Attention Deficit-Hyperactivity Disorder And Learning - Essay Example

 Attention Deficit-Hyperactivity Disorder And Learning Attention Deficit-Hyperactivity Disorder (ADHD) holds the distinction of beingthe most commonly diagnosed mental health disorder among children in the United States. Accordingly, recent research indicates that ADHD can be found in approximately 3% to 5% of school-aged children. Furthermore, this disorder is more commonly found in boys rather than girls. The symptoms of ADHD are numerous and include hyperactivity, difficulty paying attention, impulsiveness, being easily distracted and difficulty in following instructions. Often, those who have been diagnosed with ADHD are slow to develop social skills and have poorer grades in school than their peers. It is also estimated that one quarter of children with ADHD have a learning disorder. The treatment options for people with ADHD include behavioral therapy, medication, and special education programs. Research shows than an estimated 70% to 80% of children with ADHD respond to medication to curb impulsive and overactive behavior, thus allowing children to focus, pay attention and learn. Seeking to address the relationship between ADHD and learning, this essay aims to be comprehensive in the analysis of Attention Deficit-Hyperactivity Disorder. We will begin with an introduction to the subject and a thorough overview of the key definitional aspects surrounding his mental health disorder. Following this clear and concise introduction to ADHD, we will conduct a far-reaching literature review into the major issues surrounding Attention Deficit-Hyperactivity Disorder and its effects on learning. Furthermore, this literature review will draw from published research from different scholars and attempt to learn as much as possible about the published clinical research on the effects of ADHD on children. Does Attention Deficit-Hyperactivity Disorder affect learning? If so, what are the ramifications of this health disorder on the learning process and how can these consequences be mitigated? These questions, and many more, will be addressed with respect to the effects of Attention Deficit-Hyperactivity Disorder on learning. We now turn to a complete introduction to the ADHD, to be followed by a literature review, and explore the major issues surrounding this seemingly pervasive medical condition (Parment, Lymn, Glass 1804). Introducing ADHD The term Attention Deficit Disorder with Hyperactivity (ADDH) was first named in the DSM-III of the American Psychiatric Association in 1980 and was acknowledged as an important disorder warranting scholarly attention. As a commonly diagnosed neurobehavioral developmental disorder found most often among children but also in adults, ADHD is estimated to affect 4% of the total American population. Related to the brain’s chemistry and anatomical makeup, ADHD is a developmental disorder found most frequently in young children and according to the American National Institute of Mental Health (NIMH) 60% of patients with ADHD have symptoms which persist into adulthood. Although there is a little agreement on the causes of Attention Deficit-Hyperactivity Disorder, many studies assert that a person’s genetic makeup can play a large role in the persistence and awareness of the symptoms of ADHD. The National Institute of Mental Health One’s asserts that one’s genetic makeup can lead to a predisposition to the condition although a particular gene which causes ADHD has not yet been found. Other factors which may contribute to this disorder include environmental factors such as cigarette smoking and alcohol use during pregnancy, brain injury and diet. Seeped in controversy, the actual causes behind this condition are currently under debate. Accordingly controversy surrounding Attention Deficit-Hyperactivity Disorder is nothing new. In the early years after the acknowledgement of this disorder, little was known with Barkley (1982) reporting in a review of twenty years of scientific research on the syndrome that the majority provided no diagnostic criteria for ADDH (or ADHD for that matter). As a result, early studies in the literature were largely subjective and perhaps full of misdiagnoses (see Barkley 1944). The DSM-III of 1980 changed this and was a “landmark in official diagnostic nomenclature”. For the first time, it provided detailed descriptions and diagnostic criteria for ADDH. The three criteria which were established for diagnosis were: 1) specific multidimensional symptoms (involving symptoms in impulsivity, motor over activity and attentional impairment), 2) age of onset (before the age of 7 years) and finally 3) duration (symptoms must be present for at least six months). Definitional issues aside, Attention Deficit Disorder with Hyperactivity (or ADHD) is now recognized as a serious disorder with possibly important effects on cognition. Two symptom types give rise to the three subtypes of ADHD: Predominantly Inattentive, Predominantly Hyperactive-Impulsive, and a Combined type (Martinussen & Tannock 1073). This following will