Attention Deficit Hyperactivity Disorder (ADHD) in Children - Essay Example

Attention Deficit Hyperactivity Disorder (ADHD) Introduction Attention Deficit Hyperactivity Disorder (ADHD) is usually seen in children but many adults also have been diagnosed with it. The disorder is characterized by an inability to focus attention for long periods of time. According to Steven Reinberg at least nine percent of American children are diagnosed each year with ADHD. This means that approximately 4.4% of school aged children are diagnosed and 9 million adults are diagnosed each year. Although ADHD is listed in the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition -DSM-IV) as a "disorder usually first diagnosed in infancy, childhood or adolescence category", it does not have the characteristics that most "clinical" psychiatric disorders have because it is dependent on observable behavior. Because there are no clinical conditions for this disorder many children are misdiagnosed when they begin to act out in class. Many teachers are the first to "diagnose" children with this disorder which is part of the reason why the diagnosis is controversial. When a child is diagnosed with ADHD they are "automatically" placed on medication and often this can hurt the child if they do not have the disorder. Some experts believe that many children who are given this diagnosis are gifted and they go unnoticed because they do not test exactly the way that teachers think they should; they also act out in class when they are bored. Unfortunately parents take their child to a pediatrician instead of a child psychiatrist and ADHD is often the first thing the pediatrician thinks of and immediately puts the child on one of the drugs for the condition. Brunilda Nazario states that physicians are not equipped to make this diagnosis because they cannot do a comprehensive psychiatric evaluation. This means that 3-5% of school aged children who have been diagnosed with this disorder may have something entirely different. It is the assertion of this researcher that ADHD is a diagnosis that is misdiagnosed and parents should look further into the diagnosis before labeling their children with the disorder. Definition of ADHD When researching this topic it is common to associate Attention Deficit Disorder (ADD) with ADHD. The basic difference between the two is that with ADHD the child shows characteristics of being hyperactive. Most experts would agree that ADHD concerns the inability of a child to control their impulses and the inability to focus for long periods of time. Children with ADHD also lose their patience easily and are quick tempered (Baldwin 4). These symptoms in and of themselves do not mean that an individual has ADHD but when they show up some teachers and/or physicians go directly to this as the diagnosis. Often children who are bored with the regular routine of public school may act out in class. The DSM-IV says that this hyperactive-impulsive or inattention symptoms usually show problems before the age of seven and they usually happen in at least two or more settings; most often this is in school or at home (DSM-IV 84). Thomas Brown suggests that: ADD is a complex disorder that involves impairment in focus, organization, motivation, emotional modulation, memory, and other functions of the brains management. (20). Many critics of this diagnosis suggest that all children have these challenges depending on their age and their circumstances. According to Reinberg children from poor families have the highest rates of ADHD. Causes of ADHD Scientists have not found a specific reason for a cause of ADHD but there are many theories. The National Institute of Mental Health has a listing of all the current theories of this disorder. Some researchers say that genetics play a part in the disorder if one of the parents has it. They did studies with twins and found that ADHD tends to run within families. These scientists have found that children that carry the gene for ADHD actually have thinner brain tissue in areas of the brain that work with attention. It seems that some children that start out with this thinner brain tissue eventually develop stronger tissue later and their ADHD symptoms get better. There are other research studies that say environment plays a part. If the parents were smokers or drank heavily during their pregnancy this could be a reason that the child exhibits ADHD symptoms later; they have also found that lead paint could be a factor. Some children with ADHD have suffered a traumatic brain injury, Researchers have looked at whether sugar or food additives create a more hyperactive child and though they found that sugar does not create hyperactive children they have found that certain food additives do show that there are problems; more research is underway (The National Institute of Mental Health). How ADHD Is Diagnosed According to The National Institute of Mental Health ADHD is difficult to diagnose because it appears differently in different children. It usually occurs between the ages of three and six but it is difficult to discern what "normal" childhood reaction is and what is ADHD. They suggest that although many pediatricians diagnose this disorder others send children to a mental health practitioner for a comprehensive diagnosis. Children also mature at different rates and this can cause a misdiagnosis if the childs maturity level is not taken into consideration. According to RealMentalHealth.com a physician or psychiatrist should do a thorough evaluation before a diagnosis should be made. The evaluation should include observation of the child and given a series of psychological tests. In the first phase they are attempting to eliminate other conditions that could be reasons for the childs behavior. After getting a thorough evaluation the health practitioner will compare the childs profile with the DSM-IV criteria and see how this information matches. This is the best case scenario of what should happen but often these steps are not followed. Treatment for ADHD The emphasis in treating ADHD is on managing the behavior. Many children benefit from medication but others have problems with it. The Center for Disease Control and