Attention Deficit Hyperactivity Disorder and Children, Research Paper Example

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Research Paper

Abstract

Since ADHD was first identified centuries ago, it has presented enormous challenges for those seeking to help children with the disorder.  In time, initial definitions only reflecting a form of mental aberration have been refined, and physicians today isolate ADHD by the ongoing presence of several symptoms which invariably reflect hyperactivity and an inability to focus.  The typical repercussions for the children are learning disorders and ancillary social issues. The use of stimulant drugs has proven to be effective, yet there is a stronger emphasis on varieties of behavior-based treatment, both inside and outside the school, to overcome the ADHD impairments.  Research continues, and it thus far appears that a dual pharmacological and behavioral approach is most successful in helping these children.

Introduction

It is ordinarily believed that Attention Deficit Hyperactivity Disorder (ADHD) is a modern problem for children, and one possibly generated by the issues prevalent in today’s society.  The reality is different; while a variety of labels have been attached to ADHD, the disorder itself has been recognized for some time.  In the late 18th century, in fact,  ADHD was identified as “mental restlessness”.   By the 1930s, British pediatrician George Frederic Still proposed a congenital explanation for the disorder in his, “On the Child’s Temper” (Smoyak, 2008,  p. 8).  One fact was increasingly evident to the medical community, in that there were children whose persistently erratic behavior transcended the normal parameters of youthful restlessness.

Research, Prevalence, and Diagnosis

Research on ADHD, despite its having been recognized in earlier eras, is relatively recent in terms of clinical efforts.  As the disorder was more focused upon, an evolution in actual identification occurred, and the various labels assigned to it included “post-encephalitic brain disorder,” “organic drivesness, and “minimal brain dysfunction,” (Smoyak, 2008, p. 8).  In the post World War II years, methylphenidate and pemoline were prescribed for children appearing to suffer from what was then beginning to be defined as Attention Deficit Disorder (ADD) (Smoyak, 2008,  p. 8).  Essentially, the drugs were employed as psycho-stimulants, which was believed would enable greater focus.  By 1968, the disorder was – interestingly – referred to in the Diagnostic and Statistical Manual (DSM) as “hyperkinetic reaction of childhood,” a terminology still emphasizing the natural tendency for all children to display hyperactivity (Frank-Briggs, 2011,  p. 292).   Throughout the admittedly fragmented history of ADHD research, what predominates is controversy, as well as a narrowing of acceptable criteria for diagnosis.  The inherent difficulty lies in the similarity between actual ADHD symptoms and behaviors typical of children; nonetheless, past research has provided a definition, in that ADHD is: “The inability to marshal and sustain attention, modulate activity level, and moderate impulsive  actions”  (Visser, Jehan, 2009,  p. 128).   What is critical in this assessment, and what renders it distinct from ordinary behavioral assessments, is that afflicted children may not voluntarily alter the ADHD behaviors.

In regard to prevalence, ADHD affects approximately 3 to 5 percent of all children, and the signs usually manifest themselves before the age of seven  (Frank-Briggs, 2011, p. 291).  It is also determined that ADHD has a biochemical and genetic basis, and that traditional explanations of inadequate parenting or poor socialization do not account for the disorder (Ryan-Krause, 2011,  p. 50).   There yet remains debate as to exact percentages of children with ADHD, not unexpectedly, because degrees of affliction create dispute.  The highly complex nature of ADHD renders it difficult to clinically diagnose.  More exactly, one or more symptoms of it may be present in a child not afflicted with the disorder; consequently, the Diagnostic and Statistical Manual (DSM) definition relies on a confluence of persistent forms of evidence.  This is reflected in the criteria established by the Centers of Disease Control and Prevention (CDC), and each symptom must be noted as occurring consistently for a period of at least six months.  Inattention is central to the diagnosis, and is evinced by an inability to focus on a task, lack of attention in listening, poor organizational skills as appropriate to the child’s age, a propensity to make simple mistakes, a disinclination to do anything requiring attention, forgetfulness, and a tendency to become distracted easily.  Hyperactivity depends upon a similar assortment of relatively similar symptoms:  fidgeting with hands, excessive talking, a tendency to interrupt, an unwillingness to remain seated, and engaging in physical action at inappropriate times (CDC,  2012).  While discussion still surrounds precise diagnosis, it is generally agreed that two or more symptoms of both hyperactivity and inability to focus must be present for a valid appraisal of the disorder (Vance, Luk, 2000, p. 720).

