Living With Attention-Deficit/Hyperactivity Disorder, Research Paper Example

Abstract

Attention-deficit/hyperactivity disorder affects roughly 5% of children in the United States (Centers for Disease Control and Prevention, 2009).  The specific criteria needed for identifying ADHD in children has been laid out in the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association.  Physicians, psychologists, and neurologists, as well as others in the medical field who have been approved to diagnose and treat ADHD in children, follow these specific criteria in identification and treatment of the disorder.  Through proper diagnosis and treatment, children with ADHD receive help in dealing with a disorder that affects every part of their life, including home life, schooling, social interaction, and mental and emotional development.  A description of ADHD, as well as the signs and symptoms, the diagnostic process, and treatments available will be discussed in within sections of the following paper.  Specific information concerning the effects ADHD has on certain developmental domains and the effects ADHD has on daily life, such as schooling, socializing, and family life, will be discussed in separate sections.  It is the purpose of this paper to impart detailed facts, documented research, and current theories regarding attention-deficit/hyperactivity disorder.

Living With Attention-Deficit/Hyperactivity Disorder

The Centers for Disease Control and Prevention estimate that attention-deficit/hyperactivity disorder affects roughly five percent of children in the United States (Centers for Disease Control and Prevention, 2009).  ADHD is diagnosed by approved medical professionals, and treatment of the disorder is supervised by approved medical personnel and enacted by a team that can consist of doctors, parents, teachers, and additional family members.  It is a disorder with unknown causes and risk factors and can devastate a child’s life well into adulthood.  However, with proper diagnosis, close treatment, and family commitment, children diagnosed with ADHD experience full childhoods and grow into productive and balanced adults. The following sections will deal first with identification of the disorder itself, signs and symptoms, diagnostic procedure, and treatment.  Discussion of how ADHD affects development within the domains of academic achievement, social development, and self-perception will conclude the paper.

Descriptions of ADHD

ADHD is one of the most common neurobehavioral disorders of childhood. It is usually first diagnosed in childhood and often lasts into adulthood. Children with ADHD have trouble paying attention, controlling impulsive behaviors (may act without thinking about what the result will be), and in some cases, are overly active (The ADHD Molecular Genetics Network, 2002).  The term “neurobehavioral” refers to the way the brain affects emotion, behavior, and learning (Centers for Disease Control and Prevention, 2009).  Research is underway by scientists to determine causes and risk factors, things that increases a person’s chances of developing a disease (MedicineNet, 1998), of ADHD.

Currently, the causes and risk factors of ADHD are unknown, but recent research by the ADHD Molecular Genetics Network has shown the disorder to be related to genetics (Centers for Disease Control and Prevention, 2009).  However, genetics are not the only possible cause under study.  Other possible causes and risk factors of ADHD being studied include brain injury, environmental exposure to substances such as lead, alcohol and tobacco use by the mother during pregnancy, premature delivery, and low birth weight (Centers for Disease Control and Prevention, 2009).  Though scientists have not yet identified the causes and risk factors of ADHD with certainty, research has disproven some popular theories.  Evidence from research does not support excessive sugar consumption or too much exposure to television as main causes of ADHD.  Furthermore, parenting style and social factors such as poverty and a hectic family life are not main causes of ADHD.  These things may certainly enhance symptoms in an individual diagnosed with ADHD, but they are not causes in and of themselves (Centers for Disease Control and Prevention, 2009).

Through research, scientists have found that individuals diagnosed with ADHD fall into three different categories or types of attention-deficit/hyperactivity disorder.  The three types of ADHD are predominantly inattentive type, predominantly hyperactive-impulsive type, and combined type (Centers for Disease Control and Prevention, 2009).  Categorization into one of the three types is based on which symptoms an individual displays most.  The three separate types and correlating symptoms will be discussed in detail in the following section.

Symptoms of ADHD

The previous section introduced three separate types of attention-dificit/hyperactivity disorder, predominantly inattentive type, predominantly hyperactive-impulsive type, and combined type.  Each grouping is distinguished by a set of symptoms.  According to the CDC, the first type, predominantly inattentive type, applies to individuals who find it hard to stay focused on a single task and difficult to pay attention to details.  They may not be able to follow multiple instructions or to stay with the flow of conversation.  Individuals in this category often can forget details of even daily routines (Centers for Disease Control and Prevention, 2009).

