Attention Deficiency Disorder - Essay Example

Co-existing psychiatric disorders Attention Deficiency/Hyperactivity Disorder (ADHD) is one of the most common childhood disorders generally affecting school age children. The main symptoms of ADHD are inattention, impulsivity, and hyper activity and children with ADHD find it difficult to concentrate. Children with ADHD are easily distractible, generally disorganized, impulsive, and hyperactive leading to comorbid psychiatric conditions. Barkley argues that psychiatric disorders often co-exist (is comorbid) with ADHD and studies reveal that genetic, family environment, etc., may influence and contribute to the disorder. Angold and others (1999 as quoted in Barkley), based on a meta-analysis of community samples, found that any two disorders co-exist with each other and are comorbid with ADHD. There is a common notion that ADHD is not a serious disorder, rather childhood nature, as such no special attention is given for its treatment. In reality proper diagnosis of ADHD is essential to identify other coexisting psychiatric disorder. Community samples are important to identify the issue because clinical data constricts samples and may include overlap of disorder information Literature review assert that there are wide variation between large community samples and clinical information. From the report of Offord & Boyle, in a community sample “up to 44% of children with ADHD had at least one more disorder and 11% had three other disorders. In a clinical referred sample, Wilens, et al found that 75% of preschool children and 80% of their school age samples had at least one other disorder besides ADHD with an average of 1.4 additional disorders.” This has been confirmed by Pfiffner et al in 1999. It derives that, as a group, children with ADHD are prone to have more symptoms of disruptive behavior (oppressional and conduct problems), anxiety, depression or dysthymia, and low self esteem than either non disabled children or children with learning disabilities who are not having ADHD (as quoted by Barkley). Barkley concluded that each of the forms of comorbidity (as well as some others) separately though, they too may coexist with each other in the presence of ADHD. (Barkley, 2006). “The high prevalence of attention deficit hyperactive disorder (ADHD) makes it critical that primary care pediatricians feel comfortable diagnosing and treating most affected children and adolescents. ADHD can be thought as a spectrum of “attentional disorders” rather than a single entity” (Reiff, 2006). Based on the symptoms psychiatrists diagnose ADHD as predominantly inattentive, predominantly hyper active, or both combined. Major factors that contribute psychiatric disorders in ADHD are familial, environmental adversity, and social disability. Chronic family conflicts and patterns of conduct disorder in family very much impact psychopathology of children. It is also evidenced from a literature review of Sagvolden et al that, “altered dopaminergic function plays a pivotal role by failing to modulate nondopaminergic (primarily glutamate and GABA) signal transmission appropriately. A hypofunctioning mesolimbic dopamine branch produces altered reinforcement of behavior and deficient extinction of previously reinforced behavior. This gives rise to delay aversion, development of hyperactivity in novel situations, impulsiveness, deficient sustained attention, increased behavioral variability, and failure to "inhibit" responses ("disinhibition")” (Sagvolden et al, 2005, p.397-419). It implies brain functioning, a certain chemical released by it interplay in ADHD and other comorbid conditions. The condition of more than one psychiatric disorder in a patient, in medical terminology, is called ‘comorbidity’. Though, there are divide among psychiatrists, documented evidence shows that ADHD frequently occurred with conduct, mood, anxiety disorders, which linger on to mid-adolescence, leading to higher rates of antisocial activities, mood and anxiety disorders, impairment of intellectual and achievement scores. Research conducted by Biederman & Faraone found that the original diagnosis of comorbidity predicted impaired functioning and outcomes consistent with the other disorders found with ADHD: Conduct disorder in childhood predicted an antisocial diagnosis as well as alcohol and drug dependence at follow up; major depression in childhood predicted the emergence of mania at follow-up; and severe anxiety in childhood predicted more anxiety disorders at follow-up than in other ADHD children. It establishes that comorbidity is an important predictor of impaired outcome, provides clinicians with a basis for reaching a medium-term prognosis in ADHD children, and underscores the importance of recognizing co-occurring disorders early in order to develop prevention and early intervention strategies” (Biederman & Faraone, 1996). Worries and doubts are part of everyday life. However, when these concerns affect normal functioning, it is a sign that there might be greater problem. Anxiety disorders induce physical, mental, and emotional changes and its symptoms are: fearfulness