ADHD Research: Pharmacological vs. Non-Pharmacological Interventions

This literature review examines the effectiveness of pharmacological and non-pharmacological interventions for school-aged children diagnosed with ADHD, focusing on enhancing attentiveness and decreasing hyperactivity over a six-month timeframe. The review analyzes ten research articles, evaluating their purpose, research approach, data collection methods, results, strengths, and weaknesses. The studies cover various treatments, including methylphenidate (MPH), Omega-3/6 supplements, parenting programs, neurofeedback, and multimodal strategies. Key findings include the potential of combined therapies (MPH and Omega-3/6) for improved symptomatic relief, the importance of addressing psychological barriers in adopting parenting programs, and the role of Omega-3 fatty acids in reducing ADHD symptoms. The review also addresses the fiscal costs associated with ADHD diagnosis and treatment, highlighting the preference for non-pharmacological treatments and the economic impact of both direct and indirect costs. The research emphasizes the need for comprehensive evaluations and effective randomization procedures in ADHD studies, while also acknowledging limitations such as small sample sizes, potential Hawthorne effects, and the lack of untreated control groups. This assignment is available on Desklib, where students can access more solved assignments and study resources.

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Research Literature Support
Name
Institution

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Research Literature Support
The research literature support conducted for the current quantitative study is based on
the PICOT question stated below:
P: School-aged children diagnosed with ADHD
I: Prescribing ADHD
C: Non-pharmacological interventions
O: Will enhance attentiveness and decrease hyperactivity
T: A timeframe of six months
The PICOT intervention question for the study is stated as: “In school-aged children
diagnosed with ADHD, what is the effect of using pharmacological therapies for increasing
attentiveness and decreasing hyperactivity as opposed to using non-pharmacological therapies
within a six-month time frame?” The ensuing sections of the chapter present an analysis of the
research-based references to be adopted by reviewing the purpose, research approach, methods
of collecting data, results, strengths and weaknesses of each scholarly material.
Article 1: Barragán, Breuer amd Döpfner (2017)
Purpose of the research study: The enquiry seeks to analyze the effectiveness of
adopting methylphenidate (MPH), Omega-3/6 as individual treatments, and a mixture of Omega
3/6 and MPH in reducing the symptomatic expressions and impairment of the therapeutic effects
among naïve children affected with ADHD by taking the numerical percentages of the
populations that show positive responses to the treatments availed.
Research approach used: The research adopts an exploratory pilot approach with a
randomized pilot design trial to evaluate the level of safety as well as the effectiveness of
adopting a specified Omega 3/6 as a single treatment and its mixture with MPH as a therapeutic

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intervention for ADHD among school aged children in Mexico. The study embraces an
aleatorized table to randomize participants in an evaluation timeframe of 12 months.
Data collection methods: A Clinical Global Impressions-Severity (CGIS) scale in
combination with an ADHD Rating Scale was adopted in this study to facilitate the processes of
collecting ADHD symptoms depicted by the participants. Further, clinical interviews based on
the DSM-IV-TR criterion were implemented to collect data aimed at revealing the presence of
ADHD comorbidity.
Results of the study: The research revealed a decrease in in the levels of ADHD upon
application of the suggested remedies. However, participants exposed to the combined therapy
(Omega 3/6 and MPH) showed belter symptomatic improvements that those exposed to
uncombined treatments. On the other hand, the trials with MPH+ Omega 3/6 and those that
adopted Omega 3/6 alone were considered to be safer than those that implemented MPH alone.
Strength of the study: The strengths of the study emanate from its ability to adopt a
three arm design and a longer timeframe that allowed the researchers to make conclusive
inferences.
Weakness: The exploratory nature of the study limited its statistical strength. Further, the
scholarly work exposed participants to an increased baseline of disease severity.
Article 2: Smith et al. (2015)
Purpose of the study: The study investigates the motives behind decreased endorsement
and completion of parenting programs (PPs) targeting ADHD patients by scrutinizing the
viewpoints of parents for pre-school children considered as “hard to reach”.
Research approach: The analysis adopts a qualitative research method with the
application of semi structured interviews.

