ATTENTION DEFICIT/ HYPERACTIVITY DISORDER (ADHD)

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ATTENTION DEFICIT/ HYPERACTIVITY DISORDER (ADHD)

  1. 1. Attention Deficit/Hyperactivity Disorder (ADHD)Bowlby, J. (1980). Attachment and loss. Vol. 3: Loss, sadness, and Thompson, R. A. (1998). Early sociopersonality development. In depression. New York: Basic Books. W. Damon (Series Ed.) and N. Eisenberg (Vol. Ed.),Cassidy, J. (1994). Emotion regulation: Influences of attachment Handbook of child psychology. Vol. 3: Social, emotional, and relationships. In N. A. Fox (Ed.), The development of personality development (5th ed.) (pp. 25–104). New York: emotion regulation: Biological and behavioral considerations. Wiley. Monographs of the Society for Research in Child Development, Van den Boom, D. C. (1994). The influence of temperament 59(240), 228–249. and mothering on attachment and exploration: AnCassidy, J., & Shaver, P. R. (Eds.). (1999). Handbook of experimental manipulation of sensitive responsiveness among attachment: Theory, research, and clinical applications. New lower-class mothers with irritable infants. Child Development, York: Guilford Press. 65(5), 1457–1477.Crittenden, P. M. (2000). A dynamic-maturational approach to Van IJzendoorn, M. H., Dijkstra, J., & Bus, A. G. (1995). continuity and change in pattern of attachment. In P. M. Attachment, intelligence, and language: A meta-analysis. Crittenden & A. H. Claussen (Eds.), The organization of Social Development, 4(2), 115–128. attachment relationships: Maturation, culture, and context (pp. Van IJzendoorn, M. H., & Kroonenberg, P. M. (1988). Cross- 343–357). Cambridge, U.K., and New York: Cambridge cultural patterns of attachment: A meta-analysis of the strange University Press. situation. Child Development, 59(1), 147–156.De Wolff, M. S., & van IJzendoorn, M. H. (1997). Sensitivity Waters, E., Hamilton, C. E., & Weinfield, N.S. (2000). The and attachment: A meta-analysis on parental antecedents of stability of attachment security from infancy to adolescence infant attachment. Child Development, 68(4), 571–591. and early adulthood: General introduction. ChildFonagy, P., & Target, M. (1997). Attachment and reflective Development, 71(3), 678–683. function: Their role in self-organization. Development and Psychopathology, 9, 679–700.Goldberg, S., Grusec, J. E., & Jenkins, J. M. (1999). Confidence Nancy L. McElwain in protection: Arguments for a narrow definition of attachment. Journal of Family Psychology, 13(4), 475–483.Hazan, C., & Shaver, P. R. (1994). Attachment as an organizational framework for research on close relationships. Psychological Inquiry, 5(1), 1–22.Main, M., Kaplan, N., & Cassidy, J. (1985). Security in infancy, ATTENTION DEFICIT/ childhood, and adulthood: A move to the level of HYPERACTIVITY representation. In I. Bretherton & E. Waters (Eds.), Growing DISORDER (ADHD) points of attachment theory and research. Monographs of the Society for Research in Child Development, 50(1–2), 66–104. According to the Diagnostic and Statistical ManualMain, M., & Solomon, J. (1990). Procedures for identifying (fourth edition, text revision [DSM–IV–TR]; 2000), infants as disorganized/disoriented during the Ainsworth Attention deficit hyperactivity disorder (ADHD) is char- Strange Situation. In M. T. Greenberg, D. Cicchetti, & E. M. acterized by a pervasive and persistent lack of attention Cummings (Eds.), Attachment in the preschool years: Theory, and/or heightened activity level. Children with ADHD research, and intervention (pp. 121–160). Chicago: University are defined as quantifiably distinct from their peers as of Chicago Press. they have problems paying attention, staying on task, andMain, M. & Weston, D. R. (1981). The quality of the toddler’s relationship to mother and to father: Related to conflict remaining sedentary. These particular behavioral patterns behavior and the readiness to establish new relationships. are especially problematic in the school setting as chil- Child Development, 52(3) 932–940. dren displaying ADHD traits produce work that is dis-McElwain, N. L., & Booth-LaForce, C. (2006). Maternal organized and incomplete and they are easily distracted sensitivity to infant distress and nondistress as predictors of by extraneous stimuli. Symptoms of hyperactivity include infant-mother attachment security. Journal of Family fidgeting, squirming in one’s seat, talking excessively, Psychology, 20(2), 247–255. and/or acting as though one is driven by a motor (Amer-NICHD Early Child Care Research Network. (1997). The effects ican Psychiatric