.

Friday, February 22, 2019

Adhd Research Paper (Argumentative Essay)

Over the past couple of decades there has been a huge change magnitude in the diagnosing and prescriptions hold in gotn bring out for Attention deficit Hyperactivity Dis instal. harmonise to a youngs report done by regular army at once everywhere the past five years intention of minimal brain damage medicaments abide jump-startn 40% totaling 39. 5 million individual prescriptions (New findings, 2009). When statistics resembling this atomic number 18 known it is only normal for virtuallyone to ask questions. mountain ar becoming curious intimately the legitimacy of the trouble, and whether or non the intercessions existence wedded to individuals argon get.The billet seems to be strong on near(prenominal) positionings of the fence, scarcely the extended research done on minimal brain damage leaves it secure for one to believe that it is a made up disorder. Attention Deficit Hyperactivity Disorder or attention deficit disorder is a neuro lookal devel opment disorder diagnosed by a number of symptoms. An article by Ayesha Sajid, Maria C. Poor, and David R. Diaz states that the history of minimal brain dysfunction goes choke off to 1902 when physician Sir George Frederick Sill came up with what he called defect of moral fancy(58). Dr. Still saw this defect to be something beyond the sufferers control.Sajid, Poor, and Diaz go on to talk about the disorders borderinology changes up to 1980 when it was officially recognized as Attention Deficit Disorder, with or without hyper activity. attention deficit hyperactivity disorder has been defined by Russel A. Barkley as a disorder of response inhibition and executive dysfunction track to deficits in self regulation, impairment in the ability to organize manner toward boon and coming(prenominal) goals, and clog adapting sociablely and behaviourally to environ affable demands(Sajid, Poor, and Diaz 58). Subsequently it has been prove that neurotransmitter Dopamine plays a big pi ece in attention deficit hyperactivity disorders symptoms listed above.It plays a astronomic role in our brains functions including motivation, reward, and punishment. In Sajid, Poor, and Diazs article they discuss treating the escape of the neurotransmitter dopamine by using excitant medications (58). They recognize that stimuluss atomic number 18 dopamine supporter which promote the release of stored dopamine(58). Examples of arousal drug medications include still argonnt limited to Aderall, Vyvanse, Concerta, and Ritalin. Although excitants be statistically proven to be the to the highest degree effective form of discourse it is non the only option.There argon several forms of non stimulant drug medications that argon utilize for discussion but not as normally as stimulants. beyond medications be deportmental therapies which rat be effective in treating minimal brain dysfunction. The USA today article New findings raise questions about substance abuse of attention deficit disorder drugs says that at the three year mark behavioural therapies a great deal(prenominal) as p atomic number 18nting and classroom behavioral therapies catch up to stimulant medication treatment. then there was no evident difference in those who received therapies and those who pick up been victorious medications.Results in studies such as these leave galore(postnominal) to conjecture about the appropriateness of stimulant medications. now many argue about the risk of tenacioussighted term effect from stimulant medication use. wherefore not go to alternative treatment methods such as behavioral therapy? And those even much than(prenominal) opposed often deny the existence of minimal brain dysfunction only when. To many it is not a disorder, rather a result of freehanded p arnting, too much sugar, or just the result of an energetic squirt. It is soft to see how these destructions kindle easily be jumped to. A lose of person-to-person experience with the disorder is almost definitely a cause for drop of thought.Those who keep minimal brain dysfunction would be able to specialize anyone it is not something that is tumefy-to-do to understand. The constant lack of motivation, concentration, and control arent symptoms attention deficit hyperactivity disorder victims behind control. Working in inform becomes nearly im affirmable for some with these symptoms and it is not just from laziness. The lack of the neurotransmitter dopamine personal effects these move of the brains functions. These symptoms are something ca apply by a chemical imbalance rather than by the choice of an individual. Though this is true the disorder wont get better on its own. minimal brain dysfunction victims need to help themselves get better, it is a disorder that smoke be overcome. For many no matter what features are available attention deficit hyperactivity disorder is precisely not authoritative. It is diffuse to under stand where hatful with this academic degree of view are coming from. Starting off with the concomitant the minimal brain dysfunction doesnt seem to be present in otherwise countries around the world. Childrens psychologist Angela Southall carrys that 90% of the worlds Ritalin is world prescribed in the fall in States (Southhall). So yes hyperkinetic syndrome is more prevalent in the join States than anywhere else in the world.This leads many to believe that ADHD is something made up by the United States pharmaceutical industry as some sort of hoax. This is definitely an argument that can be credited even by the fence point of view. It does seem that pharmaceutical