Attention Deficit Hyperactivity Disorder - Literature review Example

Attention Deficit Hyperactivity Disorder s Introduction Attention Deficit Hyperactivity Disorder better known as ADHD is a neurological disorder which primarily affects children. Hyperactivity and inattentiveness is seen in normal children as well however, they are over expressed and frequent in children with ADHD. In some cases the problem may continue well into adolescence and adulthood as well. Research has shown that the brain of individuals suffering from ADHD matures in a normal manner but its maturity is delayed by almost 3 years on an average (Shaw et al, 2007).Molecular studies have linked the occurrence of the disorder with mutations in the genetic sequence of humans however several others factors such as environmental stress, developmental stress etc may also play a role in the development of the disease. Onset of ADHD Studies have shown that individuals with ADHD show definitive symptoms of the disease before the age of 7. According to research in this field, since even though the onset of the disease begins in early childhood it carries on or may even surface during adulthood as well and in DSM V definition of ADHD, the late onset of the problem has also been. The severity of the disease also affects the behavior. Non-complex or mild forms of the disorder may not be impairing while the complex and severe forms impairs development. Social Costs ADHD affects a person’s life from a social perspective. Not only is the patient’s life affected but the disorder also has a prominent impact on the parents and on the family. In many cases ADHD is a cause of strained relations. Harpin (2014) studied the negative effects of ADHD on the lives of child and their families at different stages of life. In cases where ADHD persisted in adulthood it was seen to have adverse impacts on both social and professional life of the person. At-risk groups Community studies show that the prevalence of ADHD in different populations ranges between 1.7% and 21%. These figures suggest that a considerable percentage of school children across racial, ethnic and socioeconomic backgrounds have ADHD (Acosta et al, 2004, p1). Biederman et al conducted an epidemiological study to investigate the risk percentage of children who had parents or siblings with ADHD and found that a high percentage of children who had ADHD parents also were diagnosed with the problem (1995). Causes and Risks The causes of ADHD are currently being researched upon however scientists have identified a few potential causes of the disorder. Besides the main factor, i.e. genetic aberration injury to brain tissue, environmental stress, premature birth and stress during fetal development have been recognized as possible contributors to the disorder. Injury to brain or altered brain functioning is a potential risk factor. Animal models have shown the occurrence of ADHD with derangement of neurotransmitters in the brain. Stress during the development of the fetus has been known to give birth to babies with ADHD. The stress in such cases comes from maternal drug or alcohol abuse during the stages of pregnancy. Environmental toxins are also potential risk factors. Higher exposed to toxins have shown behavioral problems very much similar to ADHD symptoms. Psychosocial factors are also known to have an impact. Children who are deprived of care in the early stages have higher chances of developing ADHD. Failed relations or discordant relations are mostly seen in families with ADHD children EMPIRICAL STUDIES A number of empirical studies have been done to understand ADHD and the contributing factors. Hudziak et al (2005) studied twin studies of ADHD and measured the genetic and environmental contributors with the help of Conners Rating Scales. The study primarily focused on measuring the genetic contribution. The sample for the study was twins who were about seven years old in Netherlands. Gender-genetic models were used to calculate contributions from outside environmental interaction and gender effects. The results yielded positive influences of genetics keeping at par with results from other similar studies conducted previously. Genetic analysis showed that the disorder had about 48% genetic dominance. Models of ADHD In the recent years a number of theoretical models of ADHD have been developed. These models provide better understanding of the problem and also serve as a guideline for research in the field of clinical psychology or psychiatry. Barkley provided one of the first models associated with ADHD. This model links the disorder to impairments to 4 different neuropsychological functions thereby inhibiting their working. The four neuropsychological functions are the working memory, self regulation of affect-motivation and arousal, internalization of speech and behavioral analysis and synthesis (Barkley, 1997, p65). The Cognitive-Energetic Model provide a more comprehensive model for ADHD that establishes that efficiency of information processing in the brain is done successfully at three different levels which includes response output (cognitive mechanism), effort and activation and management and that one of the three levels is inhibited. Developmental features The disease onsets primarily during childhood however late onset of the diseases is also seen in some teenagers and adults. The developmental features also vary with age. A pre-school child diagnosed with the disorder tends to be hyperactive and has almost negligible concentration ability. The child makes unnecessary movements even during calm situations and often reuses to do things that other normal children do. Late on set of the disease is noticed during adolescent years. During this span of time there is less whole body movement however constant fidgeting is noticed with negligible concentration. Adults with ADHD on the other hand are much more in control that adolescents or children with ADHD. In case of adults the restlessness may not appear outside at all. The minds of adults with ADHD are always restless though concentration power is slightly higher in adults however this concentration ability is far below that of normal adults who are not affected by ADHD. ASSESSMENT In order to design a suitable assessment for