Identifying Hyperactive Children: Attention-Deficit Hyperactivity Disorder - Essay Example

A child exhibits radical activity during and has difficulty focusing on the work that is put before them. This child causes trouble and serves as a constant distraction for the rest of the class. The teacher of this child feels that something must be done to put her class back under her control and maintain order. This child, however, is in constant activity that takes up the lion’s share of her time during the day. The natural reaction of this teacher would be frustration and resentment, but as a professional it is likely that the teacher would suggest to the parents that testing occur so that a diagnosis of ADHD could be confirmed and the child was placed on medication. The scenario that has been described is a familiar set of circumstances that have led to a rising number of children being diagnosed with ADHD. Children who are disruptive are often considered in the midst of a ‘disorder’ that needs to be rectified. The question that looms before the professionals involved in the lives of such exuberant children is how to handle the disruption that they cause in class and to provide a more balanced level of attention to the rest of the children. The problem that has evolved, however, is the appearance of a ‘disorder’ that solves disciplinary problems which is a temptation set before professionals in order to engage in the ‘cure’ to rectify the problem of difficult children. The topic of ADHD is rife with controversy as the disorder is misunderstood, often mishandled, and in question as to its existence. The history of the diagnostic frameworks that emerged early in medical history shows that it is a vague and difficult disorder in which to create a defined set of symptoms. The use of medications is controversial and the long term effects of a generation of children drugged into compliance has yet to provide enough evidence as to whether this is the appropriate course of action if the disorder is a reality. Suspicions of ADHD is the single most common reason for referring children to a physician form medical and drug therapy resolutions to issues within the classroom (Barkley 2006). The following paper will investigate the origins of the disorder and the effects of pharmaceutical management on the diagnosis of ADHD. Social work, as it relates to servicing children who have ADHD, will be explored in order to understand how the diagnosis relates to managing children who are also in social crisis and under the supervision of the state. Finally, the paper will explore the disorder for alternatives to drug therapies, establishing an inquiry as to whether or not the disorder may be related to a social need to create compliance in children through expected behaviours by creating a disorder that can be ‘treated’ rather approaching behavioural problems through an approach which helps to create coping mechanisms in children who are disruptive and unable to learn within traditional environments. Although the identification of the disorder is from the mid-twentieth century, the history of literary descriptions of the symptoms associated with the disorder can be found throughout history. In the 16th century, a physician named Alexander Crichton created a diagnostic set of symptoms that identified the features of inattentive subtype of ADHD. He described the condition associated with the symptoms that he identified as “a mental restlessness” and a “disease of inattentiveness” (Hendrickx 2010, p. 28). It was in the 19th century that diagnoses that involved the symptoms first came to be more broadly recorded. German psychiatrist Heinrich Hoffman wrote the poem “The Story of Fidgety Philip” in 1845 in which many of the problems associated with ADHD can be identified. As shown in the poem, the many problems with the idea that ADHD is a disorder lies in the nature of some of the symptoms and the way in which society approaches the problems that may be the result of the disorder. Let me see if Philip can Be a little gentleman; Let me see if he is able To sit still for once at table:" Thus Papa bade Phil behave; And Mamma looked very grave. But fidgety Phil, He wont sit still; He wriggles, And giggles, And then, I declare, Swings backwards and forwards, And tilts up his chair, Just like any rocking-horse- "Philip! I am getting cross!” See the naughty, restless child Growing still more rude and wild, Till his chair falls over quite. Philip screams with all his might, Catches at the cloth, but then That makes matters worse again. Down upon the ground they fall, Glasses, plates, knives, forks, and all. How Mamma did fret and frown, When she saw them tumbling down! And Papa made such a face! Philip is in sad disgrace. If ADHD is a disorder, behavioural problems are no longer a consequence of behavioural choices, but an outcropping of the disorder, thus the shame and disciplinary actions taken against the activities of a child suffering with the disturbances of ADHD are out of step with the compulsion of the affliction. On the other hand, if ADHD has become an excuse for drugging children into compliance, then the ‘symptoms’ are excuses used to avoid the use of discipline. Chandler (2010) claims that after the Parliamentary act of 1870 that required all children to go to school the recorded incidents that can be attributed to current diagnostic frameworks of the disorder were increasingly recorded. A cultural shift in the expected behaviours of children changed the way in which their behaviour was