Free Essay About Comparing Two Programs To Improve Executive Function In Children With Attention Deficit Hyperactivity Disorder

PSYC 3505B

Introduction: Attention deficit hyperactivity disorder (ADHD) is a neurobehavioral disorder that effects 4% to 7% of children worldwide (Markowitz, Manor, & Maeir, 2011).Children with ADHD display chronic difficulties with inattention, impulsivity and hyperactivity that result in impairment in academic and social functioning across multiple settings (home, school and with peers) (Lin, Huang, & Hung, 2009). The characteristics of inattention consist of losing items, poor reading comprehension, easily distracted by external stimuli. Impulsivity consists of making poor decisions, low frustration tolerance, and short temper. Hyperactivity manifests as inability to sit still, rapid speech, and fidgeting (Bokor, Peter, Anderson, & Pharmd, 2014). The symptoms of ADHD can manifest from childhood through adolescence (Spencer, Biederman, & Mick, 2007). One of the primary features of ADHD is the impairment of executive function, which involves a series of factors including planning, organization and making choice, visuospatial working memory, attentional control, and emotional regulation (Zambrano-Sanchez, Martinez-Cortes, Rio-Carlos, Martinez- Wbaldo, & Pbolano, 2010). ADHD can create various difficulties if not properly managed. For example difficulty in paying attention and poor organizational skills contribute to underperformance and problem with school. However children’s parents and executors today understand that deficit in critical cognitive skills which are also known as executive functions are much slower to mature in many children who have ADHD. Basically, problems with executive functions may bring several issues in brain: disorganization, remembering homework, difficulties in getting started and finishing work, writing essays and reports or memorizing some facts, remembering what was read, being on time, having plans for the future or even controlling emotions (Bokor, G., Anderson, P. D, 2014). The causes of ADHD have been attributed to several factors such as neurological abnormalities, heredity and exposure to certain toxicants (e.g, lead, and the abuse of alcohol or tobacco)(textbook). Until now there is no cure for ADHD. However some of the symptoms can be controlled with Medication such as methylphenidate, medication combined with behavioral treatment, behavioral training and cognitive behavioral therapy (Lin et al., 2009). Medications have been found to reduce classroom disruption, increase compliance, and academic productivity (Chronis, Jones, & Raggi, 2006). The purpose of this paper is to argue that active participation of parent enhance the effectiveness of the intervention for children with ADHD. This paper will begin by providing brief summaries of two research articles. Then I will make a critical analysis of the two research articles by comparing the theories, method, and findings in each one. Summary of research article 1:
The purpose of this study was to examine the effect of Cognitive function intervention to achieve occupational goals, improve executive functions in daily life and improve self-efficacy of children with Attention deficit hyperactivity disorder. Researchers hypothesized that cognitive intervention can improve the executive functions in daily life of those children who suffer from ADHD. Fourteen children diagnosed with ADHD in age 7-8 years old participated with their parents in the cognitive-functional program that focuses on facilitating cognitive strategies for occupational performance. This program targeted executive functions in occupation to improve the occupational performance in children with ADHD. Cognitive functions program involved weekly 10 sessions, one hour each, occupational therapist demonstrated specific executive strategies (Stop, Plan, Review) to achieve occupational goals by targeting self-regulation, working memory, and planning. Parents chose one occupational goal to transfer at home, at school, or in the schoolyard. Occupational therapist interviews each child to complete an activity log of a typical day to identify the occupational goals (e.g., be ready in the morning on time, organize backpack for school, and keep the room tidy). Occupational therapist used task-specific strategies of inhibition, planning and review to achieve specific occupational goals. Researchers used three measures to assess the effect of cognitive functional intervention in improving the executive function of children with ADHD. Behavioral Rating Inventory of Executive Function (BRIEF) is a rating scale for parents and teachers designed to reflect the neuropsychological construct of executive functions in everyday situations. It comprises eight scales, Global Executive Composite, and two indexes Behavioral Regulation Index and Metacognitive Index. Behavioral Regulation Index includes the Inhibit, Shift, and Emotional Control Scales, and the Metacognitive Index includes the initiate, working Memory and Plan Organize. Tower of London-Drexel University (TOLDX) is a neuropsychological assessment of Executive function impairments in planning. Scores are generated for number of moves, problem-solving time. Canadian Occupational Performance Measure (COPM) is individualized and semi-structured based on Parents’ Rating of Their Children’s