The second type, predominantly hyperactive-impulsive type, involves physical symptoms.  Individuals in this group find it hard to sit still for long periods of time.  They become restless and have to move around during meals, while working on homework, or during lectures (Centers for Disease Control and Prevention, 2009).  Fidgeting is characteristic of individuals diagnosed with predominantly hyperactive-impulsive type ADHD.  In small children, this type can be identified by constant running, jumping, or climbing.  Impulsiveness is another characteristic of this type, leading to conversation interrupting, trouble waiting turns, difficulty with directions, and increased accidents and injuries (Centers for Disease Control and Prevention, 2009).

The third category of ADHD diagnoses is a combined type that includes characteristics present in both predominantly inattentive and in predominantly hyperactive-impulsive types.  Individuals placed in the combined type group display symptoms of the other two groups in equal levels of intensity (Centers for Disease Control and Prevention, 2009).  Deciding which group an individual falls in occurs after the confirmed diagnoses of attention-deficit/hyperactivity disorder.  Making the diagnoses of ADHD is often a long and detailed process involving doctors, family members, and teachers.  This process will be discussed in detail in the following section.

Diagnoses of ADHD

Several steps are involved in the process of deciding if a child has ADHD.  The long process is necessary because there is no single test that can be used to diagnose ADHD.  Further complicating diagnoses is the fact that many other problems, like anxiety, depression, and other types of learning disabilities, have similar symptoms (Centers for Disease Control and Prevention, 2009).  To properly diagnose ADHD in a child, there must be a medical exam and hearing and vision tests to rule out other problems that have similar symptoms.  In addition, the diagnoses process includes rating ADHD symptoms present in the child and speaking with teachers, counselors, additional family members, and others that the child is in frequent and routine contact with (Centers for Disease Control and Prevention, 2009).

The diagnoses process for ADHD start with a complete medical exam by a family practitioner.  The physician will ask a number of questions about the child regarding health, medical problems, ADHD symptoms, and any issues that occur in the home and school environment (Mayo Clinic Staff, 2009).  Specific ADHD diagnostic criteria must be met before a positive diagnose of the disorder can be made.  The Diagnostic and Statistical Manual of Mental Disorders (DSM). published by the American Psychiatric Association, has laid out the criteria that must be met for diagnosing ADHD in children (Mayo Clinic Staff, 2009).

For a diagnosis of ADHD, a child must have at least six of the signs present in one of the two types, predominantly inattentive or predominantly hyperactive-impulsive, or at least six signs total from each of the two types (Mayo Clinic Staff, 2009).  The criteria list for each type is listed in the table below (Mayo Clinic Staff, 2009).

(Mayo Clinic Staff, 2009)

In addition to the presence of at least six signs from the two categories, there are other criteria that must be met to reach a correct diagnosis.  The observed symptoms must have been present and caused problems before the age of seven.  Behaviors not normal for peers without ADHD must be present.  The symptoms have to have been present for a time period of at least six months.  Suspected recognized ADHD signs must have caused impairment in more than one setting, such as at home and at school (Mayo Clinic Staff, 2009).  Before the diagnosis is made, the doctor will most likely want to conduct behavioral interviews with individuals the child comes into frequent contact with.  These individuals often include teachers, daycare providers, coaches and additional family members (Mayo Clinic Staff, 2009).  Interviewing helps to identify signs that may not appear during medical exams and also helps to identify the time period signs have been present.  The doctor will also check for similar disorders.  Some medical conditions that display symptoms similar to ADHD include anxiety, depression, hyperthyroidism, seizure disorders, fetal alcohol syndrome, tourette syndrome, asperger’s disorder, sleep disorders, and autism (Mayo Clinic Staff, 2009).

Once a general diagnosis of ADHD has been made, a more specific diagnosis of ADHD type can be made and the child will be diagnosed with the predominantly inattentive, predominantly hyperactive-impulsive, or combined type.  For very young children, additional specialists may need to be consulted during diagnoses.  Children preschool age or younger will usually be evaluated by a psychologist or psychiatrist, speech pathologist, or developmental pediatrician, in addition to a family physician (Mayo Clinic Staff, 2009).

Treatments of ADHD

Once diagnosis is positively reached and the specific type is identified, treatment can proceed.  The National Institute of Mental Health has identified doctors who are qualified to treat attention-deficit/hyperactivity disorder.  Types of doctors identified by the National Institute of Mental Health to supervise treatment for ADHD are psychiatrists, psychologists, pediatricians, family physicians, and neurologists (Mayo Clinic Staff, 2009).  Treatment for ADHD involves doctors, parents, other family members, teachers, daycare providers, and coaches all working closely together.  In most cases, ADHD is treated with a combination of medication and behavior therapy (Centers for Disease Control and Prevention, 2009).  A treatment plan that includes regular follow-ups, close monitoring of activities, and allowance for needed changes will be developed and implemented by those closest in regular, routine interaction with the ADHD child.  Treatments included in these plans include one or more of the following strategies: medication, behavioral intervention strategies, parent training, and ADHD and school (Centers for Disease Control and Prevention, 2009).

