Attention Deficit Hyperactivity Disorder (ADHD)
Introduction
ADHD is the most chronic condition of childhood. Almost 4% to12% of the children suffer from this. It is a condition of the brain that makes it difficult for the children to control their behavior and it often continues into adulthood. Those children who are constantly in motion such as tapping fingers, and making noise all the time, don’t wait for their turn instead crash into everything, poking others for no apparent reason are called hyperactive. A child with ADHD does not choose to misbehave.
ADHD isn’t just being lazy or lacking willpower, people with this disorder can focus on something they are interested in or those things that are new and exciting to them. They can get very absorbed in it. They just lose interest and lack focus on those things that are mundane, repetitive, or require a greater degree of mental effort.
Children with ADHD have problems that are severe that even interfere with their daily normal lives too. They find it very hard to pay attention to something, therefore it’s not very easy for them to learn things.
Neither do they get along with their siblings, friends, or any other family members? These children cannot control their behavior; they are short-tempered too and often put themselves in physical danger.
The Role Of Culture In Internalizing And Externalizing Behavior Problems
The values and more of culture may play a vital role in whether a certain pattern of child behavior develops or is considered a problem. One study found that in Thailand, children with internalizing behavior problems, such as fearfulness, were the ones most likely to be seen in clinics, whereas in the United States, those with externalizing behavior problems, such as aggressiveness and hyperactive, were more commonly seen. The researchers attributed these differences to the fact that Buddhism, which disapproves of and discourages aggression, is widely practiced in Thailand. They also cautioned that their results were based on assessment measures that were normed on U.S. samples and that additional work needed to be done to ensure that the assessment measures were valid for Thai children.
Findings from a follow-up study suggest that the behavior problems described in the same terms may not really be exactly the same across Thai and U.S. cultures. The researchers compared specific behavior problems (e.g., somatic complaints, aggressive behavior) and broad domains (internalizing, externalizing) using U.S. and Thai assessment measures. The broad domains of internalizing and externalizing behaviors were found to be the same in Thai and U.S. children, but more specific categories within those domains were not. Among boys, somatic complaints were seen consistently across cultures, but shyness was seen less consistently. Among girls, shyness was seen consistently across cultures but verbal aggressive behavior was not.
These studies point to the importance of studying psychopathology across cultures. It is dangerous to assume that the measures we develop to assess psychopathology in the United States will work equally well across cultures. As the investigators cited above point out, our theories about the causes of psychopathology need to be able to account for cultural variation in such factors as parenting practices, beliefs and values, and the ways in which parents report on their child’s behavior problems. This remains an urgent and important challenge for our field.
Behaviors In Adolescents With And Without ADHD
Behavior Blurts out answers Distracted easily
Doesn’t complete tasks before moving to another Doesn’t sustain attention
Doesn’t follow instructions Doesn’t listen to others well
Engages in physically dangerous activities Fidgets
Finds it hard to play quietly Gets out of their seat often Interrupts others
Loses things needed for tasks Talks a lot
Source: Adapted from Barkleyetal (1990).
| With ADHD | Without ADHD |
| 65 | 10.6 |
| 82.1 | 15.2 |
| 77.2 | 16.7 |
| 79.7 | 16.7 |
| 83.7 | 12.1 |
| 80.5 | 15.2 |
| 37.4 | 3 |
| 73.2 | 10.6 |
| 39.8 | 7.6 |
| 60.2 | 3 |
| 65.9 | 10.6 |
| 62.6 | 12.1 |
| 43.9 | 6.1 |
Clinical Descriptions
What distinguishes the typical range of hyperactive behaviors from a diagnosable disorder? When these behaviors are extreme for a particular developmental period, persistent across different situations, and linked to significant impairment in functioning, the diagnosis of ADHD may be appropriate. The ADHD diagnosis does not properly apply to children who are rambunctious, active, or slightly distractible, Using the label simply because a child is more lively and more difficult to control than a parent or teacher would like a serious mistake.
Children with ADHD seem to have particular difficulty controlling their activity in situations that call for sitting still, such as in the classroom or at mealtimes. When told to be quiet, they appear unable to stop moving or talking. Their activities and movements seem haphazard. They may quickly wear out their shoes and clothing, smash their toys, and exhaust their families and teachers.
