Running Head: ADHD 1
ADHD 14
ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD)
Tevfikcan Falah
Cambridge College
30th July 2014
ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD)
Introduction.
Attention-deficit/Hyperactivity Disorder (ADHD) is a neurobehavioral disorder most commonly diagnosed in children. The average age for diagnosis is seven, while adults can also develop symptoms of it (Holland, 2013). It is a globally recognized neurological dysfunction, which the person has trouble inhibiting unfortunate. It is commonly genetic. The crucial or the core features are the hyperactivity or compulsiveness. To validate the diagnosis of ADHD, the person must have more than one of the symptoms which should be present and cause difficulty to his or her life. The important factor of understanding individuals with Attention-deficit/Hyperactivity Disorder is often found together with other symptoms which repeats itself rather than only one condition. Treatment of the symptoms of ADHD involves the use of medication, psychotherapy (behavioral treatment), or a combination of the two. ADHD is a behavioral problem, not a medical one, and as such medication should not be used in the treatment of ADHD.
History of ADHD
ADHD was first mentioned by a British a pediatrician, Sir George Still in early 1900s, who described it is an abnormal defect of moral control in children. He found that a mentally disabled children could not function as well as a healthy kids, but were still intelligent (Holland, 2013).He believed it was a medical issue not spiritual. The American Psychological Association issued the first Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1952. This
included a list of all the known mental disorders, causes, risk factors, and treatments for each condition. The history of ADHD wasn’t known until the 20th century which American physicians started to classify it as “mentally deficient” individuals who had difficulty focusing on a specific task. In 1980 the American Psychiatric Association (APA) change the name of the disorder (ADD).Scientist believe that hyperactivity was not a symptom of the disorder, which created two subtypes of AD: ADD with or without hyperactivity.(Holland 2013). In 1987 the APA published a revised version of the third edition of DSM, and changed the name to ADHD. There are three predominate categories of ADHD. One subtype describes those who are predominantly hyperactive and impulsive.
The second category includes those who are predominantly inattentive. This subtype includes symptoms that are considered hyperactivity or impulsivity. The third major category of ADHD and the most common one which combines hyperactivity and impulsive behavior with being inattentive.
` On the other hand, ADHD can carry on into adulthood, thus logically there is a high possibility, that adults can have the same pattern of symptoms dating back to their childhood.(pg 10)book. History of the adults having ADHD see ...
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Running Head ADHD1ADHD14ATTENTION.docx
1. Running Head: ADHD 1
ADHD 14
ATTENTION DEFICIT HYPERACTIVITY DISORDER
(ADHD)
Tevfikcan Falah
Cambridge College
30th July 2014
ATTENTION DEFICIT HYPERACTIVITY DISORDER
(ADHD)
Introduction.
Attention-deficit/Hyperactivity Disorder (ADHD) is a
neurobehavioral disorder most commonly diagnosed in children.
The average age for diagnosis is seven, while adults can also
develop symptoms of it (Holland, 2013). It is a globally
recognized neurological dysfunction, which the person has
trouble inhibiting unfortunate. It is commonly genetic. The
crucial or the core features are the hyperactivity or
compulsiveness. To validate the diagnosis of ADHD, the person
must have more than one of the symptoms which should be
2. present and cause difficulty to his or her life. The important
factor of understanding individuals with Attention-
deficit/Hyperactivity Disorder is often found together with other
symptoms which repeats itself rather than only one condition.
Treatment of the symptoms of ADHD involves the use of
medication, psychotherapy (behavioral treatment), or a
combination of the two. ADHD is a behavioral problem, not a
medical one, and as such medication should not be used in the
treatment of ADHD.
History of ADHD
ADHD was first mentioned by a British a pediatrician, Sir
George Still in early 1900s, who described it is an abnormal
defect of moral control in children. He found that a mentally
disabled children could not function as well as a healthy kids,
but were still intelligent (Holland, 2013).He believed it was a
medical issue not spiritual. The American Psychological
Association issued the first Diagnostic and Statistical Manual of
Mental Disorders (DSM) in 1952. This
included a list of all the known mental disorders, causes, risk
factors, and treatments for each condition. The history of
ADHD wasn’t known until the 20th century which American
physicians started to classify it as “mentally deficient”
individuals who had difficulty focusing on a specific task. In
1980 the American Psychiatric Association (APA) change the
name of the disorder (ADD).Scientist believe that hyperactivity
was not a symptom of the disorder, which created two subtypes
of AD: ADD with or without hyperactivity.(Holland 2013). In
1987 the APA published a revised version of the third edition of
DSM, and changed the name to ADHD. There are three
predominate categories of ADHD. One subtype describes those
who are predominantly hyperactive and impulsive.