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Data collection techniques: The scholars embraced semi structured interviews to foster the
identification of facilitators and obstacles associated with the adoption of parenting programs for
ADHD.
Results: The research considered the need for institutionalization of change strategies
targeting guardians as an effective way of enhancing the adoption of PPs. Further, the study
highlights on the importance of increasing the cognizance of caregivers and patients of the
psychological barriers to effective adoption of ADHD interventions among children of the school
age.
Strength of the study: The scholarly work adopts a multidisciplinary framework that
includes caregivers, parents and preschool children as part of the participants. Such a position
enhances the validity and reliability.
Weakness: The findings of this research are restricted to a sample size of consisting of
white females. Here are tendencies that a wider range of themes would demystify if participants
from other backgrounds were included.
Article 3: Bos et al. (2015).
Purpose: The scholarly work adopts a randomized placebo-controlled trial to foster the
assessment of the potential effects of adopting Omega-3 poly unsaturated fatty acid (PUFA)
dietary supplements in releasing ADHD symptoms among small boys.
Research approach: The study adopts randomized placebo-controlled double blind trial
approach. In the study design the participants, researchers and parents were blind to the
conditions of treatment established.
Data collection: Telephone interviews were adopted to foster data collection. On the
other hand, DISC-P interviews were adopted among parents to detect the presence of psychiatric

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conditions among the participants. Further a Diet and Lifestyle Change Questionnaire (DLCQ)
was adopted to evaluate the extents to which the participants complied with the set treatments.
Results: The study revealed that ADHD symptoms among developing children can be
reduced through adoption of Omega-3 fatty acids as dietary supplements.
Strength: The strength of the research emanates from its ability to adopt a reference
group that is typically developing to evaluate the extents to which the treatments availed are only
specific to ADHD.
Weakness: Some of the participants adopted in this study with ADHD symptoms
changed their medications in the course of the intervention; an aspect that hindered effective
generalization.
Article 4: Casadei et al. (2017)
Purpose of the study: To analyze the fiscal costs associated with undertaking a 1-year
diagnostic evaluation among children of the school going age seeking treatments in ADHD
reference centers.
Research approach: The study adopted a quantitative approach by reviewing patients’
healthcare data sought from a centralizedADHD registry database.
Results: Non-pharmacological treatments for ADHD are highly preferred to
pharmacological therapies. Further, the study indicated that on average, a child spends about
$1400 on the diagnosis of ADHD on an annual basis.
Strength: The study ensures higher levels of reliability and validity through adoption of
the regional ADHD registry that is not only expansive but also effective in availing clinical data
for patients accessing ADHD centers for pharmacological and non-pharmacological remedies.

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Weakness: The study only relied on the charges adopted by the Regional Health Service
that lacks proper information on the indirect costs of care for ADHD children.
Article5: Tamm, Epstein, Peugh, Nakonezny and Hughes (2013)
Purpose: The research was conducted in order to assess the effectiveness of an ADHD
intervention initiative dubbed Pay Attention!, aimed at training “sustained, selective, alternating,
and divided attention among school going children” (Tamm et al., 2013).
Research approach: The study implemented a randomized clinical trial approach to
meet the desired research objectives.
Data collection: Semi structured clinical interviews were adopted by the study to collect
data on ADHD diagnosis, family functioning and medical history.
Results: Attention training for children with ADHD plays an effective role in enhancing
the ability to focus as well as the parents’ adequacy in fostering executive functioning.
Strengths: The study boasts of its ability to include a large sample size in the
randomized clinical trials.
Weakness: There are tendencies that he study could have suffered the Hawthorne effect from the
participants adopted. Such a position could have increased the rates of replication.
Article 6: de la Cruz et al. (2015)
Purpose: The scholars proceeded with the central objective of investigating the response
of irritability among children with ADHD to treatments that adopt stimulants and/or behavioral
therapies.
Research approach: Multivariate analyses and intent-to-treat frameworks were adapted
to foster secondary investigation of data collected from the “Multimodal Treatment Study of
Children With ADHD (MTA)” (de la Cruz et al., 2015).

