Causes, Diagnosis, Symptoms, Mechanisms of Development and Manifestations of the Destructive Disorder - Research Paper Example

? Elementary School Children Attention Deficit Hyperactivity Disorder (AD/HD) Introduction Smith et al, p.123, gives the ification of AD/HD as per DSM-IV-TR, 2000, as “a disruptive disorder expressed in persistent patterns of inappropriate degrees of attention or hyperactive-impulsivity”. Thus AD/HD is a disorder that is typified through a deficit in attention capability and behaviors of hyperactivity and impulsivity. From the perspective of the International Classification of Diseases, tenth edition, 1992, AD/HD falls under the classification of hyperkinetic disorders (Smith et al, 2012). AD/HD characteristics can be seen in affected children at a very young age, manifesting by the age of seven years. The difficulties that these children experience from AD/HD persist in most cases into adolescence and adulthood (Kormos & Smith, 2012). The persistence of the symptoms of AD/HD into adolescence is to the tune of 80%, along with the risk of persistence into adulthood. Adults with ADHD have shown a marked tendency for having lower occupational status, inferior social relationships, high risk for motor accidents, and potential for developing substance, placing a high premium on early detection and optimal management (Faraone, et al, 2003). Nature and Causes of AD/HD Neuropsychological functions that are impaired in AD/HD are broken down into attention and executive functions, with alertness and vigilance as subdivisions attention functions and working memory and response inhibition under executive functions. Cognitive flexibility, and planning have also been identified as other possible neuropsychological functions impaired by AD/HD. Attention pertains to the ability of the child for facilitated processing of one bit of information over other pieces of information. Alertness refers to the quickness in response to a stimulus. Vigilance pertains to the presence of errors in task undertaking. It is the executive functions that enable a child to plan the required steps towards a set objective, retain these steps in memory and act through it and monitoring progress achieved using these steps. Working memory pertains to the ability retain something in the mind temporarily while working on something else, or while utilizing it in the performance an action. Inhibition or interruption of the ability to respond during dynamic behavioral actions is termed as response inhibition (Aguiar, Eubig & Schantz, 2010). The executive functions hypotheses that it is a part of neuropsychological functional impairments in AD/HD have not received full universal acceptance. However, Lambek et al, 2011, after comparing executive functions in a sample of 49 school-age children in the age group 7 years to 14 years, with a control of 196 children in the same age group, report that in general children with AD/HD demonstrate more impairment of executive function deficits. Furthermore, 50% of children with AD/HD demonstrated robust executive function deficits in comparison to the other children (Lambek, et al, 2011). Signs and Symptoms in the Classroom Students with hyperactivity and impulsiveness will demonstrate signs of being active all the time, unable to sit still, and constantly chattering. Impulsiveness in these students will result in their blurting answers prior to the completion of the questions posed. They are also likely to interrupt other students in their answers and act or speak without prior thought. The inattentive nature of the disease in some students may result in teachers considering them as less of a problem then the hyperactive and impulsive students. Yet, they demonstrate poor success in classroom assessments, owing to their short attention span, or poor concentration ability, or focus on critical activities of learning. These students may also show difficulty in task initiation, finishing of tasks, and completing tasks in a timely manner (Smith et al, 2012). Lauth, Huebeck, and Mackowiak, 2006, reporting after observing a sample of 55 children with AD/HD in natural classroom situations state that children with AD/HD demonstrate more disruptive and inattentive behaviors in the classroom, and they were less able to complete tasks to keep up to the expectations of the teachers for classroom performance. Furthermore, teachers demonstrated a good ability identify disruptive behavior, inattentiveness, and poor task abilities among their students (Lauth, Huebeck, & Mackowiak, 2006). With children spending so much time in classrooms under the supervision of teachers, more often it is teachers that bring to attention the AD/HD like behaviors in children (Smith et al, 2012). Twin studies of Frankie et al 2009 and Smith et al, 2009 have shown that the heritability element in AD/HD is very high, with heritability estimated to be 76% (Aguiar, Eubig & Schantz, 2010). The true nature of the neurochemical deficits that is responsible for ADHD is still elusive. However, the evidence available suggests that hypoactivity of frontostriatal dopamine circuits and abnormal noradregenic signaling has a role to play in ADHD. These hypotheses are supported by imaging studies of the brain of patients with ADHD. In spite of the ambiguities associated with these hypotheses, they remain the best explanations for the causes of ADHD (Aguiar, Eubig & Schantz, 2010). Prevalence and Diagnostic Criteria Prevalence of AD/HD on a worldwide basis in children ranges between 5% and 10%. In adolescents it is between 2.5% and 4%, and in adults approximately 2.5%, which shows a diminishing prevalence with advance in age (Aguiar, Eubig & Schantz, 2010). In the USA one in every twenty children is estimated to be affected by AD/HD, giving a prevalence rate of 5% in the USA. There is general consensus that boys are significantly more affected by ADHD than girls (Faraone, et al, 2003). Even though AD/HD came to the attention of medical science, as a problem in children, nearly two centuries ago, no reliable single diagnosis for AD/HD has been arrived at till now. The absence of a specific diagnostic procedure has