Performance and Children’s Rating on their occupational performance of occupational and transfer goals. The result of BRIEF measure showed statistically the significant improvements in Executive function in daily life of children with ADHD. Teachers and parents reported better executive function after the intervention. The improvement of executive function of children with ADHD was maintained at follow up. The scores of TOLDX showed statistically significant improvement in strategic planning after intervention. The mean of scores showed improvement in number of moves (decreased) and problem solving time (decreased), however the scores were worse at follow-up. The scores of parents’ ratings on COPM goals and transfer goals of their children’s performance showed statistically significant improvement after intervention. The improvement of occupational goals was not maintained for all children’s at follow-up. Moreover, Children’s rating on the COMP goals and transferred goals showed statistically significant improvement after intervention. The cognitive-functional intervention improved the executive skills and improves occupational performance of children with ADHD. Researchers provided some explanations of why cognitive-function intervention worked effectively. They suggested that metacognitive strategy training played a significant role on the outcome. Also, the community ADHD clinic where the study took place may affect the performance of children with ADHD. Summary of research article 2: The goal of this study was to examine the effect of an intensive psychosocial intervention on the executive function for children with Attention deficit hyperactivity disorder (ADHD). Researchers used neuropsychological tasks of attention, and interference control, verbal and visuospatial working memory to assess executive functions. Researchers hypothesized that social intervention can have a positive effect on executive function of children with ADHD. There were 42 Children randomly assigned to one of two groups, 27 children to treatment group and 15 to group without treatment, children ranged in age from 7 to 8 years. The measures used to rate the executive function of children with ADHD are Attention measure: Continuous Performance Test (CPT), Measure of interference control: Stroop test, and measures of verbal working memory (Working memory sentences, Visuospatial working memory). In CPT test, children are told to press the space bar on a computer every time an X appears preceded by an A. In Stroop test, in the first subtest, children are told to read words (name of colors) written in black letters as quickly as possible. In the second, the child must name the color of which the letter X printed as quickly as possible. The final subtest, the children are told to name the color of the ink rather than the color named by the word. Working memory sentences measure, the experimenter read set of sentences with the last word missing and asked the child to provide the missing word of each sentences. There are 42 sentences and they are divided into four levels of complexity. Visuospatial working memory test, this test is to analyze the visuospation working memory based on three processes recognition, spatial recall, and temporal recall. Randomly 12 squares appeared on the screen and the children must remember the sequent of the appearance of the squared. The results of the study showed that there was a statistically significant difference between the treatment group and untreated group in several variables, attention, interference control, verbal working memory, and visuospatial working memory. However, only attention and visuospatial memory variables showed progress after the treatment. Children with ADHD in treatment group showed an improvement in attention and visuospatial memory after the treatment compared to untreated one. Researchers suggested that the effect of the treatment on attention may take its place because of the features of the task. The CPT is a repetitive task that does not involve problem solving or giving novel answer. Treatment group unlike untreated, they may produce effort maintenance strategy which help to improve their response. Critical Analysis: (Differences and similarities between theories, methods, and findings in two research articles) (include positive and negative criticisms)Article 1: Effectiveness of Cognitive- Function (Cog-Fun) Intervention With Children With Attention Deficit Hyperactivity Disorder.Article 2: Effect of a Psychosocial Intervention on the Executive Functioning in Children With ADHD. Method and research design: The study of the first research article was uncontrolled; all participants are given treatment with no comparison against another group (control group). This study used only one group and divided them into preintervention and postintervesion. Therefore, the results of the study cannot be taken as evidence that the treatment works. In uncontrolled study, we cannot tell if the tracks of improvement appeared due to the effect of the treatment itself. The result shows an improvement due to external factors that are not part of the study. On the other hand, the study of the second research article was randomized controlled study; researchers used two groups, one treatment group and one control group. Children with ADHD were randomly assigned to one of two groups using random