perceived. It was in the middle of the 20th century that a full description of symptoms began to emerge. George Still, a noted English paediatrician and writer on the afflictions of children, described the symptoms of a disorder as a “moral defect in control” (Chandler 2010, p. 34). He described the symptoms a including over-activity, little inhibitory volition, aggression, passion, and a resistance to punishment (Chandler 2010, p. 34). Still maintained, during a series of lectures on the topic, that the symptoms that he observed was a result of brain damage shortly after birth or through inherited factors, but not a result of poor parenting. Because causes are elusive and various symptoms affect different individuals, the framing concepts of causes, existence, and the nature of the disorder is widely studied and always in question. The causes have been attributed to both genetic and environmental causation. The debates about the effect of the chemicals in the brain, such as dopamine levels, are a part of the suspected problems that cause the inattentiveness associated with the disorder. The biggest debates, however, are on the use of medications in order to control the disorder. The use of Ritalin, the most common pharmaceutical treatment, is just as often in disdain, as much as it is applauded for its success (Hendrickx 2010). The primary question about the use of any drug therapy, however, is not whether or not it is effective but if the disorder actually is a definable disorder and requires medication, or if the behavioural framework of the individual is simply different between children and should be approached from the idea of teaching them coping skills rather than medicating them into compliance. For diagnostic purposes, ADHD is broken into eighteen specific behavioural symptoms which can be divided into categories of hyperactivity and inattentiveness: Inattention Does not provide close attention to details and shows carelessness through mistakes Has trouble paying attention to play or tasks Does not seem to listen even when spoken to directly Does not follow instructions and fails to finish work Has trouble organising activities Does not like to do tasks that require long periods of mental effort Losses things needed for tasks and activities Forgetful of daily activities Hyperactivity and Impulsivity Fidgets hands, feet, or torso when seated Gets up when expected to remain seated Runs and climbs when inappropriate Cannot play quietly Appears to be driven by a ‘motor’ and never stops moving Talks excessively Blurts out answers before questions are finished Has difficulty waiting for their turn Interrupts or intrudes on others during activities or conversations Three subtypes have been identified for ADHD: ADHD-CT, a combination of equal portions of inattentiveness and hyperactivity; ADHD-IA, a disorder subcategory that is primarily inattentive oriented; and ADHD-HI which is mostly defined by its hyperactivity features. In order to support a diagnosis of ADHD-CT at least six behavioural symptoms in each of the nine symptoms of the each category of behaviours must be present. For a diagnosis of ADHD-IA or ADHD-HI, a respective imbalance of behavioural symptoms is present with more than six in one category or the other being present. There are 7,056 possible symptom configurations from which to make a diagnosis of ADHD (DuPaul and Stoner 2003, p. 8). Williams et al (2010) describes the disorder as being childhood onset which is characterised by issues of severe inattention, impulsiveness, and motor hyperactivity which affects approximately 2% o all children. Most children who show signs of the issues of associated with the disorder continues to have problems into adulthood. Although the disorder appears to have a high rate of incidents in the same family, there are no identified genes through which the disorder is carried. This is one of the reasons that there is a continuing argument that the disorder is actually a social construct rather than a definable disorder (Williams et al 2010). As the issues are behaviour related, those who have impulses that are outside the norms of the culture are being identified as children with ADHD. Williams et al (2010) attempts to dispute the idea that it is merely a social construct through identifying sub-microscopic chromosomal structural abnormalities which are referred to as copy number variants, which contribute to genetic variation. They contend that rare CNVs have responsibility towards the development of neuro-developmental disorders such as autism and schizophrenia. Thus, they believe there may be an association between rare CNVs and ADHD. The conclusions of their tests included the statement “This increased rate of CNVs was particularly high in those with intellectual disability (0·424; p=2·0×10−6), although there was also a significant excess in cases with no such disability (0·125, p=0·0077)” (Williams et al 2010, p. 7). However, because there was a higher incidence of CNVs in the group with ADHD, they concluded that it was not merely a social construct. According to Pfiffner, Barkley and DuPaul (2006) a widely diverse and inclusive set of psychological interventions and training is needed in the school system. In order to create effective treatment, the first course of action is to make sure that all elements of the disorder be developed in order to give the best possible care to children who are having behavioural problems. One of the largest problems with the diagnosis of ADHD is that psychologists are