Psychosocial Impact of Attention Deficit Hyperactivity Disorder in Children - Essay Example

 Psychosocial Impact of ADHD in Children Attention Deficit Hyperactivity Disorder (ADHD) is a chronic developmental disorder that is primarily associated with hyperactivity and attention difficulties. It is commonly diagnosed in children before the age of 7 years (Mark, 2007). The current information on the disease has been attributed to immense research in the subject. In the mid-19th century, Heinrich Hoffman, a German Physician, was the first to describe the features of ADHD in some children (Grannie et al. 2007). In 1922, Dr. George Still (Pediatrician) and Afreld Tredgold (Physician) of Britain were the first to document the disease. George Still noted that the diseases primarily presented as inability to follow rules, restlessness, lack of limitation and an over aroused behavior. He attributed the symptoms to brain trauma, which was strongly, associated with genetic or environmental factors. Furthermore, Still described the disease as a defect of cognition, moral consciousness and inhibition violation. He thus named it the deficit of moral control (Batt, 2010). Later on, in 1922, the disease was described in several patients following an influenza epidemic. Majority of the patients developed the disease as a complication of the influenza infection. During this time, the disease was called Encephalitic behavior, which was associated, with brain trauma (Mark, 2007). In 1937, the use of stimulants for the treatment of ADHD was introduced by Dr Charles Bradley. This significantly improved the outcome of the disease. In 1956, Ritalin (methylphenidate) was considered the drug of choice for patients suffering from the disease. In the 1950, various researchers discredited the theory that brain damage resulted in the disease. The disease was then called the Minimal Brain Damage Disorder. It was later referred to as the Minimum Brain Dysfunction disease in 1960 (Mark, 2007). This was because the disease was not associated with other central nervous system deficits. Other symptoms were also associated with the disease, for example, lack of focus. In 1980, a research conducted by Douglas (Psychologist) and others shifted the focus of the disease from behavioral to attention deficit. It was described in the DSM II of the American Psychiatric Association as Attention Deficit Disorder. Later in 1987, it was described in DSM III and DSM IV as Attention Deficit Hyperactivity Disorder. Over the years, the use of stimulant drugs has been applied in the treatment of ADHD (Mark, 2007). In 1999, Focalin and Concerta were used in the treatment of the disease. In 2003, Strattera, a drug that increases the level of norepinephrine in the brain, was introduced. Causes of ADHD In 1922, brain damage was attributed to the cause of the disease (Mark, 2007). Later on, there was a shift towards behavioral ant attention deficits. There are various studies that have been conducted to establish the relationship between ADHD and the brain. However, the changes in the brain have been attributed to both genetic and environmental insults to the brain. It is thus results from both hereditary and acquired causes that result in brain injury. Various studies have attributed ADHD to a reduction in the brain volume. This mainly affects the attention areas of the brain. In 2002, Castellanos (M.D) et al. conducted brain measurement studies in patients with ADHD. They reported that these patients had reduced brain volume by about 3-5%. The reduction of brain volume affected the temporal, caudate, frontal and cerebellum regions (Grannie et al. 2007). A Volex-based study conducted in 2003 reported right hemispheric brain deficits. This corresponded to deficits in the basal ganglia, posterior cingulated and superior frontal gyrus. Sowell (Neurologist) et al. using Computerized Topography mapped the cortical area of the brain. They reported that the patients had smaller volume in the grey matter in the bilateral anterior temporal and dorsal prefrontal region. These patients also had an increase in the grey matter of the bilateral inferior parietal cortices and posterior temporal region. Durston (Psychiatrist) et al. compiled MRI report on children with ADHD in 2004 (Grannie et al. 2007). The study reported that patients with ADHD have a reduced brain volume corresponding to a reduction in the dorsolateral prefrontal cortex. The variation in the results has been attributed to differences in gender, race and other developmental comorbidities seen in patients with ADHD. However, the symptoms of the disease are associated with a defective prefrontal cortex. The prefrontal cortex occupies about one-third of the brain (Grannie et al. 2007). It is essential for perseverance, attention, critical thinking, impulse control and judgment. These functions are deficit in ADHD. ADHD is associated with decreased level of neurotransmitters. Studies reveal that a low level of dopamine is associated with decreased levels of attention. The use of Strattera (Atomexitine), a norepinephrine reuptake inhibitor drug, has been successful in the treatment of ADHD. This is because the drug results in increased levels of norepinephrine