Attention Deficit Hyperactivity Disorder
ADHD or Attention Deficit Hyperactivity Disorder can be defined as a neurobehavioral disorder affecting the development of children below the age of 7 years (Wilens, 2002). This disorder commonly affects the behavior, cognition, emotional and learning functioning of the child (Barkley, 1995). It has also been observed that ADHD does not only affect children but is also found in some adults. In addition, it is also one of the most studied common disorders ever to exist in the history of mankind where practitioners are asked to help diagnose the disorder as well as offer recommendations while educating the family (Reeves, 1990).
Attention Deficit Hyperactivity Disorder was first diagnosed in the late 19th Century after the patient suffered injury to the brain (Khan & Faraone, 2006). In the course of the 20th Century, descriptions of inattention and hyperactivity were observed in the medical literature as consequences of head injuries or associated with infections to the central nervous system (CDCP, 2005). It has been clinically observed that majority of ADHD symptoms fall under hyperactivity category as compared to those that fall under inattention. It has also been observed that boys unlike girls are more prone to the disorder and it has currently not been understood as to why this is the case (Reeves, 1990).
Clinical Description of ADHD
The very first clinical description of ADHD can be attributed to an individual known as George still who recognized and diagnosed characteristics of defiance, inattention and aggression in 43 children, in 1902 (Ingersoll, 1988). As earlier mentioned, with the onset of the 20th Century, the disorder was diagnosed on the basis of injury to the brain as well as infections and presence of toxins. Despite being difficult to assess in infancy as well as toddlerhood, symptoms of the disorder may present themselves as early as 2 years (Leutwyler, 1996).
For a clinical description of ADHD, a child is expected to portray a number of symptoms which include being disorganized as concerns activities and tasks, inability to pay attention for longer periods, making careless mistakes during play or work, as well as becoming easily distracted (Barkley, 1995). Other symptoms of the disorder that are described include not being able to listen to what is being said, fidgeting with feet or hands, not being able to sit still in a chair when expected to remain seated and interrupting or intruding on others for instance while playing or during conversations (Smith, 1991).
Even though problems may at times not manifest themselves while the child is at home, they usually do once a child is admitted to a hospital. Such cases occur when parents do not recognize the child’s behavior as being out of the norm (Osman, 1997). Lack of realization of these symptoms early enough may also be due to the problems being mild or the child still being young for the parents not to pay any particular attention to them (Wilens, 2002). With the emergence of modern day technology enabling food to be artificially processed, food additives have been observed through studies recently carried out to have a possible connection between ADHD and consumption of certain food additives (Barkley, 1995). These are said to cause the hyperactive symptom related to the disorder.
On the other hand, doctors have determined a few factors as not being a cause of the disorder. For instance, watching too much television, lack of vitamins, food allergies as well as fluorescent lights (Khan & Faraone, 2006). In addition, exposure to harmful environmental pollutants, substance abuse and smoking are also factors linked to causing ADHD (Braun, et al., 2006).
The DSM-IV Diagnostic Criteria of ADHD
DSM-IV, also known as Diagnostic and Statistical Manual for Mental Disorders is a manual providing criteria for diagnosing ADHD (Silver, 2007). In this manual, diagnosis for the disorder is determined by presence of enough symptoms of hyperactivity, inattention or a combination of both (Ibid, 2007). The diagnostic criteria of ADHD according to the DSM-IV include 5 different categories. In the first criterion, diagnosis is made after 6 or more symptoms of the disorder have been observed for at least six months (Wender, 1987). These symptoms include often failing to listen when directly spoken to, often making careless mistakes in work, school or other assigned activities and blurting out answers before questions have been completely asked (CDCP, 2005). Often talking excessively, fidgeting with feet and hand as well as having difficulty awaiting turn are also symptoms associated with making diagnosis as concerns the disorder using the manual.
In the second criterion, the DSM-IV determines that some of the ADHD symptoms causing impairment on the child were observed to have been present before reaching the age of 7 years (Reeves, 1990). While in the third criterion some impairment from symptoms of ADHD are present in more than two settings as determined by the manual, in the fourth criterion, there has to be clear evidence of significant impairment determined clinically in academic, occupational or social function of the patient (CDCP, 2005). In the fifth and final criterion, according to the DSM-IV diagnosis, ADHD symptoms cannot be observed during the course of the development of other mental disorders for instance mood disorders, schizophrenia, personality disorder or anxiety disorder (Wilens, 2002).
Two or Three Most Common Comorbid (co-occurring) Psychological Disorders present with ADHD
Clinically, majority of those individuals diagnosed with ADHD also exhibit two or more mental disorders. Research has also revealed that these high levels of psychiatric comorbidity have been present in pediatric and psychiatric patients. There have been a number of common comorbid psychological disorders diagnosed along with ADHD for instance conduct problems (Silver, 2007). Research studies have revealed that there is a high possibility of co-occurrence of defiant, anti-social and aggression characteristics in individuals suffering from ADHD. The defiant characteristic in a child may be detected as early as preschool years even though it is diagnosed fully during middle childhood (Barkley, 1995).