Many children with ADHD have difficulty getting along with peers and establishing friendships, perhaps because their behavior is often aggressive and intrusive (Blachman & Hinshaw, 2002; Hinshaw & Melnick, 1995). Although these children are usually friendly and talkative, they often miss subtle social cues, such as noticing when another child is tired of their constant jiggling. They also frequently misinterpret the wishes and intentions of their peers and make inadvertent social mistakes, such as reacting aggressively because they assume that a neutral action by a peer was meant to be aggressive.
A study involving observation of children playing tabletop football demonstrated that children with ADHD, particularly those who are also aggressive, have different social goals than other children. Children with ADHD who were also aggressive approached the game with sensation-seeking goals, such as making trouble, achieving domination, and showing off, whereas the other children were more likely to have the goal of playing fair (Melnick&Hinshaw,1996). In another study, children were asked to
Instant- message (IM) other children in what appeared to be an online chat room. Actually, children were interacting with four stimulated peers on the computer, and thus all children got the same IMs from the stimulated peers. The researchers coded the messages and the participants reported experiences of the chat elicited in subsequent interviews. Children with ADHD were more likely to IM statements that were hostile and the topic than were hostile and off-topic than were children without ADHD, children’s chat room experiences were related to other measures of social skills difficulties, suggesting that this common way of “interacting” with peers, even though not face-to-face, is also impaired among children with ADHD.
Children with ADHD can know what the socially correct action is in hypothetical situations but be unable to translate this knowledge into appropriate behavior in real-life social interactions. Children with ADHD are often singled out very quickly and rejected or neglected by their peers for example, in a study of previously unacquainted boys at a summer camp, boys with ADHD who exhibited a number of externalizing behaviors, such as overt aggression and noncompliance, were regarded quite negatively by their peers during the first day of camp, and these impressions remained unchanged throughout the 6-week camp period.
These children are most likely than those with other subtypes to develop conduct problems and oppositional behavior, to be placed in special classes for children with behavior problems, and to have difficulties interacting with their peers. Children with attention problems but with focused attention or speed of information processing, are perhaps associated with problems involving the neurotransmitter dopamine and certain areas of the brain, including the prefrontal cortex topics which we turn to below.
A difficult differential diagnosis between ADHD and conduct disorder involves a gross violation of social norms. An overlap of 30 to 90 percent between the two categories has caused some researchers to assert that these types of externalizing disorders are actually one and the same. There are some differences; however, ADHD is associated more with off-task behavior in school, cognitive and achievement deficits, and a better long-term prognosis. Children with ADHD act out less in school and elsewhere and are less likely to be aggressive and to have antisocial parents. Their home life is also usually marked by less family hostility, and they are less risk for delinquency and substance abuse in adolescence compared to children with conduct disorder.
When these two disorders occur in the same child, the worst features of each are manifest. Such children exhibit the most serious antisocial behavior, are most likely to be rejected by their peers, have the worst academic achievement, and have the poorest prognosis. Girls with both ADHD and conduct disorder exhibit more antisocial behavior, other psychopathology, and risky sexual behavior than girls with only ADHD.
Internalizing disorders, such as anxiety and depression also frequently co-occur with ADHD. Recent estimates suggest that as many as 30% of children with ADHD may have co-morbid internalizing disorder. In addition, about 15 to 30 % of children with ADHD have a learning disability in math, reading, or spelling, and many children with ADHD are placed in special education programs because of their difficulty in adjusting to a typical classroom environment.
Although having both ADHD and conduct disorder is associated with substance use and abuse, a prospective study found that hyperactive symptoms of ADHD predicted subsequent substance seating 14 and abuse or dependence at age 18 even after controlling for symptoms of conduct disorder, and this was equally true for boys and girls.
The consensus on prevalence estimates of ADHD is that about 3-7 percent of school-age children worldwide currently have ADHD. When similar criteria for ADHDareusedacrosscountriesasdiverseas the United States, Kenya, China, and Thailand, the prevalence rates are similar; however, using the same criteria may not adequately capture cultural differences in ADHD.
Much evidence indicates that ADHD is more common in boys than in girls, but exact figures depend on whether the sample is taken from clinic referrals or from the general population. Boys are more likely to be referred to clinics because of a higher livelihood of aggressive and antisocial behavior. Until recently, very few carefully controlled studies of girls with ADHD were conducted. Because so little research has been done with female samples, it is important to document the characteristics, correlates, co-morbid disorders, and other social and cognitive deficits in a carefully selected sample of girls with ADHD. Two groups of researchers have conducted such studies. One research group examined a large and ethnically diverse sample of girls with and without ADHD and reported a number of key findings at the initial assessment and then again five years later.
