4 million children 4-17 years of age have been diagnosed with Attention Deficit Hyperactive-disorder (ADHD). This disorder is one of the most common neurobehavioral disorders in American children. Children with ADHD often have trouble paying attention, sitting still, focusing on tasks, and controlling impulsive behaviors. It is a growing concern and epidemic as rates of diagnosis have continued to increase at an average rate of 5. 5% since 2003 (CDC 3).Due to an uncertain biologic cause of the disorder, there have been several speculations as to whether the disorder exists. As numbers rise, several parents, teachers, and researchers also wonder if children are being misdiagnosed and whether pharmaceutical drugs are appropriate sources of treatment.
What is ADHD? Cause ADHD is a relatively new, multifactorial disease with no known scientific cause. In the 2009 book, Medicating Children: ADHD and Pediatric Mental Health, Mayes, Bagwell, and Erkulwater discuss multiple biological causes researchers have discovered up to date.In 1963, Keith Conners and Leon Eisenberg suggested that “problems in inhibitory controlling symptoms…. and problems with arousal” cause the symptoms of ADHD. More recently, Barkley attributes the symptoms to “behavioral inhibition [that] involves delaying responses that are likely to be reinforced and protecting this delay so that other self-regulatory functions called executive functions can occur and control responses” (26-27). Mayes, Bagwell, and Erkulwater also discuss neurological studies studying cerebral blood flow and cerebral glucose metabolism.These studies have shown “decreases in blood flow in the prefrontal areas of the brain and also in the connections between these regions and the limbic system in the ADHD group” (27).
Some scientists believe that ADHD is caused by “a delay in maturation of the brain” as opposed to an “abnormal brain”, as shown before (28). Most scientists can link this disorder with genetics. ADHD runs in many families and studies have shown distinct correlations among twins. During critical developmental moments, factors such as cigarette-smoking alcohol use during pregnancy, premature delivery and low birth weight have shown linkage to children with he disorder. A small percentage of children may have developed ADHD after a brain injury. Although little scientific research occurs on these ideas, the use of refined sugar and food additives have also been linked to children with ADHD. Studies are being conducted to find correlations between the disorder and environmental factors such as poverty, family chaos, poor parenting skills, and too much television (NIMS 2).
Symptoms and Diagnosis The symptoms for ADHD have been separated into two groups: symptoms of inattention and symptoms of hyperactivity-impulsivity.The Center for Disease Control and Prevention (CDC) have presented the symptoms and diagnosis of ADHD as designated by American Psychiatric Association’s Diagnostic and Statistical Manual-IV, Text Revision (DSM-IV-TR). DSM-IV Criteria for ADHD A. Six or more of the following symptoms of inattention have been present for at least 6 months to a point that is inappropriate for developmental level: Inattention 1. Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities. 2. Often has trouble keeping attention on tasks or play activities.
3.Often does not seem to listen when spoken to directly. 4. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions). 5. Often has trouble organizing activities. 6.
Often avoids, dislikes, or doesn’t want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework). 7. Often loses things needed for tasks and activities (e. g. toys, school assignments, pencils, books, or tools). 8. Is often easily distracted.
9. Is often forgetful in daily activities. A.Six or more of the following symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for developmental level: Hyperactivity 1. Often fidgets with hands or feet or squirms in seat when sitting still is expected. 2. Often gets up from seat when remaining in seat is expected.
3. Often excessively runs about or climbs when and where it is not appropriate (adolescents or adults may feel very restless). 4. Often has trouble playing or doing leisure activities quietly. 5. Is often “on the go” or often acts as if “driven by a motor”. 6.
Often talks excessively.Impulsivity 7. Often blurts out answers before questions have been finished. 8. Often has trouble waiting one’s turn. 9. Often interrupts or intrudes on others (e.
g. , butts into conversations or games). Due to the ambiguity in symptoms, it is imperative that children are especially diagnosed by a certified clinician. Some of these symptoms may be present in children under the age of seven. Also, some may be present in multiple settings or certain settings such as at school or home. (NIMS 1). Types of ADHD Based on the criteria stated above, the APA and DSM-IV-TR have designated three subtypes of ADHD.
Combined hyperactive-impulsive and inattentive is the most predominant type, in which six or more symptoms of attention and six or more symptoms of hyperactivity-impulsivity are present. Predominantly hyperactive-impulsive is characterized by six or more symptoms in the hyperactivity-impulsivity category and less than six symptoms in the inattention category. Predominantly inattentive is characterized by six or more symptoms in the inattention category and less than six symptoms in the hyperactivity-impulsivity categories (NIMS 1). Treatment of ADHD According to the CDC, as of 2007, 2. 7 million youth ages 4-17 years (66. % of those with a current diagnosis) were receiving medication treatment for ADHD (CDC 3). A majority of the children treated, use stimulants such as amphetamines (Adderall) and methylphenidate (Ritalin) to reduce the symptoms of ADHD.
These stimulants are proven to have a calming effect, reduce hyperactivity and impulsivity, and improve the ability to focus, work, and learn. There are also non-stimulant drugs such as atomoxetine (Straetta) to treat ADHD. These drugs may exist as pills, capsules, liquids, or transdermal patches in short-acing, long-acting, or extended-release forms (NIMS 2).There has been increasing psychotherapeutic treatments, due to an increase in opposition to stimulant drug use in young children. Using set, organized routines for children with ADHD has been proven to improve symptoms. Children and Adults with Attention Deficit/Hyperactivity Disorder (CHADD) provide lifespan educational programs to help parents and individuals struggling with the disorder. In the classroom, teachers are advised to use homework folders, make assignments clear, and use positive reinforcement (CDC 4).
