Attention Deficit Hyperactivity Disorder: A Gift or Curse - Research Paper Example

ADHD: Disorder or a Gift? Introduction ADHD, the abbreviation for Attention Deficit Hyperactivity Disorder, which Dr. Heinrich Hoffman first characterized back in 1845 (National Institute of Mental Health 2), and which Sir George F. Still presented to the Royal College of Physicians in London in a series of lectures given on March 4, 6, and 11, 1902 had traits associated with what we call today as ADHD in children been published (“The History of ADHD” 1-2) and consequently been recognized. Since then, ADHD has become the interest in the study of learning disabilities (Davis 1), and has become a common medical, household and school term, yet remains controversial until today concerning its very nature, diagnosis, etiology, and treatment (Palladino xviii). Although largely misunderstood, ADHD is found “the most prevalent chronic health condition among school age children” (“Coping with ADHD” 3). In fact, “DSM-IV prevalence estimates among school children range from 3 to 5 percent” (American Psychiatric Association, qtd. in Joughin, Ramchandani, & Zwi 3). While psychiatric research findings said: “ADHD is the most commonly diagnosed psychiatric disorder in children” (Nair, et al. 617), comprising 35% of all children referred for mental problems (“ADHD and Stress,” par. 2), some medical research argued that not all children diagnosed with ADHD are sufficiently evaluated yet in some cases are prescribed with stimulant medication (Goldman, et al. 1107). The pitfalls in evaluating ADHD are both over-diagnosis and under-diagnosis. Under-diagnosis frequently occurs in the school, which discourages labeling – finding it to be more harmful and in clinics, which therapists are more ‘family systems’ oriented and are not familiar with ADHD (“ADHD Evaluation and Diagnosis,” sec. 3, par. 1-2). Over-diagnosis happens when ADHD is diagnosed without ruling out first the differential diagnoses (“ADHD in 9% of Children,” par. 4) – the conditions that imitate ADHD and that may be mistaken to be traits of ADHD such as, “bipolar disorder, tourette’s syndrome, childhood depression, oppositional defiant disorder, pervasive developmental disorder, auditory processing disorder, dyslexia, autism or aspergers, schizophrenia, anxiety disorders, child abuse, fetal alcohol syndrome, thyroid problems, mild mental retardation, drug abuse, mercury poisoning, brain trauma, food allergies, and environmental allergies” (“Problems that look like ADHD,” par. 1). Such practices have put the existence of ADHD and the effectiveness of its pharmacological treatment in question, especially so that until now, “no objective test exists to confirm the diagnosis of ADHD, which remains a clinical diagnosis” (Joughlin, et al., 2003, p. 2). Above these differences however, the prevalence of data confirm the existence of ADHD – that it is real, that it is difficult for all: the child, the family, and the school, and that if left untreated would surely result to more problems that could be more complex, especially so that “ADHD … persists into adulthood” (Kidd 402). These bring us both hope and worry. Hope that ADHD could in fact be treated; worry to the undesirable affect it could cause if untreated. Fortunately, however, there is a much better perspective than this. Much better than treatment, because it is the potential that ADHD could be transformed into brilliance or giftedness. As one study asserts: There are “two ways to handle impulses – one will make an ADHD-er crazy – the other will make them brilliant” (“How to Transform ADHD” 5). It furthered that “the personality trait which leads to Attention Deficit Hyperactivity Disorder is a great thing, but our society has not traditionally honored those with this gift” (LoPorto, par. 1). If this is true, then could all ADHD children be transformed into geniuses given the correct handling? Or perhaps, ADHD is only a disorder that should be treated? These are the two contending views that this paper would like to address. Be it one or the other, it would mean further research because both need appropriate ways to be taken, especially so that until now, ADHD remains controversial. Understanding the Disorder First, ADHD oftentimes also referred to, as ADD (Attention Deficit Disorder) is a syndrome, as its label said so, defined by the American Academy of Pediatrics (AAP) to be neurological in nature – a brain condition that makes it hard for affected children to manage their behaviors and focus on their task (“Coping with ADHD” 5). Brain images of children with ADHD may show differences compared to children without ADHD. For example, in some children with ADHD certain parts of the brain are smaller or less active than the brains of children without ADHD. These changes may be linked to specific brain chemicals that are needed for tasks such as sustaining attention