ADHD all the core features of the disorder must be taken into account. Keeping in mind the criteria for ADHD laid down by DSM V and ICD-10 a full assessment needs to be done. A proper standard assessment needs to analyse: 1. Severity of the symptoms and their origin 2. Comparison of symptoms with other people 3. Presence of other associated problems Key approaches of Assessment: The most essential components of the assessment include a interview, a medical examination and a parent/teacher assessment. Other criteria such as cognition, speech, developmental pattern may or may not be taken into account. Clinical interview: The interview must be carried out by a trained professional and the format used must be different for children and adults. The aim of this interview is to understand the problem, origin etc. Rating scales: Standard rating scales maybe used to assess mental health and behavioral problems. Medical assessment: This examination needs to be done by a physician. This helps to associate the physical problems with ADHD and also look out for associated co morbidities. Medical assessment also assesses the factors influencing the ADHD problem. For a school based level, the assessment needs to include an interview with teacher or parents to assess the development and mental ability of the child. Most ADHD children show early behavioral symptoms and inability to cope with school curriculum so it becomes increasingly important to identify the problem areas accurately. It must be taken into account that the behavioral or response pattern of ADHD children changes with setting hence an evaluator needs to adopt a wide variety of assessment methods and tool to understand the child extensively and procure substantial amount of information about him/her. Assessment at a school level needs to have a questionnaire seeking information about the social interaction and functioning in the classroom setting. If problems associated with either social or functional is seen direct observation needs to be made in the classroom setting to understand the severity of the problem. However, concentration need not be focused on just one behavioral trait or response only since that would make the evaluation biased. It is important to adopt a multi-trait, multimethod assessment approach. In this approach the evaluator with the help of a large number of tools and assessment methodologies procures information about the person which makes it easier to design a curriculum to suit the needs of the child in a psycho educational setting. CURRENT TREATMENT PROTOCOLS The treatment protocols for ADHD are different for different age groups. Psychological therapies: These therapies include CBT, behavioral therapy, interpersonal therapy, group therapy and family therapy. In case of children advice is administers to teachers, care givers and parents of the affected to help both the sides’ ability to cope up with the problem. Occupational therapy: Remedial therapies are induced to help children and adults develop normal speech and language skills. Pharmacological: A number of medications are used to tackle the symptoms associated with the disorder. Drugs for ADHD affected children include antomoxetin and methylphenidate which are the main medications used for ADHD (Heal et al,2012).Volkow et al, recognized methylphenidate as a stimulant of the central nervous system. It works by inhibiting transmission of dopamine thereby making it available for synaptic transmission (2012). Combined: Particularly in adults pharmacotherapy is the first option for treating ADHD however currently combines therapies are used as well. In fact, it has been clinically established that a combination of pharmacological approach and cognitive-behavior therapy had significanltly improved ADHD treatment (Rostain & Ramsay,2006). Substance abuse and Crime The instances of substance abuse and crime rates are higher in ADHD affected adults Drug abuse behavior becomes evident either owing to psychosocial impairment or expression of risk taking behavior. Longitudinal studies show that crime rates are also high. Studies show early onset of criminal like behavior before teenage years among those affected. Both these risk factors need to be identifies and targeted for therapy. Associated Co Morbidities Research has shown that ADHD is primarily associated with co morbid disorders of psychiatric origin. It is important to understand the basis and the pattern of the comorbid conditions for enhanced management and treatment. Oppositional, defiant and conduct disorders have been seen in association with ADHD. Anxiety disorders have been seen to be around 47% while mood disorders account for almost 38%. Substance abuse problems have been seen in almost 15% (Prim Care Companion, 2009). These co morbid problems are mainly seen in the adult population affected with the disorder. Learning disorders associated with ADHD are seen among children. The statistics show almost 25% children have learning problems (Pliszka, 1998) PREVENTION AND INTERVENTION PROGRAM Intervention programs are common among ADHD adults and children. The most common is direct intervention. Direct intervention is a direct assessment of the problem Studies show that direct interventions have been efficient in improving attention span among children. However the drawback of the direct intervention is that it difficult to get the same results from each individual and has almost zero effect on adults. Direct intervention successfully lengthens the attention span but has no control on the hyper activeness (Kimberly et al, 2010). Another pioneering intervention approach which is a type of direct intervention is the computerized progressive attentional training (CPAT) which follows the theoretical framework of cognitive therapy. It has been seen that repeated stimulation of the brain and the attention system helps ADHD children in expanding their attention span. Computerized training helped children retain much more information when taught through repetitive cognitive stimulation. CPAT affects the academic performance of students and tests have shown that in comparison to control groups ADHD diagnosed students performed better in academics (Shalev et al,2007) especially in comprehension, reading and writing