companies are marketing their ADHD medications strategically in the United States to get as many tidy sum onboard as practicable. On the opposing side of this argument it has little to do with stating whether ADHD is real or not. The ideas of the disorder did in incident come up farther before pharmaceuti cals were involved in the treatment. Another common opposition to ADHD is the medications used to treat it.People wonder why hyperactive small fryren are organism interact with stimulants. The side effects of stimulant medications seem to not be so positive and dont seem to be accep confuse for a child with ADHD. Side effects such as motor tics, insomnia, and loss of appetite are all commonly seen among stimulant medications. Stimulant medications are in alike(p) manner known to be highly addictive. Their is a dangerous possibility of snapper rib with the medications. People wonder if something causes side effects such as these, there mustiness be some sort of possibility of long term effects from medication use.It is definite that stimulant medications are not something to be messed with. They need to be used appropriately by the recompense mass in order for the treatment to be inviolable. Probably the most common argument to ADHDs legitimacy is that it is just the way that child behaves. galore(postnominal) are a slangst ordainting a labeled disorder on a child or adults spoticular behavior. To many a childs behavior is a result of the way they are parented. Kids that are not performing easy in school must have not been parented in good order at home. This is credibly the shimmy for some of the children in school but certainly not all.Many parents go above and beyond to fix their childs behavior before even thinking about putting a medical diagnosing on their child. For many parents this is the last thing they would want to do. It is all- authorized(a) to understand that ADHD is a complex disorder that involves a drawn-out and broad diagnosis knead. Understanding ADHD is not easy and requires an extensive amount of research to gain an intelligence. There are three strategic features when it comes to the ADHD diagnosis influence. Impulsiveness, remissness, and hyperactivity levels are all tested by a checklist of symptoms.An article o n ADHD states that their are five occasions of the diagnosis process. It needs to be understood that all symptoms must be more severe than another individual at a comparable level of development. The five instigates of the diagnosis process are labeled parts A through E (Goldstein and Naglieri 860). Part A contains the often cited 18 diagnostic symptoms Part B requires that symptoms must cause impairment before age 7 C that impairment must be present in deuce or more settings D that there is can tell of clinically signi? cant impairment in social, academic or occupational function (p. 3) and ? nally, E requires that symptoms should not occur exclusively during the melt down of other conditions or be better accounted for by other mental disorders. As you can see a process such as this dedicates it difficult when trying to clearly identify whether an individual has ADHD or not (Goldstein and Naglieri 860). fetching a look at ADHDs 18 diagnostic symptoms is a good way to unders tand they way ADHD effects a certain individual. The American Psychiatric Association lists the following symptoms to be part of the inattention category of ADHD.Failing to pay close attention to contingent or make careless mistakes in schoolwork, hassle sustaining attention in tasks or play activities, not listening when spoken to directly, often does not follow through on instructions and fails to finish multiply types of work, difficulty organizing tasks and activities, often avoids or is reluctant to engage in tasks that require keep up mental effort, often loses things necessary for tasks or activities, often easily flurry by extraneous stimuli, and is often forgetful in daily activities (124).These symptoms are used to secernate what is considered inattentive ADHD commonly known as ADD. The American Psychiatric Association refers to devil more categories of symptoms ascertaining ADHD. The Hyperactivity category includes symptoms such as often fidgeting with hands or f eet, Often leaves seat in classroom or in other situations in which remaining sit down is expected, Often runs about or climbs excessively in inappropriate situations, often talks excessively, often has difficulty playing or engaging in lei accepted activities quietly (124).The next category of symptoms develop by the APA regard impulsiveness. These symptoms include often blurting out answers before questions have been completed, often has difficulty awaiting turn, and often interrupts or intrudes on others (124). These two categories are used to classify two unlike types of ADHD. One be combined ADHD which requires that symptoms from the inattention and hyperactivity categories be present. The other type is hyperactive-impulsive ADHD which requires that symptoms from hyperactivity and impulsiveness are present.For an individual to be diagnosed with ADHD they must not only suffer from a upchuck of symptoms but also fulfill parts B through E of the diagnosis process. The second f our parts of the diagnosis are what separates those with ADHD and an individual that would be labeled as lazy. ADHD is developed in adolescence. This is a big concomitantor in separating those with ADHD, and say college students who trying to receive an Aderall or Ritialin prescription to help get their work done. When cosmos diagnosed it would be