improve a person’s memory, promote the tie level of attention and even enhance the extent to which a person can prioritize tasks. Some of the particular exercises that have been associated with the management of ADHD include taking weekly walks or even jogging, preferably in the morning and evening hours.
Behavioral therapy also forms a very critical aspect for the management and treatment of the ADHD condition in humans (Wigal, Emmerson, Gehricke & Galassetti, 2013). Different medical professionals have advanced many theories and test which have mainly been aimed at confirming the claims. In summary, behavioral therapy consists of the different approaches and practices which a person may be exposed with the aim of changing their negative behavior — additionally, the treatment purposes at helping a person to adopt affirmative action. The result will then be the growth and attainment of self-emotional sustainability (Bramham et al.: 2008). The above therapeutical method is beneficial for adults who are undergoing a lot of work-related stress. The individuals are exposed to the specific behavior changes mechanism such as the structuring of time management schedules or even increase their productivity through the teamwork.
One of the most widely used methods is the creation of an establishing environment for the execution of work (Sonuga-Barke et al. 2013). Researchers have produced different information related to the ways of preventing adverse actions which may include withholding a benefit or even a reward to a person (Loe & Feldman, 2007). Based on the review of the background information of the study, the researcher sought to realize the effects of behavioral therapies for the treatment and management of ADHD. The researcher used different approaches and research methods to achieve the results of the study.
Knowledge Gaps
There are many gaps which are currently present the discussions on the topic (Solanto, Marks, Mitchell, Wasserstein & Kofman, 2008). The review of the past literature reveals various shortcomings in the study which can affect the overall results achieved thus far. One of the main weaknesses which are presented in the study is the lack of clarity in how correctly exercise and behavioral therapy may be used in the management of ADHD. The above gap can be applied in promoting the understanding of the treatment importance as a medical tool. The alternative, the review of the literature revealed a difference in the measurement of behavioral therapy success on the patient (Solanto et al. 2010). It is essential for the different researchers to explicitly link the improvement in the status of a patient by connecting it to a specific management approach and method. The research will, therefore, explore the most appropriate means of managing ADHD condition. Another significant gap that the study seeks to fulfill is the methods of administering behavioral therapy and exercises as the means of enhancing the management of ADHD (Chang, Hung, Huang, Hatfield & Hung, 2014). Understandably, there are currently very few methods and approaches to promoting the execution of the above management methodologies. Cost of the people who seek to understand the management process of the conditions instead uses medical means.
The research was also keen on increasing responsiveness in the alternative methods and approaches in ADHD management (Pontifex, Saliba, Raine, Picchietti & Hillman, 2013). Currently, most of the people who suffer from the disorders are not aware of the simple methods of managing and enhancing the control of the situation — the most commonly preferred alternative for the majority of the patients in the medical intervention method. However, with the increased mindfulness, most of the patients will be able to effectively adopt the behavioral and exercise approaches (Berwid & Halperin, 2012). Generally, the study will enhance the existing literature by adding value to them and promoting their stability and success.
The researcher relied on many study materials for the research. For effectiveness, the researcher used different books and research journals to achieve the desired results.
The use of exercise has also been adopted as one of the main approaches that are used in the management of ADH. According to Berwid & Halperin (2012), there are a lot of advantages that are attached to the conduct of the exercise. Exercises increase the rate of metabolism which is one of the main things which improves the health of ADHD patients. Additionally, the ADHD who are exposed to a lot of exercises also has the advantage of enhancing their body operating systems.
Purpose Statement
The primary purpose of the research is to increase the awareness of exercise adoption and behavioral therapy as a method of promoting the management of the ADHD condition. The study will increase knowledge by adding value to the current literature.
The rationale for Purpose Statement
Many reasons can be used to support the purpose of the study. One of the main reasons why the conducts of the survey would be necessary is to help in dissemination of knowledge on correct applying of ADHD’s alternative methods managing. There are many reasons why the medical community should be ready to understand the new ADHD response plans (Zylowska et al.: 2008). One such reason is that the awareness plan will help people to personally manage the condition at an early age, thereby preventing entry into the severe stage. The government will also advance from the comprehensive knowledge, especially when formulating appropriate health policies. As part of its mandate, the states will have the ability to keep its people healthy by incorporating behavioral therapy and exercises as part of the routine management process of ADHD.
