Deficit Hyperactivity Disorder
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is one of the most regularly diagnosed childhood disorder. ADHD is a neurobehavioral disorder with the potential of impeding a child’s ability to sustain attention and effort. Data from the Centers for Disease Control and Prevention (CDC) indicate that approximately 6.4 million children and adolescents between 4-17 years in the US have an ADHD diagnosis. ADHD is caused by an intricate interaction in genes, environmental influences and brain changes during brain development. Among the symptoms of the disorder include hyperactivity, inattentiveness and impulsivity. Although pharmacotherapy using stimulants can provide temporary relief, psychotherapy is a much permanent intervention for the disorder.
Deficit Hyperactivity Disorder
Attention-deficit/hyperactivity disorder (ADHD) is among the most regularly diagnosed childhood disorders. The disorder is additionally one of the main motivations for children’s reference to psychiatrists, psychologists and pediatricians (Kaiser & Linda, 2011). Part of the reason for need for diagnosis of the disorder is the disorder’s striking symptoms of inattention, hyperactivity-impulsivity, and at other times the presence of both hyperactivity and inattention (Anderson & Guthery, 2015). While the symptoms may be a cause for worry, the resulting effect of these symptoms including functional impairment in school, home and peers, perhaps is even more cause for worry. Moreover, given that the disorder largely affects children, adolescents and adults (to a small extent), it calls for in-depth knowledge of the causes, signs and symptoms, treatment available and management of children, adolescents and adults with the disorder. Statistical information on the disorder’s prevalence and any form of racial bias can also come in handy in early recognition and intervention measures, given that the disorder is treatable.
Literature Review
In its basic sense, ADHD is a neurobehavioral disorder with the potential of impeding a child’s ability to sustain attention and effort (Daly, Creed, Xanthopoulos & Brown, 2007). The disorder additionally impedes the child’s ability to exercise age-appropriate inhibition in both behavior and task in relation to setting and cognition respectively. Data from the Centers for Disease Control and Prevention (CDC) indicate that approximately 6.4 million children and adolescents between 4-17 years in the US have an ADHD diagnosis (Paidipati & Deatrick, 2015). This data is congruent to the Department of Health and Human Services (USHHS) statistics that estimates over 5 million ADHD diagnosis among children aged between 3 and 17 years (Anderson & Guthery, 2015). This data indicates that ADHD affects 5 percent of the school-going children population in the US, with a 2:1-6:1 range in the male to female ratio (Daly, et al., 2007). In their research, Paidipati and Deatrick (2015) used a range of different cultural and ethnic groups to perform their study. However, a majority of the participants had identified themselves as Caucasian. While this does not conclusively relay the fact that the disorder largely affects Caucasian children, it strongly points to that direction. Further research is therefore necessary to unearth the cultural and ethnic prevalence of the disorder among children.
Current advances in neurology, genetics and neuroscience have a conceptualization on the causes of the disorder. According to Paidipati and Deatrick (2015), ADHD is caused by an intricate interaction in genes, environmental influences and brain changes during brain development. The genetic side of the cause means that the disorder runs in the family, and there are therefore chances of developing the disorder, if a member of the family has/had the disorder. There are on the other hand, non-genetic factors that increase the chances for the development of the disorder, and include expectant mother drinking or smoking, complications during birth or low birth weight, lead and toxic substance exposure. Other factors include neglect, food additives and social deprivation.
The disorder’s progression varies from one individual to another. However, research indicates that ADHD is a chronic disorder where the cognitive and behavioral indicators usually appear during the childhood years (Daly, et al., 2007). Such manifestations hence place the children and adolescents at a higher risk of academic, behavioral and social difficulties, in levels higher than those experienced by normal children. Evidence of the higher risks of difficulties has evidence in the fact that despite intensive intervention measure, according to Daly et al., (2007), a majority of children with ADHD (80 percent) proceed to show symptoms of the disorder in their adolescent years.
Evidence in symptoms of ADHD among children may at first look like normal children’s behavior. However, the intensity and frequency of occurrence of these behavior points to the presence the disorder among children. Among these symptoms include hyperactivity, inattentiveness and impulsivity, which Paidipati and Deatrick (2015) call the triad symptoms of the disorder. Paidipati and Deatrick (2015) further inform that the hyperactivity symptoms are mostly common among younger children; impulsivity among adolescents; and inattentive symptoms extend through the course of the disorder, easily understood as neurocognitive deficits, particularly executive functioning.
Given that the key neurocognitive processes associated with executive functioning include selected and sustained attention, time management, planning memory and sensory-motor integration among other functions, children with ADHD, therefore, present symptom that show the absence of these functions (Paidipati & Deatrick, 2015). Among the symptoms such children exhibit include problems with direction, chronic problem in completion of tasks such as homework and chores and easy distraction and forgetfulness of things. Further, such children are also impulsive, switch between activities quickly, easily lose toys, books among other things, as well as touch and play with anything in their presence. The impulsive nature of these children also sometimes makes them blurt inappropriate comments, talk and interrupt others in addition to having trouble in controlling their emotions.
Studies into children with ADHD indicate that such children and adolescents have poor outcomes in different functioning spheres including education, vocation, interpersonal relations and health risks (Evans, Owens & Bunford, 2014). Even more is that these impairments lead to substantial impairments, distress among parents as well as extensive cost to parents (Evans, Owens & Bunford, 2014). The risks associated with untreated or undertreated ADHD are graver as the child becomes vulnerable to the development of serious psychiatric comorbidities such as drug use disorders later in their lives (Paidipati & Deatrick, 2015). While the disorder in itself is a major cause of poor outcomes in education, work, relationship and community, conditions associated with the disorder such as anxiety and mood disorders, autism spectrum disorders and learning disabilities among others further increase the risk of the ADHD victims’ difficulties in educational achievement, family life and healthy relationships (Paidipati & Deatrick, 2015).
