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There are various childhood disorders which affect children as they grow, some of which continue even into adulthood. One of these most common childhood disorders is Attention Deficit Hyperactivity Disorder (ADHD). In most cases ADHD symptoms will appear in early childhood, between 3 to 6 years of age. According to LeFever et.al. (1999), 3% to 5% of children in US suffer from ADHD.  If not detected and treated early, ADHD continues into adolescence and at times into adulthood. This paper will address this childhood disorder, analyzing the types of ADHD disorders, the symptoms, combordity, epidemiology, diagnosis and its treatment. The recommended treatment for ADHD is usually through medication, physiotherapy, behavior therapy, training and education. This paper will analyze research studies on behavioral therapy and medication.

Attention Deficit Hyperactivity Disorder is a disorder whose etiology is still under research. It is believed that the disorder maybe as a result of a mixture of various factors, which may include genetics, social environmental factors and nutrition. According to the National Institute of Mental Health (NIMH, 2010), genetics play a major role in causing the disorder. The genes factor is attributed to a thinner brain tissue in the side of the brain that is related to attention. This part of the brain will however develop into normal size as the child grows up. Some scientists have suggested that the illness is heterogeneous, genetically and lesional factors playing a role. Some researches have shown that maternal smoking and alcohol drinking during pregnancy are a risk factor (Milbergeger, et.al., 1996).

Other researches have shown that lead exposure in high volumes is another risk factor. Another possible cause, but which researchers have mixed results, is the sugar intake in children. According to NMIH most researches have disputed this theory. A recent research showed that the disorder results from a dysfunction of the striatum (Lou, 2008). This research concluded that the lack of sufficient fetal circulation leads to loss of autoregulation which negatively affects the stratum. The stratum is also affected by hypo-schemic effects, which also act as one of the factors that are related to premature births. This research was used to explain why ADHD is prevalent and common with children who had been born prematurely.

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Combordity and Epidemiology

The disorder has a close relation to other disorders such as conduct disorder, mood disorders, and anxiety disorders (Bierdermann, et.al., 1991). Other disorders that may be present with children with ADHD are learning disability, oppositional defiant disorder, depression, bipolar disorder, and Tourette syndrome, sleep disorders and bed-wetting. The disease is more prevalent in boys than in girls though recent research shows that there are more girls being diagnosed.

There are instances when ADHD was never diagnosed in childhood, where the symptoms may have been ignored. The symptoms however become more serious as the child has to deal with the rigorous demands of the adolescent stage. If the symptoms are again not treated at the adolescent stage the illness continues into adulthood, with even heavier repercussions, the adult will find it difficult to retain a job, and it becomes a serious challenge for the adult to be productive. The diagnosis for the adolescent and the adult is the same as with a child which includes behavior observation by a professional. Treatment is the same for children, adolescents and adults.

Categories of ADHD

There are three types of ADHD, Predominantly inattentive behavior, predominantly hyperactive-impulsive behavior, and a combination of both.

Predominantly inattentive behavior has six or more symptoms of inattention and few of the hyperactivity symptoms. The child's lack of attention will usually lead to problems at school and at home. The child will make careless mistakes and will also forget to do the chores assigned to him. Because the child is not paying attention, the child is not attentive when being addressed and therefore cannot give proper feedback. The failure to give feedback or complete chores and assignments is because of the disorganization and inattention but mostly this can be confused with being defiant. Due to the disorganization, the child is always loosing items. Most of the children with inattention type of ADHD are of average or above average intelligence. In most cases the disorder is only recognized when a child attends school, as most parents and care givers will confuse the signs for normal child behavior. The inattention symptoms will include, being easily distracted, forgetfulness, lack of focus, quickly bored, seem not to listen when being spoken to, day dreaming, finding it difficulty to follow instructions and is easily confused.

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Predominantly hyperactive behavior can be identified when there are more than six symptoms of hyperactivity and impulsive behavior and less than six of inattention. A child with impulsive or hyperactive behavior, rarely stays still, and is always busy doing something. The child talks a lot and will blurt out words without waiting to be addressed. This makes it easier to recognize the symptoms and easier to identify the disorder in the child.

This super activity may at times lead to problems with the other children or friction with the teachers at school. The symptoms that are related with hyperactivity are being fidgety and squirmy, non-stop-talking, touching and playing with whatever they come across, constantly on the move, cannot concentrate on quiet tasks. Impulsive symptoms include a lot of impatience, blurting out words, highly show their emotions and always interrupt conversations. 

Combined Hyperactive-Impulsive and inattentive is identified where there are six or more recognized signs of inattention and six or more recognized signs of hyperactivity-impulsive behavior. The majority of children with ADHD fall in this category 

There is no test to diagnose ADHD. It is a hard disorder to diagnose as most symptoms are the same as common behavior of children who are growing up. In most cases, the teacher will be the first to notice the symptoms as the child responds differently, and is less attentive or abnormally active as compared to the other children. Once the teacher and parent suspect that the child has ADHD, they should consult a pediatrician who will usually refer the child to a professional specialized in this area. The professional will observe the child's behavior and the environment. The professional will eliminate all other possible causes of the child's behavior. During the observation period, the professional will be in consultation with every one who is involved with a child on a day to day basis, that is, the parents, the teachers, coaches and babysitters. The professional will observe the child's behavior under different circumstances and how the child reacts in different situations. The frequency at which the symptoms of ADHD appear in a child's behavior will be noted. The professional will ensure that the child is acting freely because the child may change the behavior if s/he knows that s/he is being observed. This may distort the diagnosis. There are rating scales and psychological testing instruments that may be used but can only be used to support the professional's assessment. 