According to the Centers for Disease Control and Prevention (CDC), “medication is one option that may help better control some of the behavior problems that have led to trouble in the past with family, friends and at school” (Centers for Disease Control and Prevention, 2009).  There are two types of medications used in treatment of ADHD, stimulants and non-stimulants (Centers for Disease Control and Prevention, 2009).  Stimulants are the most commonly used medication, with the CDC citing a positive response to these medications in between 70-80 percent of children with ADHD.  Brand names of stimulants used to treat ADHD include Adderall, Concerta, Ritalin, and Vyvanse (WebMD, 2009).  Non-stimulants were approved for use in the treatment of ADHD in 2003 and are reported to have fewer side effects than stimulants (Centers for Disease Control and Prevention, 2009).  Strattera is the brand name of the first non-stimulant drug approved for treatment of ADHD.  It was approved in November of 2002 (WebMD, 2009).

Behavioral intervention strategies often accompany medication in treatment of ADHD.  Because ADHD affects relationships with family and how well a child does in classes, behavioral therapy to help with these problems is usually recommended when a diagnosis is made (Centers for Disease Control and Prevention, 2009).  Behavioral therapy will take place with a psychologist, psychiatrist or school counselor.  Since it is important for treatment to carry across all aspects of a child’s life, many techniques are suggested to assist behavioral therapy outside of the professional’s office.  Parents of a child with ADHD are encouraged to create a daily routine, organize objects needed for daily activities, avoid distractions, limit choices to prevent overstimulation, use clear, brief directions, use goals and offer rewards, discipline effectively, and help the child to discover a talent or hobby to encourage self-esteem (Centers for Disease Control and Prevention, 2009).

Parent training as a treatment for ADHD refers to parent education.  Since children with ADHD may not respond effectively to usual parenting techniques, it is necessary to educate parents on effective means of communication and interaction with ADHD children (Centers for Disease Control and Prevention, 2009).  Parents can be educated on how to help ADHD children develop organizational and problem solving skills, as well as on how to effectively discipline and reward a child with ADHD.  Therapists often offer parent training in group or individual sessions.  One group, called CHADD, or Children and Adults with Attention-Deficit/Hyperactivity Disorder, devotes itself to such training (Centers for Disease Control and Prevention, 2009).  It is just as important for teachers to have the necessary skills to help children with ADHD learn and develop as it is for parents.  Regular education teachers often have ADHD students in their classroom, as the disorder does not automatically delegate students to special needs classrooms.  Teachers are encouraged to seek out information about ADHD and to follow direction in ADHD treatment plans.  Some tips for teachers from the CDC are to make assignments clear, be sensitive to self-esteem issues, give positive reinforcement, and involve the school counselor or psychologist (Centers for Disease Control and Prevention, 2009).

Effect on Domains of Development

Academic Achievement

ADHD can create difficulties in many areas of a child’s life.  The adverse effect ADHD can have on academic achievement is staggering.  Numerous studies have shown children with ADHD are less likely to complete high school, more likely to repeat a grade, more likely to be placed in special needs classrooms, and less likely to perform to their full potential (Rabiner, 2005).  A variety of reasons exist for the academic roadblocks encountered by children with ADHD.  Many of the symptoms associated with ADHD are in direct adversity to the skills necessary for academic achievement.  Not all children with ADHD suffer academically because of the disorder.  Many children diagnosed with attention-deficit/hyperactivity disorder graduate high school with no significant problems and even go on to successfully complete higher education.

A study published in the Journal of Consulting and Clinical Psychology, (Biederman et al., (2004), suggests that the difference in academic performance in children diagnosed with ADHD has to do with executive functioning deficits, or EFD’s.  David Rabiner, Ph.D, senior research scientist at Duke University, says, “Executive functions (EFs) can be thought of as the decision-making and planning processes that help to control and direct our behavior.” (Rabiner, 2005).  For example, the act of breaking down a research project into an easy to follow step-by-step process.  Important executive functions include the abilities of planning, reasoning, working memory, shifting cognitive sets, and the ability to adjust behavior to reach long-term goals (Rabiner, 2005).  For reasons not yet known, Biederman’s study on the relationship between ADHD and the presence of EFDs yields results that show children with ADHD and EFDs perform poorer academically than those without a great EFD presence (Rabiner, 2005).  In other words, the presence of EFDs in children with ADHD increases the risk for grade retention, learning disability, and lower academic achievement.

