A Deeper Look Into ADHD - Research Paper Example

?A Deeper Look Into ADHD Attention Deficit/Hyperactivity Disorder (ADHD) is a behavioral disorder characterized by inattention, impulsivity, and hyperactivity (American Psychological Association, 2000). It is considered the most common neurodevelopmental disorder that affects about 5 % of children worldwide (Polanczyk et al., 2007). It is a complex syndrome of impairments related to the development of brain cognitive management systems or executive functions. It affects a person’s organization skills, concentration, focus and prolonged attention on a task, processing speed, short-term working memory and access recall, sustained motivation to work and the appropriate management of emotions (American Psychological Association, 2000). Individuals diagnosed with ADHD share three common characteristics. First, they tend to be inattentive, often have trouble focusing on one subject idea or task at a time. This makes it difficult for them to follow instructions and organize their thoughts making them vulnerable to careless errors. Secondly, they can be hyperactive, often fidgety or cannot sit still. Children have difficulty playing quietly, as they indulge in excessive talking and interrupting. Lastly, they are likely to be impulsive, often rushing into reckless or unpredictable behaviours that have varied risks and consequences (American Speech-Language-Hearing Association, 2013). Three subtypes of ADHD have been classified. ADHD inattentive type, ADHD hyperactive-impulsive type and ADHD combined type. There are a total of eighteen ADHD symptoms and these symptoms are organized into two main types namely inattention and hyperactivity-impulsivity. Under these two main symptoms are the following: Inattention: Failure to give close attention to details, can be careless in schoolwork or other activities Difficulty in sustaining attention in tasks May not listen when spoken to Usually does not follow through on instructions and fails to complete tasks Difficulty in organizing tasks Avoids or dislikes tasks requiring sustained mental effort Easily loses things necessary in completing tasks Easily distracted by extraneous stimuli Often forgetful Hyperactivity-impulsivity Fidgets with hands or feet or squirms in seat Leaves seat in classroom in situations when sitting down is expected. Runs about or climbs excessively even when inappropriate. Difficulty in playing or engaging in activities quietly Always on the go Talks excessively Blurts out answers before questions are even finished Difficulty in turn-taking Interrupts or intrudes in others’ conversations. (Hammerness, 2009) . Brown (2007, p. 24) has enumerated the executive functions of the brain that work together in various combinations as thus: Activation – the process of organizing, prioritizing and activating for work Focus – focusing, sustaining and shifting attention to tasks Effort – regulating alertness and sustaining effort and processing speed Emotion – managing frustration and modulating emotions Memory – using working memory and accessing recall Action – monitoring and self-regulating action Recent research on AD/HD gives evidence that it is not a problem of will power but a chronic impairment in the chemistry of the management system of the brain. Castellanos & Tannock (2002) contend that it results from a disorder in the fronto-striatocerebellar brain circuitry. Brown (2007) reports that there is much evidence to show that ADD is a heritable disorder with impairments in the release and reloading of two crucial neurotransmitter chemicals made in the brain: dopamine and norepinephrine. These chemicals play a significant role in facilitating communication within neural networks that facilitate cognition (Brown, 2007). In general, ADHD seems to be caused by complex causal pathways that involve interactions between a wide range of genetic and environmental factors (Nigg, 2006). The human brain is made up of many areas with specific functions. The brainstem’s role is the efficient functioning of basic life systems such as making sure the cardiovascular and pulmonary systems are working fine. The limbic system is responsible for emotions, pleasure and motivation to do basic things in order to survive. The human brain’s main part is called the cortex which is divided into areas controlling the senses of sight, touch, sound and taste. The frontal section of the cortex is the thinking part of the brain which helps people manage problems and make decisions. It is also responsible for planning and behavioural control, apart from other areas. This is the part affected in individuals with ADHD (Hammerness, 2009). The whole brain is made up of nerve cells or neurons in charge of communicating with each other endlessly within the brain’s pathways. The illustration below shows how the neurons work together: Figure 1. Nerve cell structure, illustrated by Jeff Dixon (Hammerness, 2009, p. 54) Figure 2. Nerve cell “communication”, Illustrated by Jeff Dixon (Hammerness, 2009, p. 53) Chemical information is exchanged into the dendrites of nerve cells. This occurs at the synapse or the space between nerve cells (See Fig.2). This chemical neurotransmission