Issues with Stimulant-drug Use to treat ADHDLike most pharmaceutical drugs, both desired and undesired side effects will occur with the use of stimulants. In Taking America Off Drugs: Why Behavioral Therapy is More Effective for Treating ADHD, OCD, Depression and Other Psychological Problems, Stephen Flora relates amphetamines to “kiddy cocaine”, also using other nicknames such as “kiddy coke”, “skippy”, and “the smart drug” (81). He believes that the drugs are often abused, and that the abuse is disregarded due to the positive effects they have on the symptoms of ADHD.He also claims that the abuse of these drugs “leads to other abuse. Further side effects of amphetamines and other stimulants include decreased appetite, sleep problems such as insomnia, tics, weight gain, anxiety, and irritability. These symptoms may lower after dosage levels are lowered (NIMS 2). These side effects may cause further problems for children in classroom settings, as their peers may not understand the reasoning behind these effects.
These drugs are proven to be very effective in treating ADHD symptoms, however, and may not be abused if closely monitored by parents and teachers.Misdiagnosis of ADHD From the beginning of its finding in the early 1900’s, there have been several opponents and critics of ADHD: whether it was a valid disease or not, its over-diagnosis and under-diagnosis, and the abuse of medicines by parents and teachers. In his 1961 book, The Myth of Mental Illness, Szasz argued “mental illnesses were not illnesses at all but instead were behaviors rooted in the conflicts endemic to human relationships; thy represented individuals’ attempts to deal with common problems with living” (Bagwell et, al. 41). More associated to ADHD, Richard DeGrandpre’s Ritalin Nation, argued “children’s hyperactivity and inattentiveness were the result of their living in a competitive, fast-paced and media-saturated world” (Bagwell 142). Recent research suggests that many children are over-diagnosed with the disorder, while some argue that there are countless children who have not been diagnosed, that are living with the disorder today.In 2008, German researchers, Breuer, Willie, Dopfner, Erhart, Ravens-Sieberer and the BELLA study group, published an extensive international study to “report the results of analyses of categorical data on the prevalence rates of the symptoms of ADHD” (Breuer, et.
al 1). The study was composed of 2,452 parents of children and adolescents aged 7 – 17 years old, who were asked to complete an ADHD symptom checklist and answer additional questionnaires. The group found that “the prevalence rates for the diagnoses of ADHD to DSM-IV was 5. 0%….
The addition of other diagnostic criteria (impairment, pervasiveness, onset, duration) resulted in a significant decrease of the prevalence rates of ADHD to 2. 2%” This reduction was determined by adding the ICD-10 criteria to the diagnosis of ADHD, which requires full symptoms in ALL of the three subtypes of ADHD (inattentive, hyperactive-impulsive, combined). The group included studies from other researchers who study and observe similar drops in prevalence rates once more determinable factors were included. For example, Wolraich et al. , found that a school population in the US had an ADHD prevalence of 16. %; however, when the diagnosis included poor classroom functioning, the prevalence decreased to 6. 8%.
In addition, Gomez et al. , reported that when parents or teachers were asked to diagnose ADHD, there was a prevalence rate of 8. 8 (parents) and 9. 9% (teachers); this percentage dropped to 2. 4% when both parents AND teachers were asked. Todd Elder, a health economics professor at Michigan State University conducted a study, concluding that “nearly 1 million children in the United States are potentially misdiagnosed with ADHD simply because they are the youngest – and most immature – in their kindergarten class” (MSU 1).In the study, about 12,000 children were examined based on “the difference in ADHD diagnosis and medication rates between the youngest and oldest children in a grade” using data from the Early Childhood Longitudinal Study Kindergarten Cohort.
Elder noticed the following: “In Michigan – where the kindergarten cutoff date is Dec. 1 – students born Dec. 1 had much higher rates of ADHD than children born Dec. 2. (The students born Dec. 1 were the youngest in their grade; the students born Dec. 2 enrolled a year later and were the oldest in their grade.
…. In another example, August-born kindergartners in Illinois were much more likely to be diagnosed with ADHD than Michigan kindergartners born in August of the same year as their Illinois counterparts. That’s because Illinois’ kindergarten cutoff date is Sept. 1, meaning those August-born children were the youngest in their grade, whereas the Michigan students were not (MSU 2). Elder believes that there is an issue with the over-diagnosing of children due to cut-off dates because diagnoses are primarily heavily relied on teacher and parent opinion.When the child is not acting in accordance with his/her peers, the child is thought to be incompetent, when it may be due to the fact that the child is not in a class full of his/her peers (MSU 3). The majority of health scientists and researchers can agree that mental illnesses do, in fact, occur.
They may also agree that ADHD is, in fact, an actual disorder, which if left untreated, may be detrimental to the development of children diagnosed with the disorder. Taking Steps to Resolve the Issues Unlike autism and Down syndrome, ADHD has no exact definite cause or extremely visible symptoms.Likewise, unlike other psychiatric diseases such as schizophrenia and bipolar disorder, ADHD is found in kids, there is no definite cause, and no visible symptoms. If stimulant drugs have undesired side effects such as those listed, misdiagnosis leads to more prominent issues as children are being over-treated with medications that they may not even need. There are a few steps that can be taken to reduce the risk of this from happening. First, the criteria for the diagnosis of ADHD in children must be less inclusive, more exclusive.