hard for a doctor to really tell if the individual had suffered from the symptoms at an early age or not.People of this age being diagnosed results in people questioning the legitimacy of ADHD. It needs to be understood that ADHD symptoms are something that an individual must have dealt with nearly their whole lives. Part C of the diagnosis process states that the symptoms must be present in two or more settings. When a child isnt performing well in school, and matches ADHD symptoms there is not enough evidence to diagnose that child with the disorder. Symptoms must be seen in other aspects of the individuals life such as on a little lea gue sports team or at home.This makes it clear that the person genuinely has enigmas with the control of their actions. Similar symptoms in doubled environments make it clear that someone is actually having problems with ADHD, rather than just school itself. One of the most key parts of the diagnosis process would probably be part D. For and Individual to actually have ADHD the symptoms must be noteworthy. Symptoms are usually declared significant by being compared to by another individual at the same level of development. For modelling some childrens hyperactive behavioral actions could be explained by simply being a child.Children have a hatch of energy and enjoy to play. A child who actually has ADHD would have energy levels much higher(prenominal) than those in the rest of the class. They would appear to be much more restless and inattentive than almost all of the individuals in their class. This is the part of the diagnosis process that really separates the real cases fr om the fakes. People often over exaggerate symptoms in order to be diagnosed with ADHD. The final part of the diagnosis process part E is what declares that a child officially has ADHD.This part of the diagnosis process is what makes sure that a child isnt being misdiagnosed with ADHD. It is necessary to make sure an individuals ADHD is not being mistaken for another mental disorder. This is where it is of the essence(p) that a full background check of the individual is taken into account. It is primal that every little detail of the individuals history is taken in order to avoid a assumed diagnosis. Usually the patients genetic background pull up stakes be looked at to see if any other mental disorders are seen in that patients genetic history.The patients background check is also an important part selecting the veracious treatment. As discussed briefly earlier ADHD stimulants play a big role in the ADHD competition. It is known that stimulant medications are the most common approach to treating ADHD. An article Overview of ADHD make this claim about the effectiveness of Stimulant medications, With reported 65% to 75% clinical improvement in double-blinded placebo controlled trials in both children and adults, they are considered as first-line therapy (Sajid, Poor, Diaz 58).With statistics like this the effectiveness of stimulants cannot be questioned. Sajid, Poor, and Diaz claim that stimulants are the best researched form of treatment (58). They continue to talk about the options of either long acting or short acting stimulate formulations that contain methlyphenidate (58). Methylphenidate is what promotes the release of stored dopamine into the brain and selectively promotes the release of newly synthesized dopamine into the brain. By understanding this it is easy for one to see that dopamine certainly plays a role in ADHD.If sufferers of ADHD didnt have some sort of imbalance of dopamine levels why would the medication be so efficient. This certainl y rules out certain aspects of the opposing sides argument on ADHD. For one this shows that ADHD is not simply a disorder of laziness, bad parenting, or lack of control. The severity and uncontrollableness of the individuals behavior can be further explained by something other than reason. The symptoms are for certain a result of an individuals dopamine levels present in their brain. Through this cultivation one can see that the use of stimulant medications to treat ADHD are appropriate.Unfortunately there is a lot more to the argument for this conclusion to be made. A series of questions are brought up by the opposing view even afterward comprehend information similar to what has been presented. Opposers commonly like to question the increase in the prescription of stimulant medications since their origin. research done by the Commission for Scientific Medicine and kind health shows a 700% increase in the use of stimulant medications since the 1990s (Lefever, Arcona, and Anto nuccio). There is a lot to be said about this increase, as it explains a lot of ADHDs history.A book titled Minimal Brain Dysfunction in Children helps us trace the use of stimulant medications to treat ADHD like disorders back to 1960 (Wender et al. 10). The period of 30 years from 1960 to 1990 was more than enough prison term for people to start actually hearing about ADHD. We can assume that since 1960 the universal public in america has gained a much better understanding of the disorder. For people to be s unploughedics of the disorder and its treatment methods upon their initial discovery is something easy to understand.Once research of the disorder and its medications were made available to the public showing proper information about the disorder it would likely become more acceptable. Although the clock of an increase in the disorders popularity can be explained, the tremendous increase and continuously growing numbers may subdued seem a whodunit to many. These growing