Attention Defecit Disorder Essay, Research Paper
Introduction
There are at least two million children and adolescents with attention deficit disorders in the United States. This large number of people which are affected by this disorder makes it something which we as a society must take seriously. In the following essay I will explore many facets of this disorder. These include: An overview of ADD/ADHD, the history of understanding this disorder, common symptoms, theories about why it occurs, how to diagnose it, medical treatments, non-medical treatments, and finally how it affects those who are afflicted with this problem.
Overview
It is estimated that between two and three percent of all student age children have an attention deficit disorder. This number is most likely only a partial counting of the children who struggle with this disorder, as almost half of all cases go undiagnosed. Boys are diagnosed with this disorder between five to nine times more frequently than girls. It is believed that many girls have this disorder but don t display the disruptive behavior which people often tie to ADD/ADHD. But what exactly is this disorder that I am talking about? ADHD stands for Attention Deficit Hyperactivity Disorder. This is the official term used to describe all attention deficit disorders. These include; the predominantly inattentive type (ADD), the predominantly hyperactive and impulsive type, and the combined type. These used to all be classified under the ADD title, but for
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many children hyperactivity was the larger symptom than a lack of attention. Yet there are all kinds of children who exhibit different combinations of the symptoms which make up ADHD. ADHD is a, Developmental disorder characterized by inappropriate degrees of inattention, over activity, and impulsivity. (Rief, Checklist for Basic Information on ADD/ADHD) Yet ADHD is a disorder on many different levels. ADHD is A production disorder. It is not a problem of learning per se. A person with ADHD may know the information or material well; but it is a problem of being able to perform or output that information and to do so consistency. (Rief, Checklist for Basic Information on ADD/ADHD) ADHD is also a Physiological disorder causing difficulty with inhibiting one s behavior and impulses. self-control, and goal-directed behavior. (Rief, Checklist for Basic Information on ADD/ADHD) With ADHD the attention center of the brain is not working properly, which leads to these types of problems in performance and production. A common misconception about this type of disorder is that it only effects children. This is not true. ADHD is a lifelong disorder. Its symptoms persist into adolescents, and up to seventy percent of those afflicted continue to exhibit symptoms into adulthood. The hyperactive symptoms seen in children often translates into fidgetiness or other nervous behaviors in adults. Yet this much has not always been known about the disorder now referred to as ADHD.
History
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ADHD has not always been so clearly understood. In the early nineteen hundreds, children were noted who were excessively active and distractible, impulsive, unruly, and difficult to deal with both at home and in school. Even though some of these children were of average intelligence, with no detectable physical problems, their symptoms were associated with brain damage. This link between hyperactivity and brain damage was strengthened during the nineteen-eighteen encephalitis epidemic when scientists noticed that children recovering from encephalitis displayed this type of behavior. Research involving animals and children with epilepsy and other central nervous system disorders strongly supported the link between hyperactivity and brain damage. In order to try to explain this type of behavior in children without any physical symptoms, scientists coined the terms minimal brain damage or minimal brain dysfunction . These people reasoned that these children were suffering from brain damage which was not detectable by medical tests. These terms were used to describe children who were hyperactive deep into the fifties. Doctors of the time recommended classrooms with little or no stimulation and though that the children would outgrow these problems. As early as nineteen thirty-seven, doctors found that by prescribing stimulant s, hyperactive children could be calmed. These reports received little interest from mainstream society. It wasn t until the nineteen fifties that the idea of medicating children of this nature became a viable alternative to simply waiting for the child to grow out of it .
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During this period, research was also being done into the causes of this disorder and past myths were beginning to be challenged. The idea that this disorder was caused by brain damage was about to be replaced. Scientists saw that these children did not have brain damage, but that this had been falsely inferred based on their behavior. They noticed that, there was excessive motor activity, which brought the child into conflict with their environment. The new term for what we now know as ADHD became hyperkinesis, which means excessive motion . By the early nineteen seventies, however, scientists focused less on motor activity. Led by psychologist Virginia Douglas, scientists changed their focus to the attention span of children who exhibited this disorder. These people figured that it was not the excessive activity that brings the child into conflict, but rather the short attention span. They concluded that the children could not stop and reflect on the possible consequences of actions. Therefore they went through life acting impulsively, responding to whatever caught their attention immediately without thought of repercussions. This is where the current title of Attention Deficit Hyperactivity Disorder comes from. This is basically where the current ideas involving ADHD are from. The study of ADHD has been going on for less than one hundred years, yet so much has been learned about this disorder in such a short amount of time.