The consideration for the alternative ADHD organization approach can be related to the present gravity of the problem. (Van der Oord, Bögels & Peijnenburg, 2012) Currently, The American Psychiatric Association estimates that an average of 5% of all children within the US has ADHD (Chacko et al.’ 2013). According to the Centre for Disease Control (CDC), however, the number is even higher. CDC states that about 11% of all children in the United States have the illness. All the data highlight the importance of the problem, and the need to quickly address the issues before further escalation. Traditionally, the medical approach has predominantly been used in the management of the disorder (Chacko et al.: 2013). An alternative method of using behavioral therapy and exercises would, therefore, be appropriate.
The specific scope of the problem lies in the estimated number of people who are suffering from illnesses, and the possibility of accessing medical attention. About 6.4 million children aged between 4 years and 14 years currently have the disease (Ng, Ho, Chan, Yong & Yeo, 2017). Every day, a considerable number of people is also diagnosed with ADHD. The statistics represent a global problem that is increasingly becoming a disaster (Huang et al. 2017). The above data only show the problem’s extent and level of severity.
Research Question
Does the utilization of exercise and behavioral therapies enhance better treatment of ADHD?
Methodology
Data sources and research strategy. The research adopted a systematic review approach. The primary research databases that were used in the study is PubMed mainly because it is a medical research engine which provides many articles that are specifically on the medical field. Another database that was also used by the scholar to conduct the study was the Cochrane Library. It consists of a collection of many materials such as books and other research materials that span through the field of nursing and general medicine. Specifically, the researcher utilized the Cochrane reviews which are a collection of systematically reviewed articles that have a meta-analysis approach. The period of the study was planned for the last five months.
Study Selection Criteria. To identify the relevant studies from all the included studies, the researcher created a list of inclusion and exclusion criteria. The researched included documents that were (1) published between the years 2005 and 2019; (2) had very advanced and updated information on ADHD management; (3) investigated exercise and utilization of behavioral therapy as a method of controlling ADHD. The criterion included the use of current font size, the significant margins, presentation of figures and tables and the length of the study. The researcher however excluded studies that (1) narrowed their scope on ADHD without the mention of the management strategies (2) were published before the year 2005.
Study Data Extraction. For each of the articles meeting the selection criteria from the two databases, that researcher reviewed each abstract, introduction, research methodology, results discussions. The review of this section was to ensure that.; (1) the abstract contained the research purpose, the applicable methods and the results which were included within the research within the abstract. (2) The introduction presented by the study possessed background information on the survey as a whole, the rationale for the research and the research questions. (4) The research methods maintain the research strategy and design, the target population, the sampling methods, data collection procedures, and analysis. (5) The results presented at least some different graphical and chart representation answering the research question. (6) The discussion section had a detailed review of the research findings and the relevant interpretation of such information. (7) The limitations and weakness of the research findings we well-presented and lastly. (8) The conclusion was based on the overall review of the entire research which also contained the view on the achievement of the study goals.
Data analysis. The selected studies were analyzed using the following three models; the Cross-sectional study approach, Randomized Control Trials (RCT) study and the Thematic analysis. Under the Cross-sectional study approach, the researcher analyzed data that occurred across different literature materials based on the diverse author’s ideas. The researcher, therefore, used a representative subset to gather all the data and present them within the research as required. He then made a comparative analysis of the different findings and concluded based on the data analysis and information from the different materials. The Randomized Control Trials (RCT) study approach allows the researcher to evaluated the relevant research materials by functioning a randomized control trial process through the randomized selection of different research participants and data and including them as part of the general research outcome.
Some other factors considered during data extraction ensured that the article (1) had excellent overall quality and presentation. These entailed the manuscript arrangement, spelling and grammar issues; (s) adhered and upheld the relevant journal requirements as far as formatting and quality standards are concerned. All the above process was mainly carried out through physical verification processes. However, the researcher created a scale for the rating of the research articles by looking at the level of satisfaction of the report based on the components. It is important to outline that, according to the researcher, the validity of the items depended on the chronological availability and arrangements of the above these components.