numbers can be explained by a a couple of(prenominal) different things. To start the growing popularity of the disorder has made it seem more acceptable to have. Parents of children and adults themselves arent hesitating to be diagnosed and treated for ADHD.This factor by itself can explain an increase in diagnosis since 1990, although something as simple as this doesnt fully explain the 700% increase statistic we have seen (Lefever, Arcona, and Antonuccio). A major part of the problem linking to ADHDs overwhelming increase in acceptance is misdiagnosis and even an entirely false diagnosis. Due to the competitive nature of humans, parents are looking to have their child diagnosed to receive advantages in school. Students who have disabilities are allowed extra time on tests and given other advantages to make up for their disorder.This has parents headed to the doctor to give false accusations about the severity of their childs ADHD symptoms. A statistic given in a Medical News Toda y article states that 46. 7% of the children diagnosed with ADHD only demonstrateed mild symptoms, compared to the 13. 8% that actually suffered from severe symptoms. This statistic provides evidence that a majority of the ADHD diagnosis are made on children who dont display significant problems with their symptoms. As a result of this we can conclude that due to the entailment level of symptoms being 46. % of the ADHD diagnosed cosmos, that a majority of this population doesnt actually have ADHD according to the diagnosis process. The problem of ADHD over diagnosis can be solved through its definition. Author David Antonuccio claims in an article that part of the ADHD definition is statistical rarity trammel only a certain amount of the population to have the disorder. He goes on to say that the ADHD preponderance estimate was set at 3% to 5% (Antonuccio). Having this statistic in the definition certainly verifies that increasing false diagnosis of ADHD is certainly becoming mo re common in The United States.Another article from The Washington Post written by Steven Weinberg shares a statistic that claims 9% of children in America have ADHD. This goes 4% above the prevalence estimate of 3% to 5% when describing ADHDs statistical rarity. This helps us realize that the leniency, broadness, and lack of control over the diagnosis process is what is causing the tremendous diagnosis increase seen in the disorder. Having this information displayed makes it clear how misconceptions about the legitimacy of ADHD are created. People having seen this huge increase in diagnosis and treatment is what makes them question the disorder. this instant having seen how ADHD diagnosis has become increasingly popular we can conclude that it has null to do with the validity of the disorder. This problem belongs to the people of The United States rather than the ADHD community. It is important when looking at the truthfulness of ADHD to look at the definition of the term rather t han the cultural problems it has aroused. The problem of false and misdiagnosis are not the only things that raise questions about ADHD. People seem to think there is only a presence of ADHD in The United States.While it is true that ADHD rates are much higher in The United States, it is certainly not the only province in the world who is involved with the disorder. A newspaper article put out by The Times in the United Kingdom shows that they are transaction with problems similar to those in The United States. The article goes over statistics that display tremendous increases in stimulant medication prescriptions in several different parts of the UK. In a similar article it is stated that in the country Scotland prescriptions increased from 4,000 in 1996 to 72,000 in 2009 (Smith 8).Followed by this he says The frugal Government yesterday said the rise was down to better sensing of ADHD, a result of wider knowledge of the condition among health workers(Smith 8). After taking a lo ok at what is going on in the UK, its galosh to say they are undergoing the same process The United States did years ago. The lack of knowledge about ADHD in previous years is what kept ADHD diagnosis so low in certain countries until more recent years. This helps us clear up the misconception that ADHD is something that only exists in The United States.Countries all over the world are continuously seeing large increases in diagnosis rates of ADHD. The reason the rates arent as high as The United States is simply because the disorder is something new to these countries. Now it should be safe to say that ADHD is in fact a real disorder. With todays technologies resulting in new discoveries on the brains functions and the disorders acceptance present in the worlds developed countries make it difficult for any individual to deny this fact. Although the controversy of ADHDs legitimacy has been made clear, the argument does not end here.In close tattle to the over diagnosis controversy , a similar controversy is aroused by ADHDs stimulant medications. Stimulant medications have aroused a whole new controversy of their own in the medical world today. It is common to see an individual reject the use of stimulant medications because of the various negative side effects that come with their use. The question of long term effects being caused by stimulant medications is being seen more often among users themselves, and anyone else involved in the argument over ADHD.A study shown in the Journal of Psychosocial Nursing and Mental Health Services time lags the answers to these questions. In order to gain an understanding of stimulant medications it is necessary that a brief summary of this study is given. A table titled Effects of Long-Term Stimulant Therapy on Safety Outcomes in Children With ADHD states the following information regarding side effects of stimulants Treatment was well tolerated, 7. 