Adhd Essay, Research Paper
Emotionally Handicapped/Behavior Disorders:Attention Deficit Hyperactivity Disorder Introduction It seems that diagnosis of Attention Deficit Hyperactivity Disorder isbecoming more prevalent among children and adults. I questionedwhat has caused this increase in number of people effected by thisdisorder. The intent of this paper is to examine that question. I intendto view what Attention Deficit Hyperactivity Disorder is, how it isdiagnosed, what causes it, and what are the available and effectivetreatments. (I have a personal reason as well, four people close to andmyself exibit the characteristics of Attention Deficit HyperactivityDisorder.) There is a problem with ambiguity and inconsistency inmany areas of special education and this is an area where thevagueness can be overwhelming and frustrating. Review Definition Attention Deficit Hyperactivity Disorder (ADHD) is most commonlyassociated with children, but adults can also be affected by ADHD. TheDSM-IV criteria for ADHD are as follows. First the person must eitherhave signs of inattention or hyperactivity that last for six months and to adegree that is maladaptive and inconsistent with the developmentallevel. Second, some of the symptoms that cause the impairment werepresent before the age of seven. Third, some of the symptoms must bepresent in two or more settings. Fourth, there must be evidence that it iseffecting social, academic, or occupational functioning. The last criteriais that it does not occur during the course of any Psychotic Disorder and can not be diagnosed as a Mood Disorder, Anxiety Disorder,Dissociative Disorder, or a Personality Disorder. Signs and Symptoms Signs and symptoms vary with each person. The signs andsymptoms discussed will be those that are most commonly observed byprofessionals and parents in both educational and social settings. These signs and symptoms can be categorized into inattention,hyperactivity, impulsivity, emotional, and positive characteristics. Reif (1998) identified the most common sign of inattention ishaving trouble sustaining attention. Other signs include failure to payclose attention to detail, making careless mistakes, loses things easily,and having trouble with organization. Also distracted by outside stimuli,doesn t follow through with tasks, doesn t seem to listen to what is beingsaid to him/her. An example in an educational setting is after given a setof four directions the student may complete two of them. According to Reif (1998), the most common sign ofhyperactivity-impulsivity is not being able to sit still. More specifically,hyperactivity signs may consist of restlessness, frequent unnecessary movement, and constant movement. Other signs include veryenergetic, intruding others personal space, fidgeting, inappropriatenoises, and squirms in seat. An example of a student displayinghyperactivity would be the student that after playing with his pencil whilesitting on his knees, gets up to walk around the room making noise,then goes back to his chair and slouches. This would be done all in amatter of minutes. The signs of impulsivity include excessive orinappropriate talking, inability to wait, hurries through tasks, disruptive,and often interrupts (Reif, 1998). An impulsive student would shout outan answer as soon as he knows it and will not raise his hand or wait tobe called on. Emotional signs and symptoms are not part of the DSM-IV criteriabut is critical area to address. These signs and symptoms may includeirritability, quick tempered, low self-esteem, and immature social skills. People with ADHD also display moodiness, over stimulation,aggression, and frustration (Reif, 1998). There are many traits associated with ADHD that are positive. These traits are often overlooked. People with ADHD are often creative,innovative, resourceful, observant, and inventive. They are usuallyhighly verbal, inquisitive, tenacious, persistent, helpful, caring, andhumorous (Reif, 1998). This is just a sampling of the positive traits thatpeople with ADHD exhibit. Educators and parents often concentrate onthe negative behaviors of people with ADHD when they should focus onthe positive aspects. Diagnosis There is no concrete medical test to diagnose ADHD (yet), whichoften makes the diagnosis of ADHD subjective. That is why it isimperative that the diagnosis is done properly and by an appropriateand qualified person. Barkley (1995) and Phelan (1996) list six essentialsteps in diagnosing ADHD. The first step is the parent interview. Thisshould include presenting problems, developmental history, and familyhistory. The next step is interviewing the child about home, school, andsocial functioning. Next, behavior rating scales describing home andschool functioning are completed. The fourth step is to obtain data