Attention Deficit Hyperactivity Disorder (ADHD)

Attention Deficit Hyperactivity Disorder

Attention Deficit Hyperactivity Disorder (ADHD) is a neurological and behavioural condition. It is one of the most common mental disorder that can develop in children. It affected 5% to 8% of children. ADHD can lead to poor school/work performance, poor social relationships and a general feeling of low self esteem (American Psychiatric Association [APA], 2000; American Academy of Paediatrics 2000; National Institutes of Mental Health [NIMH], 2008). The American Psychiatric Association (2000) indicated that the disorder can appear more frequently in males then females, with the ratios ranging from 2:1 to 9:1, depending on the type of disorder and the setting. According to studies, the disorder can persist through adolescence and into adulthood. Journals written by Silver in year 2000 estimated that 30 percent to 70 percent of the patients who were diagnosed with ADHD still exhibit symptoms of the disorder in adulthood.

ADHD Reviewed

The DSM-IV-TR used by mental health professionals, provided criteria for diagnosing ADHD. According to the book ADHD was divided into three subtypes namely the Hyperactive-Impulsive type, Inattentive type, and Combined type.

Signs and symptoms of the Hyperactive-Impulsive type may include fidgety nature, talks a lot and hard to sit still to complete a piece of work or meal. Younger children may run, jump or climb constantly. Older patients may feel restless and may have trouble with impulsiveness. They may blurt out answers before hearing the whole question, interrupt others, or speak at inappropriate times, or talk excessively. Children will have difficulty in participating in sedentary group activities in preschool classes as compared to similar aged children (APA, 2000; NIMH, 2008).

Patients who were diagnosed with the Inattentive type of ADHD may experience symptoms like confusion, distraction and forgetfulness. These often results in making mistakes, having difficulty to sustaining attention, and difficulty to follow through on instructions during work, chorus or other activities. Organizing is a problem for them as they are forgetful. ADHD patients avoid, dislikes, or is reluctant to engage in tasks that require sustained mental effort for fear of being viewed as incapable. They can be often and easily distracted by external stimuli (APA, 2000; NIMH, 2008).

According to the guideline by DSM-IV-TR the Combined type of ADHD must have six or more symptoms of the Inattention Disorder and six or more symptoms of the Hyperactivity-Impulsive Disorder to be established and certified. Most children with the disorder have the Combined type but it is not known whether it hold true for adults with the disorder.

Although a child or adult may display the symptoms, it is not immediately associated with the disorder. A diagnosis of ADHD is usually determined by the number and severity of symptoms, duration of symptoms, and the degree to which these symptoms cause impairment in various life stages. It is important to note that the presence of significant impairment in at least two major settings of the person's life is central to the diagnosis of ADHD. For example losing a job because of ADHD symptoms or getting a failing grade in school. It is also important to note that the symptoms to the appropriate subtype must persist for at least six months (APA, 2000; NIMH, 2008).

Causes of ADHD

No one knows exactly what causes ADHD. There appears to be a combination of causes, from genetics to possible environmental influences. Physical differences in the brain seem to be involved. Several different factors could increase a child’s likelihood of having the disorder.

It was suggested that The School Environment factor can be one of the cause of ADHD. The caused as suggested by Goodman and Poillion (1992) can be the child’s delay in language development, learning disabilities, difficulty in adjusting to the school environment and to school-related activities. Barkley (1998) and Jensen and fellow researchers (1997) beg to differ the view. The results of Goodman and Poillion (1992) only holds true to children with ADHD having a higher incidence of academic and school related problems when compared to children without ADHD. It does not constitute to the main cause of ADHD.

There were also researchers pointing fingers to Environment Agents such as the use of cigarette and alcohol during pregnancy (NIMH, 2008; Ramsay & Reynolds, 2000). Exposure to high level of lead may also be one of the cause (NIMH, 2008; Rice, 2000; Weiss & Landrigan, 2000)

Sugar or food additives in the diet may also worsen ADHD. It was found by National Institutes of Health, US, in 1982 that diet restrictions helped about 5 percent of children with ADHD, mostly young children who had food allergies. Also it was stated by Wolraich et al. (1985) in their studies that the effect of sugar on children, using sugar one day and a sugar substitute on alternate days, without parents, staff, or children knowing which substance was being used, showed no significant effects of the sugar on behaviour or learning. However another study by Hoover & Milich (1994), whose parents were told what was given to them, reported children who received sugar were rated more hyperactive than the other children and were more critical of their behaviour.