There is no cure for ADHD and any kind of treatment will focus on reducing the symptoms. Treatment can be done through medication, psychotherapy, behavior therapy, educating and training the child and the care givers, or most commonly by using a combination of several other methods. Medication is provided to the child to assist in reducing hyperactivity and impulsiveness as well as assisting them to focus and to pay attention. Medication can either be through stimulants and non stimulants. The stimulants are used to calm down the child whenever the symptoms attack. The medication is prescribed depending on the child's needs and requirements.

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The medication may have side effects with the most common ones being loss of appetite and sleeping disorders. Since medication does not cure ADHD, most professionals will recommend combining the medication with physiotherapy. The physiotherapy will focus on helping the child to change his or her behavior. It also includes helping the child to learn social skills such as sharing and how to act when with other children. Whatever the treatment, the child will need full assistance from the parents, caregivers and the teachers.  

Medication is one of the ways to treat ADHD. According to research, about 3% of school age children use medication in the treatment of ADHD. The types of medications that are preferred are stimulants with methylphenidate being the most popular of them all. Methylphenidate is the most commonly used medication on ADHD children in the US, with the number of methylphenidate prescription being 3 or more times more than it was in 1990. Between 1971 and 1980, the rate of using methylphenidate was twice as high in every four years while the rate was twice in the period 1990-1995.  A research was conducted to identify the extent to which medication is used as a form of treatment on school going children in Southern Virginia (LeFever, et.al., 1999). The research took several social issues into consideration relating to age, gender, education and ethnicity.

The research involved all the students who take medication while in school in grade 2 to grade 5 from two cities A and B. The two cities are different in size, racial composition, income per household, as well as the rate of poverty. Information from all students who were in consistent medication at school was recorded for all the students in city A. All information relating to students who were on ADHD medication was collected from students in City B. The results of the research indicated that methylphenidate is used by 90 percent of children who take ADHD medication from school, 5 percent of whom combined methylphenidate with another drug, and only 10 percent took any other medication.

The results further showed that between 8 and 10 percent of the school going students in grades 2 to 5 used ADHD medication at school. The results also found out that most of the ADHD students were in the rightful grade by age, 91 percent and 93 percent for cities A and B respectively. There is a higher likelihood for boys to use ADHD medication as compared to the boys, the research found out, while there is a double likelihood for white children to use ADHD than there is for the black children. There was a higher possibility for old-for-grade- students to take ADHD medication. This can be explained by the theory that these students delayed going to school due to ADHD related problems.

ADHD is more prevalent to low income earners than it is with higher income earners. This was concluded after the research findings indicated that there were twice as many whites who used ADHD medication as compared to the minority. This was explained by the fact that the low income earners did not wish to have their children's prescriptions being taken from school. Another observation that was made from this research is that there is a higher possibility that children from military parents will take ADHD medication from school than the other students.

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With the research showing that medication has resulted to better results in these two cities, parents should take this as an option when considering the treatment for their children. Other research studies have supported this research and have shown that medication reduces the symptoms of hyperactivity, impulsiveness and inattentiveness. The use of these drugs has been known to result to improvement in school work as well as in interacting with the other children. Apart from methylphenidate there are other forms of stimulants that have been used, such as Dopamine D4 receptor gene polymorphism which is currently a common drug used in the treatment of ADHD.

Critics of using stimulants on children with ADHD have claimed that they are addictive and this may have a negative effect on an already high risk group of potential users. However research shows that only very few patients have resulted to drug dependency after using methylphenidate.

Behavioral therapy is another type of treatment that is advocated to a child with ADHD. Behavioral therapy is a method that provides techniques to the child and the parent with the aim of assisting the child in improving behavior and coping skills. According to research and scientists, behavioral therapy should be the first option to offer to a child who has been diagnosed with ADHD.  

A research was conducted to determine the effects of motivation incentives to children with ADHD (Groom, et.al, 2009). The research was conducted with 28 children with ADHD who came from different age groups, race, and gender and socio economic status, and were using medication. The researcher was conducted in two days whereby the participants were to go through the electroencephalography (EEG) test and a functional magnetic resonance imaging test. The participants were on and off medication. There was a control group who had been paired with the ADHD participants before going through the tests.

The results showed that the participants responded to the motivations as they selected the reward rather than the cost. The results showed a positive response in amplitude and motivation, with amplitude being higher when the participants were off medication as compared to when on medication. The results of the research also showed that the incentives given to children with ADHD should be different, in quality and in quantity, from the incentives given to other children. The results concluded that medication methods should be combined with behavioral therapy which makes it more effective. The research findings recommended that children with ADHD should be provided with more motivation. This confirmed previous research which had suggested that when a child begins treatment with behavioral therapy, the medication if required will be in a smaller dose.

From the analysis of the two researches, behavioral theory would be more effective. Medication should only be used to supplement the behavioral therapy and only when behavioral therapy fails to work on its own. According to McCarthy (2010), most recent doctors and even the American Psychological Association recommends behavioral therapy as the first option especially for children under 5 years of age. Medication may successfully treat the symptoms but will not deal with the child's behavior, thus the child becomes reliant on medication in the long-term. Again it is hard for the child who chose medication as the first option to revert to behavioral therapy. However behavioral therapy is difficult and may take months before the child and parent notice any change. The benefits are however long term and efforts should be made in this direction, both by the child, the parent and the professional.

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