and regulating activity levels. (Muenke 1) As the studies conducted by the National Institute of Mental Health in the US showed the brain areas responsible in regulating attention: ‘the right prefrontal cortex, two basal ganglia and the vermis region of the cerebellum’ are largely smaller than the normal size in ADHD children (Op cit. 12). Most neuroscientists agree that ADHD symptoms actually indicate problems in the executive functioning of the brain. Executive functions include working memory, foresight, planning, sense of time, and ability to inhibit impulses. These functions are associated with the prefrontal lobes, the last structures to fully develop as the brain matures, and are still being honed in late adolescence and early adulthood. (Palladino xiv) Second, ADHD is also thought to be chronic in nature – meaning, incurable but controllable and reducible which symptoms have been apparent in early childhood as manifested through varied behaviors such as ‘hyperactivity, forgetfulness, poor impulse control and distractibility’ (“Coping with ADHD” 5 &7). These manifestation, following the categorization of the American Psychiatric Association (APA) can be generally categorized into two major symptoms comprising the core symptoms of ADHD, which are inattention and hyperactive-impulsive or disinhibition (qtd. in Barkley 9), with each symptom demonstrating its own traits and pattern of development. Inattention is the “child’s inability to sustain attention or responding to tasks or play activities as long as others of the same age, and to follow through on rules and instructions as well as others” (Barkley 9-10). This symptom “may take many forms, including forgetfulness, being easily distracted, losing or misplacing things, disorganization, academic underachievement, poor follow-through with assignments or tasks, poor concentration, and poor attention to detail” (Krull, et al. 2). However, it must be noted that “objective research does not find children with ADHD to be generally more distracted by extraneous events occurring during their task performance, although they may be so distracted if the irrelevant stimuli are embedded within the task itself (Campbell, Douglas, & Morganstern, 1971; Cohen, Weiss, & Minde, 1972; Rosenthal & Allen, 1980; Steinkamp, 1980, qtd. in Barkley 10), because inattentive children have difficulty focusing their minds on one thing as they get easily bored, but given something of their interest can make them pay attention, although requiring them deliberate focus and conscious attention to organization and completion of task or to learn a new thing would be an entirely different thing (National Institute of Mental Health, sec. 2, par. 7). Furthermore, the symptoms of inattention become observable at the age of eight to nine years (Op cit.). Hyperactivity or disinhibition as observed in ADHD children is characterized by the APA as follows: fidgety, difficulty staying seated when required, always moving around, running, and climbing more often than other children, playing noisily, talking excessively, interrupting the activities of activities, and difficulty in waiting in line or in taking turns in games (qtd. in Ibid 10). This symptom is noticeable in the child at the age of four; it becomes more apparent the next four additional years; most severe at the age of seven to eight; and declines to the point of barely discernible at adolescent years (Krull, et al. 1). It is also believed that etiology of this symptom is more possibly related to genetic condition (Barkley, sec. 9, par. 1). Interestingly, too, “the symptoms of disinhibition in the DSM item lists seem to decline with age, perhaps owing to their heavier weighting with hyperactive than impulsive behavior, those of inattention remain relatively stable during the elementary grades” (Hart et al., 1995, qtd in Barkley, sec. 2, par. 5), eventually, however this declines by the time the child reaches adolescence (Fischer, et al.,1993, qtd. Barkley, sec. 2, par. 5) yet does not go back to the normal level. Why are these so, remains an enigma (Barkley, sec. 2, par. 5). The symptoms discussed above “overlap with those of learning abilities and behavioral and emotional problems such as depression, bipolar disease, anxiety, or post traumatic stress disorder” (4); also, it was noted that for some children “inattentive, hyperactive ands impulsive behavior could be a reaction to the expectations and constraints of the school environment” (Bailey, 2006, qtd. in Natonal Collaborating Center for Mental Health 35), thus the great probability of misdiagnosing ADHD. For this, the DSM-IV criteria specifically emphasized the following for the positive diagnosis of ADHD: The symptoms must be present in more than one setting (e.g. school and home). The symptom must persist for at least six months. The symptoms must be present before the age of seven years. The symptoms must