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.