Attention Deficit Hyperactivity Disorder - Research Paper Example

Running Head: Overdiagnosis of Attention Deficit Hyperactivity Disorder A Paper on the Overdiagnosis of Attention Deficit Hyperactivity Disorder In APA Style Name University Overdiagnosis of Attention Deficit Hyperactivity Disorder Attention Deficit Hyperactivity Disorder (ADHD) is one of the most controversial ailments that are becoming the major concern of different health organizations in different regions of the world. The concern regarding the said condition can be attributed to the different aspects that are affected by ADHD. These facets include the psychosocial and the behavioral aspects that are often considered as important faculties of the individual to communicate with others (Jensen, Kettle, Roper, Sloan, Dulcan, Hoven, et al., 1999). Another main concern in the study of the ADHD is the fact that mostly children are affected although there are cases that are also present in adults. The study of ADHD in the early period focused on the children. Concern can be attributed to the fact that it can affect the development of the individual at the early stages of life. It is important to be give attention to the condition in the stage of childhood due to the fact that it can affect the development of the emotional and social aspects. In the study of ADHD it is important to consider the effects of the disease on the psychosocial development of the child for it greatly affected and can be carried over to adulthood. To be able to determine and achieve a general knowledge and assess the danger of overdiagnosis of the condition ADHD, it is important to include the different aspects in the study of the disease such as the possible causes, the methods of diagnosis, the status of the research related to the disease and the treatments available. Causes On the basis of the different studies on ADHD, there are different surmised causes that are related to the condition. In the study by the National Institute of Mental Health (2006) there are different reasons that can be considered to cause ADHD. The causes can be classified on the basis of biological and social aspects. Based on the studies that are conducted although the ailment is social and emotional in nature, the outside environment is not solely responsible for its development and expression. There are certain causes that can be related to the contribution of the genetic composition and neurological functions in an individual (NIMH, 2006). Thus, as any other characteristics in the body there are natural and environmental effects that can be presented. There are different suggestions and propositions but the confirmation of these causes is presently being undertaken through the studies and researches that are being undertaken. Environmental factors are included in the possible causes of ADHD. The cigarette and alcohol consumption of the mother during pregnancy increases the risk of ADHD in the offspring during development. Exposure to different chemicals such as lead specifically on a young age can also lead to the development of different ailments, ADHD included. Another possible cause is injury of the brain. Although there is a very low prevalence of ADHD patients that had brain injury, there is high possibility in abnormalities in mental functions in patients that had been through head accidents. The quality of food eaten is also another essential factor in the health and human development. Based on the research that had been conducted in the 80's by the National Institutes of Health proper diet resulted to the improvement of patients with ADHD specifically in terms of the consumption of food with additives and high sugar content. A decrease in the hyperactivity of children with diets wherein sugar consumption was substituted with another food material had been observed (NIMH, 2006). In terms of the external factors that can affect and may cause the ailment for example in adult include the increasingly complicated society wherein there are problems of different types such as social, professional and personal backgrounds can cause stress to the person which can lead to the expression of different types of diseases including ADHD (DeGrandpre, 2000; Diller, 1999). In addition to the environmentally related factors, the natural causes are also essential and even given greater weight and priority by certain groups. The presence of the ADHD in the family and ancestors can contribute greatly to the risk in acquiring the disease. This is the case although the interaction and interplay of the nature and the nurture aspects that result to the expression of the ADHD condition. The present trend in the study of the ADHD causes focus on the physical properties of the brain. Upon the study of the dimensions of the different parts of the brain, and comparative analysis of the behavior and the dimensions of the brain presents significant relationship. Children with ADHD have relatively smaller brains than the other children (McGough & McCracken, 2000; NIMH, 2006). These are the important aspects in the study of the causes of ADHD, the nature which composed of the genetic makeup of the individual and nurture wherein the environmental factors and other external forces can affect the onset of the disease. Symptoms To be able to determine the cases of ADHD there are indications that can be perceived in terms of different aspects. On the basis of the study conducted and presented by the American Psychiatric Association on the symptoms that are associated with the condition ADHD there is a number of different indications that can serve as guidelines that can prompt the parents on the possible ways to seek health care (American Psychiatric Association [AMA], (2000). One of the symptoms that can be perceived in individuals with ADHD is inattention or the incapacity to be able to retain attentiveness in any activity and in any subject matter. There are specific indications of inattention majority of which should be observed to be considered as one of the factors of ADHD. One indication is the failure to look into details which may be applicable to any line of work or activity is being undertaken, thus, can lead to failure of the task. Less capacity in paying attention to any activity and gives no reaction when being addressed to in a conversation. Failure to abide by different rules and has difficulty in organization of different tasks and things. Avoiding mentally stimulating