Association [APA], 2000). of infant child care on infant-mother attachment security: Results of the NICHD Study of Early Child Care. Child ADHD diagnoses have risen steadily since the 1970s Development, 68(5), 860–879. in the United States, yet many other countries report little,Oppenheim, D., & Goldsmith, D. F. (2007). Attachment theory if any, ADHD among child and adolescent populations in clinical work with children: Bridging the gap between research (Breggin, 2002). Historically speaking, ADHD is a rela- and practice. New York: Guilford Press. tively new phenomenon, and although millions of Amer-Schneider, B. H., Atkinson, L., & Tardiff, C. (2001). Child- ican children now carry the ADHD label, this was not parent attachment and children’s peer relations: A always the case. In the 1950s, ADHD did not exist in the quantitative review. Developmental Psychology, 37(1), 86–100.Sroufe, L. A., & Fleeson, J. (1986). Attachment and the United States. In the 1970s, an estimated 2,000 American construction of relationships. In W. W. Hartup & Z. Rubin children (the vast majority of whom were boys) were (Eds.), Relationships and development (pp. 51–71). Hillsdale, diagnosed as ‘‘hyperactive’’ and the standard method of NJ: L. Erlbaum Associates. treatment was behavior-modification therapies. In 2003ENCYCLOPEDIA OF THE LIFE COURSE AND HUMAN DEVELOPMENT 35
  2. 2. Attention Deficit/Hyperactivity Disorder (ADHD)the Centers for Disease Control and Prevention reported a psychiatric disorder by the APA and, as such, wasapproximately 4.4 million American children had been included in the DSM until 1978. Defining homosexual-diagnosed with ADHD (again, the majority are boys), ity as a mental disorder clearly illustrates the subjectiveand the accepted method of treatment was daily doses of nature of the DSM and clarifies that perceptions of whatMethylphenidate (MPH), often referred to by the brand constitutes a legitimate mental disorder can change overname of Ritalin (Breggin, 2002; Stolzer, 2005). time. Despite the combined efforts by the APA and the Although it is accurate to report that ADHD diag- pharmaceutical industry, which both actively promotenoses are increasing in many westernized countries, ADHD as a neurologically based brain disorder, therescholars have pointed out that 80 to 90% of MPH exists no scientific evidence to substantiate this claimproduced worldwide is prescribed for American children (Baughman, 2006; Breggin, 2002). No neurological orin order to control behaviors that have just recently been metabolic tests are performed to confirm the existence ofclassified as pathological (Leo, 2000). Relatively recently, ADHD. Rather, diagnostic testing typically follows atypical childhood behaviors such as not paying attention prescribed pattern:and being physically active in confined classrooms hasbeen classified by the DSM–IV–TR as a verifiable mental 1. The child is having difficulty in school;disorder. According to the DSM–IV–TR (APA, 2000), 2. The parents are called in for a conference and aresymptoms of ADHD include ‘‘fidgeting,’’ ‘‘running or informed that in order to get the child the help he/climbing excessively,’’ ‘‘often has difficulty playing qui- she needs, a formal assessment must be conducted;etly,’’ and ‘‘often fails to give close attention to details ormakes careless mistakes in schoolwork.’’ Symptoms must 3. The formal ADHD assessment is done using abe present in two or more settings (e.g., home, school, or standardized checklist of behaviors for the specifiedvarious social settings), although it is unlikely that the child;child will display the same level of dysfunction in all 4. The child is then referred to a physician (most oftensettings as symptoms typically worsen in environments that to a general practitioner);require ‘‘monotonous’’ and ‘‘repetitive’’ tasks (p. 86).Conversely, ADHD symptoms are minimal (or absent) 5. The physician relies on a standardized ADHDwhen the child is receiving positive reinforcement, is under behavior checklist, and if the child exhibits six out ofclose supervision, is in an interesting environment, and/or nine of the ADHD behavior patterns, he/she isis engaged in an activity that they find enjoyable. Typically, formally diagnosed with ADHD;symptoms of ADHD are present before the age of 7 6. Psychotropic medication is the prescribed treatment(APA, 2000). plan. Many scientists have actively refuted the reliabilitySCIENCE BEHIND THE FINDINGS and validity of current ADHD assessment proceduresScholars have suggested that the DSM ’s diagnostic criteria (Baughman, 2006; Carey, 