fromschool. The data should include grades, achievement test scores,current placement, and other pertinent information. Step five is thepsychological testing for IQ and screening for a Learning Disability. Thisstep may have been previously completed. the final step is a physicaland/or neurological exams. These steps are only suggested, noteveryone follows them. Professionals who can diagnose include (but are not limited to)psychiatrists, psychologists, pediatricians or physicians, andneurologists. Parents, teachers, and professionals may provideimportant information to help in the diagnosis. The diagnosingprofessionals should always consider other possibilities and rule themout before diagnosis of ADHD, because of similiar symptoms on otherdisabilities. Phelan (1996) notes that ADHD is often missed in childrenwith good social skills, high IQ, shyness, no siblings, or no hyperactivity. These traits should also be taken into consideration so that children andadults with these characteristics are not overlooked. Suspected Causes The actual cause of ADHD is unknown, however, there are manytheories on the cause. The suspected causes in the readings seemedto depend on the authors beliefs. Reif s (1998) list of suspected causes included heredity, traumaduring prenatal, birth, or post-birth, certain medical conditions, orneurological problems. Heredity seems to be one of the most commonof the suspected causes (Reif, 1998). When people with ADHD werestudied Reif found that at least one other member of the family (mother,brother, grandparent, uncle, etc.) had ADHD. Barkley (1995) ranks neurological factors as the most likely cause.This includes any type of abnormal brain development or injury to thebrain. He also lists heredity as a possibility. Whereas Reif (1998) linksthe trauma to a developing fetus or to the infant during or directly afterbirth to brain injury. Amen (1995) has done extensive studies with ADHD. He statesthat the underlying mechanism stems from neurotransmitter dysfunctionand decreased frontal lobe cerebral blood flow. Amen also discussesthe possibility of a weak arousal system in the brain stem. He notes that
a delayed maturation in the frontal lobes could also be a possible cause. this cause would help explain why some people outgrow theirsymptoms. All three authors list neurological problems. The problems theyare referring to vary from chemicals in the brain to level of activity in thebrain. Treatment There are several different treatments available for people withADHD to help them cope with the disability. Some options aremedication, neurological treatments, alternative methods, and strategies. Often, people may try several different treatments or strategies beforefinding the one or ones that work for them. After studying the research I found that medication seems to be acontroversial subject. In many cases parents do not want to have theirchildren taking drugs everyday. These parents may not be fullyeducated in the effects and results of the drug use. The medicationsprescribed for ADHD can be grouped into three categories: stimulants,antidepressants, and hypertensives. Stimulants are commonly used in the treatment of ADHD. Thefunction of the stimulant drug is not to increase the person s physicalactivity level but to increase the level of arousal in the brain (Barkley,1995). The drug effects the area of the brain responsible for inhibitingbehavior and maintaining effort or attention to do things. Stimulantsrecommended are Dexedrine, Ritalin, and Cylert. The effects of thedrug do not last long and do not remain in the body (Barkley, 1995). Changes in dosage may need to be made if weight changes orineffectiveness of current dosage. Some possible side effects mayinclude appetite suppression, insomnia, headache, and stomachache. Sadness, irritability, drowsiness, increased hyperactivity, and tics arealso possible side effects of stimulant drug use but are less common(Phelan, 1996). Antidepressants are less frequently used but work in some cases. The most common are Norpramin or Pertofrane, Tofranil, Elavil, andProzac. These medications are primarily for people that did notrespond well to stimulants or has depression or anxiety in addition toADHD (Barkley, 1995). Like stimulant drugs, the antidepressants alsoalter the chemicals in the brain to modify behavior. Typically thesedrugs are not taken for more than two or three years due to build up oftolerance (Barkley, 1995). Possible side effects associated withantidepressants are also common with many other medications. Theyare dry mouth, increased blood pressure and pulse, nausea,drowsiness, and slowing of intracardiac conduction (Phelan, 1996). Clonidine is also a medication used to treat people with ADHD. Clonidine is a hypertensive usually used to treat high blood pressure(Phelan, 