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ADHD essay
Psychopathology (PSYCH 650)
University of Phoenix
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ADHD 1 Running head: ATTENTION DEFICIT HYPERAXTIVITY DISORDER Attention Deficit Hyperactivity Disorder, Diagnosis and Treatment Park University Abstract ADHD 2 Attention Deficit Hyperactivity Disorder (ADHD) is a disorder that is obvious in school age children, usually starting as early as the preschool years. Children with this disorder find it hard to control their behavior as well as pay attention. Approximately 2 million children in the United States have been diagnosed with ADHD. Parents, teachers, and doctors need to work together in order to meet the child needs and to avoid a misdiagnosis. Various forms of treatment options can be beneficial for a child’s development with ADHD, including drug, counseling, and therapy. Research conducted has concluded that women continue to go undiagnosed. ADHD is a lifetime disorder. People learn how to effectively treat and deal with their diagnosis and live a normal life. Attention Deficit Hyperactivity Disorder, Diagnosis and Treatment ADHD 4 There has been numerous research conducted in the field of neuropsychological disorders. Studies are based on performance patterns such as attention, activity, and vocalization. Published studies have been used to produce sample size test measures which distinguish behaviors in children and adults. One review based its findings from 33 published studies using adults as their primary focus. A similar review was based on 39 empirical studies which focused its observations on children in classrooms instead of laboratories environments. ADHD Throughout the years ADHD and ADD have had a number of different names. In 1902 it was called Morbid Defect of Moral Control (Attention deficit disorder help center). In 1922 the name changed to Post-encephalitic Behavior Disorders, followed by Minimal Brain Dysfunction in 1960, and so on. In 1980 the new term created was Attention Deficit Disorder with or without Hyperactivity. The main focus of this disorder was predominantly on hyperactivity because researchers connected the symptoms lack of focus and the outward impulsivity and hyperactivity. Not until the 1990’s that ADHD began to be studied and diagnosed. ADHD is a chemical imbalance in the brain which causes interference with our ability to focus, sustain attention, and with memory retrieval. The main characteristics are inattention, hyperactivity, and impulsivity. There are three types of ADHD, predominantly hyperactiveimpulsive, predominantly inattentive, and combined. Symptoms of ADHD take months to develop, in some cases years. ADHD children are poor at focusing, channeling effort, and channeling energy for useful purposes. They have a short attention span and a tendency to be distracted by whatever is irrelevant and to jump from activity to activity, without completing one. Motivation plays a large role in their attention span. Their attention focus varies from every ADHD 5 situation. Children with ADHD get distracted because mental discipline is not learned. They have trouble recognizing an object that stands out; because they have trouble recognizing what is important. These children usually look scatterbrained, absentminded, and forgetful; they cannot prioritize, and are absent minded. ADHD children have trouble understanding conversations and need help sorting out details. They get confused by instructions, when there are multiple steps to follow. ADHD children cannot sit still or walk slowly, they tend to jump, fidget, squirm, wiggle, and run. These children are usually very talkative and loud. They like loud noise and making sounds and clicks with their mouths. Many ADHD children also have sleeping problems, coordination problems, are self-centered, impatient, reckless, and have extreme emotional problems. Children with ADHD, during adolescence have problems such as aggression, poor self-concept, impaired peer relationships, and poor school performance, they are sad and depressed, but hyperactivity does decrease. ADHD is very difficult to diagnose because, like many other behavior disorders, it tends to appear gradually. Neurological and physiological studies show that people with ADHD have a wide range of biochemical imbalance and uniqueness. The symptoms may not be present at all times; they can change depending on the environment and moment. Diagnosis of this disorder is difficult because you must assess how much of the child’s behavior is normal, most children with ADHD usually are mentally alert, smiling, energetic, and interested in contact with others. Boys and girls who have this disorder do not always present the same symptoms. Boys are usually more overactive, aggressive, and disruptive. Both girls and boys are physically active and rowdy, and girls tend to be tomboyish. ADHD children are made up of 60 percent to 80 percent being boys. A diagnosis should be conducted by a professional trained in ADHD and mental disorders. Psychiatrist, psychologist, and development/behavioral pediatricians are among the best trained ADHD 7 that of other conditions, which confuse physicians and mental health professionals when attempting a diagnosis. Many children with ADHD experience different symptoms, all children are different, with different patterns of behavior and personality. Children with ADHD often get misdiagnosed as being emotionally disturbed. ADHD is one of the most challenging chronic conditions for children, families, schools, and physicians (Dang, 2007). Children who have ADHD may also have other disorders such as anxiety, depression, and oppositional defiant disorder. In order to avoid further misdiagnosis and treatment, it is necessary to conduct comprehensive evaluations and use aids such as teachers, parents and physicians to determine the diagnosis of a child. If parents, school staff and the health care system join forces, better care can be provided for children with ADHD. The child’s parents and school nurses are a good source for information regarding the child’s symptoms. School nurses are the primary health experts in the school environment and