Apart from the academic, social and vocational difficulties related to ADHD, parental stress is another common theme related to ADHD. According to Anderson and Guthery (2015), parents of children with ADHD are highly vulnerable to stress. The stress largely emanates from the feeling of inadequacy given the children’s inability to complete fully common tasks such as homework and house chores. Such parents question their parenting capability, and may therefore display less warmth towards the child with ADHD (Anderson & Guthery, 2015). Moreover, such parents would prefer the use of medication as an intervention measure, disregarding the possible side effects of the drugs to the health of the child (Daly et al., 2007). The absence of affectation towards the child with ADHD however has its own ramifications, including eliciting depressive symptom in the child as well as increasing anxiety and the externalization of the behavior by the child (Anderson & Guthery, 2015).
Current treatment and intervention measures for ADHD include both pharmacotherapy and psychotherapy. Pharmacotherapy remains the most popular and preferred form of treatment and intervention for the disorder; one that most parents and guardians advocate for, for the disorder (Anderson & Guthery, 2015). Stimulants remain the most widely and frequently used class of psychotropic agent, accounting for more than 80 percent of the drug prescribe to children and adolescents for the management of ADHD (Daly et al., 2007). Stimulants’ popularity as prescription stems from the fact that they are widely effective in the management of both cognitive and behavioral symptoms of ADHD.
Even with their popular use, critics continue to question their wide use, given that there is lack of sufficient evidence that stimulants have any short or long-term effect on the academic achievement and peer relationship (Daly et al., 2007). Even more criticism against stimulants is the fact that they suppress the children’s appetite, they cause insomnia and that most adolescents are incapable of adhering to the medication regimen. Critics additionally argue that ADHD’s onset has many triggers including a host of family problems including mental health needs and impairments, which stimulants cannot sufficiently treat (Daly et al., 2007).
The criticism against stimulants call for a wholesome intervention, especially in light of parental stress and the fact that ADHD’s symptoms of hyperactivity, inattentiveness and impulsivity largely contribute to the rift in parent-child relationship. For this matter, alternative interventions that are largely psychosocial are advocated, as more effective in the management of ADHD (Anderson & Guthery, 2015). Collectively known as psychotherapy interventions, the programs in this case include parent training, institutional and peer training, equipping the parents, teachers and peers with skills necessary for the management of the children and adolescents with ADHD (Anderson & Guthery, 2015).
For parents, the training includes sessions on that focus on parent/child relationship, increasing the child’s attention and limit setting. Additionally, the program includes training on interventions to increase parental patience and positivity to not only help the parents cope with the child, but also reduce the chances of increased stress due to the child’s behavior (Anderson & Guthery, 2015; Daly et al., 2007). Classroom intervention, involves training of teachers, who then implement behavioral classroom interventions targeting the disorder’s symptoms and the related functional difficulties. Through consultation with psychiatrists and psychologists, teacher can develop definite individual, classroom or school-wide behavioral modification interventions such as verbal commendation, effective command, point system, daily report card or time out system that help in the modification of the children’s behavior (Daly et al., 2007).
Evidence from research supports the fact that children with ADHD have difficulties developing and sustaining relationships (Anderson & Guthery, 2015; Daly et al., 2007; Paidipati & Deatrick, 2015). Moreover, the disorder’s impaired social functioning is among the most incapacitating aspects. Training on social skills, behavioral competencies and social problem solving can go a long in repairing the broken social relationships, given the importance of such relationship in development and mental health. Such interventions also attempt to improve social competence through the encouragement of intimate friendship and doing away with antisocial and undesirable behavior (Daly et al., 2007).
ADHD is an incapacitating mental disorder that largely affects children and adolescents, and can also extend to adults. The disorder affects a considerable number of the US children, and therefore the need for early diagnosis and treatment to enable the child’s normal social development and integration in the community. Although pharmacotherapy through stimulants works to suppress the behavioral manifestations of the disorder, they are not entirely effective and have side effects. Psychotherapy interventions have on the other hand, proven effective as intervention measures to the disorder. It is thus important to use these, given that although slow in taking effect, they have a more permanent effect on the children with the disorder.
References
Anderson, S., B. & Guthery, A., M. (2015). Mindfulness-Based Psychoeducation for Parents of Children with Attention-Deficit/Hyperactivity Disorder: An Applied Clinical Project. Journal of Child and Adolescent Psychiatric Nursing, 28, 43-49
Daly, B., P., Creed, T., Xanthopoulos, M. & Brown, R., T. (2007). Psychosocial Treatments for Children with Attention Deficit/Hyperactivity Disorder. Neuropsychol Rev, 17, 73-89
Evans, S., W., Owens, J. & Bunford, N. (2014). Evidence-Based Psychosocial Treatments for Children and Adolescents with Attention-Deficit/Hyperactivity Disorder. Journal of Clinical Child Adolescent Psychology, 43(4), 527-551
Kaiser, N., M., Pfiffner, L. (2011). Evidence-Based Psychosocial Treatments for Childhood ADHD. Psychiatric Annals, 41(1), 9-15
Paidipati, C., P. & Deatrick, J., A. (2015). The Role of Family Phenomena in Children and Adolescents with Attention Deficit Hyperactivity Disorder. Journal of Child and Adolescent Psychiatric Nursing, 28, 3-13