Prevention (CDC) say that a combination of behavior therapy and medication are the best known ways to treat ADHD. It is advisable that a treatment plan is created for each individual child and that it is monitored regularly, that there are follow-ups, and that there are changes made as the childs needs change. Generally speaking there are two types of medications that are used: stimulants and nonstimulants. Both types of medications can have adverse side effects although 70-80% of children are on them (CDC). What Parents and Teachers Can Do To Help Most experts suggest that parents must get educated about the symptoms and treatments for ADHD so they can get the best assistance for their children. Many times a treatment plan will include creating a plan for the child, helping them get organized, avoiding distractions where possible and learning how to work more effectively with their children. As an example, many parents use very long discussions about how they want a child to behave and they may need to change to short instructions with their children. They will learn a new way to deal with their children in order to assist. Teachers can assist by making their assignments cleared, make sure that they give positive reinforcement for follow-through and involve the school psychiatrist or counselor when necessary (CDC). The Controversy Surrounding ADHD Diagnosis There are many people who feel that ADHD is not a true diagnosis for many children and that it is hurting more than helping. Some of the controversy says that the drug companies are behind it because it allows them to make more money. In looking at the controversy it was important to look at both sides of this issue to get a better understanding of what should be done. Fred Baughman, a neurologist in private practice was interviewed by PBS. He suggests that teachers and parents are diagnosing children through the DSM which only lists several behaviors that any child will have at one time or another. He suggests that: National Institute of Mental Health in league with the American Psychiatric Association and the American Academy of Child Adolescent Psychiatry, represents ADHD ... to be a biologic abnormality of the brain, a so-called neurobiologic disorder. (Baughman, PBS). He suggests that many of these diagnoses are for "normal" children who have nothing wrong with their brains nor their behavior. He states that it is very easy to make this diagnosis and to put children on drugs that have adverse reactions because they do not need the drugs. In a National Institute of Health (NIH) Consensus Report many researchers presented findings about ADHD and the use of stimulants. After all the information was presented, the NIH panel pointed out that there is no valid test for ADHD and that there was no valid evidence to suggest that it is a brain disorder (Editors 10). They further said that people are diagnosing ADHD without a valid basis because they look at a cross section of society and then put the label on a few. They finally concluded that the evidence does not show that ADHD is really a disease but hat it may be "one end of a continuum of characteristics" (Editors, 10). They also said that there was no evidence that stimulants worked with ADHD to increase academic performance. Although this is a study that was done in 1999 it is still relevant today because people are still talking about the issue. Some experts are saying that ADHD does not exist and others are saying that it is a legitimate category. In CHADD’s Prescription for America, what appears to be a radical eBook it states that Ritalin is causing many children to have problems. From his website there is a link to a statement by Mr. Gene R. Haislip, Ex-Deputy Assistant Administrator, Office of Diversion Control Drug Enforcement Administration United States Department of Justice Washington, DC, in which he says that Ritalin is "over prescribed in some areas of the country as a panacea for behavior problems" ("DEA Report" 1996). He stated than that since 1990 the prescribing of the drug went up 500% and this meant that about 7% of boys were on the drug to control their behavior. Although these are old statistics it is frightening to think that children of any age are taking stimulants to manage behavior that many years ago was seen as "normal" for the average child. What Happens To Children There are several stories about how children have been misdiagnosed by their teachers. The only people that should be able to "diagnose" ADHD are a health professional, preferably a child psychiatrist. Unfortunately many places do not have them so often pediatricians are making a quick diagnosis. Teachers in classrooms, stressed because of their overwork and high class size, have taken on the idea that any child who displays any behavior that can be seen as "hyperactivity" must have ADHD. One case in Colorado found a third grader who teachers said was "uncontrollable in class, disruptive, always in motion in class, and was not well behaved" ("Teachers Cannot Diagnose ADHD"). The parents were forced to take their child out of school and homeschool them because the local school district said that the only options were to 1) sit with him in class 2) homeschool him or 3) put him on Ritalin. This mother experienced the same scenario that many parents have when confronting a teacher about ADHD. The child had never been tested for the diagnosis and the parent refused to take him because the child was only having problems in school; she thought there was something about the classroom. The teacher, defending her territory, gave the parents the above ultimatum in a parent/teacher conference that included other people form the school.