Mental Health

Diagnosing Attention Deficit Hyperactive Disorder (ADHD) in early childhood continues to prove problematic for pediatric psychological service providers. Traditional diagnostic methods have relied on children being able to engage with higher-order processes in tests which simply aren’t feasible for young children.

This inability to test is further compounded by difficulties inherent in observation-based diagnosis processes. Gilberg (2010) explains that for children 6 years old and younger it is often very difficult to differentiate between disorders and that it is common for multiple conditions to be present simultaneously (Gillberg, 2010). To resolve this problem, Gilberg helped to develop a diagnostic paradigm, ESSENCE, designed to improve the accuracy of ADHD diagnosis in young children (Gillberg, 2010).

A more recent study conducted by Alexandre, Lange, Bilenberg, Gorrissen, Søbye & Lambek (2018) has attempted to correct for noise and other problems inherent early childhood diagnosis of ADHD (Alexandre, et al., 2018). Specifically, this study performed a series of tests assessing symptom frequency in kindergarten age children. The study was run by observing a group in two settings. One observation was performed at home and the other was performed in kindergarten class rooms. Key findings from this study were the observation of regular differences between home and school-based observation on a symptom-specific basis (Alexandre, et al., 2018). The exact causes of ADHD are not known.

In a recent study, Morgan, Staff, Hillemeier, Farkas & Maczuga (2013) showed significant difference in ADHD diagnosis rates for adolescents based on race and ethnicity; however, their conclusion was not able to attribute a specific cause. None of the confound variables tested for were proven to be significant (Morgan, et al., 2013). In another study Burke, Loeber & Lahey (2001) established positive correlations between household tobacco usage and the magnitude of expression for specific ADHD symptoms; however, they were not able to determine if household tobacco usage increases the chances of an ADHD diagnosis (Burke, Loeber & Lahey, 2001).

A study that was able to find a causal correlation between ADHD diagnosis rates and a predictive variable found that the number of hours children spend watching TV in early childhood correlates to higher diagnosis rates (Christakis, Zimmerman, DiGiuseooe & McCarty, 2004). In their work, Christakis & colleagues found that as little as 3 hours of TV per day could contribute to as much as a 28% increase in diagnosis probability by age 7 (Christakis at al., 2004).

Another more recent study has shown positive correlations between smartphone usage and the severity of ADHD symptom expression in adolescents (Kushley, Proulx & Dunn, 2016). More broadly, studies have also shown and inverse correlation between attention ps and cellphone usage for non-ADHD persons as well as increased cellphone usage rates for adolescents and young children (Kushley, Proulx & Dunn, 2016; Rosin, 2013).

Prior to this study, I completed work on XYZM in response to research which indicated potential links between technology use and reduced attention ps / focus levels in adults (Taslim, 2018). The combination of work performed by Gillberg and Alexandre’s research group allowed me (2018) to pursue development of the XYZ Measure questionnaire (XYZM) (Taslim, 2018). XYZM is a sophisticated collection of Likert scale response questions which can be provided to parents and/or caregivers in order to assess technology use and ADHD symptoms.

What makes XYZM so unique is that its use of control and decoy questions allows its scoring to more-accurately predict the age at which an ADHD diagnosis can be confirmed. XYZM also provides minimally biased electronics use report data using a series of adjustments/corrections designed to compensate for caregiver bias. In my clinical trials I, Taslim, (2018) confirmed XYZM’s ability to perform as intended (Taslim, 2018). Specifically, it has been established that XYZM consistently produces accurate technology use measurements data and adjusted age of diagnosis data under test conditions.

Taslim’s work is important because XYZM is one of the first-ever standardized and clinically proven tools for observational diagnosis of early childhood ADHD and it is also an effective tool for observational reporting of technology use. In my study, I plan to build on my, Taslim’s, previous work by exploring correlations between technology use and diagnosis age for ADHD persons. Specifically, I will use a modified version of XYZM to perform a retrospective survey of parents of children diagnosed with ADHD. I will deploy my survey by targeting support groups for parents of ADHD children and leveraging their membership bases for responses.

The retrospective survey will provide comparative data for technology use as compared to specifically touch screen use while also comparing XYZM-predicted diagnosis ages to actual historic diagnosis ages. The purpose of providing this comparative data is to lay the foundation for future investigations into technology use and ADHD diagnosis linkages.

My project is important because establishing this foundation for future research may eventually help to prescriptive understandings of causal links between specific technology uses and attention-based disorder occurrences, particularly ADHD, in young children. Such understandings, should they be achieved, would prove invaluable in the development of new ADHD diagnosis, treatment, and prevention methodologies.