impair function in academic, social or occupational activities. The symptoms must be excessive for the developmental level of the child. Other mental disorders that could account for the symptoms must be excluded. (2) Third, the exact etiology of ADHD remains debatable but indicators point to the fact that it actually “involves the interplay of multiple genetic and environmental factors (as) ADHD is viewed as a heterogeneous disorder with different sub-types resulting from different combinations of risk factors acting together” (National Collaborating Center for Mental Health 29). Among the considered factors, ADHD symptoms show that genetics has the greatest influence to it, observably so that “it often appears to run in families (as) individuals diagnosed with ADHD have close blood relatives with the disorder” (Muenke 1). “Dozens of studies over the years have demonstrated that ADHD is genetically transmitted to children from their parents or grandparents” (Hartmann 6). With this, scientists believe that ADHD is a complex disorder that probably involves at least two genes” (Muenke 1). Moreover, research findings showed an almost 80% heritability of ADHD (“Coping with ADHD” 12). Another “twin studies suggest that around 75% of the variation in ADHD symptoms in the population are due to genetic factors” (Faraone et al., qtd. in National Coordinating Center for Mental Health 29). Aside from this, non-genome major etiologic contributors are also recognized such as: “adverse responses to food additives, intolerances to foods, sensitivities to environmental chemicals, molds, and fungi, and exposures to neurodevelopmental toxins such as heavy metals and organohalide pollutants” (Kidd 402). These non-genetic factors could be categorized as biological factors, dietary factors, and psychosocial factors (National Coordinating Center for Mental Health 30). As it affects all aspects of personality, diagnosis of ADHD is always emotionally overwhelming to parents whose reaction may vary from remorse to understanding because aside from the fact that ADHD diagnosis and treatment could be very costly, the implications of ADHD commonly point to negative tendencies and behaviors, illustrating it to be harmful, stressful, frustrating and unfortunate. Commonly shared observation is that ADHD children “experience trouble in school, difficulty in relationships with family members and their peers, academic underachievement and low self-esteem” (“Coping with ADHD” 7). Some also suggests that ADHD adolescents are more prone to drug abuse, especially if not medically guided as they tend to self-medicate. So far, no available evidence could substantiate this suggestion (Lynskey & Hall, Abstract). However, the National Institute of Mental Health noted that the natural desire for a teenager “to be independent, to try new and forbidden things – alcohol, drugs, and sexual activity – can lead to unforeseen consequences (33). However, it would be a good thing to consider, too, that the core impairments of ADHD could be expressed differently in varying cultural contexts (Brewis, et al. 826), as behavior is very much culture laden and as attitude and reactions to displayed behavior may vary from culture to culture. For example, one study noted, “ADHD is 50 times more likely to be differentially diagnosed in the U.S. than it is in Britain and France… (citing) the difference in orientation to the assumed etiology of ADHD (with) the U.S. having assumed a medical-disease model while Britain and France have deemed (it)… a function of the constructed world” (Weaver & Landers, sec. 2, par. 1). Although, both have no substantive database (Ibid), it has already drawn the big difference in their appreciation and address of ADHD. With the view that ADHD is a disorder, be it mental or behavioral, which etiology displays interplay of genetic and environmental factors, the treatment seen most acceptable because it comprehensively address the disorder is the ‘Multimodal Treatment’. Administration of its components varies depending on the particularity of the ADHD as NIMH study showed varied reactions to it. For children with ADHD, no single treatment is the answer for every child. A child may sometimes have undesirable side effects to a medication that would make that particular treatment unacceptable. And if a child with ADHD also has anxiety or depression, a treatment combining medication and behavioral therapy might be best. Each child’s needs and personal history must be carefully considered. (21) Finding the Gift in ADHD There is a big difference in viewing ADHD as giftedness from disorder, as the latter would instantly spell problem, but the former would spell brilliance, genius, or exceptionality in a positive sense. The assertion that people with ADHD are geniuses is not far out because the 14 features characterizing them as listed by DSM-III-R by APA almost all may also be found