Symptoms
There are many symptoms which make it possible to identify
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someone with ADHD. The following is a list of common symptoms associated with ADHD:
Attention deficit:
P does not pay close attention to details; may make careless mistakes at work, school, or other activities
P failure to complete tasks
P has difficulty maintaining attention in tasks or play activities
P does not listen when spoken to directly
P has difficulty organizing tasks
P is easily distracted
P unable to follow more than one instruction at a time
P fidgeting, squirming in seat, or moving constantly
P wandering, may leave the seat in the classroom when expected to stay
P has trouble participating in “quiet” activities such as reading
P runs and climbs in inappropriate situations
P talks excessively
Impulsivity:
P may blurt out answers before questions have been completed
P has difficulty awaiting turn
P interrupts others
n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n
P disruptive behavior
Other:
P sleep problems
P inability to delay gratification
P social outcasts or loners (possibly inability to play in groups but may perform in one-on-one situation)
P apparent disregard for own safety
P behavior not usually modified by reward or
P may have other specific learning disabilities
P failure to meet normal intellectual
(Rief, Checklist for Basic Information on ADD/ADHD)
Different children will exhibit different symptoms but if a child falls under about sixty percent of these, they most likely have ADHD. Not everyone who is overly hyperactive, inattentive, or impulsive has an attention disorder. Since most people sometimes blurt out things they didn’t mean to say, bounce from one task to another, or become disorganized and forgetful, how can specialists tell if the problem is ADHD? To assess whether a person has ADHD, specialists consider several critical questions: Are these behaviors excessive and long-term? That is, do they occur more often than in other people the same age? Are they a continuous problem, not just a response to a temporary situation? Do the behaviors occur in several settings or only in one specific place like the
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playground or the office? The person’s pattern of behavior is compared against a set of criteria and characteristics of the disorder. These criteria appear in a diagnostic reference book called the DSM (short for the Diagnostic and Statistical Manual of Mental Disorders). According to the diagnostic manual, there are three patterns of behavior that indicate ADHD. People with ADHD may show several signs of being consistently inattentive. They may have a pattern of being hyperactive and impulsive.
Causes
Health professionals stress that since no one knows what causes ADHD, it doesn’t help parents to look backward to search for possible reasons. There are too many possibilities to pin down the cause with certainty. It is far more important for the family to move forward in finding ways to get the right help. Scientists, however, do need to study causes in an effort to identify better ways to treat, and perhaps some day, prevent ADHD. They are finding more and more evidence that ADHD does not stem from home environment, but from biological causes. When you think about it, there is no clear relationship between home life and ADHD. Not all children from unstable or dysfunctional homes have ADHD. Knowing this can remove a huge burden of guilt from parents who might blame themselves for their child’s behavior.
Over the last decades, scientists have come up with possible theories
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about what causes ADHD. Some of these theories have led to dead ends, some to exciting new avenues of investigation.
ADHD Is Not Usually Caused by:
P too much TV
P food allergies
P excess sugar
P poor home life
P poor schools
(Rief, Checklist for Basic Information on ADD/ADHD)
One disappointing theory was that all attention disorders and learning disabilities were caused by minor head injuries or undetectable damage to the brain, perhaps from early infection or complications at birth. Based on this theory, as I have earlier stated, for many years both disorders were called “minimal brain damage” or “minimal brain dysfunction.” Although certain types of head injury can explain some cases of attention disorder, the theory was rejected because it could explain only a very small number of cases. Not everyone with ADHD or LD has a history of head trauma or birth complications. Another theory was that refined sugar and food additives make children hyperactive and inattentive. As a result, parents were encouraged to stop serving children foods containing artificial flavorings, preservatives, and sugars. However, this theory, too, came under question. In 1982, the National Institutes
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of Health (NIH), the Federal agency responsible for biomedical research, held a major scientific conference to discuss the issue. After studying the data, the scientists concluded that the restricted diet only seemed to help about 5 percent of children with ADHD, mostly either young children or children with food allergies. In recent years, as new tools and techniques for studying the brain have been developed, scientists have been able to test more theories about what causes ADHD. Using one such technique, scientists demonstrated a link between a person’s ability to pay continued attention and the level of activity in the brain. Adult subjects were asked to learn a list of words. As they did, scientists used a PET (positron emission tomography) scanner to measure the level of glucose used by the areas of the brain that inhibit impulses and control attention. Glucose is the brain’s main source of energy, so measuring how much is used is a good indicator of the brain’s activity level. The investigators found important differences between people who have ADHD and those who don’t. In people with ADHD, the brain areas that control attention used less glucose, indicating that they were less active. It appears from this research that a lower level of activity in some parts of the brain may cause inattention.