explore the relationship between ADHA and learning to discern if there is a direct relationship between ADHD and the ability to learn (Cantwell and Baker 87-88). Case Analyses Attempting to discern whether an association between Attention Deficit-Hyperactivity Disorder (ADHD) and learning disorders (LD) exists, Cantwell and Baker studied 600 children with LD. Using the definition put forth by the American Psychiatric Association, they defined ADHD as a syndrome with the following symptoms: motor over-activity, impulsivity, and attentional impairments. While selecting a definition for “learning disorder”, the authors took care to distinguish from other terms used interchangeably including reading retardation and academic performance problems. The researchers, Cantwell and Baker, used a definition of LD advocated by the National Joint Commission on Learning Disabilities (1997): Learning disabilities is a generic term that refers to a heterogeneous group of disorders manifested by significant difficulties in the acquisition and use of listening, speaking, reading, writing, reasoning, or mathematic abilities. These disorders are intrinsic to the individual and presumed to be due to central nervous system dysfunction. Furthermore, these researchers undertook an empirical analysis of 600 children with both speech and language impairments, arguing that children with both speech and language impairments constitute a “particularly relevant sample because they are at risk for both psychiatric and learning problems” (91). Of the 600 children studied, 69% were male, ranging in age from one to 16 years, with a mean age of 5.6 years. Initial psychiatric diagnoses revealed that a full half of the sample population entered with the study with some sort of psychiatric illness. Accordingly, ADDH was the most common diagnosis; found in 19% of children. Additionally, conduct and/or oppositional disorders were discovered in an additional seven% of the sample, showing that a total of 26% of the children in the study had some sort of disruptive behavioral disorder (Cantwell and Baker 91-93). The study by Cantwell and Baker found an important linkage between LD and ADHD. Although intuitively one would think that ADHD leads to learning disorders, the relationship is not always clearly outlined. Furthoremore, “there is scant evidence that ADHD itself, as a diagnosis, leads directly to learning difficulties…in fact, there are many children who have the ADHD syndrome but do not have LD.” (Cantwell and Baker 92). In sum, Cantwell and Baker concluded the following: “1) There is an increased prevalence of psychiatric disorders – including behavioral disorders – in children with speech and language disorders. Importantly, ADHD is quite common. In addition to ADHD, anxiety disorders are also quite common. 2) There is an increased prevalence of learning disorders (LD) in children with both a speech and language disorder. 3) There appears to be a specific association between the presence of a psychiatric disorder – such as ADHD – and the presence of LD in children. Accordingly, “this specific association is strongest for the disruptive behavior disorders”” (Cantwell and Baker 93). The research here demonstrates that there is an association between ADHD and LD which is much greater than by mere chance. In spite of this, the nature of the association between ADHD and LD remains unclear. Does LD lead to ADHD or does ADHD lead to LD? That is the mystery uncovered by these researchers. While highlighting some important very implications for future analysis on the effects of Attention Deficit-Hyperactivity Disorder on learning disorders, these scholars were unable to conclude that ADHD directly hampers learning. In an additional study on the comorbidity of LD and Attention Deficit-Hyperactivity Disorder, Mayes, Calhoun and Crowell undertook both clinical and pyscho-educational tests and data for 119 children ranging from the ages of eight to 16 years of age. Seeking to investigate the relationship between attentional problems and learning problems in a representative sample of children, the authors utilized random sample with an average age of 11.1 years. Data analyzed by Mayes, Calhoun and Crowell was obtained from the WISC-III (FSIQ and Freedom from Distractibility, Verbal Comprehension, and Perceptual Organization Index scores), the Gordon Diagnostic System (GDS) and the WIAT (an achievement test for individuals ages 4 through adulthood). Accordingly, the Gordon Diagnostic System is a portable electronic performance test aimed to measure a person’s attention (Mayes, Calhoun, Crowell 417-419). In the sample, 70% of the children who had been previously diagnosed with ADHD also experienced learning disabilities. Most common types of learning disabilities involve written expression, reading, writing, math and spelling challenges. Accordingly, the researchers described written expression as 2x more common (65%) than the other types of learning disabilities exhibited by the children. Accordingly, children who displayed signs of both LD and ADHD had more severe learning