projects and loss of things for conducting such activities is common. Distraction on any type of form is frequent as well as being absent minded in relation to routine activities (AMA, 2000; Goldman, Genel, Bezman & Slanetz, 1998). Another symptom is hyperactivity which can be perceived through different cases. Hyperactivity can be observed in body movements such as fidgeting or moving around if seated or standing still. Another scenario the difficulty to abide simple rules such as staying in a certain place e.g. for children in classes, individuals with the condition moves around or explore prohibited places. Other indications are continuous talking and trouble in staying quiet and calm. Often behave like a machine with a high amount of energy, would not stop taking or doing different things (AMA, 2000; Goldman, Genel, Bezman & Slanetz, 1998). Being impulsive is another indication of ADHD. Giving answers to questions that are not yet finished and inability to do any activity quietly are indications of impulsivity. Even waiting in line can be a difficulty. Also involuntary interfering to others speech and turn for conversation (AMA, 2000; Goldman, Genel, Bezman & Slanetz, 1998). Being impulsive can be attributed to the inability to control the possible reflexes in the body. Such indicators can be observed in different cases but it is important to consider that when a certain symptom is present it does not necessarily mean that it is another ADHD case. This is due to the fact that there are different conditions with similar symptoms and indications (AMA, 2000; Goldman, Genel, Bezman & Slanetz, 1998). History To be able to determine the related information and the developments related to ADHD, the history and early studies is another important issue considered. The first discussion of ADHD can be dated back on the previous century but the term was used in the 70's. Prior to this period, the disease was described as restlessness in children of early periods. In the early part of the century, the condition was referred to as abnormalities of the brain specifically known as encephalitis leading to postenchephalitis syndrome with symptoms corresponding to that of ADHD such as excessive energy, aggressiveness and impulsiveness. Cases of ADHD in adults on the other hand were later identified. These cases were compared to cases corresponding to Parkinson's disease in terms trembling symptoms. Other indications include pathological symptoms related to neurological abnormalities (Arnold, 1995; Wender, 1995). Based on the development in the definition of the disease, ADHD can be classified under conditions that are related to human mental health that can be transmitted through the genes dopaminergic and noradrenergic pathways of the brain function. Statistical studies presented almost 10 percent of children have ADHD within which a considerable percentage can manifest the disease even through adulthood. It is important though to consider that there are new sets of knowledge development in the field such as specific types of ADHD that can be distinctly classified on the basis of behavior and other factors (Wender, Wolf & Wasserstein, 2001). Another important factor in the study of the disease is the ailments with similar indications and related symptoms. These includes mood conditions, substance abuse, learning impairments, etc can be included in such cases wherein can also be observed simultaneously in patients with ADHD. Mood conditions include depression, bipolar disorder and dysthymia which can occur in patients with ADHD. Substance abuse, such as alcohol, drugs, etc. can increase the risk of acquiring ADHD, thus these factors are also included in the possible causes of the disease. Abnormality in personality development and learning impairments are also included in the conditions that can be connected to ADHD (Barkley and Murphy, 1998). On the basis of these notions it is important to undergo in depth study of each cases in relation to these related ailments to be able to have proper diagnosis and undergo the corresponding treatment to the particular case. Diagnosis Due to the different related diseases with parallel symptoms, it is important to confirm and focus on the assurance that ADHD is the proper diagnosis. This is to be able to provide the corresponding medication and treatment. It is important to consider that behavioral indicators of ADHD such as hyperactivity, inattentiveness and impulsivity cannot confirm cases of ADHD. These indications can only serve as warning devices to be able to seek consultation and advices of medical professionals. It is important to consider the time of observable appearance of such indicators. Symptoms of ADHD usually occur before the age of 7 and can be constantly evident for a period of 6 months. Also these symptoms have to be observable in any two of the aspects such as education, recreation and social relationship. The observable indications can then be compared to the guidelines set by heath professionals. Upon observing such symptoms, it is important to seek the services of medical professionals on mental health. In cooperation, other specialists can include developmental and behavioral pediatricians and even neurologists (NIMH, 2006). The criteria for classification of ADHD can presented on the basis of the behavior of the individual. The development of guidelines can be attributed to the American Psychiatric Association. There had been different stages of these guidelines. Table 1. Development of ADHD Guidelines DSM-III Hyperkinetic syndrome to attention deficit disorder Inattentiveness was central to diagnosis Emphasis on impulsiveness Can be diagnosed without hyperactivity DSM-III-R Formal classification into adulthood, first case For adults, it required symptom onset in childhood More emphasis on overactivity than DSM-III Name changed in this edition to attention-deficit/hyperactivity disorder DSM-IV Impulsive and hyperactive symptoms in same list but separately identified Distinction between inattention and other symptom clusters Source: (Arnold and Jensen, 1995). Through the development the DSM IV is the presently used with the stress on the three factors such as impulsivity, hyperactivity and lack of attention. Also there had been distinction on the basis of the possible types and degree of ADHD. The combined type is the focus on criteria for inattention and hyperactivity was distinct. Another is the predominantly inattentive Type