Based on the research discussed, I expect to find positive correlations between types of technology used and ADHD diagnosis rates. A higher diagnosis rate is taken to mean an earlier age of initial diagnosis. It is hypothesized that (H1) age of diagnosis will be inversely correlated with increased XYZM technology use scores; that (H2) XYZM adjusted age of diagnosis will be more consistently and significantly correlated with increased XYZM technology use scores; and that (H3) significant covariance will exist between different XYZM technology use measures as they relate to outcome measures.

If H1 is supported, it will provide evidence supporting correlation between early technology use ADHD diagnosis. If H2 is supported, it will provide evidence that adjusting for confound variables using a sophisticated 3rd party observational technique is an effective means of evaluating ADHD diagnoses in young children. If H3 is supported, it would provide evidence that specific elements of technology use, Ex: touch screen exposure, have unique impacts upon ADHD symptoms and related diagnoses. Taken together, if all 3 hypotheses are confirmed then my study model will have been proven an effective platform for further investigations of ADHD diagnosis and technology use relationships.

Methods

I will be leveraging the XYZM to conduct a proof of concept study investigating links between specific technology usage scores and ADHD diagnosis rates for young children. To serve as a robust foundation for future research, my survey must engage a wide and normally distributed sample from the general population of ADHD diagnosed persons. The study will require considerable time to accrue enough response data. Compensation may be required to induce participation. If I am resource constrained, study participation can be scaled up/down modularly by increasing/decreasing the number of support groups with which we develop relationships.

Participants

​Target participants are persons who were formally children diagnosed with ADHD between the ages of 1 and 7 years old. Response data will be collected using retrospective analysis provided by the subjects’ primary caregivers. Subjects for which response data is received must be widely varied in their race, gender, and socioeconomic status; ideally, I would hope to achieve normal distribution across as many demographic variables as possible.

Primary caregivers will be indirectly. I will target support groups which offer services to caregivers of ADHD diagnosed persons whom I will then use to reach current primary caregivers. It is possible compensation will be required to access support group memberships. If compensation is required, we will attempt to offer as little as is required to induce enough responses. It is also possible compensation will be required to induce primary caregivers to complete the time-consuming XYZM.

In both cases, compensation expenses are not expected to exceed $10 (USD) per respondent and not more than $5,000 (USD) in total. Note, among current primary caregivers, emphasis will be placed on caregivers for children currently aged 2-8 at the time of the study who were diagnosed within the last 12 months. If possible, limiting responses to current providers will help to minimize bias introduced by the retrospective nature of my proposed data collection. Note, it will be important to observe all applicable medical privacy laws re: ADHD diagnoses and to encrypt/secure/anonymize participant data as needed.

Materials/Procedures

​XYZM is an adaptive and sophisticated measure of questions which is administered remotely via a web browser interface. Participants will be able to login and participate via session-specific direct links emailed to them. Note, XYZM is not mobile compatible at this time and must be administered using a desktop computer with an up-to-date web browser. Each XYZM session will take participants between 30 and 60 minutes to complete. The significant completion time variance is the result of XYZM’s adaptive nature.

​For a given participant, their experience will be as follows: First, they will be contacted by a representative from their support group. Second, they will review the prepared survey marketing materials (email/flyer). Third, if they are interested, they will follow a general link provided to setup an online account and generate a session code.

Fourth, they will receive an email with a session code which they will then use to login to an XYZM session. Fifth, they will complete the XYZM session and receive a confirmation message containing a unique confirmation code upon completion. If compensation is given to participants, it will be done so via redemption of confirmation codes. Following these steps will ensure only unique identities are scored. The use of confirmation codes for compensation will also allow for optimizing compensation strategies for future studies.

Measures

​XYZM contains many measures; however, the only measures our study is concerned with using are touch screen use, screen use, age of diagnosis, and adjusted age of diagnosis. (Note, the adjusted age of diagnosis is an algorithmic output of the XYZM. Values produced represent the age at which the child would have been diagnosed with all other factors being equal.

Age outputs range from 1 to 7 years old). The first two variables are independent variables being used to measure specific types of technology usage. XYZM aggregates a series of adaptive Likert scale question responses to produce an index score for each ranging from 1 to 10 with 1 being the lowest possible amount/degree of the specific technology usage and 10 being the highest possible amount/degree.

Age of diagnosis is a self-reported dependent variable, respondents are asked at what age their subject was diagnosed. Adjusted age of diagnosis derived from a series of corrective steps designed to minimize and normalize the impact of confound variables upon diagnosis age across racial, gender, ethnic, socioeconomic, and geographic conditions. Adjusted ages of diagnosis range from 1 to 7 years old. For a full and complete description of how XYZM’s measures are derived and scored, please reference Taslim’s report (Taslim, 2018). See Appendix A, Table 1 for predicted results and see Appendix B for related scatter plot visualizations.