The second category includes those who are predominantly
inattentive. This subtype includes symptoms that are considered
hyperactivity or impulsivity. The third major category of ADHD
and the most common one which combines hyperactivity and
impulsive behavior with being inattentive.
3. ` On the other hand, ADHD can carry on into adulthood,
thus logically there is a high possibility, that adults can have
the same pattern of symptoms dating back to their childhood.(pg
10)book. History of the adults having ADHD seem like going
back to 1960s. Earlier, ADHD was known as ‘’minimal brain
damage or dysfunction’’ (MBD).There are three main sources
which was the first publication of several early follow-up
studies demonstrating the persistence of symptoms of
hyperactivity/MBD into adulthood in many cases (Mendelson,
Johnson, & Stewart, 1971; Menkes, Rowe, & Menkes, 1967).
The second source was the publication of research showing that
the parents of hyperactive children were likely to have been
hyperactive themselves and to suffer in adulthood from
sociopathy, hysteria, and alcoholism (Cantwell, 1975; Morrison
& Stewart,1973).Therefore, many doctors believes that children
with ADHD symptoms were
more likely to have parents with ADHD symptoms logically
indicating that ADHD could hence it could exist in adults.
Causes
Scientists have not generally agreed on any of the one theory as
to the cause of ADHD, but some ideas include the person’s
inherited DNA and the proteins surrounding it in the cells
(genes), and environmental influences, including chemicals
consumed during pregnancy , brain injuries, food additives and
sugar are also considered by some to be causes.
First of all, genes and heredity have a role with genetics in
ADHD. There is a one in five chance you have the ADHD, if
one of your family member have the disorder, either it has been
diagnosed or not. Researcher have been focusing on genes more
than any time before. The main reason for that is, to be able to
prevent the disorder before it actually occurs. Also, the
researchers can predict with a higher accuracy which will help
people to be less likely to develop the disorder. Therefore, the
4. speculations around the ADHD medications can be strictly
regulated. On the other hand, ADHD has a different pattern of
certain genes that effects, the differences in brain development
the area of the brain related with attention and planning
typically thickens three year later than the normal children’s.
(http://www.nimh.nih.gov/health/topics/attention-deficit-
hyperactivity-disorder-adhd/index.shtml)
The second factor which causes ADHD is the dissimilarities in
brain chemistry. For many of us, to focus on a task, and have a
power on our impulses, our brain needs to have two main
chemicals: norepinephrine and dopamine. Those two chemicals
helps us to regulate mood, movement and attention. If the
individual have ADHD, your brain is sending either too much or
too little of norepinephrine. Some research and writings in
recent years have strongly condemned many of the diagnoses
for ADHD, especially for boys. These experts include (Camille
Anna Paglia, currently a professor at the University of the Arts
in Philadelphia, Pennsylvania. And Mona Charen), not
technically an expert, but a writer. As a matter of fact,
environmental factors and brain injuries are the other main
causes of ADHD too.
Symptoms
According to Russell, “some of the symptoms may be existing
in all cases of the disorder, while others may happen in many
different combinations or may not be present at all.” The main
symptoms that are related to ADHD are, lack of focus,
organization, restlessness, forgetfulness and difficulty finishing
projects. Previously some kids with learning disabilities were
simply considered stupid or slow learners, as these disorders
had rarely, if ever, been diagnosed previously. Many believed
or hoped the key to being admitted to a university with a high
academic reputation was to treat their child for what was a
learning disorder. According to a National Center for Learning
Disabilities website. These disorders include dyscalculia,
dyspraxia, dyslexia, dysgraphia, attention deficit hyperactivity
5. disorder or ADHD. (1) Now among the most common of the
ostensible childhood disorders, ADHD can continue through
adolescence and adulthood. Reputed experts believe these
learning disabilities are caused by neurological disorders. All or
most of them can make it difficult of acquire particular
academic or social skills. Those with ADHD often have either
all or some combination of disorders, including difficulty
focusing on specific tasks, uncontrollable behavior and
hyperactivity. Since these behaviors typically vary in frequency
by age and level of development for those deemed normal, for
one to be considered as having ADHD, the symptoms must
exceed the normal range of activity. A few of the symptoms
may include inattention, forgetfulness, does not seem to listen
when spoken to, having trouble doing quiet tasks, such as;
reading and writing.