should help with identifying and helping children with ADHD. Not only is it important to recognize ADHD early but also properly diagnose children in order to help their academic and health improvement. The American Medical Association created an official scale called the DSM-IV Diagnostic and Statistical Manual of Mental Disorders used to diagnose ADHD. The usefulness of this scale has been questioned because studies have shown that 3 out of 5 children over the age of seven have not been diagnosed properly due to the psychologist’s precision during their diagnosis. Ritalin is a drug that was commonly prescribed to anyone who had a few of the symptoms but not the number necessary to meet the DSM-IV requirements. Both parents and teachers often did not adhere to DSM-IV guidelines and failed to completely fill out the long questionnaire. The questionnaire works more effectively when people take the time to complete ADHD 8 it correctly. There are other scales in which ADHD can be measured but their criterion is vague and can cause a misdiagnosis. A misdiagnosis can be very traumatic for a child especially when done at a young age. If a child is misdiagnosed and is taking medication they can become dependent on the drugs. The drugs are prescribed to help the child’s attention span increase, but the dependence of the drug can harm the child for life and make them susceptible to others drugs such as cocaine. Abuse of prescriptions drugs such as Ritalin, was a huge problem a few years ago. Many mothers were misdiagnosing their own children in order to get prescription drugs for their own use. These children were labeled which affects them long term as well. Treatment The National Institute of Mental Health (NIMH) has funded many studies of treatments for ADHD and has conducted the most intensive study ever undertaken for evaluating the treatment (NIMH) of ADHD. The multimodal treatment study of children with ADHD was based on four treatment options for elementary school boys and girls. The treatment options included: medication management only, behavioral treatment only, combination, and routine community care. The results concluded that long term combination treatment and medication management showed better results than the other treatments. Above all the combination treatment was more successful. The pros and cons of medication for ADD or ADHD have been argued between doctors, parents and teachers for years. In the United States 60 percent of children diagnosed with ADHD are medicated sometime during their life. Research has shown that teens that used drugs to treat ADHD were equivalent to those who did not use ADHD drugs. More studies need to be conducted in the field of long term versus short term effects of medication use for ADHD. It’s been proven that ADHD medication provide short term benefits, ADHD 10 extensive bruising, and low blood cell count. There are emotional effects as well. Ritalin can be addictive, and some children have a hard time getting off the drug, sleeplessness, and extended hyperactivity is also common. Cylert magnesium pemoline is also a central nervous system stimulant. This drug is like Ritalin for effectiveness but has different side effects. Cylert is has fewer common side effects but the less common side effects are highly serious. Studies show that Cylert can stunt growth, both height and weight, in children, and is highly addictive. Also it can cause both Tourette’s syndrome and tics in children. An alternative to Ritalin and Cylert is Adderall dextroamphetamine . Adderall, unlike other medications used to treat ADD has very few side effects. The most serious side effect is loss of appetite, which can easily be solved by sticking to a regular diet. Adderall is a long lasting drug which eliminates the nervousness and hyperactivity. Dexedrine dextroamphetamine sulfate is also a good alternative to other drugs. This drug is very inexpensive and is much like Adderall. It is a long lasting pill, with few side effects that relieves ADHD symptoms. Alternatives Medication is very helpful with relieving symptoms of ADHD, but there are other sources of treatment. Alongside medication, medical, psychological and educational intervention, and behavior management techniques are required to affectivity treat ADHD. Treatment should start immediately after being diagnosed with ADHD. Medication alone will not fix all the problems associated with ADHD symptoms. It is common for individuals to become immune to the medication they are prescribed, rendering that medication ineffective. It’s important for children with ADHD to learn coping skills, because these skills are especially important in the classroom. Parents of an ADHD child need to learn behavior management, in order to make better informed decisions when dealing with their child’s problems and symptoms. ADHD 11 A very important part of ADHD treatment is appropriate educational programs. Teachers should be informed about ADHD to effectively deal with ADHD symptoms. Lastly, individual and family counseling should be ongoing. Research over the next several years is likely to focus on the development of new non-stimulant treatments for ADHD that produce benefit throughout the day, safer long-term treatments of impulsive-aggression, and interaction of drugs with nutrition and nutrients (Newcorn, 2007). Research There has been several research conducted in an effort to isolate trends among ADHD children and adults, as well as the best environment for conducting a proper diagnosis. A study conducted by Kathleen A. Platzman, Mary R. Stoy, Ronald T. Brown, Claire D. Coles, Iris E. Smith, and Arthur Falek from Emory University School of Medicine focuses on children with ADHD in classroom settings. Additionally, a review conducted by Aaron S. Hervey, Jeffery N. Epstein and John F. Curry from Duke University Medical Center focus on adults with ADHD. Both articles agree that there is not a clear criterion in determining a diagnosis of ADHD. The most often criteria use are based on versions of the Diagnostic and Statistical Manual of Mental Disorders (DSM). Both reviews used age and gender as their main variables in their review. In both reviews the high