Data Analysis Plan

​The overall intent of this study is to establish preliminary correlations between several variables measured. Specifically, I plan to establish correlations between the independent variables of different types of technology use and dependent variables of diagnosis and adjusted diagnosis age. I will establish correlations by running correlation tests using the SPSS statistical software package. Correlation tests are appropriate for establishing correlations because no additional testing is required.

Specifically, correlation tests are expressly designed to establish correlations, there is no more-appropriate test. Assuming one or more theorized correlations exist, I also plan to compare their magnitudes to confirm H2 and conduct an analysis of variance (ANOVA) between the four variables to address H3. An ANOVA is appropriate in this case because it will help isolate variance between groups so that more-accurate comparisons can be made. Based on literature reviewed, I predict significant correlations will exist; however, it is unclear what the interrelationships will be between said correlations. Confirming H1 should be likely; however, I am less confident about confirming H2 and H3.

Because the overall purpose of this study is to establish preliminary findings as the basis for future work, and because it is unclear what baselines to expect, I plan to set my initial p-value requirement at .1 with a two-tailed t-test. Using this relatively low threshold for significance will allow me to cast a wide net in my analysis. Use of the two-tailed t-test is important because I am unable to predict in which direction my predictions may be incorrect. Note, higher degrees of confidence will be used where applicable; however, lower degrees of confidence will be considered as failing to reject their related null hypotheses.

​I am measuring two related independent variables. The first (IV1) is touch screen technology usage as measured by XYZM. The second (IV2) is screen technology usage as measured by XYZM. It is theorized the interactive nature “touch” technologies will cause them to be more significant predictors of ADHD than their “non-touch” counterparts.

​I am measuring one dependent variable in two different ways. The first (DV1) is a simple self-reported value of the age at which a given participant was diagnosed with ADHD. The second (DV2) is an adjusted age of diagnosis value derived from XYZM’s adaptive algorithm. It is theorized adjusted age values will more-closely match overall IV-DV correlation trends across varied demographic clusters.

​For H1 I expect to find strong inverse correlations between age of diagnosis and technology use: The higher a participant’s technology use score, the lower their age of diagnosis. For H2 I expect to see stronger correlations for DV2 with IV1/IV2 than for DV1, I also expect an ANOVA to reveal reduced variance within DVD2 response groups as compared to variance within DV1 response groups. For H3 I expect to see a stronger and/or more significant inverse correlation between IV1 and DV1/2 than for IV2: Touch screen usage is a stronger predictor of ADHD diagnosis than screen usage. See Appendix A, Table 1 for predicted results and see Appendix B for related scatter plot visualizations.

There is no health without mental health, a growing body of evidence indicates, yet resources to help facilitate and guide health policy to navigate this coordination of care is largely overlooked in our U.S. pediatric population. Childhood mental and developmental disorders are a complicated challenge to healthcare policy makers. Children with behavioral health issues are more likely to experience a compromised developmental trajectory with increased need for medical and disability services if not addressed. Childhood adversity and the perpetuating cycle of adverse events stems beyond the child’s control and is often a subset of inherited problems within the family structure. Approximately 15 million children in the United States – 21% of all children – live in families with incomes below the federal poverty threshold (NCCP).

Socioeconomic and repetitive factors such as poverty and violence perpetuate and force parents and children to both respond or react to each other’s behaviors – physically, physiologically and psychologically; however, the child is reacting to both their own fears and behaviors and responding to the stress of their parent’s reactions. When children are exposed to long term adverse events such as poverty, violence, repeated trauma or neglect, there is a higher likelihood of developing long term health conditions into adulthood. The onset of many adult mental and developmental disorders occurs in childhood.

Childhood adversity is a significant problem in the U.S., particularly for children growing up malnourished and who deal with the same behavioral health issues present in adult lives. Among adults in California, 61% reported adverse childhood experiences (ACEs). Those ACEs were associated with $10.5 billion in excess personal healthcare spending during 2013, and 434,000 Disability-Adjusted-Life-Years (DALYs) valued at approximately $102 billion dollars (Miller et al., 2020). In 2016, 34 million children age 0–17—nearly half of all US children—had at least one of nine ACEs, and more than 20 percent had two or more (Johnson et al., 2017). Children with multiple ACE scores access the healthcare system 2.5 times more often than people with lower or no ACE scores. The higher the ACE score in children, the higher potential an adverse effect can cognitively impair the child as they develop into adulthood.

Children younger than 18 years constitute approximately 25% of the US population and, as is often said, 100% of our future (Dziuban et al., 2017). Transition from pediatric to adulthood population and the role mental and physical health care has in development is critical. Nearly three-quarters of adult disorders have their onset or origins during childhood, becoming harder to treat and incurring ever-greater social, educational, and economic consequences over time (Wissow et al., 2016).