2002; Stolzer, 2007). Accord-have serious scientific flaws. Fred Baughman (2006) asked: ing to published research, ADHD assessment tests areAt what point does hyperactivity become ‘‘persistent’’? How highly subjective and vary tremendously from one raterdoes one tell the difference between ‘‘normal’’ childhood to the next (Carey, 2002). The answers contained on thebehavior and pathology? Baughman also asked: What is assessment tests are limited to never, rarely, sometimes,‘‘typical’’? typical for a particular classroom? a particular often, and always. Scientifically speaking, these are notgeographical location? or perhaps a particular culture? Also, operationally defined terms and clearly carry multiplethe DSM–IV–TR does not in any way control for gender meanings depending on the perceptions of a specificdifferences in behavior patterns—differences that can rater. At the present time, these terms are not universallybe quantified across cultures, across historical time, and quantified, and this fact most certainly decreases both theacross mammalian species (Bjorklund & Pellegrini, 2002; reliability and validity of the ADHD diagnostic processStolzer, 2005). (Breggin, 2002; Carey, 2002). Other scholars have sug- As is the case with all psychiatric disorders, members gested that the status of the rater (e.g., the teacher,of the APA vote on which disorders meet the criteria for parent, or physician) is not considered in the course ofinclusion in the latest DSM. ‘‘The Purpose of the DSM is assessment. Tolerance level, understanding of normativeto provide clear descriptions of diagnostic categories in developmental processes, gender, age, personality type,order to enable clinicians and investigators to diagnose, education, and cultural background are variables thatcommunicate about, study, and treat people with various heavily influence rater perception, yet these variables aremental disorders’’ (APA, 2000, p. xxxvii). It is interesting not controlled for in any quantifiable way (Carey, 2002;to note that homosexuality was for many years defined as Stolzer, 2007).36 ENCYCLOPEDIA OF THE LIFE COURSE AND HUMAN DEVELOPMENT
  3. 3. Attention Deficit/Hyperactivity Disorder (ADHD)ECONOMIC CONTEXT natural elements, and are expected to remain sedentaryAny discussion of ADHD must address the economic for hours at a time (Stolzer, 2005; Wilson, 1993). Acontext surrounding this disorder. In 1975, Americans review of the literature indicates that aggression, hyper-enacted legislation (often referred to as the Mainstream- activity, and inattentiveness decrease when children areing Act) that allowed children with physical disabilities exposed to the outdoors, have freedom to engage in largeaccess to the public school system. In 1991, children with motor activity, are interested in the subject matter, andbehavioral and/or learning disabilities were included in are involved in one-on-one interaction with a caring andthis amendment, and since that time, ADHD diagnoses competent adult (Breggin, 2002). Although the DSM–have skyrocketed across America (albeit this is not the IV–TR currently classifies ADHD-typed behaviors assituation in other countries). Under the 1991 American pathological, Breggin insisted that inattentiveness,amendment, schools that enroll students with disorders disorganization, high activity level, and getting boredsuch as ADHD receive federal funding. That is, the more easily with mundane tasks is not only developmentallychildren who are diagnosed with behavioral disorders, appropriate but is in fact observable across cultures andthe more money the individual school receives. It is also across historical time with regard to child populations.interesting to note the disparities that exist with regardto ADHD rates among American students. Private IMPORTANT PREDICTORSAmerican schools receive no federal money for children OF ADHDdiagnosed with ADHD and typically have extremely ADHD is diagnosed by particular behavioral patterns thatlow rates of ADHD among their student populations. include fidgeting, excessive running or climbing, not pay-Conversely, public schools receive federal money for ing attention to instructions, and difficulty playing quietly.each child diagnosed, and the rates of ADHD among These behaviors must be persistent and must be displayedpublic school students are as high as 60% in some more frequently and more severely than is typicallyAmerican school districts (Baughman, 2006). observed in individuals who do not have ADHD (APA, 2000). However, according to the Surgeon General of theGENDERED AND DEVELOPMENTAL