problems than children with diagnosed learning disabilities but no ADHD. The authors found that children with LD but no ADHD exhibited degrees of attention problems – not enough to warrant a full ADHD diagnosis on its own – and children with ADHD but not LD had learning problems, likely as a result of attention problems such as the inability to stay focused and concentrate. Accordingly, children with LD and ADHD had the greatest problems with learning, followed in order by children with LD and no ADHD, then children with ADHD and no LD, and finally children without LD and ADHD. Furthermore, Our study showed that referred children with ADHD had a significantly greater frequency of LD than children without ADHD. LD frequencies in reading, math, and spelling in children with ADHD were consistent with prior research. The prevalence of LD in each of these areas was close to one third. However, the overall prevalence for LD doubled (70%) when written expression was included in the assessment. According to federal guidelines (Education of the Handicapped Act, 1977), a child may have LD in written expression. In spite of such guidelines, written expression was neglected in previous studies investigating learning disabilities in children with ADHD, resulting in an underestimation of LD in these children. Given that 65% of our children with ADHD had LD in written expression, it is important for psychologists to assess written expression when evaluating a child for ADHD or LD. Our findings suggest that problems with attention and with academic achievement are found for both children with ADHD and children wit LD, although the problems differ in degree, as would be expected (Mayes, Calhoun, Crowell 421-422). After extensive analysis, Mayes, Calhoun, Crowell concluded that “learning and attention problems are on a continuum, are interrelated, and usually coexist” (Mayes, Calhoun, Crowell 417-424). Arguing that ADHD is diagnosed as a result of “persistent, developmentally inappropriate and impairing symptoms of inattention and hyperactivity/impulsivity”, Martinussen & Tannock sought to better understand the cognitive effects of ADHD on learning and memory. Their study was composed of 143 children, divided into four groups, with children between the ages of 7 and thirteen years of age. Some children was recruited from an outpatient department of psychiatry in a pediatric health science center and each had been referred for attentional, behavioral, and/or learning problems. Accordingly, the other set of children were brought in for a comparative sample and recruited from local elementary schools. Initial qualitative work was conducted in large part through clinical diagnostic interviews with teachers, parents and the students themselves while child assessments included the Wide Range Achievement Test-3 (WRAT-3; Wilkinson 1993) as well as the Word Attack and Word Identification subtests of the Woodcock Reading Mastery Test-Revised (Martinussen & Tannock 1073-1088; Woodcock 1987). Martinussen & Tannock discovered that working memory limitations may impact both the behavioral expression of poor attention as well as the academic underachievement of children diagnosed with ADHD. Therefore, the children with Attention Deficit-Hyperactivity Disorder, especially those children with significant attentionial problems or who exhibit language disorders, may also exhibited a wide range of functional impairments due to deficits in working memory. Learning Disorders (LD) thus can have an important effect on ADHD, but as with the study undertaken by Cantwell and Baker, a direct link between the effects of ADHD on learning could not be conclusively proven (Martinussen & Tannock 1087-1090). Undertaking a transnational study on the effects of Attention Deficit-Hyperactivity Disorder and Learning Disabilities (LD) among children in Korea, Min-Sup Shin and her team of researchers examined the performance of a combination of children with varying learning disabilities, medical diagnoses and cognitive impairments. Their clinical study included 57 children between the ages of 6 and 13 years old and each child had what would be described as a medical diagnosis of some sort. 15 of the children were diagnosed as having ADHD, 13 were diagnosed as having a learning disorder and 15 were diagnosed as having a tic disorder. Studying organizational scores through an analysis of the Rey-Osterreith Complex Figure, a neuropsychological method of assessment, these Korea researchers found significant organizational challenges with the students who had previously been diagnosed with Attention Deficit-Hyperactivity Disorder. Accordingly performance on the recall component of this test was recorded as being poorest amongst students with both ADHD and a learning disability suggesting, according to the researchers “the presence of nonverbal memory problems” within this group (Shin et al 835). Accordingly, Many previous studies of ADHD...have suggested the implication of frontal lobe dysfunction in ADHD. Consistent with the results of such studies, the children with ADHD of this study