in the brain. Dopamine is essential in the transmission of messages in the attention areas. ADHD worsens as the patient make an effort to focus. This is due to depletion of the already deficient pool of dopamine in ADHD. Researchers have demonstrated a correlation between the deficiency of dopamine and genes that code for the dopamine transporters. Studies on twins have demonstrated that genetics play a role in development of the disease. Environmental factors, for example, tobacco and alcohol exposure during early in life has been associated with ADHD. A study conducted by the Lancet in 2007 reported a correlation between artificial food color and dietary sugars with hyperactivity. Development of ADHD has also been associated with dysfunctions in the family (Batt, 2010). Relationship with the parents and the caregivers has a significant role in the development of ADHD. Currently, the study on the neurobiology and physiology of causes of ADHD is not conclusive. The proposed theories on the causes of ADHD are faced with various challenges. There is ongoing research to find out the exact cause of ADHD so as to improve the management of the disease. Signs and symptoms In the majority of the cases, the signs and symptoms of ADHD are manifested before the age of 7 in children. However, ADHD can be diagnosed in adults. Diagnosis of this disorder is not easy as the symptoms and signs are not clearly described. It is classified into three forms. In the first case, the patient presents with features of lack of attention. In the second case, the patient presents with features of hyperactivity and inattention. In the third case, the patient presents with impulsivity, hyperactivity and inattention (Batt, 2010). Lack of attention is manifested by the inability to follow rules and instructions, difficulties when trying to focus on a task, easily distracted from a task and failure to complete a task. Hyperactivity presents as talking excessively, difficulty in staying seated, climbing and running inappropriately and fidgeting excessively. These patients also have trouble waiting for their turn. They are always on the move. In order to diagnose ADHD, the patient must show the symptoms for a minimum of 6 months in at least two settings. These settings include at home, school, daycare centre and other places where the patient spends most of their time. In addition, the symptoms must cause social, educational and psychological impairment to the patient. Impulsivity presents as temper tantrums, the patient often interrupting others, the patient acts without thinking and when taking a test they rather guess than take time to solve the question. The patient blurts out answers without waiting to be asked or before the question has been asked. During games, they are unwilling to wait for their turn (Brinkman & Stein, 2009). This significantly affects the patient’s ability to relate well with others. The symptoms of ADHD can coexist with other psychiatric disorders (Batt, 2010). In children, the patient may present with features of anxiety and mood disorder. Other patients present with mental retardation, motor control and learning difficulties while in adults, patients present with bipolar, obsessive compulsive disorder, personality disorder and drug abuse. In rare cases, the patient presents with features of depression and other mood related disorders. Diagnosis There is no specific imaging and laboratory test available for the diagnosis of ADHD. It is based on the DSM-IV and ICD 10 standards. The diagnosis is made on the basis of clinical observation as well as thorough history on the patient. The specialist must consider the patient’s family history and rule out other comorbid feature associated with ADHD. The diagnosis of ADHD is described by DSM-IV and ICD-10 standards. In these classifications, the patient must experience the symptoms for at least 6 months, in two different settings. These symptoms must also cause educational, social and psychological impairment in the patient’s life. According to DSM-IV, the patient should present with at least 6 of the symptoms classical of inattention, hyperactivity and impulsivity symptoms. Moderate ADHD is diagnosed when these symptoms result in moderate impairment of the patients functioning. ADHD is a clinical diagnosis that relies on that relies on the patient’s history at home and school. Patients are classified as combined type ADHD if the patient presents with lack of attention and hyperactivity with or without impulsivity for the past 6 months. Predominantly Inattentive ADHD is seen in patients who present with difficulties in attention for the last 6 months. Predominantly hyperactive-impulsive ADHD is characterized by hyperactivity and impulsiveness without inattention. Treatment of ADHD is modified depending on the ADHD the patient has. During diagnosis, it is the role of the parent to observe the patient carefully and report the child’s history to the specialist. They should also offer emotional support for the child through the diagnostic process. The parent should facilitate speedy and accurate diagnosis of the child by availing relevant information to the specialist. Where necessary, it is the duty of the parent to seek a