Are ADHD Medications Overprescribed in Children? Research Proposal Example

Introduction

Attention-Deficit Hyperactivity Disorder (ADHD) is a mental disorder that is commonly diagnosed in children in the United States. Many parents and educators associate inattention and hyperactivity with the presence of this disorder. However, it is hypothesized ADHD over diagnosed and therefore ADHD medications are overprescribed in children. Activity and lack of attention are characteristics that are considered to be common developmental characteristics of school-aged children. Therefore, many individuals are diagnosing these traits as ADHD when in reality, they are normal characteristics. It is detrimental to over diagnose ADHD medications in children because doing so can contribute to aberrant side effects that will damage the health of the child.

Methods

Children who have been formally diagnosed as having ADHD and provided with medication for treatment will be observed in the classroom setting over ten class periods, five sessions will be observed when they are taking their medication and five will be observed when they are not taking their medication. Their actions will then be compared to ADHD diagnostic criteria using the DSM-V. It will then be determined whether these individuals were correctly diagnosed and provided medication on this basis or whether their medication was mistakenly provided.

Prospective Results

It is expected that approximately 75% of students are provided with ADHD medication when they do not need it in reality. Furthermore, it is expected that many of the abnormal behaviors seen in these children are consequences of the ADHD medication, rather than the presence of a mental disorder.

Background Information

Attention-Deficit Hyperactivity Disorder (ADHD) is a mental illness that is characterized by the lack of the ability of an individual to concentrate or stay still. This is a problematic disorder for all individuals that have been diagnosed with it, but it is particularly difficult for students with the disease to participate in school activities. The symptoms of ADHD are commonly mistaken for learning disabilities, as the individuals who exhibit them often demonstrate difficulty with learning. However, these symptoms are not related to learning impairment and result in an impaired ability to learn because these individuals are not able to concentrate in the same way as their peers.

ADHD is typically diagnosed when a parent, friend, or teacher observes that the behavior patterns exhibited by an individual is not characteristic for his or her age. In order to confirm this diagnosis, the individual will typically travel to a psychologist to be evaluated. A series of tests will be conducted that attempt to assess whether the child is simply energetic and cannot always retain focus or whether there is a chronic problem. The psychologists will use a combination of these tests in addition to self-assessment from the patient and observations from friends and family to make the diagnosis. Many medical professionals believe that ADHD could be treated in part through therapy sessions that aim to adjust reactions to certain stimuli, while others believe that because the illness has a biological basis, medication is the only effective treatment method. Yet, other parties believe that a combination of therapy and medicine is the only proper way to treat ADHD.

Professionals attempt to diagnose individuals with ADHD using criteria from a book called the DSM-IV. Some professionals prefer to use this book for mental disorders, while others opt to use the newer addition of this publication called the DSM-V. As a whole, this document describes ADHD as “persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development” (CDC, n.d.). For ADHD to be diagnosed by a professional, they must observe that these symptoms have been occurring over a long period of time. Therefore, one of the primary criterion for this diagnosis is that individuals must exhibit six or more of the following symptoms: they must not be able to give complete attention to details or make unanticipated mistakes at their jobs, in school, or in other functions; they must often not appear to listen to verbal directions despite repeated attempts; they must not frequently follow directions which leads to them not completing projects that they have started and are expected to finish; they frequently have trouble organizing tasks and activities; they often ignore and do not enjoy work that requires a lot of thought; they frequently misplace objects that are necessary to complete their responsibilities; they are frequently and easily distracted; they are frequently generally forgetful with regards to daily activities (CDC, n.d.). While many of these situations are exhibited by children or adults at some point, individuals with ADHD repeat many of these behaviors over a long period of time, which interferes with their ability to function in school or at work. Therefore, children with ADHD are typically diagnosed by teachers or other members of school staff because they are most likely to pick up on these behaviors before the parents. It is often an educator or a school psychologist who arranges the appointment for the formal diagnosis with the parent.

An additional symptom of ADHD is hyperactivity and impulsivity. According to the psychologist’s diagnostic manual, the following symptoms must be met, demonstrating inappropriate behavior for the child’s age level: they are frequently not able to stay still and must play with objects or move in their seat; they frequently travel away from their seats when remaining seated is appropriate; they are not able to play quietly; they must frequently talk or move; they respond to questions in class before they have fully completed the question; they have difficulty taking turns; they frequently invade the space of others (CDC, n.d.). Many individuals believe that these symptoms do not signify ADHD because they understand that some children exhibit these behaviors normally. While this is true in some cases, children with ADHD exhibit a majority of these symptoms, which have been repeated over a long period of time. These individuals are generally those who are unable to remain seated and quiet in school, which may interfere with the learning process of both themselves and of their peers. Individuals with ADHD exhibit some symptoms that overlap with other disorders, so it is necessary for the health care professional to rule out these other options before confirming a diagnosis of the disease (Greathead).

It is hypothesized ADHD over diagnosed and therefore ADHD medications are overprescribed in children. It is expected that at least 75% of study participants will have incorrectly been provided with ADHD medication to treat their naturally occurring behaviors. Many adults see symptoms of ADHD as abnormal, when in reality, they are an indication of the child’s natural developmental stage. While these behaviors can be seen as bothersome, it will be beneficial to recognize them as natural if it is found that ADHD is over diagnosed and over treated in many members of the elementary and middle school populations.