("Teachers Cannot Diagnose ADHD"). In this situation and many others the teacher is making the diagnosis instead of a doctor. When a parent will not comply they want to send the child somewhere else which is a violation of the childs rights. Since most parents are not informed about their rights and the rights of their children they "comply" in someway to the ultimatums until they find out more information. One of the challenges that many children are facing is that they learn a different way and when they are in a classroom and are bored, they start to fidget. This is usually what any child or individual does when they are in a situation that is boring. Teachers have classrooms with certain rules. You must sit in your seat, quietly, with your hands folded in your lap. You can take out your pencil and work on something but only if the teacher tells you to do it. If you want to draw while the teacher is talking, the teacher thinks you are not paying attention. What is happening in all of these situations is that children have different learning styles. One child can only read when they are moving around. This is something she has learned to do at home and this can be a natural thing. As an example, in the movie, "Akeelah and the Bee" Akeelah could only spell when she kept rhythm with her hand. She learned how to use this trick in order to win spelling bees. Although this is a fiction story, it is a good example of how children may need to use a physical device to learn a concept. Some children fidget anytime they are bored. Why this is a problem in a classroom it is not known except that teachers want to have total control within them. Today, children are used to computers, cell phones, video games, television and more and each of these devices keep children engaged. The classroom no longer keeps a child engaged and unless the child is one who learns best by memorization, the child is apt to get bored in their classroom. Another challenge for children in the classroom is that many parents do not know their own child. In not knowing them, they do not understand what is "normal" or not for their children. When a teacher says the child is disruptive, the parent gives them discipline instead of asking what is going on. The child may be experiencing boredom or need another way to work within his classroom but he is not shown a different way. Instead, the teacher says he is ADHD because he cannot focus. Sometimes a child focuses better when they can do something physical while listening. As an example, the child who is drawing in class may actually be struggling to stay focused on a lecture. A teacher can check this by asking a question; usually the child can answer the question because they were listening, but they need to do something physical. What Can Be Done The challenge with an ADHD diagnosis is that people are not thinking about what happened. There needs to be more education with teachers and parents about what ADHD is and what it is not. A childs maturation along with the environment must be taken into consideration and children must be allowed to be children. Teachers have to understand that they do not have the credentials to diagnosis this "problem" and they will gain resistance from many parents because parents do not want their children to be on major medicines for things that they see as "normal" in their children. Although Ritalin has been a problem, there are other medications that are not as deadly as Ritalin that can be used and talking to a doctor is the best way for parents to understand options for their children. Conclusion We are a nation of impatience. We expect that everything should happen quickly and when it does not we get upset. Everyday whether you are driving your car or responding to someone on your cell phone we expect things to happen quickly. As a nation we also have a problem with differences and when children are seen as "different" parents just want to take care of the problem. ADHD has become quite a problem for children since the No Child Left Behind Legislation has teachers tied to a classroom that can no longer make room for a child who needs special attention. When walking into any classroom it is difficult for children when there is no creativity and an endless day of reading, math and other subjects that are not relevant to the students needs. Anyone would be bored in this environment but we expect our children to pay attention because school is a mandatory activity that they must do. Many famous people have had ADHD like Ann Bancroft, Alexander Graham Bell, Beethoven, Leonardo Da Vinci and John Denver ("Famous People and Attention Deficit Disorder"). Each of these people have created wonderful works of art, inventions or became wonderful actors. ADHD is not a "sentence" and it should be something that is examined more closely to make sure that a child who is diagnosed as having it really does have it. Otherwise we are raising a nation of children who are given drugs for those behaviors that used to be normal childhood practice. Works Cited Baldwin, Carol. Attention Deficit Disorder. Illinois: Heinemann Library, 2003. Baughman, Fred. "Does ADHD Exist?" PBS Frontline. 4 May 2009. < http://www.pbs.org/wgbh/pages/frontline/ shows/medicating/ interviews/baughman.html>. Brown, Thomas E. Attention Deficit Disorder. Connecticut: Yale University Press, 2005. Center for Disease Control and Prevention. "Attention-Deficit / Hyperactivity Disorder (ADHD)". 4 May 2009. Children and Adults with Attention Deficit/Hyperactivity Disorder. CHADD’s Prescription for America (eBook). ADHD-Information-Exchange.com. 04 May 2009 "DEA Report on Ritalin: ADD/ADHD Statement of Drug Enforcement Administration" . Statement by Gene R. Haislip. 1996. Optometrist Network. 04 May 2009. . Editors. "NIH Consensus Report Highlights Controversy Surrounding ADHD Diagnosis and Stimulant Treatment. News Commentary". Ethical Human Sciences and Services 1(1): 1999: 9-11. 04 May 2009. . "Famous People and Attention Deficit Disorder" . 04 May 2009. . Morrison, Jaydene. Coping with ADD/ADHD (Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder). N.Y.: Rosen Publishing, 2000. National Institute of Mental Health. "Attention Deficit Disorder: ADHD". 2008. 3 May 2009. . Nazario, Brunilda (reviewer). " Is It ADHD or Bipolar Disorder?" MedicineNet.com. 04 May 2009. . Real Mental Health. "How ADHD Affects The Workplace.". 2006. 3 May 2009. < http://www.realmentalhealth.com/adhd/adhd_statistics.asp>. Reinberg, Steven. "9% of U.S. Kids Have ADHD". The Washington Post. 4 September 2007(no page number). 2 May 2009. "Teachers Cannot Diagnose ADHD: The Kind of Story that makes Everybody Unhappy." AmericanChiropractic.net. 04 May 2009 Read More