The approach helps reduce biases regarding the use of certain books or journals within the research. The level of efficiency was also likely to increase through the RTC method. Since many resources had relevant information, while testing different concepts, or proving a specific theory, the researchers majorly chose random books and journals as part of the research study. Thematic analysis approach, on the other hand, allowed the selection of the articles based on a thematic analysis of the study. The method adopted was based on the identification of different research themes and analyzing the data based on them. Correctly, the researcher identified the relevant issues within the study and evaluated the research materials that contained those themes. The investigator mainly considered that books and journals whose significant concentration was on the management of ADHD through physical exercise and behavioral therapies. While discussing the topic, the researcher used specific themes or issues then identified the particular journals that had more information on such issues to form the basis of the analysis.
RESULTS
Eligible Studies.
Availability of the essential components
One of the main rules that the researcher used was the evaluation of the necessary parts. Most of the research articles met the standardized procedure for the above criteria. For example, both Safren, Sprich, Perlman & Otto, (2017) and Emilsson et al. (2011) had a uniform abstract which was presented in a way that portrayed the overall standards required for research. Both articles submitted the purpose of the study, while also ensuring that they provide a highlight of the research methods and results. Ramsay & Rostain, (2014) also presented a final research outcome by offering a conclusive introduction to the study. The presentation was captivating and had all the core components. The same author also showed a clear methodology which also gave the study population and the necessary data collection methods. Rostain & Ramsay, (2006) and Antshel & Olszewski, (2014) also applied several essential components, while formulating their work. The others presented a chronological arrangement of results and further developed detailed discussions on their studies.
Overall quality and presentation of the research study
Most of the studies had a well-organized presentation of the whole study. Looking at two significant examples, Antshel, Faraone & Gordon, (2012) and Ramsay, (2007) had a proper presentability of the research. The authors ensured that the outlook if their work met the highest quality standards of representation. An analysis of the work of Anastopoulos & King, K (2015) indicated that the research was thoroughly revised and was free from any grammatical or any other serious error. In general, all the articles reached the best overall quality, especially in their presentation.
The adherence and upholding of the necessary journal requirements
All the articles were also evaluated on their ability to meet the requirements needed for the formulation of journals. One primary example that represented the focus on the adherence to the rules was the work of Solanto, (2011) and Goodman & Thase, (2009). The authors were keen to develop an overall representation of the paper. The issues such as the labeling of the figures and the tables used in the studies were accurately articulated. Additionally, the researcher also ensured that the length of their works was within the requirements.
Of the total number of studies identifies 84 from PubMed and 222 from Cochrane only 30 studies qualified for analysis. The rest were eliminated as either duplicated repeated, inappropriate and not meeting the eligibility criteria. The researcher will evaluate a total of thirty articles. The articles will be referenced at the end of the study. Additionally, the researcher will also cite the reference throughout the paper. (Fig 1)
Figure 1. Flow diagram showing study selection
Source: (Study data, 2019)
Cross-sectional study Approach
The researcher evaluated the results by carrying out an analysis based on information drawn from different sources, journals and books. Since all the materials were based on the management of ADHD, the studies were largely similar in outlook but different in components. However, there were slight differences in the research outcomes which the researcher carried out. One of the major examples of the cross-sectional analysis was on the determination of the persons who have ADHD based on racial segregation across the US in 2014.
Table 1.0: ADHD accord different racial groups in 2014
Racial profile
Percentage (%)
Hispanic
5.1%
White/ Non-Hispanic
12.1%
Black
8.1%
Source: World Health Organization
The above data, which is extracted from WHO, but used by Safren, Sprich, Perlman & Otto, (2017) in their studies represent the ADHD profile across the different races in the US. On the other hand, other authors also represent the same data, but with different outcomes as shown:
Table 2.0: ADHD accord different racial groups in 2014
Racial profile
Percentage (%)
Hispanic
7.0%
White/ Non-Hispanic
10.3%
Black
9.5%
Source: Centre for Disease Control
Based on the findings of the research, both in table 1.0 and table 2.0, it is clear that the cross-sectional approach adopted by the researcher was important in noting the different ideas borne by the researcher. Table 2.0 was used by Virta et al. (2010). The above results mean that the prevalence of ADHD is widespread and are increasingly becoming more common among different ethnic compositions.