Another category includes those who are predominantly
inattentive. This subtype includes at least six inattention
symptoms, and fewer than six indications of ADHD are
considered hyperactivity or impulsivity. Children with this form
of ADHD generally act out less frequently and are more
sociable with other children. Since they may sit quietly, but are
still not paying attention to anything specific, their disorder
may not be noticed and consequently not treated. According to a
National Institute of Mental Health (NIDD) website, symptoms
of inattention include the following: (2) Easily distracted, miss
details and often switch from one detail to another. Second,
difficulty focusing, especially when needing to complete a task,
learn something or organizing. Quickly gets bored with a task
after just a few seconds later, unless it is enjoyable to them. If
it’s a enjoyable task then the individual may hyper focus on a
task and can stay focused for many hours. Moreover, they are
having difficulties on completing or turning in homework
assignments, and following instructions. They mostly every
time lose items, such as cell phones, papers, money. Also, they
tend to not listen when spoken to, they often don’t seem to
listen. They often daydream and they are easily confused and
6. move slowly. The third major category of ADHD and the most
common is hyperactivity and impulsive behavior with being
inattentive. At least six symptoms of inattention, and
hyperactivity-impulsivity are usually manifest. According to the
NIDD, symptoms of hyperactive children include: (Russell A.
Barkley, PhD)
1. Often fidgeting and squirming in their classroom seats (boys,
including male boys deemed normal, do this more often than
girls).
2. Talk when not supposed to.
3. Move around quickly, playing and touching with everything
and anything they can (once again, normal boys often do this
more than girls do).
4. They often refuse to sit still, at school or home. (to repeat
once more, normal boys often win on that one).
5. They are often continually in motion.
6. Difficulty performing quiet activities or tasks.
And the NIDD also states that impulsive children often: Tend to
be impatient, blurt out inappropriate comments, become
unrestrained emotionally, and act without regard to
consequences. Indeed, they are impatient waiting for something
they want or for their turn in games and frequently interrupt
activities or conversations.
Diagnosis.
ADHD diagnosis can be successfully achieved by using
different techniques and diagnostic processes. The diagnosis
should be made by a certified mental health provider. The
diagnosis is based on comprehensive psychosocial and clinical
assessment of the impacts of the symptoms on the subject’s
development, functioning and review of rating scales. Contrary
to the popular belief, rating scales alone cannot be enough to
make a final diagnosis on ADHD condition.
The diagnostic approach involves several steps that
include: assessing clinical and psychosocial status of the patient
to review their behavioral and symptomatic concerns in their
lives. In this step, the developmental history of ADHD is
7. documented. The childhood history is then established. And in
the process the symptoms are assessed. These symptoms can
then be confirmed to check if they have clinically significant
impact on social and occupational
functioning. The next diagnostic step is the use of the rating
scale. An 18 item adult self-report scale (ASRS-v1.1, Appendix
2) is used to determine the likelihood of attention deficit
hyperactivity disorder (ADHD) Comorbid psychiatric symptoms
such as depression, anxiety, drug abuse and even alcoholism can
be assessed using the available tests. Tests for bipolar disorder
can be done. The last step that’s however not compulsory is the
psychological testing. Most patients with ADHD develop
difficulties with executive functions that includes organization,
planning, attention spans, working memory and even impulse
control. To achieve accurate results, further interviews and
observations can be conducted to determine the extent of
severity of the developed difficulties. It also helps to establish
the extent of comorbid disorders and how they influence the
symptoms presented.
The DSM-IV diagnostic procedure can also be used to establish
if a patient has ADHD. The procedure has several symptoms
which are used for the diagnosis problem. When the technique
was introduced in 2013, several changes in the ADHD diagnosis
were introduced. The ADHD condition was classified into 3
subsets which included hyperactivity, impulsivity and other
added criteria’s. The DSM-IV procedure also extended the
ADHD onset years to 12 and reduced the symptom threshold for
diagnosis from six to four.