number of male participants was evident and the belief of unidentified females with ADHD is apparent and of major concern. Methods The first study conducted by Kathleen A. Platzman, Mary R. Stoy, Ronald T. Brown, Claire D. Coles, Iris E. Smith, and Arthur Falek, included empirical studies used to determine the best observational methods in distinguishing non-medicated ADHD children from contrast groups. In this review 39 empirical studies were used which met the criteria of contrast/control ADHD 13 Results for the first review revealed that there is a major focus on males with ADHD and in only 13 of the studies used indicated female participants. It seemed that there is a vast number of under identified females with ADHD in the clinical population. In this review they concluded that “classroom studies were strikingly more discriminating than laboratory-based studies” (Kathleen A. Platzman, Mary R. Stoy, Ronald T. Brown, Claire D. Coles, Iris E. Smith, and Arthur Falek, 1992). The main difference was found among ADHD and contrast groups in classroom environments. The classroom setting was more reliable in identifying ADHD children from contrast groups. The findings indicate that class observations are more useful for diagnosis and a teachers input should be a primary source of diagnostic. The results of the second review indicated that there are a variety of both general and specific performance differences that result in neuropsychological deficits among adults with ADHD. The results were not specific to a particular neuropsychological deficit. One of the main domains that were more obvious for ADHD adults is that of attention deficit. The use of a metaanalytic approach also revealed “impairments in nonexecutive functioning aspects of memory, processing speed, and motor speed, suggesting that frontal-sub cortical dysfunction only partially characterizes the deficits seen in adults with ADHD” (Aaron S. Hervey, Jeffery N. Epstein and John F. Curry, 2004). Conclusion Medication and other treatment can be beneficial to a child development both in school and at home. There are many treatment options and some children cannot tolerate stimulants, in such cases antidepressants can be substituted. ADHD cannot be cured; medication can only help control the symptoms. Medication can help a child concentrate their attention and improve their school work. Behavioral therapy, emotional counseling, and practical support will help ADHD ADHD 14 children cope with everyday problems and increase self esteem. It is essential for a clinical psychologist to perform the proper test and procedures to conclude a proper diagnosis for children. New drugs such as Adderall and Dexedrine have very few side effects with all good results. There is insufficient data available to predict the long term effects that current drug treatment will have on children. A treatment plan should be personalized to treat the needs of the individual child in order to provide better results. Every child is different and may experience different symptoms, a proper diagnosis is crucial when prescribing and treating for a child’s symptoms. In contrast, many studies and research has been conducted concluding the ADHD drugs do not have any long term benefits for children with ADHD. The drugs prescribed to children with ADHD only are useful for short term results, and may sometimes do more harm than good. Regardless if a child is medicated or not, in their adolescent years they will be just as competent as any other child. The ADHD drug effects and risks outweigh the short term benefits in the long run. There are other options such as behavioral therapy, emotional counseling, a healthy diet and nutritional supplements, which can benefit a child and lessen the symptoms of Attention Deficit Hyperactivity Disorder. The studies indicate that neurocognitive deficits are not always obvious and easily assessed. The reviews focused on behaviors commonly seen in children and adults diagnosed with ADHD. In the adult based review, deficits are based on performance domains ranging from subtle to high in magnitude. In the child classroom and laboratory based review classroom studies show more discriminating power compared to laboratory studies. Both reviews agreed that the majority of participants were men, which reinforces the idea of women being undiagnosed. ADHD 16 References American academy of pediatrics. (2008). Web site: aap/healthtopics/adhd.cfm Attention deficit disorder help center. (2008). Web Site: add-adhd-helpcenter/archived_newsletters.htm Baum, S., Olenchak, F. R. (2002). The alphabet children: Gt, ADHD, and more. Exceptionality, 10, 77-91. Dang, M. T., Warrington, D., Tung, T., Baker, D., Pan, R. J. (2007). A school-based approach to early identification and management of students with ADHD. The Journal of School Nursing, 23(1), 2-12. Hervey, A. S., Epstein, J. N., and Curry, J. F. (2004). Neuropsychology of adults with attention deficit/hyperactivity disorder: a meta-analytic review. Neuropsychology, 18(3), 485–503 McLennand, W. (1980). Hyperactive children. American Psychologist, 35(4), 392-393. National institute of mental health. (2008). Web site: nimh.nih/health/publications/adhd/complete-publication.shtml Newcorn, J. H., Ivanov, I. (2007). Psychopharmacologic treatment of attention-deficit hyperactivity disorder and disruptive behavior disorders. Psychiatric Annals, 37(7), 477489. Platzman, K., Stoy, M., Brown, R. T., Coles, C., Iris E. Smith, I. E., and Falek, A. (1992). Review of observational methods in attention deficit hyperactivity disorder (ADHD): implications for diagnosis. School Psychology Quarterly, 7(3), 155-177 ADHD 17 Semrud-Clikeman, M., Pliszka, S., Liotti, M. (2008). Executive functioning in children with attention-deficit/hyperactivity disorder: Combined type with and without a stimulant medication history. Neuropsychology, 22(3), 329-340. Subcommittee on ADHD. (2001). Clinical practice guideline: Treatment of the school-aged child with attention-deficit/hyperactivity disorder. PEDIATRICS, 108(4), 1033-1044.
ADHD essay
Course: Psychopathology (PSYCH 650)
University: University of Phoenix
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