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Data collection methods: The data used by the researchers was adapted from the MTA
dataset (MTA96, Version #1).
Results: Simulants play a significant role in enhancing irritability among children with
ADHD.
Strength: The study ensures higher levels of reliability by adopting a large sample size
(n= 7000).
Weakness: The participants adopted for the study were not blinded to the assignments
availed on the treatment group; an aspect that hindered effective determination of the differential
outcomes.
Article 7: Holtmann, Pniewski, Wachtlin, Wörz and Strehl (2014).
Purpose: The scholars examine the influences of neurofeedback and neurophysiological
factors among children with ADHD.
Research approach: The study adopted a randomized control trial with the application
of neorofeedback targeting ADHD patients in outpatient environments.
Data collection methods: The study adopts a Child Behavior Checklist, Strengths and
Difficulties Questionnaires and Quality of Life Questionnaire to collect data pertaining key
participant characteristics.
Results: Neurofeedback was proven as an effective technique of reducing the core
symptoms depicted by ADHD and as an alternative treatment to stimulant therapy among
patients depicting minimized response to medication.
Strength: The ability of the researchers to alienate the use of blinded settings reveals the
strength of the psychotherapeutic treatments adopted by the study in which he participants are
taught on how to acquire the desired behavior.

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Weakness: The research limits its neurofeedback training to the withdrawal of
medications among children affected with ADHD; an aspect that demeans its applicability in
other behavioral disorders.
Article 8: Quintero et al. (2018)
Purpose of the study: To evaluate the direct and indirect healthcare and societal costs
incurred in treating children with ADHD in Spain.
Research approach: The scholars adopt a multicenter, cross-sectional, descriptive
approach based on the Spanish “Plan of Action” research contexts.
Data collection: A case report form (CRF) was adopted to act as a questionnaire in
fostering the processes of collecting primary data.
Results: The researchers established that in Spain the average cost incurred in treating a
child affected with ADHD is $5700 per year. Direct costs accounted for about 60% of the fiscal
expenses incurred in offering direct and indirect treatments for these children.
Strengths: The researchers adopted participants from different regions in Spain; an
aspect that enhances its levels of reliability. Further, the study assesses the fiscal effects by
considering both the direct and indirect costs incurred in dealing with children affected with
ADHD.
Weakness: The researchers do not include the financial effects incurred due to
psychiatric comorbidities which gave been shown to instill significant upward effects on the
expenses incurred in treating ADHD.
Article 9: Moreno-García, Meneres-Sancho, Camacho-Vara de Rey and Servera, (2017)
Purpose: The researchers proceed with the aim of investigating the effectiveness of
multimodal treatment strategies comprising of a combination of neurofeedback and

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methylphenidate as a stimulant medication while comparing its results with those depicted by
single treatments among children with ADHD.
Approach: The study adopts a randomized controlled trial with a complement timeframe
of 6 months
Results: There were great symptomatic improvements after completion of the remedies
administered 6 months after treatment. However, the targeted children did not show significant
advancements in their academic performance as well as their levels of hyperactivity.
Strength: One of the greatest strengths of the study emanates from its ability to adopt
comprehensive evaluations and effective randomization procedures targeting children as the
primary participants based on their age groups, sex, levels of IQ and distribution of the primary
ADHD symptoms.
Weakness: The limitation of the research emanates from its inability to adopt a study
design that incorporates an untreated control group.
Article 10: Raman et al. (2015)
Purpose: The scholars describe the initial pharmacological therapeutic fashions depicted
by children in the United Kingdom as a strategy of evaluating the independent interpreters of
persistence among patients exposed to initial ADHD remedies.
Study approach: The scholars applied a longitudinal observational approach to examine
the degrees of persistence of the ADHD treatments administered among the United Kingdom’s
children of all age groups.
Data collection: The researchers adopted secondary data from The Health Improvement
Network (THIN): a UK based system adopted to store longitudinal electronic patient data.