second opinion before subjecting the child to life-long treatment. The diagnosis of ADHD is dependent on the patient’s history at two different setting. It is the role of the teacher to observe the patient and report to the client. In the USA, majority of patients diagnosed with ADHD are in the school going age. At school, the teacher should report the patient’s behavior. It is also beneficial for the teacher to record the patient’s performance in class. This will indicate whether the disease has impaired their ability to perform academically. Psychosocial impacts According to the DSM-IV about 3%-7% of the school going children suffers from ADHD (Bussing & Alain, 2011). Those mainly affected by this disorder are between the ages of 4-17 years. However, the symptoms of ADHD manifest in children before the age of 7 years. In the USA, about 9.5% of the total children population was diagnosed with ADHD. The effects of the disease are likely to persist in adulthood. The number of cases diagnosed with ADHD increased by an average of 3% per annum from the year 1997-2006. According to CDC (2007), about 13.2% of patients diagnosed with ADHD were boys while girls were 5.6%. CDC further reported that, there was an increase of about 22% of the parent-reported cases of ADHD (Centre for Disease Control [CDC] 2007). According to CDC (2007), in 2005 the estimated cost of ADHD was at $36-$52 billion. ADHD creates a financial burden due to the medical costs and work loss both for the patient and family members. According to CDC, the annual average amount of payment for a patient with ADHD is $1,574 while that of a matched control is $541. It is estimated that a total loss of about $143.8 million is lost due to decreased productivity in patients with ADHD. This is because workers with ADHD are likely to have at least one day per month off due to sickness unlike those without ADHD (Bussing & Alain, 2011). This means that ADHD has effects on the patient, family and community. The patient is unable to form meaningful relationship with other people. In cases where they are impulsive, they may lead to damage of property as well as loss of life, for example, reckless driving resulting in loss of life. In some cases, parents have been blamed for their children’s behavior. Although the disease is inherited, the parents have no direct correlation with the etiology of the disease. However, they should be involved in the diagnosis and management of their children. Treatment The treatment of ADHD comprises of both medical and non-medical intervention. Various studies have demonstrated that about 70%-90% of the patients respond to medical treatment (Louis, 2011). The application of both medical and non-medical interventions has been shown to be successful in the management of ADHD. The use of psycho-stimulant drugs was introduced in 1937. Since then, various stimulant agents have been applied for the treatment of ADHD. These drugs act by affecting the concentration of catecholamines in the brain. They mainly lead to an increase in the concentration of dopamine in the attention areas. Methylphenidate (Ritalin and Concerta) has been widely applied for the treatment of ADHD. Dextroamphetamine (Dexadrine) was introduced for the treatment of ADHD in 1948. Although, these drugs are beneficial they have been associated with short and long term side effects. After a few weeks of treatment, the patient complains of anorexia, insomnia, nausea, irritability and weight gain. These symptoms regress as the patient continues to take the drugs. Later on, they develop headaches, depression, sleepiness, social withdrawal and nausea. In rare cases patient may develop toxic psychosis and seizures. In other cases, the patient may develop a nervous stimulation syndrome, for example, Tourette’s syndrome (Louis, 2011). After long term use of the medications, the patient develops increased weight gain and a decline in growth. This mainly affects the children between the ages of 5-18 years. Long term prescription of the drug may result in tolerance. In the USA, the dosage of the drug has to be increased in about 49% of the patients due to tolerance (Modre, Groholt, & Ellen, (2011). Tolerance results from the down regulation of receptors in the brain. This means that the previous dose is not effective as the receptors have reduced. Many researchers suggest the introduction of drug holidays for the patient because of tolerance. However, the patient may experience rebound behavior upon withdrawal of the drugs. Although the drug has several side effects, the patient’s symptoms improve quickly. However, ADHD is a chronic disease that requires long periods of treatment. In 1990, non stimulating drugs were introduced for the treatment of ADHD. The first drug to be used was Strattera (Atomexitine). This is an antidepressant that inhibits the reuptake of norepinephrine in the neurons. The drug is causes increased ability to focus as well as reduced hyperactivity in the patient (Modre, Groholt, & Ellen, 2011). It is associated with nausea, vomiting, loss of appetite that may result in weight loss. It also causes priapism, decline in the growth rate, severe hypersensitivity reactions and mood swings. Long term therapy is