United States (1999), diagnosing an individual with aINFLUENCES mental disorder is open to many different interpretationsThroughout human history, males and females have fol- that are rooted in value judgments that may vary acrosslowed very different developmental trajectories. Accord- cultures. The Surgeon General also stated that diagnosing aing to Peter Jensen and colleagues (1997), males evolved disorder such as ADHD is rather precarious, as there are noin an environment that required elevated activity levels. definitive markers (e.g., lesions, lab tests, or brain abnor-As males perfected this ‘‘hyperactive’’ way of being, this mality) that can positively identify a particular mentaldistinct and valuable male trait was not only highly disorder. According to Peter Jensen and James Cooperdesirable but was in fact integral to the survival of the (2000), the belief that ADHD is neurological in nature ishuman species. As compulsory schooling became the norm not supported by scientific evidence as current assessmentin most societies, uniquely male traits were not at all procedures ignore the complex and diverse range of varia-adaptive in the newly constructed classroom setting. bles associated with particular childhood behaviors. Fur-According to Bjorklund and Pellegrini (2002), the high thermore, researchers have pointed out that drawing preciseactivity levels currently in observed children can be directly and accurate boundaries between typical child behavior andlinked to humanity’s ancient and evolutionary past. School abnormal behavior patterns is difficult at best. The sciencesystems in the modern era require sedentary learning (e.g., of accurately diagnosing ADHD is especially problematicsitting in desks for extended periods of time), and these because of the ongoing processes of cognitive, emotional,relatively new expectations coupled with the proliferation and physical development. By their very nature, childrenof new childhood psychiatric disorders has, according to are ever changing, thus making stable measurements and/orJensen and colleagues, fueled the unprecedented rise of diagnoses extremely complex. Using adult criteria for men-ADHD diagnoses across much of the United States. tal illness in children and adolescents is also scientifically questionable as many of the symptoms of adult pathology From a developmental perspective, childhood has are characteristics of normal development in child popula-been altered dramatically over a relatively short time tions (Surgeon General of the United States, 1999).period. The unstructured, outdoor roaming of the pasthas been replaced by sedentary, adult-monitored play.Television, computers, and electronic video games now KEY DISPARITIES IN THE CAUSESengulf children at every developmental stage. Children AND TREATMENT OF ADHDare continually immersed in artificial light and temper- Proponents of the ‘‘disordered brain’’ hypothesis insistature, are surrounded by four walls with no access to the that ADHD is the result of an atypical neurologicalENCYCLOPEDIA OF THE LIFE COURSE AND HUMAN DEVELOPMENT 37
  4. 4. Attention Deficit/Hyperactivity Disorder (ADHD)system and that pharmaceutical drug intervention is nec- dysfunction, hepatic coma, angina, and toxic psychosisessary to correct a chemical imbalance within the brain. (Breggin, 1999; Novartis, 2006).The pharmaceutical industry has a vested economic inter- According to the pharmaceutical firm Novartisest in promoting this disordered brain hypothesis and has (2006), MPH is a central nervous system stimulant;been quite successful in using a multimedia advertising however, the mode of therapeutic action in ADHD iscampaign. Parenting magazines, television, and physi- not known. Novartis openly states that the specific etiol-cian offices routinely distribute materials that refer to ogy or cause of ADHD is unknown and that no singleADHD as a brain disorder, although no scientific data diagnostic test can definitively diagnose ADHD. Novar-supports this assertion (Baughman, 2006; Breggin, tis acknowledges that the effectiveness of MPH for long-2002; Jensen & Cooper, 2000; Surgeon General of the term use (i.e., more than two weeks) has not been estab-United States, 1999). lished in controlled trials and has stated unequivocally Jensen and Cooper (2000) postulated that ADHD- that the safety of long-term use of the drug in childtyped behavior is highly adaptive and served human populations has not yet been determined.beings well until the advent of compulsory schooling.Baughman (2006) hypothesized that ADHD assessment LABELING