Discussion

Learning Disorders Related to ADHD

That children with ADHD experience severe problems in learning is hardly surprising.  On the most basic level, acquiring information in any fashion demands a measure of attention, and such children are not equipped to provide this.  The entire range of ADHD symptoms, in fact, is virtually a list of elements going to learning disorders (LDs): “Inattention, problems with following instructions, poor planning/executive dysfunction, and other symptoms that characterize ADHD thus increase the risk for learning disorders” (Talero-Gutteirrez, Van Meerbeke, & Reyes, 2012,  p. 157).   There is, then, no specific arena of learning that presents issues to the child with ADHD, as the problems stemming from the disorder affect all.  When attention is lacking, the information is not processed.  When some attention is given, short-term memory issues of ADHD prevent any valid retention of the learning, and the cycle of impairment perpetuates itself.  Added to this is the hyperactivity, which must disrupt any processes even temporarily engaged in learning.

In no uncertain terms, ADHD prohibits learning to a significant degree.  As the LDs have their effect, the daily experience of the child suffers further because of the inherently social component of the classroom setting.  Children ordinarily require peer approbation, and the ADHD child’s behavior tends to diminish this; for example, they are too restless to wait their turn in games (Frank-Briggs, 2010,  p. 292).  Consequently, a degree of disruptive behavior caused indirectly by the ADHD, and a type removed from the impulsivity and hyperactivity marking the disorder, is frequently manifested.  ADHD gives rise, then, to oppositional defiance disorder, which is intrinsically a result of the unsatisfactory learning/social experience (Ryan-Krause, 2011,  p. 51).  The child, due to the biochemical and genetic factors creating the impairments, is subject to immense frustration, and this must only increase exponentially when achievement of any kind is perpetually thwarted.  As will be seen, learning issues, so critical to the ADHD sufferer, are arenas of research and treatment interest and approach.

Social Disorders

The research on how ADHD affects children in social arenas is, at best, discouraging.  This is an unfortunate inevitability, as a child’s socialization typically centers on the school.  Apart from the family unit, this is the child’s universe, so persistent inabilities to match the efforts of peers create social isolation.  There is also another disturbing component to the social issues, in that children with ADHD do not tend to report having difficulties, while those around them contradict this (Kofler, Rapport, Bolden, Sarver, Raiker, & Alderson, 2011, p. 805).  Children not suffering from ADHD evaluate those with the disorder as less popular and less competent, and after very brief periods of interaction.  There is active rejection of the ADHD children on the part of the non-afflicted peers;  ADHD children, conversely, relate little awareness of these distinctions as perceived by peers.  More accurately, a cycle of negative behavior and unfavorable peer reaction is set in motion (Kofler et al, 2011, p. 815).

Additionally, adults, in the form of parents and teachers, uniformly report similar circumstances.  The ADHD children are typically dismissed by the other children, and are more likely to become aggressive or be bullied (Kofler, et al, 2011,  p. 806).  As with learning issues, the usual consequences of the disorder take on an exponential character.  More exactly, even as the ADHD children do not overtly relate feelings of being ostracized, they gain an awareness of it and respond in alternately hostile or introverted ways.  All of this supports the reality that the relationship between learning and social disorders is inextricably linked.  For example, ADHD often is manifested by extreme memory deficits, and these have a blatant effect on abilities to employ and maintain information.  The same deficits, however, present enormous difficulties in negotiating social interactions.   Recent research supports that these failures of memory disrupt or completely impede the child’s ability to decode social messages and interpret non-verbal cues in social situations; more precisely, each message and cue is “new” to the ADHD child unable to recall having experienced it (Kofler, et al, 2011,  p. 807).   As may be obvious, this breeds an intolerance in those unafflicted with ADHD.  Children are not notoriously forgiving or accepting of that which is different from them.  Then, as the ADHD children appear to the others to merely be behaving in a manner engaged in by themselves at times, there is no understanding of an actual illness at work.  Consequently, as the learning problems fuel social conflicts, the child with ADHD is essentially locked in a cycle admitting of no support.