releases packets of neurotransmitters such as dopamine. The dopamine attaches itself to specific receptors which pass off the information and stimulate the necessary action within the nerve cell. This chemical message turns into an electrical message travelling to the soma or main body of the cell which produces an impulse or “action potential” passed down through the axon to another nerve cell (Fig. 1). In sum, the brain functions with the communication of neurons through chemical neurotransmitters. In order for the brain to implement its function, it is essential that the message is passed (Hammerness, 2009). Hammerness (2009) explains that in individuals with ADHD, there is impairment in this process. Stimulant medication augments such impairment. Such medication comes in the form of pills or capsules to be swallowed or as a patch or liquid absorbed into the bloodstream and travels to the brain where it works to improve ADHD symptoms. Back in the thirties, children’s brains were studied with head x-rays which involved injecting air through a needle into the spinal column of a child. Upon sitting down, the air is allowed to rise up the brain where the x-ray can be taken. This procedure can cause headaches in the children. Doctors tried to find a remedy for the headaches and stumbled upon a common treatment for allergies and asthma, Benzedrine. This is a stimulant similar to medication effectively used in for individuals with ADHD. Doctors were surprised how Benzedrine helped the children to study well Hammerness, 2009). The stimulants used for ADHD increase the neurotransmitter (dopamine/ norepinephrine) messages from one neuron to the next. The ADHD diagnosed individual’s brain does not get adequate messages between its cells. When this happens, the brain does not perform its function in directing the individual’s attention to the task at hand, hence the inattentiveness. Stimulant medications affect the motivation areas of the brain of the individual with ADHD and increase their “saliency” in the task, hence, when successfully administered, the stimulants increase the individual’s sense of interest or pleasure in attending to the task (Hammerness, 2009). Stimulant medications facilitate the passage of the neurotransmitters in two ways. One way is by blocking the transport of the chemical signal back into a brain nerve cell. This means that after the chemical message has been relayed in the nerve synapse, the message is transported back into the original cell to be reused at a later time. With ADHD individuals, blocking the transport back into the cell means more of the neurotransmitter is now available between cells so messages between nerve cells move more smoothly. Hence, the areas of the brain in charge of paying attention, avoiding distractions and remembering details become more active. Another way to increase the flow of messages between cells is for the stimulants to push more chemical out of the nerve cell. In both ways, the availability of messages exchanged between cells is increased (Hammerness, 2009). Certain medications have been manufactured to compensate for the inefficient release and reloading of essential neurotransmitters at countless synaptic connections in the brain. Individuals with the ADHD disorder have experienced remarkable improvement in their functioning when they are treated with appropriate doses of such medications. These medications alleviate symptoms only for the time when the medication is active in the brain, thus helping the individual in most self-management tasks (Brown, 2007). Hammerness (2009) reports that stimulant medications such as Ritalin which is a methylphenidate are effective helping children with ADHD to be calm and focused. Studies have shown that children diagnosed with ADHD are at risk for poorer outcomes in adolescence and adulthood. Barkley et al. (2006) and Lee & Hinshaw (2006) claimed higher rates of the manifestation of behavior disorders such as oppositional defiant disorder and conduct disorder in children with ADHD. Poorer educational, social and occupational outcomes also threaten such children. Many of them are at the risk of grade repetition, suspensions and lower attainment and achievement in school. They may have fewer friends due to difficulty in maintaining friendships and as adults, exhibit poorer job performance (Owens et al., 2009; Barkley et al., 2006; Lee et al., 2008). Stimulant medications have been proven to improve ADHD symptoms of 65-75% of children who take them (Hammerness, 2009). Such medications provide children with more control of their bodies, their speech and their focus. It has proven to improve the core symptoms of ADHD in that population (Poulton & Cowell, 2003). For example, studies on the effectiveness of the stimulant, Risperidone in reducing the level of disruptive behaviours in children with IQ below 85 have concluded that its use has likewise significantly reduced ADHD symptoms according to checklists such as the Aberrant Behavior Checklist (Aman et al., 2004). This emphasized the addition of Risperidone to other stimulants resulted in decrease in hyperactivity than was achieved with stimulants alone. The use of medication