not adequately trained towards giving a medical evaluation and medical professionals are not adequately trained on assessing and treating the behavioural issues (Wender 2000). While pills are more often the singular route of treatment that is sought out by desperate parents, behavioural modification and psychological treatments are just as important as medicine in creating an effective treatment program (Mundson and Arcelus 1999). Pharmacological remedies that have been used to address the behavioural problems of ADHD include stimulants which help to sharpen the focus for an individual. The most common drug that is used to treat ADHD is Ritalin. According to Menhard (2007), the reasons that Ritalin works for ADHD are not clear. What appears to happen through the use of Ritalin (generic name methylphenidate) is that the drug helps regulate the levels of both serotonin and dopamine, creating a calming affect on the student (Menhard 2007). There is a great deal of controversy about the use of Ritalin for students. There is a belief that children who are prescribed drugs to change the way in which they behave is a social prescription, rather than one that is addressing a need within the neurological framework of the mind. In teaching Rather than teaching coping skills and addressing modification of behaviours, there is a pervasive belief that medications are the more efficient routes to managing problems. Western culture has emerged through the use of medications, rather than natural remedies, for many of the social problems that are being experienced. The problem with using medications to manage social problems for children is that, first, their bodies are only just beginning to form as well as their identities and changing the way in which they approach their lives through medication rather than psychological substantive change can leave them without the proper skills to navigate their issues. Loe and Cuttino (2008) engaged in a study in which the exploration of a group of college students who were medicated for their ADHD issues were part of a culture in which the belief in the academic persona was based on the introduction of medication. According to Loe and Cuttino (2008, p. 303), “while medications may enable to manage academic performance and take control of ‘disordered bodies’, many remain uneasy about the extent to which they are controlled by drugs.” One of the deeper issues that emerge through the use of drugs for behavioural control is that the identity and the individual become absorbed into the behaviours that emerge while under the influence of a drug therapy, rather than developing coping skills through which to manage their individual personality traits as they would naturally be expressed through behaviours. The problem with studies that draw conclusions based on the presence or absence of something at a higher rate means that this is indicative of a disorder is that there is an assumption that the behaviours associated with the disorder qualify as a disorder. Just as the research done by Williams et al (2010) shows that there is a higher incidence of rare CNRs in those with ADHD, it also shows that those without ADHD can also have a higher rate of CNRs. According to Lloyd, Stead, and Cohen (2006), the social model of disability can be used as a way to explain how a disorder like ADHD could develop within society. Some researchers have posited that the development of the disorder is a way of providing forgiveness to parents who may not be able to control their children. This shifts the focus for guilt from a medical issue to the psycho-social explanation. In other words, if misbehaviour is defined as a problem that occurs through a physical problem, then all behaviours that a child has exhibited must be blamed on the disorder rather than the family dynamics. The concept that the diagnosis for ADHD has been developed to explain those who do not fit into the normal social responses that are expected from children in the academic structure seems reasonable. Children whose behaviours are not main stream can easily fit into the parameters seen in Figure 2. Through medicating children into compliance with social behavioural norms, society has run the risk of creating children who do not understand how their identity has developed. The role of the social worker in addressing the needs of a child who has ADHD is in finding the most suitable treatment through which success can be found. Social workers in the context of the school provide counselling that can help children who are experiencing control issues to find ways in which to cope with those behaviours that are socially not acceptable. Recommendations on how to handle treatment when a child is suspected of having ADHD are crucial in best serving the child and a social worker must have a well-balanced arsenal of information in order to best address the issues that have brought them into counselling. Through membership in the GSCC (General Social Care Council) as a professional social worker, provides for an understanding and a promise to follow the codes of conduct and laws that apply to the scenarios in which the social worker comes into contact. The code of conduct that is most relevant to the treatment of suspicions of ADHD is that the social worker has agreed to “Protect the rights and promote the interests of service users and carers” (Gray and Webb 2007, p. 40). Therefore, the interests of the individual child should come into priority over the interest of a class. The class can adjust, shifting