Consistent evidence to support the benefits in integrating mental and physical health for better clinical outcomes in pediatric populations lacks. Because population health data for pediatrics is not federally mandated by all payors for reimbursement as it is required for adult and Medicare populations – the expectations to produce clinical standards is overlooked. While adult primary care is derived from patient-specific interaction, independence and autonomy, health care systems miss the correlation between mental and physical health within the pediatric population and the long-term cost financially associated distinctively – missing that the two health conditions are at times interrelated and can coexist.

There are significant differences between adult and pediatric health care models, which may affect adherence by young adults with chronic diseases (Castillo & Kitsos, 2017). As children experience chronic stress, the amygdala and prefrontal cortex within the brain becomes overworked, altering neurochemistry during what should be a time of cerebral and physiological development. Because children are not cognitively wired to recognize or communicate danger at a young age, continuous triggers and stress to these areas of the brain create greater erosion in what are known as telomeres – effecting the areas responsible for cerebral and physiobiological development.

Research shows that young adults who repeatedly faced biological stress as children showed significant erosion of their telomeres – the protective caps on the ends of DNA strands that keep genome healthy and intact. Adults with adverse childhoods who showed eroded telomeres were more likely to develop chronic disease – making cells age faster, increasing the risk for cancer, heart disease, liver disease, pulmonary disease, auto-immune disease, and obesity.

Mental health is a term often used by many to imply the absence of mental disorders therefore inferring that the individual has reached an appropriate acceptable balance in all aspects of their life. It’s how we think, feel and behave.

In fact, according to WHO (2014), mental health is: ‘… a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.’ WHO also stresses that mental health ‘is not just the absence of mental disorder.’ Mental health can affect every aspect of our lives and sometimes even our physical health.

“ADHD is a neurodevelopmental disorder affecting 5% of children and adolescents and 4% of adult across ethnic, racial, gender, and socioeconomic lines in Europe and around the world (Clark, Carr-Fanning, & Norris, 2011).” There are three types of Attention deficit/hyperactivity disorder. There’s the hyperactive-impulsive type, the inattentive type and the combined type. ADHD rarely looks the same in any two students. The first signs of ADHD are generally diagnosed in primary school – when a child’s lack of focus, forgotten homework, or behavioral issues draws teachers’ attention.

Symptoms used to be mistaken for mood disorders, anxiety, or silliness are finally being recognized as ADHD later in life – commonly when parents recognize themselves in their child’s symptoms. People with ADHD have different levels of neuro transmitters which alter their behavior. These individuals with predominately hyperactive have changes to their dopamine transport gene. Thus affecting the dopamine levels in the brain.

Individuals predominately inattentiveness have changes to their norepinephrine transporter gene which affects the levels of this neurotransmitters in the brain. There are various medications that target these neurotransmitters. Stimulants such as Ritalin and Adderall help increase dopamine levels while those who are predominately inattentive take Strattera which increase the neuron transmitter norepinephrine.

Since there are two distinct types of ADHD, the Hyperactive and the inattentive type there are a number of symptoms for each type of ADHD. The Hyperactive/Impulsive Type is usually identified in students by some of the following; they are most likely to fidget with or tap hands or squirms in their seats. They tend to leave their seats in situations where they are expected to remain seated and often find a need to go for a run sometimes even outside the classroom. They are often unable to play or engage in leisure activities quietly and are seen as always “on the go,” acting as if “driven by a motor” mainly because they are unable to or uncomfortable being still for extended time. They tend to talk excessively and often blurt out answers in class because they have difficulty waiting their turn. They often interrupts or intrudes on others.

On the other hand the Inattentive Type is apparent when the students do not give a close attention to details and make careless mistakes in schoolwork and other activities. They frequently have difficulty sustaining attention in tasks or play activities and probably daydream during lessons. They would often seem with their minds elsewhere while directly spoken to. They do not follow through on instructions and fail to finish schoolwork, chores, etc.

They struggle to organize tasks and activities like managing sequential tasks or keeping their school belongings in order. Hence they often have messy, disorganized work which is never ready on time. They hate engaging in tasks that require mental effort and to their utmost to avoid them. They often lose their school stationery and other school materials. They are easily sidetracked by irrelevant stimuli and are often forgetful in daily activities such as doing their chores, running errands and other responsibilities

A child may be diagnosed with ADHD only if they exhibit at least six of nine symptoms from one of the mentioned above, for a period of at least six months in two or more settings. What’s more, the symptoms must interfere with the child’s functioning or development.

“The condition is best understood as a bio-psychosocial condition, which means that it is medical in origin, but it is affected and influenced by the environment and the social and emotional aspects of the person and situation (Cooper, 2001)”.