Randomized Control Trials (RCT) study Approach.
The researcher also used a randomized control trial method in obtaining the relevant data. There are different data and information which are informed by the analysis of the studies. First, the research articles found out that there has been an increase in the rate of new persons who contract the ADHD condition. The table below shows the percentage of new infections of the disease within the US-based on an analysis between the years 2003 and 2011.
Table 1.0: Increase In the diagnosis of ADHD between 2003 and 2011
Year
Increase in ADHD
2003
7.8%
2004
8.1%
2005
8.7%
2006
9.1%
2007
9.5%
2008
9.8%
2009
10.3%
2010
10.8%
2011
11%
Source: ADD resource center
Based on the information on the above table, there as a consistent increased growth of ADHD patients. The increase reflects the growth in the problem and the need for quick action in resolving the issues related to the condition. Between the years 2003 and 2011, there has been an overall increase in the ADHD condition by 3.2%, representing a vast number of people.
The above findings showed that the rate of infection of ADHD was still not effectively managed. According to Muñoz-Solomando, Kendall & Whittington, (2008), despite the many efforts put in by the different government, there was still very little success in curbing the condition. Based on the research, therefore, Emilsson et al. (2011) found out that there is little success since the percentage of people who have ADHD continue to rise steadily.
Thematic analysis basis
The researcher also analyzed different studies based on the various themes that are related to the topic of ADHD management. The different themes that the researcher explored included ADHD infection among children and the medical intervention for the condition.
Children with ADHD
There has also been an increase in the record of the number of children who currently have ADHD around the globe/ the figures are represented in the figure shown below.
Source: Centre for Disease Control
Based on the above data in figure 1.0, it is estimated that the number of children with ADHD has been steadily rising over the years. Between 2003 and the year 2011, the condition has affected more people as reflected by the steady rise in the figure. However, in 2016, there was a steady decline in the number of persons with ADHD. As shown in the figure, the affected number of children dropped to 6.1 million as compared to a similar figure of 6.4 million in 2011. According to the National Survey of Children Health, most of the children who are always diagnosed with the condition fall between the ages of 4 and 17 years. The figures in 2016 can, therefore, be broken down further into the rates of infections as expressed through the ages of the children.
The findings support the ideas of Safren, Sprich, Perlman & Otto, (2017) which appreciates that the spread of ADH among children has been a major concern and medical researchers are trying to manage the situation. The findings of Ramsay, (2010) are also clear from the results since the spread of ADHD is still high among the population of children.
Table 2.0: number of ADHD affected children in 2016
Age
Approximate number of children
2-5 years
388,000
6-11 years
2.4 million
12-17 years
3.3 million
Source: Centre for Disease Control
The table can be represented as shown below:
Table 2.0 breaks down the statistics on the spread of the disease among the children. According to the CDC, the majority of the children who are diagnosed with the condition are between the ages of 12 and 17 years.
The findings support those of Ramsay, (2010) which acknowledge that children between the ages of 12 and 17 years have the highest infection rate of ADHD.
Medication intervention for children diagnosed with ADHD
Table 3.: Medication intervention for children diagnosed with ADHD
NUMBER OF CHILDREN
TYPE OF MEDICATION
6 out of 10
Psychological treatment
3 out of 10
Behavior therapy
4 out of 10
Social skills training
3 out of 10
Peer interventions
2 out of 10
Cognitive behavior therapy
2 out of ten
Dietary supplements
Source: Centre for Disease Control
Table 3.0 also shows different medical interventions as adopted by the researcher. The data from the table show that there are many medical intervention methods, even though most of the affected children are not exposed to proper medication procedures.
The findings within the table show that the level of medication for children with ADHD is still shallow. According to Muñoz-Solomando, Kendall & Whittington, (2008), the record of children who receive either medical or alternative medication for ADHD is still deficient.
