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ADHD:
As a globally detected disorder, Attention Deficit Hyperactivity
Disorder (ADHD) is the diagnostic label given to children presenting
significant problems with attention, impulse control, and activity
levels (Barkley, 1990). Having been in medical literature for over a
hundred years, ADHD is not a newly discovered disorder, however, what is
new is the increased awareness of the disorder (Silver, 1999).
CAUSES:
What causes ADHD is essentially unknown (National Health and Medical
Research Council (NHMRC) (1997). Scientists and researchers have found it
difficult to find a single accepted cause for the disorder. Treatment
issues have all been examined and focused on to attempt to give reason
for this disorder. Suggested causes include:
Wodrich (1994) has summarized that ADHD is at least partially inherited,
and not generally caused by brain injury or external factors like sugar
ingestion. There has also been no connection made between birthing
complications, or the manner in which parents raise their children, and
the development of ADHD. The NHMRC (1997) has reported that maternal
substance abuse during pregnancy may be associated with ADHD, where
substances such as cocaine and nicotine induce ADHD-like symptoms
(Nichols and Chen, 1981; and Steinhausen et al, 1993; cited in NHMRC,
1997), but no direct correlation between birthing complications and
ADHD. Silver (1999) concurs with many of Wodrich's (1994) and the
NHMRC's (1997) suggested causes, but, like Giler (2000), proposes that
ADHD appears to be mainly the result of neurotransmitter deficiency in a
specific area of the brain, more specifically the frontal cortex region,
causing an absence in the ability to control certain behaviours.
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DIAGNOSTIC
CRITERIA (DSM-IV):
Despite the uncertainty of the cause, or causes, of ADHD, the American
Psychiatric Association (APA) (1994) reports a universally accepted and
used set of criteria outlined in the DSM-IV to help diagnose young
individuals with ADHD. The diagnostic criteria for ADHD in the DSM-IV is
outlined as follows:
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A.
Either (1) or (2):
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six
(or more) of the following symptoms of inattention have
persisted for at least 6 months to a degree that is maladaptive
and inconsistent with developmental level:
Inattention
-
often
fails to give close attention to details or makes careless
mistakes in schoolwork, work, or other activities
-
often
has difficulty sustaining attention in tasks or play
activities
-
often
does not seem to listen when spoken to directly
-
often
does not follow through on instructions and fails to finish
school work, chores, or duties in the workplace (not due to
oppositional behaviour or failure to understand
instructions)
-
often
has difficulty organizing tasks and activities
-
often
avoids, dislikes, or is reluctant to engage in tasks that
require sustained mental effort (such as school work or
homework)
-
often
loses things necessary for tasks or activities (e.g. toys,
school assignments, pencils, books, or tools)
-
is
often easily distracted by extraneous stimuli
-
is
often forgetful in daily activities
-
six
(or more) of the following symptoms of hyperactivity-impulsivity
have persisted for at least 6 months to a degree that is
maladaptive and inconsistent with developmental level:
Hyperactivity
-
often
fidgets with hands or feet or squirms in seat
-
often
leaves seat in classroom or in other situations in which
remaining seated is expected
-
often
runs about or climbs excessively in situations in which it
is inappropriate (in adolescents or adults, may be limited
to subjective feelings of restlessness)
-
often
has difficulty playing or engaging in leisure activities
quietly
-
is
often "on the go" or often acts as if "driven
by a motor"
-
often
talks excessively
Impulsivity
-
often
blurts out answers before questions have been completed
-
often
has difficulty awaiting turn
-
often
interrupts or intrudes on others (e.g. butts into
conversations or games)
B.
Some hyperactive-impulsive or inattentive symptoms that caused impairment
were present before 7 years.
C.
Some
impairment from the symptoms is present in two or more settings
(e.g. at school [or work] and at home).
D.
There
must be clear evidence of clinically significant impairment in
social, academic, or occupational functioning.
E.
The
symptoms do not occur exclusively during the course of a
Pervasive Developmental Disorder, Schizophrenia, or other
Psychotic Disorder and are not better accounted for by another
mental disorder (e.g. Mood Disorder, Anxiety Disorder,
Dissociative Disorder, or a Personality Disorder).
(DSM-IV,
APA, 1994)
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TREATMENTS:
Unfortunately, due to the uncertainty of ADHD's origin, there is also a
weak treatment plan for the disorder. Silver (1999) proposes that the
treatment of ADHD must involve a multi-disciplinary approach. Thus,
individual and family education, individual and family counselling,
appropriate behavioural management programs, and appropriate medications
must be included.
From the approaches identified, the one that has caused much debate and
examination is treatment through medication. Because it is believed that
ADHD is caused primarily by a deficiency of a specific neurotransmitter,
the goal of medication is to increase the level of the neurotransmitter involved
(Silver, 1999). The most widely recommended medication for the disorder
are stimulants such as Methylphendate, also known as Ritalin, and
Dextroamphetamine, also known as Dexedrine. These stimulants,
according to Barkley (1990), work by primarily increasing how much of
these chemicals are available in the brain, the stimulants increase the
action of these brain cells, which seem to be responsible for inhibiting
our behaviour and helping us to stick to what we are doing.
Children with ADHD taking stimulants are found to be:
-
less
impulsive, and
-
have
fewer problems with
-
aggression,
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noisiness,
-
non-compliance,
and
-
disruptiveness.
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However, with the use of these stimulants, Silver (1999) has reported
symptoms of:
A far more intricate treatment direction without medication is behaviour
modification, or behaviour management. Wodrich (1994) states that
behaviour management's most basic idea is that children learn many of
their behaviours from their environment, and so, children with ADHD,
although with impulse control and attention problems, also learn many
behaviours from the world around them. The aim is then for parents to
work with their children, health professionals, family members, school
teachers, and the like to re-teach more acceptable behaviours.
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