The brain is involved in everything we think, feel, and do so ADHD affects many, if not all, aspects of a person’s life. However, ADHD is not a single entity. Rather, it varies across people and fluctuates with age, development, and environmental demands. In addition, the situation is further exacerbated by the fact that individuals with ADHD demonstrate behaviours beyond the core symptoms (Harrison et al., 2010).

According to DuPaul and Stoner (2004) the core symptoms act as a ‘magnet’ for other difficulties which can be more detrimental than the characteristics associated with the ADHD. In fact children with ADHD are more likely than others to also have conditions such as Learning disabilities, Anxiety disorders, Depression, disruptive mood dysregulation, Oppositional defiant disorder, conduct disorder, Bipolar disorder or Tourette syndrome.

Risk factors

A person with ADHD will have socializing problems because to their inattentiveness others might thing they are not interested. They often struggle in the workplace due to a number of factors such as poor organizations skills, concentration problems, keep deadlines for work completion and have a poor respond to rigid authority.

For these reasons they tend to have fewer career achievements hence often change their jobs frequently and may simple quit out of boredom. Adults with ADHD are more likely to engage in sensation seeking activities such as substance abuse. They are also more likely to have problems related with their less than desirable driving.

Aetiology (theories which explain the disorder e.g. biological, cognitive etc.)

ADHD is a brain-based, biological disorder not caused by bad parenting, too much sugar, or too many video games. Various studies reveal that a child with ADHD is four times as likely to have had a relative also diagnosed with the condition.

Although diagnoses of ADHD are based on behavioural symptoms of inattention and/or hyperactivity/impulsivity, evidence suggests that children with ADHD also display a number of cognitive weaknesses in areas that are needed for the student’s daily functioning both at home and in school. Studies indicate that children with ADHD often have problems in executive functions, their working memory and a slower speed of information processing when compared to their peers. It is important to note that many of these cognitive processes are often correlated. For instance, problems in working memory can negatively affect other executive functions, or slow processing speed may reduce one’s ability to recall and organize information.

Strategies and services which support the student and their family at an individual and school level

For students with ADHD establishing a supportive and structured classroom is essential to boost their self-esteem, hence encouraging to learn while still enforcing discipline. That is why it is important to establish rules and routines for them to follow within the classroom. With input from students, establish short, simple classroom rules and state them in a positive way not stating what the student can not to but what s/he should do. This will help students stay on task. The routines should and could be used for all students in class like always having the homework/task at hand written on the board.

Strategies may include providing a visual time table and a reward chart because ADHD students are highly receptive of visual cues. The class LSE could check with the student with ADHD at the end of the day to make sure they understand what is required of them for homework and that they takes all the necessary material with them in order to complete the tasks. Children with ADHD require more guidance than their peers because of their delayed maturity, forgetfulness, distractibility, and disorganization. If the use of an LSE is not an option teacher could opt to use the buddy system where a more responsible classmate could help remind the student with ADHD of homework and classwork.

Another strategy which could easily be adopted by the teacher is to monitoring the student’s progress and develop a plan for him/her to adopt if they fall behind, for example offer a concession for the student to submit his/her work a few days after the rest of the class to help them get back on track. Students may be given more time to finish their classwork, extra time during tests, shorter or segmented writing tasks, which will help keep the student motivated and confident.

It is very important that in class potential distractions are minized as possible, therefor it is vital to have some sort of order even in the class decorations. It’s a good idea to have the students with ADHD sit infront of the class because this will help them stay focused and follow instructions related to the lesson. The use of positive peer model is also an effective way to reduce challenging behavior. Another important aspect is to prepare the students for transition, so a few minutes before changing lesson or class the students should be warned of what is going to happen, in order for the student to prepare accordingly and get less frustrated. Student with ADHD need to be given plenty of time and reminders to cope with the situtuation especially if it is a school trip or any other activity which is outside of their routine.

Students with ADHD will benefit if at the end of the day before going home their school bag is checked to make sure all of the necessary textbook and workbooks needed for the homework are there and that homework is propely listed in the school diary or on the school platform. This could be done by the class LSE or by a more mature student. Students will also benefit a  lot if they are allowed movement preferably something useful or which has a reason, like allowing the student to go to the bathroom or get a glass of water from the office.

Since sometimes this is not possible students can be allowed to play with fidgeters given that they are quite and not too distracting such as a squeeze toy. It is also important that student with ADHD are allowed to take their break even if they are still not finished with their classwork. Letting them take the break with the rest of the class will help them keep the usuall routine while at the same time with the use of play (physical movement) will help promote the student’s focus for the coming lesson.