Treatment

Given the array of issues stemming from ADHD it is generally agreed that multi-modal approaches are most likely to succeed, involving pharmaceutical and behavioral interventions (Leggett, Hotham, 2011, p. 513).  Regarding the latter, a relatively simple approach relating to schooling lies in the form of tutoring.  A recent study from Australia found that providing additional instruction by tutoring, along with support supplied by teachers and parents, significantly improved learning potentials (Leggett, Hotham, 2011, p. 514).  School-based interventions are increasingly recommended (Frank-Briggs, 2011, p. 295).  A variety of strategies have been found to produce results, including the regulation of note-taking by the child, assignment tracking, and even the simple process of organizing all school materials in a binder.  The same research indicates that consistent measures of intervention in the home as applied by the parents, in setting and monitoring the child’s performance, are crucial for success in the school-based approach (Schultz, Storer, Watabe, Sadler, & Evans, 2011, p. 258).   Simply, the ADHD child not compelled to concentrate on home tasks will likely repeat the behavior at school.

It is interesting that, as ADHD has been more recently focused on as a biomedical condition, which goes to its integrity in research processes, there arises a further cry that the psycho-social demands of the illness be addressed in a way apart from drug interventions.  As noted, and validated by studies, social problems are a potent source of conflicts for ADHD children (Kofler, et al, 2011,  p. 815), and school is an intrinsically social arena.  As parents must be educated as to the best means of understanding and addressing ADHD, so too must teachers be instructed in both noting the signs of the disorder and responding appropriately.  More exactly, teachers and parents must learn to distinguish between ordinary, childhood restlessness and ADHD.

That medicines be employed in treating ADHD is widely considered necessary.  Since the 1930s, there has been marked success with the use of stimulants, particularly of the amphetamine and methylphenidate varieties.  These drugs have been shown to promote focus, and even lessen hyperactivity.  Not unexpectedly, and particularly given the ages of typical ADHD patients, the potentially adverse cardiovascular effects of these drugs must be carefully monitored; the American Heart Association (AHA) strongly urges electrocardiograms before any such drugs are administered (Ryan-Krause, 2011, p. 53).  When applicable, however, these stimulants produce consistently favorable results:  “The core behavioural features of ADHD and cognitive features, such as response inhibition and verbal and non-verbal working memory performance, improve in approximately 80% of children”  (Vance, Luk, 2000, p. 724).  At the same time, these are short-term results, and there is widespread concern over long-term effects.  More exactly, there is debate over how dominant the biomedical approach should be.  Methylphenidate, for example, regulates the transmission of dopamine in the brain, and thus normalizes ADHD behaviors (Visser, Jehan, 2009,  p. 239).   Data regarding just how impactful such medications are over time, nonetheless, is not yet conclusive.  As will be noted, this very “normalizing” of the ADHD is seen by some as a suspect, and possibly invalid, treatment in place only to moderate blatant behaviors.

Treatments and Controversies

As noted, virtually all treatments attempted today rely upon a multifaceted approach, in which behavioral issues are addressed along with pharmaceutical aids.  In a recent Australian study, combinations of interventions were applied to a random sampling of ADHD sufferers, incorporating counseling, behavioral therapies, the implementation of support systems, and psycho-stimulants in varying degrees.  The study is cited as being typical of most modern research; given the social and biological components of ADHD, only such varied approaches may be successful.  The results were generally good, yet the actual responses from parents were widely disparate.  Even as the drugs seemed to ameliorate the ADHD symptoms of the children, for example, many parents were reluctant to have them used.  The clinicians found that the parents allowed drugs to be used chiefly because they evinced a societal responsibility to “control” their children, but were less than eager to do so. Then, a small percentage of the subjects reacted adversely to the medications, behaving even more erratically (Leggett, Hotham, 2011, p. 516).  In all of this, moreover, it is difficult to ascertain the actual efficacy of either drug or behavioral intervention, simply because ADHD children respond to both to alternating degrees.

The reality is that ADHD treatment may not be properly discussed without the inclusion of ADHD controversy.  There are schools of thought not directly opposed to one another, but blatantly more on the side of either the psycho-stimulant approach or social and behavioral intervention.   This is hardly surprising; the subjects are children, and there is an understandable unwillingness to render children dependent on chemical aids.  This leads to a perhaps optimistic view of non-pharmaceutical means as most effective.  There is, again, validity to this: “Short-term improvements in the core symptoms of ADHD…have been noted with teacher and parent training programs that involve reinforcement of positive behaviour” (Vance, Luk, 2000,  p. 724). This is not to suggest that those favoring non-pharmaceutical treatments do not perceive the severity of ADHD; rather, they tend to be more focused on socialization skills as promoting a control of the biomedical issues.  Similarly, it appears that those supportive of stimulants do not discount the benefits of other interventions.  Perhaps most impactfully, however, controversy exists in that there is a significant dearth of information regarding long-term stimulant use in these cases:  “well-designed studies, with randomized controls of youth in treatment versus placebo groups, occurring over long periods of time, are lacking” (Smoyak, 2008, p. 9).   It is likely, then, that controversy will be in place until more definitive information is obtained.