had a significantly low organization score compared with the other groups. Such a result demonstrated the underlying problems of children with ADHD in their organization ability. Seidman et al also found a low organization score for children with ADHD on the Rey-Osterreith Complex Figure compared with normal children.19 Because the executive function, which is mediated by the prefrontal cortex, is manifested on the Rey-Osterreith Complex Figure as strategic planning and organizing abilities, 4,5 such results suggest children with ADHD to be cognitively undirected and disorganized and provide support for previous studies that hypothesized a linkage between ADHD and frontal lobe dysfunction (Shin et al 840). What is remarkable here is that these researchers are postulating a linkage between Attention Deficit-Hyperactivity Disorder and frontal lobe dysfunction, thus explaining both the ADHD diagnosing and perhaps ensuing learning disabilities. Initially put forth by Seidmen, further research into the linkages between frontal lobe dysfunction and ADHD is currently being undertaken using MRI scans and technology to attempt to successfully point out a physical frontal lobe dysfunction and the presence of ADHD among adults and children. Concluding Remarks According to the American Psychiatric Association, Attention-deficit hyperactivity disorder (ADHD) is one of the most common developmental disorders of childhood (1994). This literature review has provided an overview of four independent studies on the association between ADHD, learning and learning disorders (LD). Cantwell and Baker found that there is an increased prevalence of psychiatric disorders – including behavioral disorders – in children with speech as well as language disorders. Furthermore, it looks like there is a specific association between the presence of a psychiatric disorder, such as ADHD, and the presence of LD in children. Mayes, Calhoun, Crowell discovered different challenges among children with LD and children with ADHD and determined that while interrelated, it is impossible to conclusively say which affects the other (Mayes, Calhoun, Crowell 417-424). Seeking to dispel the myths surrounding the effects of ADHD on learning and memory, Martinussen & Tannock found that Learning Disorders (LD) can have important effects on ADHD, but as with the study by Cantwell and Baker, these researchers were unable to provide a direct link between the effects of ADHD and learning. Undertaking a study in the Korean context, Shin et al concluded that performance on the recall component of their test g poorest among students with both ADHD and a learning disability which meant “the presence of nonverbal memory problems” within this group (Shin et al 835). Furthermore these researchers also found support for the argument that there is a linkage between ADHD and frontal lobe dysfunction (Shin et al 840). The research studied here has demonstrated that an association between ADHD and LD exists to a much greater degree than would occur by chance; however the nature of the particular association is unclear. Does ADHD affect LD or does LD lead to ADHD in reverse? While highlighting some important implications for future analysis on the effects of ADHD on learning, each study above was unable to conclusively prove that ADHD directly inhibits learning. Conversely, the overarching conclusion by each set of research teams was that learning disorders can contribute to ADHD and the two routinely go hand in hand. As Mayes, Calhoun, Crowell so eloquently stated “learning and attention problems are on a continuum, are interrelated, and usually coexist” (417-424). references Barkey, R. (1982). Guidelines for Defining Hyperactivity in Children: Attention deficit Disorder with Hyperactivity. In B.E. Lahey & A.B. Kazdin (Eds), Advances in Clinical Psychology, 137-180. Cantwell, D.P. & Baker, L. (2001). Association between Attention Deficit Hyperactivity Disorder and Learning Disorders. Journal of Learning Disabilitie,s 1:2: 88-95. Diagnostic and statistical manual of mental disorders (2004). American Psychiatry Association. Washington, D.C. Mayes, S. D., Calhoun, S.L & Crowell, E.W. (2000). Learning Disabilities and ADHD: Overlapping Spectrum Disorders. Journal of Learning Disabilities, 33: 417 - 424. Martinussen, R. & Tannock, R. (2004). Working Memory Impairments in Children with Attention-Deficit Hyperactivity Disorder With and Without Comorbid Language Learning Disorders. Journal of Clinical and Experimental Neuropsychology 28:7: 1073-1094. Parment, S., Lymn, C. & Glass, R.M. (2002). Attention Deficit/ Hyperactivity Disorder. The Journal of the American Medical Association 288:14: 1804. Shin, M. et al. (2003). Neuropsychologic Characteristics of Children With Attention-Deficit Hyperactivity Disorder (ADHD), Learning Disorder, and Tic Disorder”. Journal of Child Neurology 18: 835-844. Wilkinson, G.S. (2003). Wide Range Achievement Test-Third Edition (WRAT-3). Wilmington, DE: Wide Range. Woodcock, R.W. (1987). Woodcock Reading Mastery Tests-revised. Austin, TX: DLM Teaching Resources. Read More