It is very important for the LSE to built a positive relationship with students and provide frequent positive feedback and praise thoughout the completion of a task. When the student does well in a task, the task could be posted on the class bulletin board hence getting more positive feedback from the rest of the school. This will encourage the students to improve and do better. On the other hand repremending the student is best avoided and instead use different strategies such as questionining. Therefore if you notice the answer of a particular task is not correct, the LSE could ask the student “Do you think that’s correct?’ this will help correct the student without him/her feeling repremended.

On the other hand misbehavior needs to be dealt with not only in class but also at home. This is why communication with the parents/guardians of the child is of utmost importance because it will help reinforce the lessons learned in class not only in terms of behaviour but also accademically. This is why the LSE could either use the student’s diary or set up a communication book to comunicate with the parents on a daily basis, thus informing the parents/guardians of what the student’s needs. This will guide the parents/guardians on how to help the student with completing the homework, or unfinished classwork, help the child organize his work in the necessary folders, and prepare all the necessary material for the next school day. Instead of using a communication book LSE could opt for the use weekly reports.

In regards to school work students with ADHD should only be assigned work that match their skill level hence avoiding tasks that are too long or too difficult for them to complete. Given student a choice about the tasks at hand has proven to be a benecial strategy because they tend to produce better quality work and are less grumby about the task.

Other strategies may include the use of hand-on learning where the students learn things first-hand and the use of role playing games which will help them learn about social aspects of their lives.

Stigma of mental illness and how it can be addressed by schools and policies

While I believe nowadays the Maltese Society is more accepting of Mental illness, there are still some issues about how individual persons relate to mental illness among their families and friends. The impression is that the Maltese tend to avoid talking about, or owning up to the presence of Mental Health issues in the family. Although awareness around mental health issues has improved, the stigma and discrimination that people with mental health problems and their families face, is still high.

This is mainly due to social perceptions of mental health problems and the misconceptions about people with mental health problems continue to prevail not only in the media but also within professional and educational settings as well as in the health sector mainly due to lack of knowledge. That is why in Malta a number of awareness campaigns were launched in 2018 to help increase awareness and better inform the public thereby reducing the stigma related to mental health.

Anna Quindlen in the article, “The C Word in the Hallways” , explains that teenage murder is horrible but it can be prevented. Quindlen supports her claim by giving in-depth details and specific statistics. The author’s purpose is to inform people about this problem so that more parents would be aware with what goes on at their child’s school. The author writes in a serious tone for her readers. Agree with Quindlen when she describes how teenage killers are victims of inadequate mental health care. Some people say that inadequate mental health care is the main reason for teenage killing. Quindlen supports this when she says “Kip Kinkel, now 17, had been hearing voices since he was 12.

” This shows how something as little as hearing voices in your head can cause a big problem. He should have informed someone about these noises in his head. Kinkel should have at least told his parents about the noises in his head so that maybe they could get help. Quindlen also supports her claim when she says “Parents are afraid, and ashamed, creating a home environment, and a national atmosphere, too, that tell teenagers their demons are a disgrace.” Parents really don’t focus on what goes on inside their child’s head. Nobody can really tell if someone wants to kill somebody just by staring at them. Parents need to pay more attention to their child and how they act. Anna Quindlen in the article, “The C Word in the Hallways” describes how teenage killers are victims of inadequate mental health care. She uses in-depth examples and exact statistics to support her opinion.

Recently, A friend asked me, “Why do you work out so much?” Considering I go to the gym at least four times a week, I pondered the question. Truthfully, there is not one answer to this question. There is an abundance of benefits for exercising regularly. Exercise is well known to enhance one’s appearance and increase physical health and stability. What most people do not realize, is that exercise has also been proven to help relieve stress, reduce anxiety, and dramatically increase mental and emotional health. I cannot think of a single aspect of gradually increasing physical activity that would harm a person rather than help them.

The most common interest in increasing exercise is for the health and visual benefits. Regular physical activity reduces the risk for cardiovascular disease, weight fluctuations, and high blood pressure. According to a Mayo Clinic article about the benefits of physical activity, “In fact, regular physical activity can help you prevent or manage a wide range of health problems and concerns, including stroke, metabolic syndrome, type 2 diabetes, depression, certain types of cancer, arthritis and falls. When doctors tend to patients with these types of diseases, it is the norm to encourage the patients to increase activeness.

This is simply because of the plethora of hormones that are increased during physical activity, however, physical wellbeing is not the only benefit from exercising regularly. Anxiety disorders can be closely correlated to our physical inactiveness. Inactivity can decrease brain functionality and can impair emotional and mental health. One of the most frequently used reasons for anxiety is unused energy. The energy a person could be burning while being active, is now being used to create hormones in our brains the secrete stress, anxiety and in some cases, more serious mental illnesses, such as depression, anxiety disorders, and phobias.