in helping individuals with ADHD manage their condition has been greatly welcomed when a study published in the New England Journal of Medicine in November, 1990, reported that ADHD is a neurologically based behavioural disorder that is best treated by stimulants (Mayes & Erkulwater, 2008). In general, vast research provide evidence that ADHD medication are safe especially when administered over short-term use For children, management of ADHD should not be limited to medication and should be given a combination of interventions. Some camps are against the use of medication for children with ADHD since they believe it is not appropriate to condone “drugging” problematic children in order to behave well (Mayes & Erkulwater, 2008). Hammerness (2009) reported that some children suffer from side effects in taking stimulant medication such as insomnia, stomach problems, abdominal pain, low appetite accompanied by weight loss, headaches. These side effects may be mild and last briefly. Other side effects include mood changes, irritability, anxiety, emotionality, aggressiveness or lack of motivation. The National Institute for Health and Clinical Excellence (NICE) in the UK proposed clinical guidelines for ADHD endorsing the use of non-pharmacological treatments for young children, young people and adults with ADHD. It recommended the use of pharmacological intervention as part of a comprehensive intervention package which includes psychological, behavioural and educational interventions (Young and Amarasinghe, 2010). ADHD is not a learning disability per se, but its effects on the learner in terms of academic performance may lead to the development of certain learning disabilities. Since it is detectable at an early age, it is usually linked to how children learn by focusing and concentrating well on tasks. This means that when a child is diagnosed with ADHD, it is likely that he or she will have difficulty in some learning tasks (ADD Special Education Facts, n.d.). Levine’s (2002) clinical work with students with learning disabilities has also indicated that a recognition of and capitalization on their specific strengths of mind fosters their development, whereas a focus on their specific weaknesses compromises their development. This would be a good guiding principle when dealing with children with all kinds of disabilities. In doing so, their self-esteem is built up and they are empowered to push themselves towards their optimal potentials. Harlacher, Roberts & Merrell (2006) identify some Behavioral and Educational interventions for managing ADHD as follows: Contingency Management; Therapy Balls; Self-Monitoring; Peer Monitoring and Instructional Choice. Academic Interventions include: Classwide Peer Tutoring; Instructional Modification and Computer-Assisted Instruction. These are briefly described below: 1. Contigency Management is the application of consequences that are contingent on identified behaviors. To increase the frequency of appropriate behaviors, positive reinforcement is given every time they manifest it. For example, students earn tokens or chips for certain behaviors exchangeable for greater reinforcers, praising when they are attentive as well as removal of such reinforcers on inappropriate behaviors (Harlacher, Roberts & Merrell, 2006). 2. Therapy balls as the child’s seat, as they need to concentrate and sit still in order to balance themselves on such balls. 3. Self-monitoring involves agreed upon behaviors that the student will monitor himself (ex. Completion of task, attentiveness, talking out) and self-evaluate to indicate how well he has performed. If the student matches his rates with the teacher’s evaluation, he is rewarded. This happens until the teacher fades out her own evaluation and the student relies on his own realistic evaluation of his behaviors. 4. Peer Monitoring involves students monitoring each other and reinforcing positive behaviors. 5. Instructional Choice is the provision of choices to the student as to which activity he prefers to do, or the schedule of what comes first or last in his task list. Being given choices makes the child feel powerful over some things, as he needs to commit to his own choice. 6. Class-wide peer tutoring is an effective intervention in terms of gaining academic skills. Students are paired, provided the curriculum materials and take turns tutoring each other. To further reinforce the effectiveness of peer tutoring, points may be earned for correct answers, successful error correction and correct procedures (Harlacher, Roberts & Merrell, 2006). 