number generator. This ensures that each participant has an equal chance of being placed in any group. Random controlled study help ensure that any differences between groups can be attributed to the treatment. Moreover, in first article, researchers used three assessments to assess the effect of cognitive functional intervention on executive function of children with ADHD. These assessments are Behavioural Rating Inventory of Executive Function (BRIEF), Tower of London-Drexel University (TOLDX), and Canadian Occupational Performance Measure (COPM). Researchers provided the test-retest reliability coefficients of the three assessments, BRIEF (rs=.72-.84), TOLDX (rs=.80), COPM (rs= .80). All of these assessments show a good coefficient. So, there is a good consistency of these assessments measures across time. However, Occupational therapist could be biased when she/he ran the assessment measures. In the same way the researchers in the second article used different types of assessment to test the effect of psychosocial intervention on the executive function. Unlike the first article, researchers did not provide information about the validity or reliability of the assessments. Also, we do not know if these neuropsychological tests are sensitive in evaluated the effect of the intervention. In the first article, fourteen children diagnosed with ADHD were recruited from community ADHD clinic. This can limit the generalization of the result because all the participants were from one centre which is Community ADHD clinic and these participants may not represent the general population. In contrast, second article recruited 42 children diagnosed with combined subtype attention-deficit disorder or exhibited typical ADHD behaviors in public. Although this research study used bigger sample size of children but they only selected children with combined subtype, which limit the generation of the result. In addition, the age of children with ADHD ranged from 7 to 8 for both studies. Intervention:In the first article researchers provided information about Cognitive-Functional intervention and how to implement it. This intervention involves parent to attend each session with their children. Parent can attend each session with their children to learn about the intervention and to learn how to reinforce positive strategy implementation at home. The positive thing about this intervention is that they involved parent as part of the treatment, which as a result may lead to positive change. Nevertheless, in the second research article, researchers did not provide information about the psychosocial intervention. The main goal of the study was to examine the effect of psychosocial intervention on executive function for children with ADHD.Findings: The result of the first research article showed statistically significant improvements in Executive function in daily life of children with ADHD. Although the cognitive functional intervention improved the executive skills and occupational performance of children with ADHD, but the study was uncontrolled thus the external factors that are not part of the intervention affect the results. The result of the second article showed that there was a significant difference between the treatment group and untreated group. Children with ADHD in treatment group showed an improvement in attention and visuospatial memory after the treatment. However, the positive change may due to the characteristic of the task not the intervention. Conclusion
This paper compares two researches with methods of treatment for Attention deficit hyperactivity disorder. Both methods serve as the existing cure on the way to final treatment, but to my mind one of them has more assets than the other. Summarizing the above, the second research represents its dominating advantages over the first one. The first research looks limited and underestimated due to its uncontrolled process, where results are very shaky and uncertain. Its leading feature is the presence of parent of children which cannot be replaced by anything from the second research. However, the ways of treatment of ADHP in second research overshadow those from the first one due to the presence of controlled experience, existence of actual comparisons and participants who were just the residents of general population. In fact, there were three times more children in the second research which increases the chances to receive more accurate result of exploration of the phenomena.
Although no immediate cure for ADHD is in sight yet, hopefully new researches will come up in the nearest future while parents must not get discouraged and provide their ADHD children with full support.
Using a variety of research tools and methods, scientists are beginning to uncover new information on the role of the brain in ADHD. Researches go on and there are several questions I have for advanced technological research on the brain cells.

Using advanced genetic studies will it be possible to understand the inherited ADHD nature?

Will it be possible with advanced technology to examine baby’s brain cells and effects on ADHD while the baby is in the embryo stage?
Will it be possible to find the cure in the nearest future which could be combined with the medicines for ADHD that already exist so that it could remove its side effects?
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