rendered identification of AD/HD among children a difficult task. Diagnosis of AD/HD may be further confounded by the coexistence of several other disorders along with AD/HD, or other disorders mimicking the symptoms of AD/HD (Brock & Clinton, 2007). The confounding factors and the heterogeneity of symptoms of demonstrated by children with AD/HD make diagnosis of AD/HD a difficult task. The most accepted guide to the diagnosis of AD/HD is the DSM-IV-TR. This guidance informs that AD/HD is made up of four types of exceptionalities. These exceptionalities are attention deficit hyperactivity disorder, which is predominantly the inattentive type; attention deficit hyperactivity disorder, which is predominantly the hyperactive or impulsive type; attention deficit hyperactivity disorder of the combined type; and attention deficit hyperactivity disorder, which is not otherwise specified. The identification of the type of AD/HD within these four types is dependent on the number and type of the symptoms demonstrated by the child (Smith et al, 2012). Teachers can bring to attention the AD/HD signs and symptoms in children, but are not to make the diagnosis of AD/HD (Lauth, Huebeck, & Mackowiak, 2006). The role of the school psychologist in the diagnosis of AD/HD still remains undefined, as AD/HD does not fall under the special education category as per state or federal regulations. Some districts do not permit school psychologists to make the diagnosis of AD/HD in children. This situation raises issues with regard to regulations. The state and federal governments do acknowledge the eligibility of students with AD/HD to receive special education services or Section 504 protections (Brock & Clinton, 2007). Assessment of Children with AD/HD at the Elementary Level Quoting evidence from Lahey et al, 1998, Mariani & Barkley, 1997, and Shelton al, 1998, Du Paul and Stoner, 2003 opine that children with AD/HD entering the elementary school level are deficit in basic math concepts, pre-reading skills, and fine motor abilities. This evidence of deficits in children with AD/HD at the elementary school level received support from the later O’Reilly, 2002 study. These deficits contribute to students with AD/HD at the elementary level lagging behind their peers in the required critical academic skills. The most suitable manner in meeting the challenge of behavioral, academic, and social deficits in these children is for early identification and intervention, so as to boost academic function and reduce the intensity of medical interventions. Classroom-based screening and individual-based screening are two methods for early identification of AD/HD at the elementary school level. Teachers need to incorporate questions like, whether the disruptive behavior is the result of immaturity, attention span levels, improvement in classroom behaviors, and classroom expectations are age-appropriate, and so on before committing a child for a diagnosis of AD/HD and the relevant interventions (Du Paul & Stoner, 2003). Eligibility for Special Education Services There are two federal laws under which children with AD/HD can be provided the appropriate educational support. Under the Individuals with Disabilities Act (IDEA), students with AD/HD are eligible for special education and other services, when the impairment has a significant bearing on their educational performance or learning. To assess the significance of the impairment the services of a multidisciplinary team may be required. For those children that require resource room aide or training an Individual Educational Program IEP) has to be arranged. While IDEA looks after children with educational or learning impairments, Section 504 of the Rehabilitation Act of 1973 and the Americans Disability Act (ADA) provides support for disruptive behavior (Millichap, 2010). Conclusion AD/HD is a disease that presents at a young age, through children demonstrating disruptive behaviors and poor educational abilities and performance in classrooms. AD/HD is a complex disease, with no clear picture of its causes. For identification purposes AD/HD is classified into four types, essentially based on the signs and symptoms demonstrated by the child with AD/HD. Teachers are a critical element in the early identification of AD/HD in children, though not in the diagnosis, for the appropriate intervention. Under IDEA, Section 504, and ADA, children with AD/HD are eligible for special education services. Literary References Aguiar, A., Eubig, P. A. & Schantz, S. L. (2010). Attention Deficit/Hyperactivity Disorder: A Focused Overview for Children's Environmental Health Researchers, Environmental Health Perspectives, 118(12), 1646-1653. Brock, S. E. & Clinton, A. (2007). Diagnosis of Attention-Deficit Hyperactivity Disorder (AD/HD) in Childhood: A Review of Literature. The California School Psychologist, 12, 73-91. Du Paul, G. J. & Stoner, G. (2003). ADHD in the Schools: Assessment and Intervention Strategies, Second Edition. New York: The Guilford Press. Faraone, S. V., Sergeant, J., Gilberg, C. & Biederman, J. (2003). The worldwide prevalence of ADHD: is it an American condition? World Psychiatry, 2(2), Retrieved March 13, 2012, from Web Site: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525089/. Kormos, J. & Smith, A. M. (2012). Teaching Languages to Students with Specific Learning Differences. Bristol, UK: Multilingual Matters. Lauth, G. W., Huebeck, B.G. & Mackowiak, K. (2006). Observation of children with attention-deficit hyperactivity (ADHD) problems in three natural classroom contexts. British journal of educational psychology, 76(Pt 2), 385-404. Lambek, R., Tannock, R., Dalsgaard, S., Trillingsgaard, A., Damm, D. & Thompsen, P. V. (2011). Executive Dysfunction in School-Age Children with ADHD. Journal of Attention Disorders, 15(8), 646-655. Millichap, J. G. (2010). Attention Deficit Hyperactivity Disorder Handbook: A Physicians Guide to ADHD, Second Edition. New York: Springer. Smith, T. E., Polloway, E. A., Patton, J. R., Dowdy, C. A., & McIntyre, L. J. (2012). Teaching students with special needs in inclusive settings (4th Canadian Ed.). Toronto, ON: Pearson Canada. Read More