Similar to findings with male samples, girls with the combined type had more disruptive behavior symptoms than girls with the inattentive type.
Girls with the combined type were more likely to have a co-morbid, diagnosis of conduct disorder or oppositional defiant disorder than girls without ADHD, and this difference remained five years after year’s initial diagnosis.
Girls with the combined type were viewed more negatively by peers than girls with the inattentive type and girls without ADHD; girls with the inattentive type were also viewed more negatively than girls without ADHD.
Girls with ADHD were likely to be more anxious and depressed than were girls without ADHD, and this remained five years after initial diagnosis.
Girls with ADHD exhibited a number of neuropsychological deficits, particularly in executive functioning, compared with girls without, ADHD replicating other findings.
- By adolescence, girls with ADHD were more likely to have symptoms of an eating disorder, and substance abuse than girls without ADHD.
At one it was thought that ADHD simply went away by adolescence. However, this belief has been challenged by numerous longitudinal studies. Although some children show reduced severity of symptoms in adolescence, 65 to 80 % of children with ADHD still criteria for the disorder in adolescence. Many children with ADHD do not appear to take a ‘hit’ with respect to academic achievement, however – many studies indicate that achievement is within the average range for both adolescent boys.
In adulthood, most people with ADHD are employed and financially independent, but some studies have found adults with ADHD are generally at a lower socioeconomic level and change jobs more frequently than is typical. The rates of ADHD in adulthood vary depending on the method of assessment. Specifically, when ADHD in adulthood is assessed self-reports of adults who had had ADHD as children, more than hall meet the criteria for ADHD. Whose assessment is correct? This question is impossible to answer. It may be the case that the adults with ADHD are less aware of their symptoms, or it could be that the parents’ reports are influenced by their memories of their children. Findings from a review of studies that have assessed ADHD longitudinally into adulthood indicate that up to 15% of people continue to meet full
Criteria as 25 years old adults. Even more people close to 60% continued to meet the criteria for ADHD impartial remission as adults. Thus, ADHD symptoms appear to decline with age, but they do not entirely go away for many people with ADHD.
Onset
There are theories that say that ADHD is a psychological condition that is present since birth. But the noticeable begins early in childhood. Before the age of 5 ADHD symptoms are not easy to diagnose, because most young children are highly energetic, easily distractible, and impulsive. So, it is not necessary that they are suffering from ADHD. It gets quite hard to detect. Its symptoms usually start before 12years. ADHD symptoms can be mild, moderate, or severe and they may continue into adulthood. There are 2.5 boys for every 1 girl that has been diagnosed. Yet when we look at adults it is 1 to 1 – it’s not late on set – it’s a late diagnosis. 54% of adult women diagnosed with ADHD as minors wish they had been diagnosed sooner.
Symptoms
=> Common symptoms may include:
- Excessive talking
- Restlessness
- Fidgeting
- Impatience
- Forgetfulness
- Distractibility
- Poor organization
- Risk-taking
- Loss of focus
- Abrupt behavior
- Lack of attention to detail
Causes
=> The causes of ADHD currently remain the subject of research, but experts believe contributing factors may include;
- Genetics
- Brain injury
- Premature birth
- Low birth weight
- Substance uses during pregnancy
- Exposure to environmental hazards during pregnancy or at a young age
Treatment
1. Stimulant medications- stimulant medications, such as methylphenidate, or Ritalin, have been prescribed for ADHD since the early 1960s. Other medications approved by FDA to treat ADHD include Adderall, Concerta, and Strattera. In 2006, an estimated 2.5 million children in the United States were taking stimulant medications (nationals survey on children health, 2003), including almost 10% of all 10-years-old boys. The prescription of these medications has sometimes continued into adolescence and adulthood in light of the accumulating evidence that the symptoms of ADHD do not usually disappear with the passage of time.
The drugs used to treat ADHD reduce disruptive behavior and improve the ability to concentrate. Numerous controlled studies comparing stimulants with placebos in double-blind designs have shown short-term improvements in concentration, goal-directed activity, classroom behaviors, shown short-term improvements in concentration, goal-directed activity, classroom behavior, and social interactions with parents, teachers, and peers, as well as reductions in aggressiveness and impulsivity in about 75% of childhood ADHD.