6% of patients discontinued treatment. Minimal effects on weight and hei gh were seen. splendid if any changes in blood pressure or nerve centre rate. Headaches were seen in 3% of patients, insomnia in 19. % of patients, hangd appetite in 18. 7%, type AB pain in 11. 1%, and tics in 9. 4% of the patients (Wilens, Donner, Michaels, Ambrosini, Biederman, and Lerner). As you can see questionable side effects are seen with the use of stimulant medications. There is a possibility to have trouble sleeping, have problems with group AB pain, a decreased appetite, and suffer from tics. This study was done over a two year period so it insures that most side effects caused by stimulants were seen in this study. In the two years of this study nothing was discovered that wasnt know before.With the long term use if stimulants you will most likely suffer from a few negative side effects. ADHD patients involved in stimulant treatment would be able to tell you the side effects may not seem pleasant, but can be overcome by proper use of the stimulant. To begin stimulan t medications must be taken early in the morning to avoid possible insomnia. For extended release stimulants the effects last anywhere from 12-18 hours. Taking your medication early in the morning gives time for the medications effects to break-dance off. It is also important that an individual under treatment makes the effort to eat.Stimulant medications decrease appetite not allowing an individual to realize their hunger. Although one may not feel hungry, it is important to eat healthy foods for every meal of the day. non eating due to stimulant treatment can become a problem and result in serious weight loss. It is important that a few more things are taken into account when being treated with stimulant medications. originally treatment even starts it is important that the proper prescription be given. The article Overview of ADHD gives this information on stimulant treatment, Before prescribing any medication, a full history should be taken.In the case of stimulants, it is es pecially important to check for a personal or family history of heart conditions and arrhythmias. Of Course, a complete physical examination is also required with referral to a cardiologist if indicated from information in the history (Sajid, Poor, Diaz 58). Once heart Conditions are ruled out it is safe to say that with a proper ADHD diagnosis stimulant treatment is appropriate. Parents may want to monitor their children cautiously once treatment begins. It is important to watch the way one reacts to the medications to make sure none of the side effects cause serious harm.Weight and summit should be monitored carefully. In the instance of significant weight or pinnacle change treatment should be discontinued. Stimulant medications hold another refer that give users one more reason to take caution. Stimulant medications are proven to be addictive when the user trim downs their prescribed amount. It needs to be understood that in no case should an individual exceed their recommen ded dose. This is considered abuse of stimulant medications and can result in serious problems. An article regarding the harm and abuse of stimulant medications gives a list of symptoms that help detect ruin or abuse.Users themselves and parents of adolescent users should look for behavioral changes, problems in school or work, change in activities and friends, heightened attention, long periods of sleeplessness, not eating, secrecy and isolation, fatigue, depression, racing heart, mental confusion and delusion, aggressiveness, irritability, mood swings, weight loss, and dilated pupils (McCarthy). These symptoms will all become apparent when dealing with one that abuses their prescription. The possibility of addiction among stimulant users does in fact exist.This addictive attribute can be disregarded given that the prescription is used as directed by his or her physician. Through the series of information given on the effects of stimulants it can be said that theyre appropriate as long as the individual being treated takes the necessary precautions. They are effective in treating those with ADHD, and are the answer to the problem for many. For some individuals stimulant medications may not be the right treatment. In this case there are many other options of treatments and therapies that are appropriate for treating those with ADHD.In fact the effectiveness of behavioral therapies among those with ADHD has aroused another controversy regarding stimulant medications. This relatively new controversy is brought up in the USA Today article New findings raise questions about use of ADHD drugs. A reiterate from the article regarding studies on behavioral therapies says, It now reports the advantage is done for(p) by the three-year mark. By the six and eight-year mark, across 30 musical rhythms of behavior and academics, the children still being given medication by their parents fared no better than their non-medicated counterparts (2009).This quote is referrin g to behavioral therapys ability to catch up to the effectiveness of stimulant medications after a three year period. This causes many to question the use of stimulant medications. It wouldnt make sense to pump your child full of amphetamines when you can gain the