The next step will be to research why there is less activity in these areas of the brain. Scientists hope to compare the use of glucose and the activity level in mild and severe cases of ADHD. They will also try to discover why some medications used to treat ADHD work better than others, and if the more
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effective medications increase activity in certain parts of the brain. Researchers are also searching for other differences between those who have and do not have ADHD. Research on how the brain normally develops in the fetus offers some clues about what may disrupt the process. Throughout pregnancy and continuing into the first year of life, the brain is constantly developing. It begins its growth from a few all-purpose cells and evolves into a complex organ made of billions of specialized, interconnected nerve cells. By studying brain development in animals and humans, scientists are gaining a better understanding of how the brain works when the nerve cells are connected correctly and incorrectly. Scientists and research institutions are tracking clues to determine what might prevent nerve cells from forming the proper connections. Some of the factors they are studying include drug use during pregnancy, toxins, and genetics. Research shows that a mother’s use of cigarettes, alcohol, or other drugs during pregnancy may have damaging effects on the unborn child. These substances may be dangerous to the fetus’s developing brain. It appears that alcohol and the nicotine in cigarettes may distort developing nerve cells. For example, heavy alcohol use during pregnancy has been linked to fetal alcohol syndrome (FAS), a condition that can lead to low birth weight, intellectual impairment, and certain physical defects. Many children born with FAS show much the same hyperactivity, inattention, and impulsivity as children with ADHD. Drugs such as cocaine–including the smokable form known as crack–seem to affect the
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normal development of brain receptors. These brain cell parts help to transmit incoming signals from our skin, eyes, and ears, and help control our responses to the environment. Current research suggests that drug abuse may harm these receptors. Some scientists believe that such damage may lead to ADHD.
Toxins in the environment may also disrupt brain development or brain processes, which may lead to ADHD. Lead is one such possible toxin. It is found in dust, soil, and flaking paint in areas where leaded gasoline and paint were once used. It is also present in some water pipes. Some animal studies suggest that children exposed to lead may develop symptoms associated with ADHD, but only a few cases have actually been found.
Other research shows that attention disorders tend to run in families, so there are likely to be genetic influences. Children who have ADHD usually have at least one close relative who also has ADHD. And at least one-third of all fathers who had ADHD in their youth bear children who have ADHD. Even more convincing: the majority of identical twins share the trait. At the National Institutes of Health, researchers are also on the trail of a gene that may be involved in transmitting ADHD in a small number of families with a genetic thyroid disorder.
Medication
For decades, medications have been used to treat the symptoms of ADHD. Three medications in the class of drugs known as stimulants seem to be
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the most effective in both children and adults. These are methylphenidate (Ritalin), dextroamphetamine (Dexedrine or Dextrostat), and pemoline (Cylert). For many people, these medicines dramatically reduce their hyperactivity and improve their ability to focus, work, and learn. The medications may also improve physical coordination, such as handwriting and ability in sports. Recent research suggests that these medicines may also help children with an accompanying conduct disorder to control their impulsive, destructive behaviors. Unfortunately, when people see such immediate improvement, they often think medication is all that’s needed. But these medicines don’t cure the disorder, they only temporarily control the symptoms. Although the drugs help people pay better attention and complete their work, they can’t increase knowledge or improve academic skills. The drugs alone can’t help people feel better about themselves or cope with problems. These require other kinds of treatment and support.
For lasting improvement, numerous clinicians recommend that medications should be used along with treatments that aid in these other areas. There are no quick cures. Many experts believe that the most significant, long-lasting gains appear when medication is combined with behavioral therapy, emotional counseling, and practical support. Some studies suggest that the combination of medicine and therapy may be more effective than drugs alone. NIMH is conducting a large study to check this. Stimulant drugs, such as Ritalin,
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Cylert, and Dexedrine, when used with medical supervision, are usually considered quite safe. Although they can be addictive to teenagers and adults if misused, these medications are not addictive in children. They seldom make children “high” or jittery. Nor do they sedate the child. Rather, the stimulants help children control their hyperactivity, inattention, and other behaviors. Different doctors use the medications in slightly different ways. Cylert is available in one form, which naturally lasts 5 to 10 hours. Ritalin and Dexedrine come in short-term tablets that last about 3 hours, as well as longer-term preparations that last through the school day. The short-term dose is often more practical for children who need medication only during the school day or for special situations, like attending church or a prom, or studying for an important exam. The sustained-release dosage frees the child from the inconvenience or embarrassment of going to the office or school nurse every day for a pill. The doctor can help decide which preparation to use, and whether a child needs to take the medicine during school hours only or in the evenings and on weekends, too. Nine out of 10 children improve on one of the three stimulant drugs. So if one doesn’t help, the others should be tried. Usually a medication should be tried for a week to see if it helps. If necessary, however, the doctor will also try adjusting the dosage before switching to a different drug.