wherein inattention criteria are perceived and not the other criteria. Predominantly hyperactive-impulsive type combines hyperactivity and impulsiveness but inattention was not evidently perceived (American Psychiatric Association, 2000; Arnold and Jensen, 1995). Overdiagnosis Based on the presented criteria, the cases of ADHD are determined. It is important to consider though that medical professional are the only individuals authorized to present opinions. This is due to the fact that there is a high danger of misdiagnosis and overdiagnosis in ADHD which is the main concern of the study. The cases of overdiagnosis and misdiagnosis can present immediate danger to the patients specifically children that are the required to take neurological medications due to the fact that ADHD is considered to be a mental disorder (NIMH, 2006). In the study on the diagnosis and treatment of ADHD in children, results showed that there in insufficient evidence of misdiagnosis and overdiagnosis. But one observation is important in the study, it was determined that stimulant medication is given when there are other safer options available. Still another issue is the over prescription of drugs such as methyphenidate (Goldman, Genel, Bezman & Slanetz, 1998). Another issue on overdiagnosis is the case of Ritalin prescription to children. There are exposes that target the prescription of such medication to children in school. Based on different studies such medications can be comparable to the illegal drug cocaine, also a psychostimulant that is freely given to the children diagnosed with ADHD (Jensen, Kettle, Roper, Sloan, Dulcan, Hoven, et al., 1999). It is in fact a known notion that the supply of Ritalin is insufficient due to increasing consumption which can project a high ADHD percentage, estimated as 2 million children in the US alone. One negative notion on the high Ritalin consumption is the recommendation of some medical practitioners to take the medication in the absence of complete health examination and trial of alternative medication and therapy. It is in fact important to primarily choose non-drug treatment due to other causes of ADHD such as environmental effects (DeGrandpre, 2000). Other specialists such as Duller summons the reexamination of Ritalin as medication due to the use. He questioned the high percentage of children in school that use the medicine. There is an environmental influence that affects these children due to the fact that most belong to a particular social environment. A query on the reason for giving medication with composition comparative to cocaine in a condition which can be overdiagnosed or can be attributed to external and environmental factors (Diller, 1999). Treatment The different treatments are presented to be able to compare and give other options aside from the ones known in the market. The common age of observation of ADHD is around 6 or 7 years old, but NIMH is into development and clinical studies on treatment at an earlier age. The treatments than can be given to individuals with ADHD are medication, behavioral, a combination of medication and behavioral and routine community care. Based on results on pre-school children, the combination of the treatment techniques is most effective. It is in fact suggested that children with ADHD should be given a combination of treatments to balance the effects and not to rely on a single action only (NIMH, 2006). Medication is one of the treatment techniques that are important to fight ADHD. Although this is the case medication alone cannot be the answer. Stimulants are considered t be the most effective to ADHD, e.g. Ritalin. Based on the published document of NIMH, these are the most common medications used. Table 2. Medications commonly prescribed for ADHD. Source: (NIH, 2006) Although medication is the most common answer to different diseases, in depth analysis of the case of ADHD is important before taking medication. This is due to the side effects that can be achieved such as effects on appetite, cases of insomnia and even anxiety which can be dangerous for children. Effects on the stomach and head such as uncomfortable aches are also possible (NIH, 2006). Other forms of treatment are therapies. These includes psychotherapy, behavioral therapy, social skills training, support groups, and parental skills training. Psychotherapy involves acceptance of the condition by the patient himself. Therapists give guidance and explanations for the patient to understand the situation. Behavioral therapies help individuals acquire skills in decision making in spite on the ADHD. Social skills training assist the children and the individuals to cope and interact with the people around and build healthy relationships. Support groups provide the needed assistance in cases of problems and confusion. Parenting skills training is most important for children. This will enable the parents to develop the children with ADHD properly. Conclusion The issues discussed in the study are the pertinent concerns related to ADHD and the overdiagnosis of the condition. The issue arises on the basis of the concern of the society for the children taking medication targeting neurological functions. Although there are insufficient evidences that can point out to cases of overdiagnosis and misdiagnosis, the presence of such issues can present the notion that the medical field needs to reconsider the presentation of treatments such as medication e.g. Ritalin. References: American Psychiatric Association (4th Ed) (2000). Diagnostic and Statistical Manual of Mental Disorders. Washington, DC: American Psychiatric Association, 2000. Arnold, L. E and Jensen, P. S. (1995). Attention deficit disorders. In: Kaplan HI, Sadock BJ, eds. Comprehensive Textbook of Psychiatry, vol 2. 6th edition. Baltimore, Md: Williams & Wilkins. Barkley, R. A. and Murphy, K. R. (2nd Ed) (1998). Attention-Deficit Hyperactivity Disorder: A Clinical Workbook. New York: Guilford Publications Inc. DeGrandpre, R. J. (2000). Ritalin Nation. USA: W. W. Norton & Company, Inc. Diller, L. H. (1999). Running on Ritalin: A Physician Reflects on Children, Society, and Performance in a Pill. New York: Bantam. Goldman, L. 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Attention Deficit Hyperactivity Disorder in Adults. New York: Oxford University Press. Wender, P. H., Wolf, L. E. and Wasserstein J. (2001). Adults with ADHD: an Overview. Ann N Y Acad Sci., 2001, 931, 1-16. Read More