Achievement of the study objectives
Most of the studies achieved their indented goals. The main aim of the researcher was to enhance a proper understanding of the topic on the use of exercise and behavioral therapy in the management of ADHD condition. Ramsay, (2010), for example, noted that ADHD has visible signs and may differ within individuals. The author argued that within adults, ADHD was more pronounced and required a more focused management process. However, Muñoz-Solomando, Kendall & Whittington, (2008) noted that cognitive therapy within children and adults offered the best way of managing the condition.
On the other hand, Virta et al. (2010) argued that apart from the exercises and cognitive therapy, it was also very critical for the people affected by ADHD to have regular medical care to the illness. The authors argue that cognitive treatment should only be used as a support to the therapeutic process. According to Mongia & Hechtman, (2012), the management of ADHD should be based on a prior medical assessment to ascertain the best management technique. The author, however, appreciates that reasonable steps and the adoption of regularized exercises can conclusively be used in the management of the condition.
DISCUSSIONS
Overall, the study sought to answer the question of whether the exercises utilization and behavioral therapies enhance better treatment of ADHD. The evaluation of the reviews and the statement by the different authors required to answer the above question. Overall, the study findings indicated that behavioral therapies and the use of exercise were very critical in the enhancement of the condition of ADHD patient. The study also noticed that traditionally, a medication approach had been the most preferred method of managing the situation. A recent study has however revealed that there are many benefits which are associated with the adoption of behavioral therapy as the primary management method for the ADHD condition.
Based on the authors’ findings, and the support given by the different journal materials, the researcher concluded that indeed ADHD is a critical problem that needs urgent attention. The author agrees with the researchers’ findings. The main point which the author finds interestingly similar is the fact that the ADHD management is needed urgent attention. Despite some books advocating for purely behavioral therapy and exercise as a management method, the researcher, however, disagrees. The researcher appreciates that both medical and non-medical intervention methods are appropriate for the handling of the problem. Overall, the researcher’s conclusions correlate with much of what the authors say about the topic of interest.
There are many limitations which were directly related to the study’s conduct. The evaluation of the effect level of each restriction varied, depending on the impact extent of such a limitation to the study outcome. One of the main limitations of the study was the fact that there were limited resources which had a detailed analysis of the topic while representing the most relevant data. Most of the research articles that were related to the matter had been published earlier and had not been updated with the most recent information. The above limitation was detrimental to the achievement of the overall results since some of the data and information that were used in the studies might have changed over time. Despite carrying out comprehensive research, the study, therefore, may have accumulated a small portion of marginal error. Another major limitation to the success of the study was related to the data collection methods. The researcher adopted a qualitative approach and collected primary data. As with any other research with a similar nature, there could be a possibility of an error arising from the study. When receiving data using method such as interviews and questionnaires, some of the respondents are never genuine with their responses. However, such respondents will always tend to give the reactions which they believe the researcher expects to hear.
In conclusion, the research achieved to evaluate and examine the effectiveness of exercises and behavioral therapy as a method of managing the ADHD condition. The research findings indicated that there is a need for ADHD patients to ensure that they undertake regular exercise and undergo behavioral change as part of the process that would enhance their healing. However, the research also appreciated the fact that there is a need for ADHD to first undergo a medical assessment with the aim of determining the most appropriate approach in the disorders’ handling and managing. The findings of the research are also significant as they have evaluated the gap that still exists in the management of the ADHD condition. The results, therefore, open more possibilities and techniques through which more research can be accomplished. New research should focus on the management of the state by developing new methods of therapy. Based on the findings of the study, and the evaluation of the researcher, going forward, there is a need for the thorough assessment of ADHD patients before being subjected to the medication. Patient education and awareness programs on the use of exercise and behavioral therapy should also be increased. Further research should also focus on the specific evaluation criteria for the determination of appropriate medication process for the ADHD patients.
The studies that were reviewed by the researcher will be expanded in the future based on the gaps that were identified. More research would be performed by evaluating the different methods of ADHD managing, especially within children.
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