Biopsychological
Research Methods in ADHD
The most prevalent childhood disorder, attention
deficit hyperactivity disorder (ADHD), impedes the ability to focus, maintain
attention, control behavior, and causes overzealous activity (NIMH, 2012). “Approximately 4.4 million children in the
United States meet criteria for the disorder and half are receiving
pharmacological treatment” (Martin, Hymer, Poprawski, & Associates,
2010). The symptoms range from mild to
severe functional deviations of the central nervous system, inclusive of
boredom, daydreaming, excessive or disruptive talking and playing, anxiety, and
impatience. Although ADHD was once
exclusively considered a childhood disease, modern research indicates that
individuals are prone to retain such symptoms throughout adolescence and into
adulthood. Those afflicted with the
disorder are typically proficient, lacking significant neurologic or
psychiatric disturbance (Remedy Health Media, 2012). However, the disorder tends to impede
concentration, hence, academic performance, career stability, and safety
measures may be compromised. The causes
of ADHD are extensively regarded as inheritance, environment, brain injury,
sugar, and food additives. Furthermore,
as several of the symptoms associated with this disorder are common among all
children, it may be difficult to diagnose.
Thus, licensed health professionals must gather the subject’s personal
and familial information and consider his or her behavior and environment
(NIMH, 2012). Major components to
managing ADHD, as with most disorders and diseases, are early detection and
adequate treatment which may improve work performance, social interaction, and
overall quality of life (Mayo Clinic, 2012).
Treatments ranging from medication, psychotherapy, instruction or
training, or a combination of techniques are employed to reduce symptoms and
progress functioning (NIMH, 2012). Of
these, the foremost method of treatment is a pharmacological approach, yet practitioners
have sought invasive electrophysiological recording methods and magnetic
resonance imaging (MRI) as well (Pinel, 2011).
When implementing these methodologies, the practitioner must consider
the advantages and disadvantages or side effects in relation to the
individual. In effort to examine these
methods the following case studies have been reviewed.
The first study explores the usage and effect of
medication in treating ADHD, a pharmacological approach. Stimulant drugs such as methylphenidate (MPH)
and amphetamine, typically Ritalin and Adderall, are commonly prescribed. “Since the 1990s there has been a precipitous
increase in pharmacotherapy for treating this disorder in young children. In fact, the use of stimulants for preschool
children enrolled in state Medicaid programs doubled over the 6-year period
1992–1998” (DuPaul & Kern, 2011, p. 149).
Historically, these means have consistently proven to augment one’s attention
span and impulse control. However, in
more recent times, nonstimulant meds such as Strattera, Catapres, and Intuniv
are utilized. Thus far, the side effects
of nonstimulants are less harmful than those of stimulant drugs, while enhancing
educational and social functioning. Yet,
the effects of nonstimulants are inconclusive as they are not widely
utilized. Hence, the focal point of ADHD
treatment remains on stimulant medications.
The leading research of such is the Preschool ADHD Treatment Study (PATS)
(DuPaul & Kern, 2011). Initially,
this study included 303 participants (76% boys, 24% girls) age 3 to 5.5
years. Once the children were screened
and their parents were trained over a 10 week period, 147 participants
remained. Over the next 9 weeks, the
children were administered MPH, of which the first 5 weeks consisted of dosage
levels of placebo, 1.25mg, 2.5mg, 5mg, and 7.5mg, as each dosage was used for
each week. Once the most appropriate
dosage per child was determined, the last 4 weeks the participants were
randomly given either the placebo or their optimal dosage. During this time, researchers utilized parent
and teacher ratings in conjunction with the observation of behavior in a
classroom setting. Results during the
initial 5 weeks indicated that ADHD symptoms significantly declined with the 3
highest dosages although they did not fluctuate among those dosages. Additionally, 12% of participants
demonstrated no response or a more favorable response to placebo as opposed to
their full dose of MPH. These
participants along with 26 others who demonstrated faltered behavior or extreme
adverse side effects were excluded from the remaining 4 weeks, leaving a sample
of 114 children. Of these, 77
participants completed the remainder of the study. Again, it was determined that optimal levels
of MPH resulted in fewer ADHD symptoms than placebo dosages. Moreover, participants receiving optimal
doses exemplified more social competence and overall improvement as opposed to
participants receiving placebo.
Furthermore, nearly 30% of remaining participants experienced moderate to
severe side effects including decreased appetite, trouble sleeping, and weight
loss. The potential of stunted growth
was a concern as well. These effects
occurred more often after MPH dosage versus placebo. Post-study, 95 PATS children participated in
a 10 month open-trial period in which they continued to receive their optimal
dosage, 14-20mg per day, inclusive of observation and necessary
adjustments. Results held constant. However, 45 additional children who
exclusively participated in the 10 month trial phase ceased treatment due to
adverse side effects, poor behavior, or switching to alternative stimulants (DuPaul
& Kern, 2011). These findings
indicate that gradually introducing medication is more favorable than initially
administering higher dosages. In
general, utilizing pharmacological methods inclusive of stimulant medications
such as MPH to treat children with ADHD may effectively reduce ADHD symptoms
increasing the child’s social function, although, recipients and parents should
be aware of relative adverse side effects.
Next, practitioners must implement additional
biopsychological means to study ADHD.