Learning styles
The learning styles of most ADHD patients are greatly
affected. The most commonly known learning styles include the
auditory learning, visual learning and the tactile or the
telekinetic learning. Children affected by ADHD show little or
no change during their learning curve. Persistent ADHD since
childhood leads to development of difficulties in academic
8. performance especially in adolescents. Also, other problems
however are linked to an increase in disciplinary actions that
includes suspensions and even expulsions from learning
institutions. Lower academic achievements and greater grade
retentions is evident in adolescents affected by ADHD. Further
follow up studies into adult hood shoed that the affected
students had less education and achieved lower grades compared
to others. According to the Milwaukee Study (Barkely, Fischer,
et al., 2006) it was established that at the age 21 follow up,
more than three times as many hyperactive control groups had
retained in grade during their schooling as compared to the
community control group members. The established ratio was
found to be (42%:13%) In limited cases, ADHD students
develop dysgraphia. It is a learning disability that affects
writing, It requires a complex set of motor and information
processing skills. In the disability, there are problems in
spelling, poor handwriting and transferring thoughts to paper.
People with the condition might have difficulties organizing
letters, words and numbers on a page or on a given line.
Treatment.
In ADHD treatment, the primary goal is to minimize the
manifestations of the ADHD symptoms on patient functioning
while at the same time maximizing on the patients ability to
cope with the remaining difficulties. In cases where comorbid
conditions are presented, the more severe disorders are to be
treated first. A classic example is in a patient suffering from
ADHD and depression. The recommended treatment regimen is
the treating the ADHD first. Once the disorder is treated, its
vital to continue treatment of the remaining comorbid
conditions. Pharmacological approach can be considered to
address psychological, occupational and even educational needs
among patients. Treatment can be successfully achieved using
two broad ways. (1) Non pharmacologic/lifestyle modification
techniques or (2) the pharmacologic technique.
The non-pharmacologic technique of ADHD treatment
majorly involves psychosocial interventions. Though the cure of
9. ADHD doesn’t currently exist, psychosocial interventions will
help the patients to cope or manage the symptoms. Another
widely used non pharmacologic treatment is the cognitive
behavioral therapy (CBT). It is a short term therapy that
includes agenda setting, monitoring progress towards goals,
skill development, assignments and homework reviewing. It
specifically focusses on Behavioral skills training, addressing
dysfunctional patterns of thought especially those associated
with procrastination, attentional shifts and avoidance. This
technique has specifically been found to be effective in adults
who receive the therapy in a group setting. However, certain
non-pharmacological approaches have been discouraged since
they do not have tangible proof of effectiveness. They include
elimination of sugar from the patients diet, anti-motion sickness
treatment, Antifungal treatment especially for Candida albicans,
Optometric vision training, Metronome training and even
Neuro-feedback techniques
The pharmacologic techniques involve using of drugs to
control ADHD and comorbidity condition among patients. Since
pharmacologic treatment involves infusion of stimulants, The
patients cardiac history must be taken to ensure safety in the
process. The patients have to be informed of the long-term
effects of stimulant use which can include dysphoria. Other
risks involved in the pharmacologic response include elevation
in blood pressure, cardiac arrhythmias, insomnias, anorexia,
mood and even behavioral disturbances. Known Stimulants that
are used to treat ADHD include Ritalin and Adderall. They are
sometimes called cognitive enhancers since they have shown
improvement in attention spans, concentration and in certain
cases, short term memory. A study was conducted in June and
it looked at medication usage and educational outcomes of
nearly 4,000 students in Quebec over an average of 11 years and
found that boys who took ADHD drugs actually performed
worse in school than those with a similar number of symptoms
who didn't. Girls taking the medicine reported more emotional
problems, according to a working paper published on the
10. website of the National Bureau of Economic Research, a
nonprofit economics research firm.
As an antidote, according to an April 27, 2009 article
titled, ADHD Medication Can Improve Math and Reading
Scores, Study Suggests, and published by a University of
California at Berkeley website, states the medications do
improve academic performance. (5) It states, “Pediatricians and
educators have long known that psycho-stimulant medications
can help children with … (ADHD) concentrate on learning for
short periods of time. But a new study from (UC Berkeley), has
found evidence that grade scholars with ADHD who take
medications can actually improve their long-term academic
achievement, and make greater gains in standardized math and
reading scores than students with ADHD who do not take
medications. "Our study found that the children with ADHD
who used the medication were several months ahead of their
non-medicated peers in reading and math, which is significant
because early progress in school is critical to ongoing academic
success," said Richard Scheffler, professor of health economics
and public policy at UC Berkeley.”