passage. This particular therapy addresses most of cognitive learning. PROGRAM FOR SCHOOL Children suffering from ADHD can be treated at an early age with the help of intervention programs in their educational setting. A meta-analysis study has shown that school-based interventions are effective in reducing ADHD problems and makes the children more capable and open to learning normal traits (Dupaul & Eckert,1997). This will help them control the problems associated with the disorder. It has been seen that early intervention programs among children have helped them drastically in controlling the problem areas and living an almost-normal adulthood. The program needs the following components in the educational setting: Parental and teacher advice Just like parents teachers are also sometimes unaware about how to handle a child with ADHD. The program must ensure that both the sides become aware as to what exactly ADHD is and how the problem may be taken care of. It is important to make them understand that the disorder is treatable to some extent but needs a number of therapies. Since ADHD children need more time than normal children to understand things teachers should be trained to help them understand the things in a slightly different mode. Classroom activities Stimulating activities must be introduced. It must be remembered that the attention span of an ADHD affected child is small and hence stimulating activities must be done such that with a small span of time the child is able to grasp on things and learn. Activities may also be broken down into more than one step such that the children are able to take each task at a time and complete it. This is done to assure that each step obtains the attention span of the child. Positive feedback intervention: ADHD children fail to do most chores and tasks however it had been seen that positive feedbacks act as positive reinforcements and must be introduced. This particularly needs to be understood by the teachers since at the school setting ADHD students are guided by them. It has also been seen that positive feedback also enhances social interaction among ADHD students. New skills required: The program in the educational setting does not require high skills but does require training. This may be done by a child psychologist. ATTITUDE CHANGE Spreading awareness about ADHD would automatically help tackle the attitude problem. Parents, teachers and fellow students need to understand that ADHD is not only a physical problem but affects the learning and cognitive ability and hence no negative remarks or attitude should be shown to those affected. Conclusion ADHD being a psychiatric problem must be managed effectively to keep the problem with control. Programs that help ADHD need to be introduced at the earliest at the school level. Early intervention will help the affected people in overcoming the problems at a younger age, this gives them enough time to learn and cope. It is very important for education instructors, teachers and parents to be aware that a child who may show defiant behavior may have ADHD and proper attention needs to be given. Sometimes owing to lack of information childhood ADHD is not diagnosed and the problem persists into adulthood as well. In such cases evaluation of self behavior is extremely crucial to help understand probable problematic areas of behavior and response to settings. ADHD is severe problem but with proper management plan it can be restrained and brought under control with positive results. REFERENCES Acosta et al (2004). Attention deficit/hyperactivity disorder (ADHD): Complex phenotype, simple genotype? Genetics in Medicine, 6, 1-15. Assessing Adults with ADHD and Comorbidities. (2009). The Primary Care Companion To The Journal of Clinical Psychiatry. doi:10.4088/PCC.7129bs4c Barkley, R. A. (1997). Behavioral inhibiton,sustained attention and executive functions- constructing a unifying theory of ADHD. Psychological bulletin, 121(1), 65-94. Biederman et al (1995). High risk for attention deficit hyperactivity disorder among children of parents with childhood onset of the disorder: a pilot study. Am J Psychiatry, 152(3), 431-435. D, V. N., G, W., Tomasi, D., Kollins, S. H., Wigal, T. L., Newcorn, J. H., . . . Swanson, J. M. (2012). Methylphenidate-Elicited Dopamine Increases in Ventral Striatum Are Associated with Long-Term Symptom Improvement in Adults with Attention Deficit Hyperactivity Disorder. Journal of Neuroscience. doi:10.1523/JNEUROSCI.4461-11.2012 Harpin, V. A. (2005). The effect of ADHD on the life of an individual, their family, and community from preschool to adult life. Archives of Disease in Childhood. doi:10.1136/adc.2004.059006 Heal et al (2012). ADHD: Current and Future Therapeutics. Curr Top Behav Neurosci, 9, 361-390. Hudziak, J. J., Derks, E. M., Althoff, R., Rettew, D. C., & Boomsma, D. I. (2005). The genetic and environmental contributions to attention deficit hyperactivity disorder as measured by the Conners Rating Scales-revised. American Journal of Psychiatry. doi:10.1176/appi.ajp.162.9.1614 Kerns, K. A., Eso, K., & Thomson, J. (1999). Investigation of a Direct Intervention for Improving Attention in Young Children With ADHD. Developmental Neuropsychology. doi:10.1207/S15326942DN1602_9 Pliszka, S. (1998). comorbidity of attention-deficit/hyperactivity disorder with psychiatric disorder-an overview. journal of clinical psychiatry, 50. Rostain, A. L., & Ramsay, J. R. (2006). A Combined Treatment Approach for Adults With ADHD—Results of an Open Study of 43 Patients. Journal of Attention Disorders. doi:10.1177/1087054706288110 Shalev, L., Tsal, Y., & Mevorach, C. (2007). Computerized Progressive Attentional Training (CPAT) Program: Effective Direct Intervention for Children with ADHD. Child Neuropsychology. doi:10.1080/09297040600770787 Shaw et al (2007). Attention Deficit/Hyperactivity Disorder Is Characterized By A Delay in Cortical maturation. Proc Natl Acad Sci U S A, 104(49), 19649-19654. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2148343/ The Effects of School-Based Interventions for Attention Deficit Hyperactivity Disorder: A Meta- Analysis — National Dissemination Center for Children with Disabilities. (n.d.). Retrieved from http://nichcy.org/research/summaries/abstract2 Read More