in bright, talented, creative, gifted children (Webb & Latimer, 2). To clearly illustrate, let us compare the behaviors associated with ADHD as summarized by Barkley (qtd. in Ibid 3) with the behaviors associated with giftedness as summarized by Webb (qtd. in Ibid 3), which are as follows: BEHAVIORS ASSOCIATED WITH ADHD (Barkley, 1990) 1. Poorly sustained attention in almost all situations 2. Diminished persistence on tasks not having immediate consequences 3. Impulsivity, poor delay of gratification 4. Impaired adherence to commands to regulate or inhibit behavior in social contexts 5. More active, restless than normal children 6. Difficulty adhering to rules and regulations (qtd. in Webb & Latimer 3) BEHAVIORS ASSOCIATED WITH GIFTEDNESS (Webb, 1993) 1. Poor attention, boredom, daydreaming in specific situations 2. Low tolerance for persistence on tasks that seem irrelevant 3. Judgment lags behind development of intellect 4. Intensity may lead to power struggles with authorities 5. High activity level; may need less sleep 6. Questions rules, customs and traditions (qtd. in Webb & Latimer 3) In fact, “98% of all wildly successful entrepreneurs, rock starts, and artists have this ADHD trait” (“How to transform ADHD,” sec. 3, par. 2). To name a few, the following is a list of famous people who had or have ADHD yet were excellent, and were even geniuses, in their chosen fields: Alexander Graham Bell – Inventor of the telephone Hans Christian Andersen – Author Beethoven – Composer Harry Belafonte – Actor, Composer, (Singer) Terry Bradshaw – Retired NFL Quarterback and Sports Commentator George Burns – Actor Admiral Richard Byrd – Navy Aviator Andrew Carnegie – Industrialist and Philanthropist Lewis Carroll – Author (of) Alice in Wonderland Prince Charles – Future King of England Cher – Actress/ Singer Winston Churchill – Statesman Bill Cosby – Actor Leonardo Da Vinci – Sculptor and Artist Thomas Edison – Inventor Albert Einstein – Inventor Dwight D. Eisenhower – Former President of the United States Benjamin Franklin – Politician, Inventor Michael Jordan – Basketball Player Abraham Lincoln – Former President of the United States Stephen Spielberg – Director, Filmaker (“Coping with ADHD” 10-11) As ADHD can be controlled, evidences above also proved that people with ADHD could manage and take control of their lives and be able to live normally and be famous and successful (Ibid 11) given proper recognition, opportunity, and support to reach their potential. A case in point is Richard Branson – an ADHD rebel billionaire, who found and brought to progress the multi-billion dollar Virgin Empire. He is ADHD and dyslexic but instead of suppressing his ADHD he chose to ‘break-out’ discovering his genius behind his ADHD. This brought him fame, great fortune and wild success (“How to Transform ADHD” 1). Evidently, “this gene makes him a risk taker, a thrill seeker, and a rebel, but most of all it makes him a brilliant entrepreneur” (3). In fact, Albert Einstein’s grade-school teachers, who simply evaluated his ADHD traits as problem traits thus calling him a problem student, also ridiculed Albert Einstein, to whom we attribute our great leaps in science and technology. And Leonardo DaVinci, an ADD himself, became the greatest artist and inventor ever because he fully utilized his temperament and was able to bring out his artistic genius that no one has surpassed yet (Ibid). As Garret LoPorto, the author of The DaVinci Method – a method that transforms ADHD from a problem into a gift – emphasized to people with ADD or ADHD: ADD is the result of not working to your strengths when you have the DaVinci trait. Attention Deficit Hyperactivity Disorder is the other edge of the DaVinci gene's double edged sword. With the DaVinci gene you will either be "in the flow" with your God-given brilliance or you will be struggling to fit in - trying to be like the other 90% of the population called "normal". You are not normal. You have a choice, let go and be brilliant with grace and ease, or struggle your whole life just to be mediocre. ADD is the direct result and symptom of rejecting your brilliance. Attention Deficit Hyperactivity Disorder comes from forcing yourself to behave in artificial ways, (often fueled by your desire to "fit in"), instead of just letting go of "shoulds" and just being you. (par. 5) You - with the activated DaVinci gene - basically have a choice: Be brilliant or suffer from the symptoms of ADD along with the potential to develop many other disorders like depression, addiction, narcissism, anxiety, obsessive compulsive disorder, and bi-polar disorder. (par. 6) What could better explain what makes ADHD more of a potential for brilliance, exceptional talent or genius is the recent finding that ADHD is genetic. “While only about 10% of the general population has this gene, most geniuses, entrepreneurs and artists have the ADHD gene” (“How to