Rationale

It is important to ensure that children are not wrongly prescribed ADHD medication because doing so can expose them to a variety of side effects and health risks that could have otherwise been avoided. Low appetite, stomach pain, and sleep problems are common risks that are problematic for developing children (WebMD). In fact, low appetite and sleep problems can reasonably contribute to many of the ADHD symptoms regularly observed in this population. It is therefore reasonable to determine how many ADHD patients are being over diagnosed in addition to the corresponding percentage of overmedication. It is important for us to protect the health of our children, but the only way to do so is by ensuring that they are not being provided with inappropriate medication that could potentially damage their well-being.

Objectives

The objective of this study is to assess whether ADHD medications are overprescribed in children and to provide recommendations to help alleviate this condition if a problem is found.

Description of the Project Design

Children who have been formally diagnosed as having ADHD and have been formally prescribe ADHD medication for treatment will be observed in the classroom setting over ten class periods. Five sessions will be observed when they are taking their medication and five will be observed when they are not taking their medication. Their actions will then be compared to ADHD diagnostic criteria using the DSM-V. The DSM-V checklist will act as a rubric for ADHD diagnosis during each visit. The students will be provided a score based on the number of ADHD conditions they meet during each observation session, and be given a final ADHD score based on the number of diagnostic criteria that they meet. It will then be determined whether these individuals were correctly diagnosed and provided medication on this basis or whether their medication was mistakenly provided. The average score received when the child is on medication will be compared to the average score received when the child is not on medication. A student’s t-test will be conducted to determine whether the variation between these values is statistically significant. A statistically significant variance will indicate that the medication is effective, while a non-statistically significant variance will indicate that the medication is not effective and the child has likely been prescribed the medication erroneously. It will be necessary to gather informed consent from both the school and of the parents of the children who are participating in the experiment because it will be necessary for these children to temporarily cease using their medication in order to retrieve relevant results. All informed consent documentation will be written at an 8^th grade reading level to ensure that all parents understand the risk of participating in the study and parents will be informed that they have permission to withdraw their child from the study at any time.

Sample Size Determination

A total of 30 students will be observed. This value represents the average amount of students expected to be in a classroom, so this sample size will be reflective school-aged students who have been formally diagnosed with ADHD. A power score will not be calculated because the population being used is drawn from a convenience sample, indicating that it may not be plausible to reach the number determined by this calculation. As such, this experiment will be considered a preliminary study.

Subject Selection

The selection of subjects will be as a convenience sample from local elementary and middle schools. The student selection will be biased based on which schools agree to participate in this project. Until the schools are contacted for this purpose, it will not be possible to formulate a more precise description of the participant pool. However, all elementary school participants will be from grades 4 and 5, while the middle school participants will be from grades 6 and 7 to ensure that a close yet representative age range can be achieved.

Data Collection Methods

Each student will have a packet of 10 DSM-V checklists designated for their analysis; five will be used when the student is not taking medication and five will be used when the student is taking medication. The checklist will serve as a mode of data collection to allow the researcher to quickly score their ADHD symptoms during the classroom period.

Data Analyses

Microsoft Excel will be used to compile the scores prescribed to each student for each test. All information will have participant identifiers removed in order to ensure that the identity of these individuals are protected. After determining the final scores based on the DSM-V criteria, the average score received when the child is on medication will be compared to the average score received when the child is not on medication. A student’s t-test will be conducted to determine whether the variation between these values is statistically significant. A statistically significant variance will indicate that the medication is effective, while a non-statistically significant variance will indicate that the medication is not effective and the child has likely been prescribed the medication erroneously.

Prospective Results

Discuss Possible Results

It is expected that a majority of students observed will have ADHD symptoms while they are on medication that are similar to the symptoms observed when they are not taking medication. While the type of symptom observed may vary, the number of symptoms will remain constant. Furthermore, it is expected that these results will remain consistent independently of the age of the participant being observed or the subject that is being taught when they are observed. Student focus is expected to remain fairly consistent across the observation days. Overall, it is expected that 75% of participants will not show a statistically significant change in behavior from the times that they are on their medication to the times that they have withdrawn from the medication. Furthermore, it is expected that many of the abnormal behaviors seen in these children are consequences of the ADHD medication, rather than the presence of a mental disorder.

Indicate Data Collected

Only information from the literature has been gathered at this point in time. These studies indicate that there is reason to believe that children are regularly overprescribed ADHD medication.

Link to Conclusions

The conclusions drawn from the peer-reviewed literature indicate that ADHD is both over diagnosed and overmedicated. It is therefore reasonable to believe that adjustments to the diagnostic process should be made and effort should be put forth to reduce the harm that could befall children for taking unnecessary medication.

Works Cited

Armstrong T. ADD/ADHD Alternatives in the Classroom. 1999. Web. 22 November 2015.

CDC. Data and Statistics. N.D. Web. 22 November 2015.

CDC. Symptoms and Diagnosis. N.D. Web. 22 November 2015.

Cohen DJ. Cicchetti D, ed. Developmental Psychopathology, Developmental Neuroscience (2nd, illustrated ed.). John Wiley & Sons, 2006.

Curatolo P, D’Agati E, Moavero R. The neurobiological basis of ADHD. Ital J Pediatr 36(2010): 79.

Greathead, Philippa. Language Disorders and Attention Deficit Hyperactivity Disorder. 6 November 2013. Web. 22 November 2015<http://www.addiss.co.uk/languagedisorders.htm>.

Ramsay JR. Cognitive behavioral therapy for adult ADHD. Routledge, 2007.

Schonwald A, Lechner E. Attention deficit/hyperactivity disorder: complexities and controversies. Curr. Opin. Pediatr. 18.2(2006):189–195.

Sim MG, Hulse G, Khong E. When the child with ADHD grows up. Aust Fam Physician 33.8 (2014): 615–618.

WebMD. Tips to Reduce the Side Effects of ADHD Medications. N.D. Web. 22 November 2015.