No full-text available
To read the full-text of this research,
you can request a copy directly from the author.
A New Behavioral Approach for ADD/ADHD and Behavioral Management Without Medication
Abstract
Attention-Deficit-Hyperactivity Disorder (ADHD) is generally considered a biologically or neurologically determined disorder that is effectively managed with a combination of stimulant medication and a behavioral approach featuring prompts, reminders, and token economies, while minimizing disciplinary contingent responses to target behaviors. Recent reviews of the extant quality research and consensus conclusions among leading experts do not support this current prevailing paradigm and management. A new conceptualization of the basic nature and cause of ADD/ADHD behaviors is proposed, in which cultural forces prevalent in or unique to our culture combine to produce a behavioral syndrome that is primarily developmental in nature and may be largely preventable by parenting approaches and other environmental modifications. A behavioral approach based upon underlying premises differing from those in conventional management is discussed, and evidence that this may provide an effective treatment for ADD/ADHD behaviors without the use of stimulant medication is presented.
Corruption can take various forms, including frank bribery and the corruption of knowledge. Prominent in the health field is corruption associated with the pharmaceutical industry. This can impair true freedom to choose optimal therapeutic strategies by misrepresenting less qualified yet more expensive (“pseudo‐innovative”) products, resulting in increased expenditures without improvement in the quality, efficacy or safety of the health care supplied. Promotion of products is legitimate, but the border to corruption is not easily discernible and is readily violated. Senior management within the pharmaceutical industry has to become aware of the destructive consequences of corruptive and other improper promotional activities and be prepared to fight them through implementing Codes of Conduct.
Medical health care professionals are the main targets for corrupt practices on the part of the pharmaceutical industry. They need to be sensitized against disinformation and material influences which can impede professional care. Professional and self‐governing institutions have to develop Codes of Conduct and strategies to guarantee transparency and the independence of advisory functions.
National legislation should be promoted to create or extend anti‐corruption law to members of professional medical societies or self‐governing bodies in health care. Governments should recognize the need for patients' participation and public control at all levels of health care systems, also in the so‐called private sector, and establish the necessary legal framework.
Children have been exposed to unjustifiable risks that in some cases amount to research abuse. Powerful, financially interconnected stakeholders control all facets of research, including the approval process. Physician investigators, their academic institutions, and institutional review boards (IRBs) all come under the influence of funding sponsors, whose interests conflict with the best interest of children. Children cannot rely on IRBs or on any of the existing research oversight agencies to protect them, for research too often takes inordinate risks in the name of the greater good.
To determine if the American Academy of Pediatrics Attention-Deficit/Hyperactivity Disorder (ADHD) guidelines require tailoring for different settings, the researchers used a mixed-method research design to review an ADHD quality improvement effort in community clinics and private offices in San Diego County. Clinically, no differences were noted in rates of ADHD in the two settings. Children in community clinics (58.3%) were more likely to report public insurance (p<.001), diverse ethnic backgrounds (p=.003), low household incomes (p<.001), single parent households (p=.009), and to screen positive for Oppositional Defiant Disorder/Conduct Disorder (p=.027). They were also more likely to have experienced socio-environmental stressors (p<.001) including foster care, homelessness, parental drug use, and domestic violence. No differences were noted by treatment received at 12 months post-evaluation by office type. Open-ended interviews with clinicians confirmed these findings and revealed a need for tailoring of implementation strategies to more closely fit the needs of children and families cared for in public sector settings.
The kindergarten curriculum has undergone fundamental change over the past 50 years. The shift in curriculum in favor of reading preparedness has had the effect of emphasizing boys' weaknesses and girls' strengths. Two changes are proposed. First, alternative kindergartens emphasizing group activities and nonverbal skills must be established. Second, boys must be encouraged to enter such a kindergarten when they turn 5 years old. After 1 year of alternative kindergarten, the boy would enter contemporary kindergarten at age 6. Girls would continue to enter kindergarten at age 5. Most boys would therefore enter first grade at age 7, most girls at age 6. Substantial evidence suggests that such a change would have many benefits, particularly for boys. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The kindergarten curriculum has undergone fundamental change over the past 50 years. The shift in curriculum in favor of reading preparedness has had the effect of emphasizing boys' weaknesses and girls' strengths. Two changes are proposed. First, alternative kindergartens emphasizing group activities and nonverbal skills must be established. Second, boys must be encouraged to enter such a kindergarten when they turn 5 years old. After 1 year of alternative kindergarten, the boy would enter contemporary kindergarten at age 6. Girls would continue to enter kindergarten at age 5. Most boys would therefore enter first grade at age 7, most girls at age 6. Substantial evidence suggests that such a change would have many benefits, particularly for boys.
Millions of children in North America are diagnosed with Attention- Deficit/Hyperactivity Disorder and treated with psychostimulants such as methylphenidate, dextroamphetamine, and methamphetamine. These drugs produce a continuum of central nervous system toxicity that begins with increased energy, hyper-alertness, and overfocusing on rote activities. It progresses toward obsessive/compulsive or perseverative activities, insomnia, agitation, hypomania, mania, and sometimes seizures. They also commonly result in apathy, social withdrawal, emotional depression, and docility. Psychostimulants also cause physical withdrawal, including rebound and dependence. They inhibit growth, and produce various cerebral dysfunctions, some of which can become irreversible. The 'therapeutic' effects of stimulants are a direct expression of their toxicity. Animal and human research indicates that these drugs often suppress spontaneous and social behaviors while promoting obsessive/compulsive behaviors. These adverse drug effects make the psychostimulants seemingly useful for controlling the behavior of children, especially in highly structured environments that do not attend to their genuine needs.
A low concentration of platelet serotonin has been demonstrated in 88 per cent of 25 children who have symptoms of hyperactivity without classical evidence of neurologic dysfunction. In 2 children, during residence in the research ward of the hospital, the serotonin concentration rose toward the normal range and the children's hyperactivity lessened. When the children returned to their homes, the serotonin returned to prehospitalization concentrations and hyperactivity increased again.
In response to concerns about the increasing use of psychotropic medications in preschoolers, the National Institute of Mental Health and the Food and Drug Administration convened a workshop in October 2000 to examine the current state of knowledge regarding psychopharmacology for young children and discuss a variety of topics relevant to research in this age group, including safety, efficacy, investigational methods, and ethical aspects. The meeting gathered researchers, practitioners, ethicists, industry staff, and family and patient representatives. Efficacy and safety of psychotropics have not been systematically evaluated in preschoolers. The major limitation to this research is the diagnostic uncertainty surrounding most manifestations of psychopathology in early childhood. Research in developmental psychopathology is needed to clarify diagnosis and provide sensitive and specific methods for clinical trials. Possible approaches to expanding the research basis of this area of clinical practice, including a recently started study of methylphenidate in preschoolers, are reported here.