Transform ADHD,” par. 2). This finding is essential because, the presence of the ADHD gene affects the relationship of the brain with dopamine (Ibid, par. 3) – “an important neurotransmitter (messenger) in the brain… a precursor (forerunner) of adrenaline and a closely related molecule, noradrenaline” (“Definition of Dopamaine” 14345). Such relationship causes one to be stimulated and be hyperactive, looking for thrills, enjoying challenges and risks, enchanted in discovering and experimenting new ways of doing things, thus making one bolder and gaining more charisma (Op cit) – characteristics strong in successful people. Moreover, the temperament accompanying this ADHD genetic difference is similar with the temperament that makes successful and famous ‘rock stars, inventors, artists, and athletes, entrepreneurs, leaders and self-made billionaires” (par. 3). In fact, the Fortune Magazine stated that “people with ADHD are 300% more likely to start their own company” (qtd. in Ibid, par. 4). But how could ADHD be transformed from a problem into a gift? The key… is learning how to channel all that creative energy into taking intelligent risks, because people with ADHD are brilliant risk takers. (“How to Transfrom ADHD, par. 4). Another important thing is learning to trust in them. “Most ADHD children learn to not trust themselves, feel inferior, frustrated and have low self-esteem all because they were raised by parents and teachers who didn't understand them and never witnessed to their brilliance” (Ibid, sec. 7, par. 2). “In one longitudinal study, the only factor that determined whether a child with ADHD became successful as an adult was whether he or she had at least one adult who believed in him or her as a child. As we believe in our children, our children believe in themselves” (Palladino xv). However, it should be understood that not all people with ADHD are gifted and vice versa. What is possible is the coexistence of both conditions. To mislabel gifted children as ADHD and to avoid working frustratingly to death trying to bring out a genius in an ADHD child only, the combined conditions should be differentiated. Between the two, it is easier to pinpoint the gifted child in an ADHD than pointing out ADHD in a gifted child. For this matter, two considerations are suggested: First, “identified gifted ADHD children are more impaired than other ADHD children… Second, high ability can mask ADHD, and attention deficits and impulsivity tend to depress the test scores as well as the high academic performance that many schools rely on to identify giftedness” (Neihart 1). A gifted child's over-reliance on her strengths unintentionally obscures her disability. While emphasizing strengths may highlight a child's gifts and talents, it does not eliminate the reality of the condition. It can, in fact, lead to an even worse dilemma: She can doubt her abilities because of her struggle just to maintain them. If a child is allowed to acknowledge her difficulties as a disability, she may learn appropriate coping skills. (Kaufmann, et al. 3) Now we know that “ADHD is not a defect that must be ‘cured’. In fact, ADHD cannot only inhibit, but can also enhance the realization of gifts and talents” (Ibid), given the right coditions. And this is a big challenge to us, especially so that conditions necessary to unlock the genius that has been hidden behind ADHD are not yet in place in our society – not even in our immediate consciousness. This challenge becomes greater because the “conditions that bring out the genius and brilliance of those with the activated ADHD gene are overwhelming and disturbing to the “normal” (non ADD) general population – average people just don't have the energy and creativity to fuel this special approach to life” (“How to Transform ADHD,” sec. 3, par. 2). Conclusion So, is ADHD a disorder or a gift? Disorder in our discussion may mean many things. It may mean a pathological disease, it may mean unwanted behavior, or it may mean something above or below the normal. While gift is obviously referring to brilliance, talent, or exceptionalities. In this context therefore, it would be dangerous to choose one or the other, because as what have been discussed ADHD is a disorder – which to our discussion leans more to a neurological disorder causing behavioral disorder – but is potentially hiding exceptionalities in gifted children. The merit of this paper is not to discredit one over the other, but to emphasize that ADHD is a delicate issue that should not be ‘boxed’ into strictly drawn labels or concepts, but something that should merit keen attention not only medically, but also socially. Most importantly, what all the plethora of contending researches want to make us realize is that, as historically evinced by gifted ADHD – ers is for us to learn to truly appreciate what is different. 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