7. Another strategy is instructional modification wherein the student’s tasks are modified into shorter ones so he can easily complete them because they are more manageable and not overwhelming for his challenged attention span. Kirby et al. (2008) have suggested some strategies that students with ADHD and/or other learning difficulties can use. One is the use of study aids that reduce the amount of reading they need to do such as highlighting important notes or summaries in some text materials. Another strategy is managing their time so that they have enough to process their reading as they require a longer time than other students. Still another strategy is having a deeper approach to learning and committing to high quality educational outcomes, which implies that they need to work much harder in order to reach their goals. All these interventions have been found to decrease inattentiveness of students with ADHD as well as help them complete their tasks with more accuracy. It has also been found to decrease hyperactivity, disruptive behavior and increase their compliance to directions (Harlacher, Roberts & Merrell, 2006). It just goes to show that having ADHD is not a hopeless condition if there is enough support and patience for the diagnosed child. He can still function well in a mainstreamed environment. Children who are diagnosed with ADHD are usually expected to be hyperactive, difficult to manage and exasperating to teach due to their flight of ideas and tendency to move around. Hence, they are often perceived to fail in more complicated tasks requiring good focus and concentration. Their attention spans need much improvement if they are to comprehend and complete tasks assigned to them. The good news is that there are several options available in helping these individuals with ADHD. Apart from medication created to manage their hyperactivity, behavioural and educational strategies have been designed to keep them focused on the tasks at hand and assist them in the challenges they encounter in their academic and daily lives. People should understand that their impulsive behaviours are not deliberate ways to infuriate others but are caused by impaired connections in their brains. This does not mean that they cannot function productively anymore. This is where biological, educational, behavioural interventions and full support of their families, teachers and peers come in. Like all other individuals with developmental disorders, people with ADHD need a little patience and understanding of their condition in helping them live well in the mainstream and even contribute their own talents, efforts and creative ideas to make this world a better place for all. References ADD Special Education Facts (2013) Attention Deficit Disorder. Retrieved on November 9, 2013 from http://addspecialedfactsheet.weebly.com/ Aman M. G., Binder C. & Turgay A. (2004) Risperidone effects in the presence ? absence of psychostimulant medicine in children with ADHD, other disruptive behavior disorders and subaverage IQ. Journal of Child and Adolescent Psychopharmacology, 14, 243–254. American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington, DC: Author. American Speech-Language-Hearing Association (2013) Attention Deficit/Hyperactivity Disorder (ADHD). Retrieved on September 12, 2013 from http://www.asha.org/public/speech/disorders/ADHD.htm Barkley, R.A., Fischer, M., Smallish, L., Fletcher, K.E. (2006) Young adult outcome of hyperactive children: adaptive functioning in major life activities. Journal of American Academy of Child Adolescent Psychiatry, 45:192–202 Brown, T. E. (2007) New approach to attention deficit disorder, Educational Leadership, Feb. 2007 Castellanos, F., Tannock, R. (2002) Neuroscience of ADHD: the search for endophenotypes. National Review of Neuroscience 3:617–628. Hammerness, Paul Graves, Biographies of Disease. Westport, Conn: Greenwood Press, 2009. Print Harlacher, J.E., Roberts, N.E., Merrell, K.W. (2006) Classwide interventions for students with ADHD. Teaching Exceptional Children. Nov/Dec 2006 Council for Exceptional Children Kirby, J.R., Silvestri, R., Allingham, B.H., Parrila, R. La Fave, C.B. (2008) Learning Strategies and Study Approaches of Postsecondary Students With Dyslexia, Journal of Learning Disabilities, Volume 41 Number 1 Lee, S.S., Hinshaw, S.P. (2006) Predictors of adolescent functioning in girls with attention deficit hyperactivity disorder (ADHD): the role of childhood ADHD, conduct problems, and peer status. Journal of Clinical Child Adolescent Psychology 35:356–368 Lee, S.S., Lahey, B.B., Owens, E.B., Hinshaw, S.P. (2008) Few preschool boys and girls with ADHD are well-adjusted during adolescence. Journal of Abnormal Child Psychology 36:373–383. Levine, M. (2002). A mind at a time. New York: Simon & Schuster. Mayes, R. & Erkulwater, J. (2008) Medicating Kids: Pediatric Mental Health Policy and the Tipping Point for ADHD and Stimulants, The Journal of Policy History, 20 (3) Nigg, J.T. (2006) What causes ADHD? New York: The Guilford Press New York Owens, E.B., Hinshaw, S.P., Lee, S.S., Lahey, B.B. (2009) Few girls with childhood attention-deficit/hyperactivity disorder show positive adjustment during adolescence. Journal of Clinical Child Adolescent Psychology, 9(38):132–143. Polanczyk, G., de Lima, M.S., Horta, B.L., Biederman, J., Rohde, L.A. (2007) The worldwide prevalence of ADHD: a systematic review and metaregression analysis. American Journal of Psychiatry 164:942–948. Poulton A. & Cowell C. T. (2003) Slowing of growth and height in weight on stimulants: a characteristic pattern. Journal of Paediatrics and Child Health 39, 180–185. Young S. & Amarasinghe M. (2010) Practitioner review: nonpharmacological treatments for ADHD: a lifespan approach. Journal of Child Psychology and Psychiatry 51, 116–133. Read More