In secondary analyses undertaken to clarify the key findings from the MTA study, researchers reported that the behavioral treatment alone was superior to the community–based care at three of the six sites, but not at the other three. In addition, further comparisons of the combined treatment with treatment by medication alone suggested that 20%more children who received were also associated with fewer behavioral problems at school, and additional analyses suggest that this effect may be linked to a decrease in negative and ineffective parenting. Finally, analyses that examined treatment effects by ethnicity indicated that white, African American, and Latino children benefited equally from treatment, particularly from the combined treatment.
2. Psychological treatment- other promising treatments for ADHD involve parent training and changes in classroom management. These programs have demonstrated at least short-term success in improving both social and academic behavior. In these treatments, children’s behavior is monitored at home and in school, and they are reinforced for behaving appropriately- for example, for remaining in their seats and working on assignments.
School interventions for children with ADHD include training teachers to understand the unique needs of these children and applying operant techniques in the classroom, providing peer tutoring in academic skills, and having teachers provide daily reports to parents about in-school behavior, which are followed up with rewards at home. Researchers have demonstrated that certain classroom structures can help children with ADHD.
Diagnosis
Either A or B;
Six or more manifestations of attention present for atleast 6 months to amal adaptive degree and greater than what would be expected, given a person’s developmental level, for example, careless mistakes, not listening well, not following instructions, easily distracted, forgetful in daily activities.
Six or more manifestations of hyperactivity-impulsivity present for at least 6 months to amal adaptive degree and greater than what would be expected, given a person’s developmental level, e.g., squirming in the seat, running about inappropriately, acting as if “driven by a motor”, incessant taking.
Some of the above present before age 7.
Present in two or more settings, e.g., at home, school, or work.Significant impairment in social, academic, or occupational functioning.
Not part of other disorders such as schizophrenia, an anxiety disorder, or a mood disorder.
Conclusion
In early childhood, it may be difficult to distinguish symptoms of ADHD from age-appropriate behavior in active children (e.g., running around or being noisy).
Inattention in the classroom may also occur when children with high intelligence are placed in academically understanding environments.
There are so many renowned personalities who have struggles with attention deficit hyperactivity disorder such as Stephen Hinshaw psychopathology researcher and expect on mental illness stigma, who is Conducting one of the largest ongoing studies of girls with ADHD. Michael Phelps who won 8 gold medals in swimming at the 2008 Olympics also struggled with ADHD as a child.
Top 13 Interesting Facts About ADHD
ADHD children are often viewed as simply undisciplined and that it is a symptom of bad or ineffective parenting. It is a medical condition caused by a chemical imbalance in the brain.
While many children with ADHD are hyperactive, noisy, and impulsive, the condition canal so exists in quiet and withdrawn kids.
Thirty years of medical imaging proves that there are multiple differences in the ADHD brain versus the normal brain.
We focus a lot on the attention problems of ADHD is more than just an attention issue it is not a learning disability.
There are three types of ADHD, only one of which is heavily hyperactive. This condition is inattentive and the third type is a mix of hyperactive and inattentive.
Boys are more than twice likely to be diagnosed with ADHD than girls, simply because they usually display more hyperactivity and theism or are easily diagnosed.
ADHD was first mentioned in 1902, but it was only towards the end of 1968 that the APA recognized ADHD as a mental disorder. This is the fact that there are now more accurate techniques for diagnosing ADHD as well as more awareness of the condition in general leads to a higher number of diagnoses.
A life with ADHD can be riddled with differences in functioning, interpersonal, social, academic, and professional skills. It can lead to significant issues at school and work, relationship problems, anxiety, and depression, which is why proper diagnosis and treatment are key to supporting children with ADHD.
Every now and then there are studies that suggest that ADHD might be caused by diet, vaccines, trauma, or a number of other issues.
ADHD is manageable, but for the treatment to be effective one needs an individualized, multimodal treatment that can include behavioral intervention, parent and patient training, educational support, and medication.
At least 60% of children with ADHD will continue to exhibit symptoms of the disorder to an impairing degree during adulthood.
You cannot punish someone’s brain into working differently. However, there are coping strategies and self-discipline measures that can be taught/learned to help kids with ADHD manage their symptoms. Giving ADHD children structure, routine, and breaking instruction into little, manageable ones. It can help them to cope better with everyday tasks.
It is not necessarily true. Although living with ADHD has its challenges, lots of people with ADHD lead very successful and fulfilling lives.