Conclusion

Today, the combined approach remains the most conducive to progress in treating ADHD, with an emphasis on lessening the application of drugs.  Few ADHD patients, for example, are treated only by stimulants, as most caregivers insist on behavioral interventions as well (Leggett, Hotham, 2011, p. 517).   Moreover, there is an increased acknowledgment that a key to ameliorating ADHD issues lies in improving the child’s ability to store information in the memory through the development of specific skills; procedures accomplishing this, it seems, may greatly lessen other ADHD effects, in enabling the control that derives from retained knowledge (Kofler, et al, 2011, p. 815).  The advantages to stimulants notwithstanding, there is an emphasis today on the ADHD child as being more encouraged to assist in their own treatment.

The implications for research and progress in ADHD are, sadly, critical.  The reality is that ADHD profoundly impacts on how these children grow into adulthood and function in society, and the facts are discouraging:  “Almost half of all ADHD students never finish high school” (Frank-Briggs, 2011,  p. 296).  Many experience difficulty in all arenas of living, from careers to personal relationships, because of the limitations on them imposed by the disorder in their formative years, as well as by the challenges it continues to create.  Devising a treatment to truly address the many and unfavorable aspects of ADHD, most likely to be achieved through a combination of moderate stimulant usage and a stress on behavioral development, is essential for providing children with ADHD a chance to grow into stable, healthy adulthood.

References

Centers for Disease Control and prevention (CDC). (2012).  Attention-Deficit/Hyperactivity Disorder (ADHD).  Symptoms and Diagnosis.  Retrieved 25 April, 2012, from http://www.cdc.gov/ncbddd/adhd/diagnosis.html

Frank-Briggs, A. (2011). Attention deficit hyperactivity disorder (ADHD). Journal Of Pediatric Neurology, 3, 291-298.

Kofler, M. J., Rapport, M. D., Bolden, J., Sarver, D. E., Raiker, J. S., & Alderson, R. (2011). Working memory deficits and social problems in children with ADHD. Journal Of Abnormal Child Psychology: An Official Publication Of The International Society For Research In Child And Adolescent Psychopathology, 6, 805-817. doi:10.1007/s10802-011-9492-8

Leggett, C., & Hotham, E. (2011). Treatment experiences of children and adolescents with attention‐deficit/hyperactivity disorder. Journal Of Paediatrics And Child Health, 8, 512-517. doi:10.1111/j.1440-1754.2011.02013.x

Ryan-Krause, P. (2011). Attention deficit hyperactivity disorder: Part III. Journal Of Pediatric Health Care, 1, 50-56. doi:10.1016/j.pedhc.2010.10.001

Schultz, B. K., Storer, J., Watabe, Y., Sadler, J., & Evans, S. W. (2011).  School-based treatment of Attention-Deficit/Hyperactivity Disorder.  Psychology in the Schools, 48, 254-262.

Smoyak, S. A. (2008). Attention-deficit/hyperactivity disorder: Questions and controversies. Journal Of Psychosocial Nursing And Mental Health Services, 8, 8-19. doi:10.3928/02793695-20080801-03

Talero-Gutierrez, C., Van Meerbeke, A., & Reyes, R. (2012). A clinical study of ADHD
symptoms with relation to symptoms of learning disorders in schoolchildren in Bogota, Colombia. Journal Of Attention Disorders, 2, 157-163. doi:10.1177/1087054710383116

Vance, A. A., & Luk, E. L. (2000). Attention deficit hyperactivity disorder: Current progress and controversies. Australian And New Zealand Journal Of Psychiatry, 5, 719-730. doi:10.1046/j.1440-1614.2000.00809.x

Visser, J., & Jehan, Z. (2009). ADHD: A scientific fact or a factual opinion? A critique of the veracity of attention deficit hyperactivity disorder. Emotional & Behavioural Difficulties, 2, 127-140. doi:10.1080/13632750902921930

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