Another co-occurring psychological disorder present with ADHD that has been clinically diagnosed is developmental and medical problems. Developmental problems incorporate dysfluency in language production and speech delay while medical problems incorporate organization of language and motor co-ordinations (Frankel, et al., 1997). In addition, problems in social relationships with other children have been observed in children suffering from ADHD. Due to their condition, these children are often perceived as being immature as well as having little or no regard for social consequences as a result of their behavior (Smith, 1991). Despite their being able to talk excessively, they may not be able to respond to verbal interactions where their peers are concerned. Problems in social relationships may be caused by children suffering from ADHD not being able to interpret the intentions of others towards them (Khan & Faraone, 2006). This may in turn result in peers as well as other individuals pulling away from them hence painful isolation of which they cannot be able to understand.
When ADHD is co-occurring with another mental disorder, it is usually the first one to be diagnosed and those children suffering from severe ADHD symptoms are most likely to develop other mental disorders (Wilens, et al., 2002). When trying to evaluate Comorbid conditions, doctors are often advised to try and determine if one main condition can account for the most distressing and visibly disabling symptoms (Silver, 2007). Once it has been determined whether both conditions are responsible for the patient’s impairments, the doctors are required to proceed with making diagnosis as concerns the ADHD and the comorbid condition, providing treatment in the process (CDCP, 2005). On realizing that comorbidity is a vital predictor of impaired outcome clinicians are given a foundation with which to reach a medium-term prognosis in children suffering ADHD (Frankel, et al., 1997).
Etiology of ADHD according to the Biopsychosocial Model
Biopsychosocial model is a guide meant to assist professional mental health clinicians figure out what is wrong with an individual after assessing him/her broadly (Fava & Sonino, 2008). This guide assumes that mental health disorders are usually influenced by multiple areas of human experience rather than being limited to a particular human experience area. For instance, an individual who is suffering from depression is assumed to have come to that state as a result of a certain medical, psychological or social conditions (Wilens, 2002).
The aetiology of ADHD has not been fully proven up to present day. However, according to the Biopsychosocial Model, there are a few factors believed to contribute to the disorder. For instance, genetic factors where a child or an individual can inherit genes carrying the disorder from their parents (Reeves, 1990). In addition, exposure to environmental toxins or a mother’s use of alcohol and/or cigarettes during pregnancy can also be a contributing factor of ADHD. A number of studies have observed significant relationship between tobacco smoke exposure and ADHD. Lead exposure in the environment to the infant has also been related to high degrees of inattention as well as impulsivity (Fava & Sonino, 2008).
According to the Biopsychosocial Model’s point of view, an illness or disease do not present or exhibit themselves in terms of pathophysiology but also tend to affect different levels of functioning of an individual (Barkley, 1995). Mental disorders for instance anxiety disorders, substance abuse and mood disorders are often observed by clinicians who in turn sanction the Biopsychosocial Model as a guide to treating these psychiatric disorders (Smith, 1991). This guide states that all mental disorders have social, biological and psychological causes where a clinician’s evaluation will include making an effort in trying to understand how distinct factors lead to a patient’s symptoms (Fava & Sonino, 2008). While determining the etiology of ADHD in a patient using the Biopsychosocial Model, family issues are normally explored to get necessary background information needed to make the correct diagnosis of the symptoms being exhibited.
In addition, the Biopsychosocial model guide makes an assumption that mental disorders are rarely limited to one area and are on the contrary influenced by a number of domains of an individual’s experience, resulting in psychological, social or spiritual as well biological impacts (CDCP, 2005). Problems with distractibility and inattention can be as a result of numerous factors such as poor eating habits, poor study skills, anxiety, poor sleeping habits and drug abuse (Braun, et al., 2006). The Biopsychosocial Model guide recommends that once a child is diagnosed with ADHD, he/she is required to collaborate with a therapist or a physician in trying to improve study habits or organizational skills.
Clinically Supported Psychological Interventions used to treat ADHD including Psychopharmacological Treatments
Research carried out has revealed that a care plan for children suffering from ADHD should incorporate psychological interventions in addition to any prescribed medication that might be recommended (Ingersoll, 1988). This is because the interventions have been observed to be able to decrease and improve symptoms associated with the disorder as well as reduce the medication dosage required for effective treatment (Smith, 1991).
There have been a number of clinically supported psychological interventions used to treat ADHD including psychopharmacological treatment that have proved helpful. For instance, parenting skills training that is offered by professional therapists or while attending special classes (Osman, 1997). This training enables parents to be well equipped with techniques and tools needed to manage their child’s behavior. Some of these techniques include the use of isolation or time-out to a designated place in the house when the child is out of control or unruly (Barkley, 1995). Psychiatrists and clinicians have realized the fact that ADHD children’s numerous disorders are often easily managed by use of stimulant treatment. However, the most common treatment interventions clinically supported have been cognitive-behavioral and behavioral interventions (Osman, 1997).
Cognitive-behavioral intervention focuses on ensuring that young people learn reflective problem-solving techniques with the expectation of attaining an increased level of self control over their impulsivity (Sullivan, 2006). In addition, behavioral interventions teach children suffering from ADHD on how best to manage their behavior and control it to suit their respective environments. Another clinically supported intervention used to treat the disorder is school-based interventions. Majority of children suffering from ADHD usually exhibit their difficulties in school environment settings (Frankel, et al., 1997). Therefore, alterations need to be made to cater for the needs of these children since they do not comfortably fit into traditional school environment settings.
Since there are some aspects of behavior problems that cannot be treated with medication, treatment for ADHD is multimodal and involves both behavioral and drug therapy. Teachers and family are also involved in interventions that include parenting training and psychotherapy. As a result, individuals suffering from ADHD are assured and guaranteed of a better, healthier life where they will be able to live almost normal lives.
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