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Results: The researchers revealed that between 1994 and 2006, 46% of the 2,878
children diagnosed with ADHD were privileged to access at least one prescription within a
timeframe of two years.
Strength: The research reveals higher levels of reliability based on its inherent ability to
adopt a larger sample space (n = 2,878).
Weakness: There are tendencies that the ADHD measurements obtained may be
subjected to multiple variations based on the exclusion criteria adopted. For instance, the
researchers did not underscore the reasons for discontinuing ADHD medications for the cohort
group.
Research Approach and Design
Research method
The intended study will adopt a quantitative research method. According to Creswell and
Creswell (2017), quantitative approaches in research proceed by identifying a hypothesis
followed by the collection of primary and secondary data. On the other hand, Kratochwill (2015)
explains that quantities studies are aimed at verifying the existence of empirical evidence to
support the identified premise. The efficacy of quantitative approaches emanate from its ability
to apply variables in the form of numerical data (Brannen, 2017).
Selected quantitative research design

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A longitudinal descriptive research design will be adopted for the identified quantitative
approach. According to Bryman (2017), descriptive research designs proceed with the aim of
explaining the prevailing state of a phenomenon. The fact that the proposed study aims at
analyzing the effect of using pharmacological therapies for increasing attentiveness and
decreasing hyperactivity as opposed to using non-pharmacological therapies within a six-month
time frame reveals the efficacy of the chosen design as the researcher is only needed to make use
of data that is observational in its upbringing.
Rationale of the descriptive research design
Descriptive research designs that are longitudinal in nature proceed with the aim of
studying a given population within a specified period of time (Chi-Pei and Chang, 2017). The
proposed study proceeds with the aim of analyzing the effect of using pharmacological therapies
for increasing attentiveness and decreasing hyperactivity as opposed to using non-
pharmacological therapies within a timeframe of six months. Therefore, I adopted a longitudinal
descriptive research design based on its higher levels of effectiveness in fostering the
advancement of knowledge and identification of problems aimed at fostering further researches
(Antwi and Hamza, 2015).
Advantage of descriptive designs
One of the greatest advantages of descriptive research designs emanate from their
positions as precursors to future analyses and investigations (O’Rouke, Duggleby and Fraser,
2015, Polit and Beck, 2016). According to Noble and Smith (2015), descriptive research designs
are effective in fostering the identification of variables with the ability of being tested. For
instance, the fact that the current study underscores the effect of using pharmacological therapies
for increasing attentiveness and decreasing hyperactivity as opposed to using non-

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pharmacological therapies within a timeframe of six months may act as a helpful precursor to the
identification of other variables that may be of great essence in impacting he adversity of ADHD
among school going children and other populations.
Disadvantage
The methods used in descriptive research designs give the scholar an allowance of
instilling bias in multiple ways (Norris, Plonsky, Ross and Schoonen, 2015). For instance,
Hussein (2015) and Park and Park (2016) explain that the words adopted in the questionnaires
used in the processes of collecting data could suffer the vulnerabilities of bias on the side of the
scholar. On the other hand, there are tendencies that the scholar may make subjective decisions
concerning the kind of data to be recorded as well as the levels of emphasis on a certain line of
findings (Claydon, 2015).
Sampling
Description of the target population
300 participants of age 6-17 years will be considered for this study. The research will
consider ADHD children referred to the mental health facilities located in Texas within a period
of three years. The children adopted will then be taken through multiple experiments in a period
of 6 months. The researcher will seek consent and approval from the children’s parents,
administrators of the educational institutions they attend and guardians. Further clinical
assessments will be conducted by a qualified psychiatrist to reveal their ADHD statuses.
Inclusion criteria