The detrimental relationship of EFDs and ADHD is just one theory that warrants greater study before any certain statements can be made.  Active treatment that involves the use of medication along with behavioral theory, parent training, and school involvement has also proved effective in helping children with ADHD to overcome academic difficulties.

Self-Esteem/Self-Perception

According to pediatrician and neurologist Dr. Chris Steer, “Self-esteem is about how we see ourselves, our personal achievements, and our sense of worth… It gives children the power to believe in their abilities and the courage to try new things.  It helps them develop respect for themselves, which in turn leads to being respected by other people.” (Steer, 2007).  A child’s self-esteem is created by how he or she thinks, what he or she expects of themselves, and how other people feel about him or her (Steer, 2007).  Self-esteem and self-perception becomes a problem when other individuals do not understand the behavior enacted by a child with attention-deficit/hyperactivity disorder and so judge them because of expressed ADHD symptoms.  As a result, many children with ADHD find it difficult to make and keep friends (Steer, 2007).  They have problems with teachers in school and sometimes difficulties at home.  ADHD children may often be punished for disrupting different situations (Steer, 2007).  All of these instances have an effect on a child’s self-esteem.  A child who is punished frequently will come to regard himself or herself as naughty, stupid, or a failure (Steer, 2007).

One of the biggest problems for children with ADHD concerning self-esteem is the problem of exclusion.  Hyperactive and disruptive behavior is a major symptom of ADHD and children with the disorder cannot prevent their own behavior.  Many times individuals children with ADHD come into contact with are not educated on how to handle this constant disruptive behavior.  Uninformed teachers may try to deal with a disruptive student by excluding him or her from the classroom (Steer, 2007).  When a child has a reputation of disruptive and “bad” behavior, other parents are less likely to want to have to deal with that child.  This can lead to exclusion from birthday parties and other social events that are a part of normal childhood experience (Steer, 2007).  Exclusion from normal childhood activities and normal classroom environments reinforces thoughts within the child with ADHD that he or she does not “fit in” or “belong” with their peers.  This leads to feelings of negativity towards oneself.  If such negative feelings continue to be internalized, serious self-esteem issues arise for the child with ADHD.  Negative self-esteem further prevents accomplishments in academic achievement and social interaction because a child with negative self-perceptions is not likely to try as hard to succeed, already having a set view of failure (Steer, 2007).

The tools used to help a child with attention-deficit/hyperactivity disorder achieve a positive self-esteem are the same as for any other child.  There are five basic tips given by Dr. Chris Steer for improving self-esteem in children.  The first is to praise and reward, for both small and large actions.  The second tip is to express love unconditionally and make it clear the child is trusted.  Assistance in setting and attaining realistically achievable goals will grow a child’s self-esteem.  Also, encouraging interests and hobbies will promote positive self-esteem by the achievement of new skills and positive interaction with peers.  Finally, a maintained focus on the positive, such as a list of positive characteristics and traits of the child in a frequently viewed place, will encourage a positive self-perception (Steer, 2007).

References

Centers for Disease Control and Prevention. (2009, October 7). Attention-Deficit/Hyperactivity Disorder (ADHD). Retrieved October 31, 2009, from CDC Centers for Disease Control and Prevention: http://www.cdc.gov/ncbddd/ADHD/

Mayo Clinic Staff. (2009, February 13). Attention-deficit/hyperactivity disorder (ADHD) in children. Retrieved October 31, 2009, from MayoClinic.com: http://www.mayoclinic.com/health/adhd/DS00275/DSECTION=tests-and-diagnosis

MedicineNet. (1998, March 26). Definition of Risk Factor. Retrieved October 31, 2009, from MedicineNet.com: http://www.medterms.com/script/main/art.asp?articlekey=5377

Rabiner, P. D. (2005, February). Attention Research Update. Retrieved October 31, 2009, from Attention Research Update: http://www.helpforadd.com/2005/february.htm

Shaffer, D. &. (2009). Developmental Psychology (8th ed.).

Steer, C. (2007, March 22). Self Esteem and ADHD. Retrieved October 31, 2009, from netdoctor: http://www.netdoctor.co.uk/adhd/selfesteem.htm

The ADHD Molecular Genetics Network. (2002). Report from the third international meeting of the attention-defiicit hyperactivity disorder molecular genetics network. . American Journal of Medical Genetics , 114:272-277.

WebMD. (2009, October 31). Stimulant Drugs for ADHD. Retrieved October 31, 2009, from WebMD: http://www.webmd.com/add-adhd/guide/adhd-stimulant-therapy