EFFECTStests actually measure adults’ frustrations with typical and For more than 40 years, social scientists have been awarehistorically documented child behaviors. According to of the deleterious effects of labeling children and adoles-Baughman, a respected pediatric neurologist, ‘‘In the cents. Once an official label is affixed, adults’ perceptionsoverwhelming majority of cases, the underlying issue is of the individual child can actually bring about expectedeither a clash between a normal child and the require- behavior via a process called the ‘‘self-fulfilling prophecy’’ments of his adult controlled environment or the product (Feldman, 2007; Rosenthal & Jacobson, 1968). Withof diagnostic zeal in a newly deputized teacher-turned- regard to the ADHD label, the problem is assumed todeputy brain diagnostician’’ (p. 215). Baughman clearly be within the individual child, requiring no alteration ofpointed out the controversial nature of ADHD: Is this the familial, contextual, physical, or socioemotional var-disorder a brain malfunction requiring pharmaceutical iables that surround the child. The children are notintervention? Or is ADHD a remnant of an evolutionary taught that they themselves can control their behaviorpast that does not fit in with the rigid structure of the (e.g., develop an internal locus of control). Rather, theAmerican school system? child is convinced by adults that the only way to control behavior is through pharmaceutical intervention. In thisMEDICATION way, individual self-efficacy is compromised, and behav-The overwhelming majority of children diagnosed with ior is collectively defined as being outside of the child’sADHD are prescribed MPH in order to control undesir- control.able behaviors (Baughman, 2006). Although it is wellknown that MPH can reduce disruptive behaviors and FUTURE DIRECTIONincrease compliance and sustained attention, very seldom OF ADHD RESEARCHare the dangerous effects of this drug discussed openly The pharmaceutical industry currently monopolizes(Stolzer, 2007). The Food and Drug Administration ADHD research by systematically promoting ADHD as(FDA) has classified MPH as a Schedule II drug along a neurological disorder, funding major medical confer-with morphine, opium, and barbiturates as these types of ences relating to ADHD, funding ADHD research,drugs have been proven to be highly addictive and to providing financial incentives for physicians who pre-cause a wide range of physiological atrophy (Breggin, scribe specific ADHD drugs, and funding groups such2002). as CHADD (Children and Adults with Attention Deficit MPH has been found to produce severe withdrawal Disorder) who openly promote psychotropic drug usesymptoms, irritability, suicidal feelings, headaches, and in child populations (Breggin, 2002; Jureidini & Mans-Tourette’s syndrome, a condition that causes both phys- field, 2001). In the future, it is imperative that unbiased,ical and verbal ‘‘tics’’ (Breggin, 1999; Novartis Pharma- empirical research is conducted to increase our under-ceutical Corporation, 2006). The drug also has been standing of the highly varied nature of ADHD. Further-associated with weight loss, disorientation, personality more, laws must be enacted that guarantee thatchanges, apathy, social isolation, depression, insomnia, scientifically based, objective research is guiding conven-increased blood pressure, cardiac arrhythmia, tremors, tional therapeutic practice (Stolzer, 2007). Certainly, it isweakened immunity, growth suppression, agitation, easier to medicate children than to collectively addressfatigue, accelerated resting pulse rate, visual disturbances, the wide-ranging factors that are affecting child anddrug dependency, anorexia, nervousness, aggression, liver adolescent populations in the modern era. Perhaps future38 ENCYCLOPEDIA OF THE LIFE COURSE AND HUMAN DEVELOPMENT
  5. 5. Autismresearchers will concentrate on the multitude of individ- Wilson, E. O. (1993). Biophilia and the conservation ethic. In S.ual and society-level variables that affect developmental R. Kellert & E. O. Wilson (Eds.), The biophilia hypothesis.processes and, in doing so, will significantly increase our Washington, DC: Island Press.understanding of the vacillating complexities associatedwith the ever-developing human. J.M. StolzerSEE ALSO Volume 1: Disability, Childhood and Adolescence; Learning Disability.BIBLIOGRAPHYAmerican Psychiatric Association. (2000). Diagnostic and AUTISM statistical manual of mental disorders (4th ed., rev.). Autism is one of five pervasive developmental disorders. Washington, DC: Author. These developmental disorders were identified as perva-Baughman, F. (2006). The ADHD fraud: How psychiatry makes sive because they affect more than one domain of devel- ‘‘patients’’ of normal children. Oxford, U.K.: Trafford. opment (as opposed to a specific developmental disorderBjorklund, D. F., & Pellegrini, A. D. (2002). The origins of that affects only one domain of development, such as a human nature: Evolutionary developmental psychology. reading disorder). The other four pervasive developmen- Washington, DC: American Psychiatric Association. tal disorders are Asperger’s Disorder, Pervasive Develop-Breggin, P. (1999). Psychostimulants in the treatment of children mental Disorder–Not Otherwise Specified (PDD–NOS), diagnosed with ADHD: Risks and mechanisms of action. Rett’s Disorder, and Childhood Disintegrative Disorder. International Journal of Risk and Safety in Medicine, 12, 3–35. These disorders vary in terms of timing, severity, andBreggin, P. R. (2002). The Ritalin fact book. Cambridge, MA: nature of symptoms. However, all pervasive developmen- Perseus Books. tal disorders involve deficits in social functioning andCarey, W. (2002). Is ADHD a valid disorder? In P. S. Jensen & repetitive behaviors. J. R. Cooper (Eds.), Attention deficit hyperactivity disorder: Current prevalence estimates suggest that 1 in every State of the science: Best practices. Kingston, NJ: Civic Research 150 children in the United States is affected by a pervasive Institute. developmental disorder (Centers for Disease Control,Feldman, R. S. (2007). Child development. (4th ed.). Upper 2007). Additionally, autism occurs four to five times more Saddle River, NJ: Prentice Hall. often in boys than in girls (Volkmar, Szatmari, & Spar-Jensen, P. S., & Cooper, J. R. (Eds.). (2000). Attention deficit row, 1993). Current estimates of prevalence in the United hyperactivity disorder: State of the science, best practices. States are similar to those of other countries, though Kingston, NJ: Civic Research Institute. significantly greater than in earlier decades. In 1979Jensen, P. S., Mrazek, D., Knapp, P. K., Steinber, L., Pfeffer, C., autism prevalence was 2 to 5 children per every 10,000 & Schowalter, J. (1997). Evolution and revolution in child (Wing & Gould, 1979). The cause of this increase in psychiatry: ADHD as a disorder of adaptation. Journal of the autism prevalence is widely debated. Some argue that this American Academy of Child and Adolescent Psychiatry, 36(12), 1572–1679. number reflects a true increase in cases of autism. Others argue that the change in prevalence is because of increasedJureidini, J., & Mansfield, P. (2001). Does drug promotion awareness and more accurate diagnosis of autism (espe- adversely influence doctor’s abilities to make the best decisions for patients? Australasian Psychiatry, 9, 95–100. cially high-functioning autism). Researchers have not fully resolved this debate.Leo, J. (2000). Attention deficit disorder: Good science or good marketing? Skeptic, 8(1), 63–69. Autism is a characterized by deficits in three areas:Novartis Pharmaceuticals Corporation. (2006). Ritalin LA (a) social interaction, (b) communication, and (c) repet- (package insert). East Hanover, NJ: Elan Holdings. itive behaviors or interests. Although mental retardation is more common in children with autism than in theRosenthal, R., & Jacobson, L. (1968). Pygmalion in the classroom: Teacher expectations and pupils’ intellectual development. New general population, not all children with autism also have York: Holt, Rinehart, & Winston. mental retardation. Furthermore, some experts have argued that standard IQ tests, which rely heavily onStolzer, J. (2005). ADHD in America: A bioecological analysis. Ethical Human Psychology and Psychiatry, 7(1), 65–75. language, underestimate the intelligence of children with autism.Stolzer, J. M. (2007). The ADHD epidemic in America. Ethical Human Psychology and Psychiatry, 9(2), 37–50. Children with autism comprise a very heterogeneousSurgeon General of the United States. (1999). Mental health: A group, reflecting variability in the nature and severity of report of the Surgeon General. Washington, DC: United States symptoms. For example, children with a severe presenta- Department of Health and Human Services. Retrieved April tion of autism (e.g., low-functioning autism) may be (a) 16, 2008, from http://www.surgeongeneral.gov/library entirely uninterested in social interaction; (b) have noENCYCLOPEDIA OF THE LIFE COURSE AND HUMAN DEVELOPMENT 39

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