Who knows whom you are supposed to believe? So are taking
these medications, such as Ritalin, Adderall, Dexedrine,
Focalin-XR, Concerta and Vyvanse generally a good thing? As
always, it depends on whom you talk to. With the proliferation
of information on the internet, one can now get any opinion on
any subject. But surely, success or help by the medication does
depend on the particular child and which specific drug he takes.
But there is no doubt the majority of experts, or at least the
ones in the most prestigious positions, along with the greatest
influence over the decisions of lay people, believe and argue
these drugs mostly have a positive effect on children who are
failing to learn to their potential due to their behavior. And
plenty of teachers argue these medicated kids learn more once
the treatment starts. According to a website published by
Helpguide.Org, “medication can help reduce symptoms of
hyperactivity, inattentiveness, and impulsivity in children and
11. adults with ADD/ADHD.”
“However, medications come with side effects and risks—
and are not the only treatment option. Whether you’re the parent
or the patient, it’s important to learn the facts about
ADD/ADHD medication so you can make an informed decision
about what’s best for you or your child.” Side effects and risks?
Sounds ominous. The site states side effects can include loss of
appetite, insomnia, upset stomach or headaches, dizziness and
mood changes. “The long-term effects of ADD/ADHD
medication on the youthful, developing brain is not yet known.
Some researchers are concerned that the use of drugs such as
Ritalin in children and teens might interfere with normal brain
development.” (6)
Attention deficit/hyperactivity disorder (ADHD) may affect
children in cases where they show slower learning abilities and
cannot keep up with the normal child’s development. ADHD
also affects children because they are more predisposed to
hurting themselves. ADHD will also affect students because
they present with lower learning abilities. This can also pose a
psychological problem of victimization of the student. If the
condition is not diagnosed in and early condition, the child
might face harsh treatment from fellow normal students. Parents
are among the most affected group because they are tasked with
the work of looking after their affected children. To afford
medication for Attention deficit hyper activity disorder is not
cheap and thus it costs parents so much money. Furthermore,
ADHD has been associated with increased healthcare costs for
patients and their family members. ( Arch Dis Child 2005;90)
I believe the most efficient strategy to control ADHD Is the
joint effort from the parents, teachers, physicians and even the
patients themselves. Education and psychotherapy should be
used I conjunction with medication to ensure success in the
process. Since patients with ADHD present with slowed
learning, Parents and even teachers should exercise patience
while working with them.
12. Attention deficit hyperactivity disorder is a neurological
disorder. It presents with an inability to focus, being overactive
and in most cases not being able to control ones behavior. The
most cost effective technique in managing ADHD is the use of
education and psychotherapy. If these measures fail to control
the condition, other measures such as medication can be used as
an intervention. ADHD patients are people like us. If we join
forces, we’ll be able to extricate the complexities of its
symptoms and even comorbidities involved.
REFERENCES
“Adult ADHD Self-Report Scale-V1.1” (ASRS-V1.1) Symptoms
Checklist. Retrieved from WHO Composite International
Diagnostic Interview
DuPaul, G. J., & Stoner, G. D. (1994). ADHD in the schools:
Assessment and intervention strategies. Guilford Press.
Russell A burkely, Kevin R murphy, Mariellen Fischer, ADHD
in Adults “What the science says, Newyork, The Guilford press.
Treating Children with ADHD, 31st July 2014, Retrieved from
http://www.searchthebestanswer.com/what-are-your-views-on-
treating-children-with-meds-for-add-adhd.html
V.A Harpin, “The effect of ADHD on the life of an individual,
their family and community from preschool to adult life.
Weiss, G., & Hechtman, L. T. (1993). Hyperactive children
grown up: ADHD in children, adolescents, and adults . Guilford
Press.
Attention Deficit hypersensitivity disorder (ADHD) 31st July
2014, Retrieved from
http://www.nimh.nih.gov/health/topics/attention-deficit-
hyperactivity-disorder-adhd/index.shtml