Anxiety is also known as the body’s “fight or flight” system. Inactivity is the act of doing nothing, therefore, when we are inactive, our brain can misfire stress and anxiety hormones. Cortisol is a stress hormone, an excess of Cortisol is the cause of anxiety. Physical activity counteracts the release of Cortisol and prevents more from being produced, which will greatly benefit a person’s mental health. Mental health is a person’s condition with regard to their emotional wellbeing. Mental health consists of, and can potentially affect a person’s memory, self-image, emotional state, and alertness. Poor mental health can result in insomnia, high stress levels, and poor academic performance.

Good mental health is important in daily activities. The brain is no different than any other muscle in the human body. Exercise, especially aerobics can greatly benefit brain function. Scientifically, physical activity increases heart rate, which pumps more oxygen to the brain. The brain then actively distributes good hormones that replenish brain cells.

A good flow of oxygen to the brain can decrease a person’s anger and confusion levels, as well as cure headaches. Physical activity enhances one’s appearance and increases physical health and stability, as well as help relieve stress, reduce anxiety, and dramatically increase mental and emotional health. Memory, stress, anxiety, and anger, can all be reduced by physical activity. Even low impact activities such as swimming and walking, can promote physical and emotional health. In retrospect, exercise is imperative to improve one’s life. It only takes one step at a time.

Home phones have limited eaters such as call forwarding, caller identification, vocalism, and of course free long distance. On the other hand, cell phones have a wide variety of features including but not limited to text messages, Internet, camera, e-mail, and application downloads, etc. These cell phones are also known as smart phones or Pad’s. Home phone lines are good for DSL Internet connection, home security systems and faxes. Personally those are the only reasons we have a landlines In our home.

Another difference between the two Is pricing, depending on the type of cell phone and the ATA package that your phone requires they can be more expensive, while your landlines has one monthly bill. Cell phones are such in demand that the local phone companies are now offering cell phone service in addition to regular home phones. While you can record music to your home phone’s answering machine, a cell phone acts as a whole music system and can store hundreds to thousands of songs, depending on the memory on the phone.

Add a memory card to your cell phone, another plus that the home phone doesn’t offer, and this adds even more memory to our phone where music, photos, applications, contacts and much more can be stored. Once the memory card is removed, It can be used In another phone and so you won’t lose your Information. On the other hand, reception complaints with the new Phone, and sometimes every mobile phone In the world, have made the decision to ax one’s landlines less clear-cut than we thought It would be by this stage of the cell game.

But as consumers continue to cut costs, more are cutting the cord. One in four homes in the U. S. Relied on cell phones alone during the last half of 2009, an increase of 1. Percentage points since the first half of 2009, according to a survey by the National Center for Health Statistics. Having a landlines means relatives and family friends can reach all members of your household (in theory) by dialing one number and/or leaving one message. (That’s assuming voice mail in your household gets checked more than once every two months. It also means you can have several phones within your house, rather than conjoining yourself to your cell phone In order to hear Incoming calls. Landlines phones don’t require you to plaster yourself against he bay window to hear and be heard. Although a landlines-based cordless phone sometimes has spotty reception If you’re far from the phone’s base. Relying solely on a cell phone demands diligence in keeping it charged. A landlines will work in power does require AC power, you can buy a four- to six-hour battery backup from your service provider for around $45.

Verizon fiber phone service will provide you with one free. And, Consumer Reports still recommends having landlines service, because emergency services can more reliably locate you quickly from a 911 call on a landlines than from a cell phone. Based on advancements, it is reviewing that advice and may revise it later in the year after a survey of consumers’ 911 experiences. While the landlines is more reliable than the mobile phone, it lacks the ability to be carried around and utilized in all day-to-day activities.

Mobile phones also provide callers with the ability to send text messages and, in some cases, take photographs, surf the Internet and play games. With cell phones, wallpapers or backgrounds can be personalized, as well as ring tones. Landlines consume more energy than cell phones, as they remain plugged in at all times. This is true of cordless landlines phones as well, because of the charger required. And while mobile phones generally do not last as long as landlines (as they often become outdated), they are easier to recycle.

Mobile phones are more for people on the go, the ability to make a phone call at any time from any place have saved countless lives especially people who have been in car accidents. There are many advantages to owning a cell phone from staying connected, safety reasons and general convenience, but is that enough reason? When it comes to landlines vs.. Cell phones, landlines can’t compete when t comes to features the mobile phone is way ahead when it comes to that.

The downside to mobile phones is you have to keep them charged whereas a landlines you do not. When it comes down to it the deciding factor is going to be your budget if you really don’t have money to spare each month, dishing out for a phone isn’t going to be very helpful but if you have an extra ten dollars and you feel you could use a mobile phone for convenience or maybe to stay in touch with your spouse or children while you’re out, then you might want to consider the pay as you go option.