same results by behavioral therapy. Refuting the previous argument three years is a long time. As Stimulants are instantly effective many individuals are looking for instant results. Although reaching a conclusion on this argument isnt possible, combined treatment methods completely erase the idea of the argument.If both forms of treatment are seen to be equally effective, why not use them both. With the instant effectiveness of stimulants and the long term effectiveness of behavioral therapies, a whole new therapy can be created that is twice as effective. ADHD patients on stimulants would be more susceptible to participating in behavioral therapies. Thus the therapies process would go much quicker producing positive resu lts in half the time. Combined therapy is the ultimate way for any ADHD victim to overcome their problem.Through all of the information that has been given in this argument two final conclusions have been reached. The first conclusion was that ADHD is in fact a real disorder. The second conclusion would be that among individuals that qualify for their use, stimulant medications are an appropriate method of treatment. After seeing long term studies on the safety of their use and studies on their overall effectiveness it is safe to make this conclusion. As ADHD is one of the most researched disorders in medicate it is only normal for a large portion of information to be left out this argument.The large amount of information that has been left out of this argument makes it natural for objections to be made. For some the evidence presented isnt enough to agnize the truth of the conclusions that have been reached. This is completely understandable among those who are heavily apposed to the argument. It is possible that there is information available that opposes the view that was presented. Chances are that information would be much less credible than what was presented, but it is important to recognize possible objections before the argument is complete.It is only normal for any individual to hold personal beliefs. Individuals opposed to the argument may have their own beliefs that disregard the facts that have been presented. For example an individual that is heavily opposed stimulant medication use would object to the conclusion reached on behavioral therapies. To certain individuals behavioral therapy is better option than the combination of stimulants with therapy. Their personal belief being stimulants are an inappropriate method of treatment leaves the effective option of behavioral therapy to be the better choice of treatment.In this situation credit can be given to this objection, but the facts available dont give it as much support as the original concl usion. There are certainly objections to the argument that can be based on fact. The position stated on the presence of ADHD in other countries will be objected by many opposers of the argument. yet after seeing the factual evidence that ADHD popularity is on the rise in other countries, many would argue that the presence in other countries is only a fraction of what is seen in The United States.This statement may seem to be the basis of a strong argument but is counteracted by other factors. When the numbers are measured in individuals the countries population needs to be taken into account. The US has a much big population than most countries causing individuals as a unit of measure to be much higher. When a percentage is created by dividing the amount of individuals by the countries population much more accurate results becomes available. When looking at ADHD rates in units of percentage similar rates are seen among the worlds developed countries.The most expected objection to the given position would be regarding stimulant medications. Although the results of the two year study regarding the safety of stimulant medication use displayed no significant danger in use, opposers remain pessimistic. To many the evidence provided by a two year study isnt enough. It is strongly believed by many that the long term use of stimulants will eventually negatively impact health. This objection is hard to argue due to the fact that we are not able to look into the future. Negative health effects from long term use of stimulant medications is certainly a possibility.Looking back on the fact that ADHD and its treatments are among the best researched ideas in medicine gives confide that any long term health effects would have by now been recognized. Now that all of the possible flaws on the presented position have been reviewed it can now be said that the conclusions reached are justified. ADHD is in fact a real disorder, and the use of stimulant medications for treatment are appropriate. ADHD is a disorder that should be accepted and understood by society. It is a mental disorder that results in significant behavioral and social problems in an individuals life. The disorder is omplex and causes changes in the brains functions causing a series of symptoms to occur. baseball club needs to realize that disregarding ADHDs legitimacy is offensive to those who suffer from it. It is of import for members of society to regard that use of medications for treatment is the only way for some individuals to overcome these symptoms. Passing on knowledge of ADHD is important to the future of the disorder on those who suffer from it. Regardless of any personal beliefs it is important to respect the beliefs of other. The controversy over the disorder needs to come to an end, and the fact that ADHD is real needs to be recognized.

No comments:

Post a Comment