to accommodate the needs of all the children with discipline issues addressed through the safest and best possible solutions rather than eliminating a problem. The GSCC requires that each child be treated as an individual, thus it is the needs of the individual that must be addressed, with the needs of the collective required to adjust to accommodate any problem he or she may have. The Codes of Practice state that a social worker must: Treat each person as an individual Respect and promote individual views and wishes of users and carers Support people’s rights to control their own lives Respect and maintain dignity and privacy Promote equal opportunities and respect diversity (Mandelstam 2009, p. 57). In discussing these codes, it is clear that once again the needs of the individual are what are of concern for the social worker. In addressing the problems of reported ADHD symptoms in a child, it is essential to take into consideration the whole of the child, rather than an assumption of the dominance of just one part. Medication, as the discussion of Ritalin does not show a promising level of success, must be used as a last resort, and with alternative therapies considered in relationship to ADHD. From a personal perspective, while ADHD may have some validity for the idea that there is a set of symptoms that define some children, the prevalence that has currently been a part of society indicates that social influences may be contributing to the number of diagnoses of the disorder. The draw towards medicating behaviours, making children more complacent so that they can be a part of class rather than a distraction from class, would be a high temptation. If a child is monopolizing the instructional period, then a change is needed and if behaviour can be medicated into compliance it would be highly desirable to have them evaluated. As a social worker, the needs of the school would be a priority, but the need of a child in behavioural crisis has a higher priority. Through personal experiences, it has been observed through two individual cases that the coincidence of family crisis was accompanied with an eventual emergence of diagnoses of children with ADHD. As families were in the middle of problems between the mother and father, at least one of the children began to act out. As this was experienced in two families, it is likely that the behavioural problems were the result of the family issues, and not ADHD, yet both of these children were placed on Ritalin and handled within the school system throughout their years as children with ADHD. This diagnosis can work towards creating harmony in the class room, defining a standard for behaviours that are defined by the social structure. It is possible; however, that something is lost when all children behave the same and the ability to dictate to them what behaviours must exist is the priority. Artistic points of view and academic creativity with exuberance for learning through unconventional and high energy methods may not be an example of a disorder, but of a creative thinker emerging within the system. As a social worker in a school setting, the number of children that are sent for testing might reveal that the decision to test is influenced by factors that are only based upon social considerations over medical considerations. Creating a system in which conformity is achieved through medication is not really a world that is desired. Attention deficit hyperactive disorder has been widely researched and evidence that children have been observed for similar behavioural difficulties can be traced back through history, but more specifically to the 16th century. The defining elements of ADHD emerged in the mid 20th century, however, and there are now two sets of nine criteria through which a diagnosis of the disorder is made. There is some speculation that the disorder is merely a social construct in which non-conforming behaviours are identified as being a problem of mental health, medication becoming the resource through which order is attained. As a social worker, it is a responsibility to the individual that must take priority and therefore the idea of medicating for behavioural modification might not fit into the code of ethics for social work. The case of ADHD as a method of creating order in a classroom should not be a temptation to the social worker who instead should help to provide resources through which alternatives to drug therapy can be made available. Word Count 3484 (because I took out the words referring to the figures), so it is 16 words under 3500 at the moment, which I can adjust. Let me know if at this point it addresses your topic, or if you need further revision. Thanks!) References Barkley, Russell A. 2006. Attention-deficit hyperactivity disorder: a handbook for diagnosis and treatment. New York: Guilford Press. Chandler, Chris. 2010. The science of ADHD: a guide for parents and professionals. Chichester: Wiley-Blackwell. Conrad, Peter. 2006. Identifying hyperactive children: the medicalization of deviant behavior. Aldershot: Ashgate. DuPaul, G. J., and Stoner, G. 2003. ADHD in the schools: Assessment and intervention strategies. New York: Guilford Press. Gray, Mel and Stephen A. Webb. 2007. 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Rare chromosomal deletions and duplications in attention-deficit hyperactivity disorder: a genome- wide analysis. The Lancet. [Online] accessed 4 January 2012 from http://www.thelancet.com/journals/lancet/article/PIIS0140- 6736%2810%2961109-9/abstract Read More