Genetics influences or hereditary can also lead to one of the cause of ADHD. Biederman et al. (1990) and Robert (2001) wrote in their studies that child of an adult with ADHD has approximately a 25% chance of having ADHD.

Accompanying Disorder

Many children with Tourette's Disorder also have ADHD. Statistics by DSM-IV-TR showed that 50% of the clinic-referred individuals with Turette’s Disorder also had ADHD but it also stated that individuals with ADHD may not have Turette’s Disorder. Children with Tourette's Disorder may also have learning disabilities or thoughts or behaviours that are repeated over and over, such as eye blinks, facial twitches, or grimacing.

Both Bipolar and ADHD shared many similarities in its characteristics of the Disorder. The many characteristics may include impulsivity, inattention, hyperactivity, behavioural and mood changes. Therefore differentiating between ADHD and bipolar disorder in childhood can be difficult (American Psychiatric Association, 2000). Outbursts and temper tantrums lasted a shorter duration in child with ADHD then child with Bipolar. Attention spent for child with ADHD are still shorter when compare to child with Bipolar. Children with Bipolar can spent a long time watching his favourite TV show but children who are ADHD, even if interested, may not stay as long.

Treatments

It is useful to note that behavioural therapy, emotional counselling, and practical support helped children with ADHD to feel better about themselves.

Treatment techniques such as the Dialectical Behaviour Therapy by Dr. Marsha Linehan (1991) can help individuals with ADHD better manage their life. It seeks to teach the patient how to learn to better take control of their lives, their emotions, and themselves through self-knowledge, emotion regulation, and cognitive restructuring. It is a comprehensive approach that is most often conducted within a group setting.

Administer of drugs such as methylphenidate was also used. Much success was reported in the therapy with drugs (Carlson et al., 1992) but parents tend to favour behavioural treatment over pharmacological treatments (Pelham, 1999).

Teaching and Support

As was indicated by DSM-IV-TR there was no particular signs and symptoms that can diagnosis ADHD. Although parenting and discipline style do not cause ADHD, parents’ involvement in the behavioural treatment can help manage the symptoms. It is suggested schedule, rule and reward, and punishment system to be set in order to help the patients and to condition them to such desirable behaviour or outcome.

Schedule may be set for specific times like waking up, eating, playing and doing homework. The schedule had to be easily visible also because it will keep reminding them of the time for specific task. On the other hand, they will be conditioned after some time, consciously or subconsciously, to do the task at the times.

Another example will be to focus on effort rather than on the grade of the child. Reward the child when he or she finished the homework as grade may not be the ‘true knowledge’ to what they have learned in school. Is it also important that they make it a habit to finish an assignment. Most important of all, there have to be quires about the child from parents to teachers on how the child is doing in school.

Short Term Memory

Short-term memory was sometimes referred to as "primary," "working," or "active" memory, was said to hold a small amount of information for about 20 seconds. Short-term memory can also be described as the capacity for holding a small amount of information in mind in an active, readily available state. The information held in short-term memory may be recently processed sensory input or items recently retrieved from long-term memory or the result of recent mental processing The most important characteristic of a short-term store was that it retains information for a limited amount of time only. Most definitions of short-term memory limit the duration of storage to less than a minute, and in some models as little as 2 seconds.

The Brown-Peterson’s paradigm developed by Brown in 1958 and the Petersons in 1959 tested two hypotheses in what caused forgetting in Short-term memory (STM). The interference theory suggested that the cause of forgetting was the entry of other items into STM. It claimed that strength of information already in STM weaken as new items enters. The decay theory was associated with the length of time in which the information remained in STM; the longer the passage of time, the probability of correct recalling was reduced. In other words, it tested the effects of interference and time limit of STM.

The Brown-Peterson’s paradigm made use of the distracter task to prevent its subjects from rehearsing the letters. When experimented with the paradigm, the subjects had to memorize three short words that were written on an index card for a variable delay with the inclusion of an interfering task. The subjects would hear a three digit number and from there they count the number by three for a period of time. At the end of the interval, subjects were asked to recall the items. Findings suggested that the recall was quite accurate at the short retention intervals but drops rapidly, when the retention interval was approximately 15 to 25 seconds.

Methods

With regards to the Brown Peterson Paradigm, an experiment was conducted using a slightly modified version of the paradigm. The experiment was conducted using 99 participants in Perth, year 2007. It was a simple design, with two within subjects variables: Delay (1, 11, and 21 seconds) and Repetition (Time 1 VS Time 2).