One method to consider is brain imaging, more specifically magnetic
resonance imaging (MRI). This procedure
utilizes high-resolution images “constructed from the measurement of waves that
hydrogen atoms emit when they are activated by radio-frequency waves in a
magnetic field” (Pinel, 2011, p. 104).
This three dimensional imagery illustrates variances in spatial
location. In a particular instance,
researchers from the National Institute of Mental Health concluded that
individuals suffering from ADHD maintained lower rates of glucose, the brain’s
chief energy source, predominantly in regions controlling attention,
handwriting, motor control, and inhibition reactions (Remedy Health Media,
2012). Additional research concludes
that “the claustrophobic and anxiety inducing environment of MRI machines
result in greater attrition for subjects who are younger, female, and anxiety
sensitive, such as ADHD subjects” (Czarnolewski, 2011, p. 2).
Another means of treating ADHD is the invasive
electrophysiological recording method.
These processes enable practitioners to examine the
function and dysfunction of the neural system (Aston-Jones & Siggins,
2000). More specifically,
electrophysiological measures of activity in the central and the autonomic
nervous systems are analyzed to determine the core deficits in ADHD (Barry,
Clark, & Johnstone, 2005). Utilizing
this methodology, researchers from the Chicago School of Professional
Psychology, Loyola University Psychology, and First Chicago Neuroscience
Research observed ADHD amongst children.
The study included 30 participants, 17 males and 13 females, aged 6-17, as they completed both an
initial baseline and post-medication observation to examine brain electrophysiology
through quantitative electroencephalography (qEEG). Furthermore, they self-evaluated their mood,
inclusive of depression and anxiety testing, were given IVA + Visual and Auditory Attention Testing in order to calculate
attention and response capacities, and orally received Adderall or Ritalin. As the children were seperated into electrophysiological
clusters, researchers examined their response to the stimulants. The results indicated that the participants
did not replicate traditional data. The
majority of the children demonstrated surplus amounts of frontal-central
bilateral beta in their qEEG and additional irregular blends of fast and slow
wave movement. Additionally, two new electrophysiological
clusters were introduced. The
participants illustrating positive responses to the medications, regardless of
Adderall or Ritalin, proved to have enhanced frontal lobe beta suppression and decreased
negative dispositions. Consequently, overall
attention and response levels were increased or normalized. In comparing the participants to those
afflicted with ADHD in traditional research, the participants exemplified
varied hyperactive behaviors and more severe symptoms (Martin et al., 2010). Moreover, as opposed to other brain imaging
methods such as PET, SPECT, MRI and MRS, the qEEG method enables practitioners
to perform simultaneous tasks and is considered an effective, safe, and
inexpensive means of examining cortical electrophysiological dysfunction in
neuropsychiatric disorders such as ADHD (Song, Shin, Jon, & Ha, 2005).
In
closing, ADHD encompasses functional deviations of the central nervous system
affecting an individual’s attention span and impulse control as well as
hyperactivity (Remedy Health Media, 2012).
While it affects approximately seven percent of children in the U.S., it has
the potential to exist throughout adolescence and into adulthood. As ADHD has become more common in modern
times, practitioners are increasingly implementing biopsychological
methodologies to diagnose, evaluate, and provide treatment. Hence, pharmacological, invasive
electrophysiological recording and magnetic resonance imaging are utilized. Furthermore, neuropsychological research is
applied. As the causes vary from altered
brain function and anatomy, heredity, maternal smoking, drug use, environmental
toxins, sugar and food additives, these methods assist practitioners in their
efforts to identify and observe such as well as the behaviors associated with
the ADHD (Mayo Clinic, 2012). Currently,
numerous variants and genetic phenomena are yet to be discovered. Therefore these methods will remain
beneficial in the explanation, diagnosis, and treatment of the condition.
References:
Aston-Jones, G.S. & Siggins, G.R. (2000). Electrophysiology.
Retrieved May 21, 2012, from
Barry, R.J., Clark,
A.R., & Johnstone S.J. (2005). Electrophysiology in attention deficit /
hyperactivity
disorder. [Electronic version]. International
Journal of Psychophysiology 58, 1-3.
Czarnolewski, M. (2011). Further ADHD differences
identified with a false discovery test.
Washington, DC:
American Psychological Association.
DuPaul, G.J. & Kern, L. (2011).
Psychotropic medication treatment. In G.J. DuPaul & L. Kern,
Young
children with ADHD: Early identification and intervention (pp. 149-165).
Washington, DC:
American Psychological Association.
Martin, C.N., Hymer, J., Poprawski,
T.J., Paciora, R.A., & Konopka, L.M. (2010). Childhood
ADHD: translating
electrophysiological laboratory findings into a clinical setting. American Psychological Association 2010
Convention Presentation. Retrieved May 21, 2012, from http://web.ebscohost.com/ehost/pdfviewer/pdfviewer?sid=da778f01-4630-4125-8786-5968ab89e65e%40sessionmgr113&vid=29&hid=123.
Mayo Clinic. Attention deficit /
hyperactivity disorder (ADHD) in children. Retrieved May 21,
2012, from http://www.mayoclinic.com/health/adhd/DS00275.
NIMH. Attention Deficit
Hyperactivity Disorder. Retrieved May 21, 2012, from
Pinel, J.P.J. (2011). Biopsychology
(8th ed.). Boston, MA: Pearson Education, Inc.
Remedy Health Media. Attention
deficit / hyperactivity disorder. Retrieved May 21, 2012,