Life Skills in Substance Abuse and Mental Health Treatment School of Advanced Studies, University of Phoenix Wesley Tyler Meredith Ward Substance Abuse and Mental Health Treatment Recidivism relates to a person repeating an undesirable behavior after they have either experienced negative consequences of that behavior, or have been treated or trained to extinguish that behavior (Henslin, 2008).

Progress being made in families and individuals due to lack of life skills that lead to causal factors to high recidivism rates in substance abuse and mental health treatment has been a growing issue posed by researchers. According to Miller & Hobler (1996), “In Deleware, 84% of Life Skills participants are male; 66 percent are African-American; 25% are white, non-Hipic; and about 6 percent are Hipic. The average age is 31.

The lead offenses of 33% of the participants are violent offenses against persons; 38% are drug offenses, the more serious of which also are classified as violent in Delaware”. “Despite advances, differences in health status and access still remain. Minorities are still at increased risk, primarily because they live in adverse conditions linked to poverty” Hall (1998, p. 1). Problem Formulation Poor life skills are thought to increase recidivism among minorities (Reference) .

The purpose of this study is to determine whether addicts who have completed life skill training have an improved recidivism rate over those who have not received life skills training. This study may provide education on effective life skills training and reinforce the importance of substance abusers with life skills. Study Design and Research Method A quantitative correlation study will be used to measure two different variables; life skills (independent) and recidivism (dependent) in order to determine whether and in what way recidivism and life skills characteristics might be interrelated.

Quantitative studies quantifies observable behaviors and each occurrence of the behavior is counted to ascertain frequency (Leedy & Ormrod, 2010); non-experimental quantitative studies show correlations between variables and examines the extent to which differences in one variable is related to differences in one or more variables (Leedy & Ormrod, 2010); this methodology will look at the relationship between life skills and recidivism and the effect poor life skill training has on the increase of the recidivism rate.

Research Question 1. Does life skill training reduce recidivism in drug addicts? Through historical and developmental research an effort to reconstruct or interpret historical events through the gathering and interpretation of relevant historical documents and/or oral histories. Primary research data will consist of surveys, in-depth interviews, focus groups and experiments. Primary data will be gathered through informal interviews and observations.

According to Lev, Brewer, & Stephenson (2004), “Interviews can be used to determine what services current customers would like to have access to, while observation can be used to determine which current providers are popular through other vendors. ” There is an emerging literature on the relationship of coping strategies and substance use. Some evidence shows that individuals naturally adopt coping strategies to moderate behavioral and substance abuse problems (King & Tucker, 2000; Sugarman & Carey, 2007).

Similarly, in a study with heroin users, participants who were abstinent at follow-up had greater increased use of coping responses compared with participants who had lapses or relapses (Gossop, Stewart, Browne, & Marden, 2002). Secondary research may consist of published research and data provided by the government in addition to data collected and analyzed by private companies. Secondary research will be gathered through peer reviewed journals and publications. Contribution to knowledge

According to Samhsa (2011), “The use of illicit drugs among Americans increased between 2008 and 2010 according to a national survey conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA). The National Survey on Drug Use and Health (NSDUH) shows that 22. 6 million Americans 12 or older (8. 9-percent of the population) were current illicit drug users. The rate of use in 2010 was similar to the rate in 2009 (8. 7-percent), but remained above the 2008 rate (8- percent). ” (para. 1).

The proposed study may contribute to the literature and to leaders in the substance abuse field by further research and understanding of patterns in healthcare services provided to substance abuse and mental health recipients. Factors that influence recidivism among minority recipients are very important to filling the gap and delivering accurate treatment. This study may contribute to probable causes of inadequate life skills such as income, education, healthcare literacy and services solicited to target market are variables or central phenomena of the study.

Review of Relevant Scholarship “We stand at a crossroads in our nation’s efforts to prevent substance abuse and addiction,” said SAMHSA Administrator Pamela S. Hyde. “These statistics represent real lives that are at risk from the harmful and sometimes devastating effects of illicit drug use. This nation cannot afford to risk losing more individuals, families and communities to illicit drugs or from other types of substance abuse — instead, we must do everything we can to effectively promote prevention, treatment and recovery programs across our country. Research Question 1. Does life skill training reduce recidivism of drug addicts? References Henslin, James. “Social Problems: A Down-To-Earth Approach. ” (2008). Miller, M. L. , & Hobler, B. (1996). Delaware’s Life Skills program reduces inmate recidivism. Corrections Today, 58(5), 114. Retrieved from EBSCOhost. SAMHSA. (2011). Retrieved from http://www. samhsa. gov/newsroom/advisories/1109075503. aspx