associated with jaundice due to liver toxicity and suicidal ideation in the patient. Other non stimulation drugs that have been approved for the treatment of ADHD include Intuniv (guanfacine) and Kapvay (clonidine hydrochloride). These drugs have been used for the treatment of ADHD in patients between the ages of 6-17 (Martin, 2012). They have been associated with increased attention and reduce the patient’s distractibility. These drugs act by altering the catecholamines in the brain. Intuniv is associated with headache, fatigue, sedation, abdominal pain and sleepiness. It is also associated with cardiac toxicity as it causes changes in the heart rhythm and a significant increase in blood pressure. Kapvay is associated with sleepiness, fatigue, cough and nausea. In some cases, it results in insomnia. It also causes cough and predisposes the patient to upper respiratory tract infections. The non stimulant drugs are preferred as they do not cause agitation and tolerance. In the US, they are prescribed in a majority of patients with ADHD (Modre, Groholt, & Ellen, 2011). In addition to medical treatment, research indicates that patients also benefit from behavioral therapy. They are taught how deal with distractions, be organized as well as control their emotions. They are also educated on how to focus during class and relate with others both at home and school. Parent education about the disorder is also beneficial. This is because children with ADHD may require special parenting skills (Martin, 2012). Parents are thus taught on parenting skills as well as how to deal with challenges associated with ADHD. Various studies have demonstrated the benefits of dietary restrictions in patients with ADHD. Patients with ADHD have shown sensitivity to artificial preservatives and dietary salicylates. It is thus the role of the parent to ensure that the patient feeds on the recommended diet. Other studies have shown a correlation between dietary sugars and hyperactivity. This is because it provides energy bursts that precipitate hyperactivity. It is the duty of the parent to ensure sugar restrictions in the diet of patients with ADHD (Martin, 2012). In school, the teachers should undergo unique training on handling patients with ADHD. This is because children with ADHD are not enrolled in a special school, but they have learning and concentration difficulties. Teachers should employ different learning methods for patients with ADHD, for example, peer tutoring. In order to enhance learning, the teachers may use report cards to monitor the progress of the patient. Public Policy Patients with ADHD present with various other comorbid conditions. They are at risk of poor education attainment. Their management poses a social cost burden to the community (Brinkman & Stein, 2009). They are also at risk of suicide and property destruction due to their impulsivity. Public health policies must be applied in a way that addresses and acknowledges the high risk for secondary condition and comorbidities. They also require special programs as well as foods that are free of preservatives and additive. The policies should provide for the manufacturing of these preservative free foods. In conclusion, ADHD is a chronic developmental disorder that has significant effects on the patient, family and community. It is imperative to diagnose and treat the condition early so as to prevent the complications associated with the disorder. Although there has been intense research on ADHD, the neurobiological evidence is not conclusive (Brinkman & Stein, 2009). ADHD poses a financial cost burden on the patient, family and the economy. This is because productive days are lost due to the patient’s illness. The cost of management is also high as the management of the condition requires prolonged periods of treatment. Reference List Batt, E. (2010). ADHD negatively impacts a child’s Relationship with Siblings. Journal of ADHD, 13, 1283-93. Bauchner, H. (2010). Safety of Attention-Deficit/Hyperactivity Disorder Medications in Children and Adolescents. Pediatrics Med, 12 (3), 43-48. Brinkman, W., & Stein, T. (2009). Why Parents Decide to Initiate, Continue, or Stop ADHD Treatment. Journal of Pediatrics Medicine, 124, 580-589. Bussing, R., & Alain, J. (2011). Both Parent and Adolescent Perceptions Influence ADHD.Treatment J Adolescent Health, 49, 7. Centre for Disease Control (2007). Attention Deficit/ Hyperactive Disorder (ADHD). USA Grannie et al. (2007). Mapping Brain Structure in ADHD; A Volex-Based MRI Study of Regional Grey and White mater Volume. Psychiatry Research on Neuroimaging, 15, 171-180. Louis, M. (2011). New AAP Guidelines for ADHD: A Challenge for Primary Care. Journal of Pediatrics, 128, 1007. Martin, T. (2012). Decreasing Participation by Pediatricians in Diagnosis and Treatment of Children with ADHD. Academic Pediatrics, 12, 110. Mark, L. (2007). ADHD: Can it be Recognized and Treated within 5 years. Infants and Young Children, 19, 86-93. Modre, M., Groholt, D., & Ellen, K. (2011). The impact of ADHD and conduct disorder in childhood on adult delinquency: A 30 years follow-up study using official crime records. BMC Psychiatry, 11, 57. 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