1996). The positive effects of this drug are that it doesn t wearoff quickly like a stimulant and it helps reduce motor activity. Clonidinealso seems to increase a child s level of tolerance for frustration andcooperation (Barkley, 1995). The most common side effect with thisdrug is drowsiness. Blood pressure should be monitored because it isa drug that lowers high blood pressure (Barkley, 1995). Neurological treatments are also available to treat ADHD. Amen(1995) refers to Brain SPECT Imaging to evaluate and treat ADHD. Using this imaging, he is able to determine blood flow patterns and lobeactivity. After determining where the problems are in the brain, thedoctors are able to take a course of action (Amen, 1995). Sears and Thompson (1998) identify neurofeedback as atreatment for ADHD. This process is somewhat complex. It takes thebrain waves and translates them like an electroencephalogram. Thenthe feedback changes the brain activity. The following alternative methods are not scientifically proven andare less effective than previously stated methods but have worked onoccasion. Restricted diets and nutritional interventions work for somepeople with ADHD. Also, proper amounts of vitamins and mineralshelp people with ADHD. Medicines to correct inner ear problems,chiropractic adjustments, allergy treatments, and yeast infectiontreatments are also ways to help people cope with thisdisability(Mediconsult, 1998). There is a wide range of strategies for people with ADHD to use tohelp make everyday life easier. Various strategies work for differentpeople in diverse settings. There are strategies for school, home andself-management. People often need to try several strategies to find theones that work best for them. Common examples of strategies for school is having materialpresented clearly, structure, and using multi-sensory learning andconcrete experiences. At home, common strategies are helping withorganization, effective commands, and constuctive punishment(Barkley, 1995). Self management strategies should include settinggoals, breaking down tasks into smaller parts, and reduction ofstimulation and distraction (Reif, 1998). Discussion After researching ADHD, I found that the steps in the diagnosisand effective treatments are very vague and ambiguous. The authors Iresearched claimed that their own diagnosing process and treatmentswere the most effective. At times, their studies agree, but often theydon t all agree equivocally. This inconsistency is often seen allthroughout the special education field. The diagnosising process seems to have several similarities. Infact, Barkley and Phelan both listed the same six essential steps. Itwould be intersting to see how many professionals follow those sixsteps when diagnosing people with ADHD. It seems that everyone is puzzled on what the cause of ADHDmight be. The most recent research focuses on neurological problemsor heredity. I think that the cause may stem from neurological problems. Heredity seems to be stretching a little bit. It sounds more like anexcuse rather than a case. For example if my grandfather s uncle had,then I might have it also. I am still perplexed by the issue of treating people with ADHD.The research has convinced me that there is not just one effectivetreatment but many. Every person with ADHD must be treated in a . thewat that is most effective for that particular person. Also, when thetreatment that is best is found, it may work for a limited time and then anew one has to be found. Overall, by doing this research, I ve answered a few of myquestions but more importantly preempted new ones to find anwers for. This topic has stimulated my thoughts to find out if other disabilities runinto the same problems with diagnosis, cause, and treatmant as ADHD. Conclusion Looking at the big picture of Attention Deficit HyperactivityDisorder, we see that there are few characteristics that are concrete. Everything seems to vary with who, what, when, and how. One thingthat is definite is that Attention Deficit Hyperactivity Disorder is real and iteffects more people than that are diagnosed. Hopefully in time,researchers will come up with concrete answers in reference to thecause and the most effective treatments. Until that day comes, we needto be conscious of and patient with people that have ADHD. References Amen, D. (1995) Windows into the ADD mind. Fairfield, CA: Mindworks Press. Barkley, R. (1995) Taking charge of ADHD. New York: GuilfordPress. Mediconsult.com (1998) Decade of the brain [On-line] Available: http://mediconsult.com Phelan, T. (1998) All about attention deficit disorder. glen Ellyn,Illinois: Child Management Inc. Reif, S. (1998) The ADD/ADHD checklist. Paramus, NJ: PrenticeHall. Sears, W. & Thompson, L. (1998) The ADD book. New York : Little Brown and Company