The experiment was conducted to test two hypotheses. Hypothesis number one was that “practice makes perfect” and hypothesis number two was hypothesized as “Fatigue when performing task twice”. In other words, the result should indicate an improved and more accurate result at Time 2 than Time 1 in hypothesis one. On the other hand, hypothesis two should indicate a more accurate result or performance in Time 1 than in Time 2

Results

Table 1

Repetition Delay	Mean	Std Error
1 1	79.628	2.066
2	81.818	1.870
3	82.390	2.166
2 1	92.120	1.388
2	90.679	1.319
3	87.317	1.554

The results of Delay experiment, as from above showed, argued in favor of the Brown Peterson Paradigm. The standard error went up as time of delay lengthens. Therefore, conclusion was that the participants were not able to recall as efficiently as time of delay increased from 1 second to 20 seconds.

Table 2

(I)Delay (J)Delay	Mean Difference (I-J)	Std Error
1 2	-2.190	2.483
3	-2.762	2.723
2 1	2.190	2.483
3	-.572	2.387
3 1	2.762	2.723
2	.572	2.387

Table 3

(I)Delay (J)Delay	Mean Difference (I-J)	Std Error
1 2	1.440	1.730
3	4.803	1.830
2 1	-1.440	1.730
3	3.363	1.532
3 1	-4.803	1.830
2	-3.363	1.532

Comparison between Time 1 and Time 2 showed a drop in mean difference and improved standard error. The subjects had actually performed better when tested the second time. The result therefore did not comply with the hypothesis of “Fatigue when performing the task twice”. In other word, it showed a more accurate result or performance in Time 2 than in Time 1, proving that practice do make perfect. Repetition had actually produced better performance or results.

Discussion

Findings from the experiments suggested that time and exposure to a task can affect STM. Repeated exposure to a task can improve a person’s STM, shown in the experiments, was also proven by Tarnow and Eugen in 2005. Duration in which information can be retained in the STM can be lengthen by repeating or rehearsing either by articulating it out loud, or by mentally simulating such thoughts. In this way, the information will reenter the short-term store and be retained for a further period. As demonstrated by Brown-Peterson paradigm, the longer the delay of a task in STM the less accurate it becomes. It can be argued that as time lengthens, new information enters STM and thus reducing correct recalling or causing forgetting.

Although it was shown that STM was limited by duration of retaining, methods such as chunking can also increase a person’s ability to recall. Ericsson et. al. demonstrated in 1980 that a person was able to increase their recalling ability through the use of chunking. For example, in recalling a phone number, the person usually chunks the digits into three groups. First, the area code (such as 814), then a three-digit chunk (123) and lastly a four-digit chunk (4567). In Singapore’s context where there are only 8 number locally; the number was divided into two parts, such as 1234 then 5678. This method of remembering phone numbers is far more effective than attempting to remember a whole string of numbers.

Miller, in 1956, summarized evidence that people can remember about 7 chunks in short-term memory tasks. However, that number was meant more as a rough estimate than a real capacity limit. Others have since suggested that there was a more precise capacity limit, but that was only 3 to 5 chunks.

Research by Baddeley et. al. in 1975 had shown that seven number was roughly accurate for college students recalling lists of digits, but memory span varies widely with populations tested and with material. The ability to recall words in order depends on a number of characteristics of the words. Fewer words can be recalled when the words have longer spoken duration.

The working memory model that was developed by Baddeley and Hitch in 1974 led them to propose that the memory we use when working on a task was divided into 2 areas, the visual or acoustic. Visuo-spatial sketch pad deals with visual material and phonological loop deals with auditory material.

When their speech sounds are similar to each other; this is called the phonological similarity effect (Conrad and Hull, 1964). More words can be recalled when the words are highly familiar and/or occur frequently in the language (Pointer and Saint-Aubin, 1996); recall performance is also better when all of the words in a list are taken from a single semantic category (such as sports) than when the words are taken from different categories (Pointer and Saint-Aubin, 1995).

The key concept associated with a short-term memory was that it had a finite capacity, with a time of not more than 30s to the estimates of about 9 varying elements. The average person may only retain about 7±2 different units in his or her short term memory, to be able to improve STM, various methods of techniques had to be applied. The limits to an individual had to really depend on the various situation factors and their conditions. Therefore, general conclusions about STM can rarely be made.

Answers and Green Light

We can never know everything beforehand, and we often only learn things when we need to learn them. Often follow by disappointment. Therefore many people never start projects simply because they do not have all the answers. In reality fact, anyone in the world will never know or have all the answers.

" Many people will not cross the street until the light is green. That is why they don't go anywhere "