or apprehension, tiredness, poor concentration and restlessness, irritability, dizziness and fainting, sleep interruption, sickness, sweating and nausea, increased heart rate, and palpitation. Different types of anxiety disorders are: panic disorder; phobic disorder; obsessive compulsive disorder; and stress related disorders. Children with panic disorder may exhibit headache and stomach upsets, increased heartbeat, periods of intense fear and discomfort, dizziness and sweating, as well as breathing problems. Obsessive-compulsive Disorder (OCD), is one of the anxiety disorders, develops with recurring thoughts or impulses which are unrealistic, irrational, and also from certain compulsive behavior, either mental or physical. “When such a person attempts to remove these obsessions, that person develops and performs compulsively a set of actions to relieve the discomfort caused by the obsessions” (Kane, 2004). Not only adults, but children may also experience anxiety and stress, when a child is unable to cope with situations or events for various reasons ranging from befriending to parental splitting. When children experience anxiety disorder compounded with ADHD, overlapping of these two symptoms make it difficult for them to cope up in life as well as the clinicians to diagnose. Anxiety disorders may be treated with medication, behavioral therapy or counseling. Bipolar disorder, also known as manic-depressive illness, is a severe brain disorder that causes unusual shifts in a person’s mood, energy, and ability to function. Bipolar disorder typically develops in late adolescence or early childhood, and is difficult to diagnose at the early stages of its onset. Patients with bipolar disorder shows swing in their mood from irritable to sad, high and low, interspersed with periods of normal mood, known as maniac episode and depressive episode. A mild to moderate level of mania is called hypomania and severe episodes of depression include symptoms of psychosis. The illness with recurrent episodes of mania and depression is called Bipolar I Disorder. People with this disorder may have damaged relationships, poor performance rate in education and job, and even suicidal tendency. It is a long term illness requiring careful management, and can be treated. (Bipolar Disorder, 2007). All children are oppositional from time to time, particularly when tired, hungry, stressed or upset. Oppositional Defiant Disorder (ODD) is defined as “a recurrent pattern or negativistic, defiant, disobedient, and hostile behavior toward authority figures that seriously interfere with the youngster’s day to day functioning.” (Children with Oppositional Defiant Disorder, 1999). Major symptoms of ODD are frequent temper tantrums, anger and resentment, excessive arguing with adults, active defiance and refusal to comply with adult requests and rules, and even seeking revenge. Clinicians should evaluate children showing ODD to identify presence of other disorders such as ADHD, learning disability, mood disorders, anxiety disorders, etc. Its treatment includes individual psychotherapy, Cognitive-Behavioral therapy, and parent training, which are essential to inculcate positive behavioral skills in children with ODD syndrome. We should not forget that “everyone is different and responses to treatment vary, so a specialist is the most appropriate person to diagnose and decide the therapy” (Steer, 2007). Reference Children with Oppositional Defiant Disorder. (1999). AACAP. Facts for Families. No. 72. Retrieved December 6, 2007, from http://aacap.org/page.ww?name=Children+with+Oppositional+Defiant+Disorder§ion=Facts+for+Families Barkley, Russell, A., 2006. Attention-Deficit Hyperactivity Disorder: A clinical work book. 3rded. Comorbid Disorders, Social and Family Adjustment, and Sub typing Chapter-4. New York: Gilford Press. Biederman, Joseph & Faraone, Stephen. (1996). Attention Deficit Hyperactivity Disorder. On The Brain. The Harvard Mahoney Neuroscience Institute Letter. V. 5. No.1. Retrieved December 6, 2007, from http://www.med.harvard.edu/publications/On_The_Brain/Volume05/Number1/ADD.html Kane, Anthony. (2005). Does your child have Obsessive-Compulsive Disorder? Retrieved December 6, 2007, from http://addadhdadvances.com/OCD.html Bipolar Disorder. (2007).Maniac-Depressive. NIMH. Retrieved December 6, 2007, from http://www.nimh.nih.gov/health/publications/bipolar-disorder/complete-publication.shtml Sagvolden, Terje, et al. (2005). Attention Deficit and Disruptive Behavior Disorders , physiopathology. A dynamic development theory of attention-deficient/hyperactivity disorder (ADHD) predominantly hyperactive/impulsive and combined subtypes. Behav Brain Sci; 28(3). P.397-419. Retrieved December 6, 2007, from http://lib.bioinfo.pl/meid:238989 Reiff, Michael, I. (2006). ADHD: A Guide to Assessment and Diagnosis. CMP Medica. Consultant Live. V. 5. N. 8. Retrieved December 6, 2007, from http://www.consultantlive.com/showArticle.jhtml;jsessionid=X3ECEYUIWARHGQSNDLPSKH0CJUNN2JVN?articleId=196511264 Steer, Chris. (2007). Anxiety and ADHD. Net doctor co. UK. 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