Attention Deficit Hyperactivity Disorder - Research Paper Example

 Attention deficit hyperactivity disorder Attention deficit hyperactivity disorder (ADHD) or Attention deficit disorder (ADD) is one of the most common psychiatric disorder affecting children. It also affects the adolescents and adults. Adhd is a behavioral and developmental disorder whose cause remains an issue governed by controversies. The affected individuals lack the ability to stay focused and are inattentive. They are hyperactiveand are easily distracted. These symptoms can be present individually or as a combinition of both of the above. Adhd is the most common psychiatric disorder diagnosed in children affecting them at the frequency of 3-5%, though 4-7% of the affected children continue to suffer in the adulthood as well. Boys are affected 2-4 times more frequently than girls are. The reason for this discripancy still remains to be identified. Adhd is basically a behavioral disorder, which renders its diagnosis rather difficult. These symptoms are considered a part of normal developmental behavior of a child at a young age, but when these symptoms do not resolve with increasing age or if the severity of the syptoms woresens, then this points to the diagnosis of adhd. Running around, roughhousing, shouting and being difficult to handle, are normnal for some kids and are rarely alarming for parents. If the school going years bring constant complains about the child, like not being attentive, being disruptive and messing with other kids, not lisening to the teacher and lacking behind in the homework. Such constant complains raise a concern in parents mind and this is usually the time when parents seek doctors advice. And most of such children are diagnosed to suffer from adhd. With proper long term treatment and behavior therapy, most of the cases can be managed, though not cured. The core pathology behind adhd still remains an issue of controversy. Frontal cortex dysfunction and cerebellar dysfunction plays a role, since frontal cortex is the area of brain that controls the process of thinking. There is a general reduction in brain volume. Neuroimaging shows that the problem lies in the four interrelated frontostriatal regions, namely lateral prefrontal cortex, dorsal anterior cingulate cortex, caudate, and putamen (Miller et al 2006). Research into the cause of adhd has shown the involvement of a genetic component. People having "seven-repeat variant of dopamine D-4 receptor" are at a 30%greater risk of developing adhd. The right brain of such individuals also shows unusual thinness. Dopmaine is the neurotransmitter that is responsible for the focus and attention (Faraone et al 1995). Dopamine depletion in thinking areas of brain leads to impairment of the ability to focus and to keep the focus locked-on to a particular task. And the affected child seems to be hyperactive, switchng from task to task because of the lack of focus. Adhd is a disorder influenced by genetic as well as environmental factors. Diet and soial conditions can alter the expression of the disorder. The environmental influences include maternal smoking during pregnancy, premature delivery, low birth weight, exposure to lead in early life. Some studies even suggest a link between the time spent by a child in front of television and future attention difficulties. Ingestion of artificial food colors and preservatives in early life leads to hyperactivity (NINDS). The social conditions that a child is brought up in tend to mould his behavior. Emotional abuse, violence, family dysfunction and improper counselling and education system adversely affect a childs attention and self control. Adhd has three subtypes, and an affected individual can be placed in either one of them if he presents with six or more symptoms pertaining to that subtype. PREDOMINANTLY HYPERACTIVE-IMPULSIVE TYPE: They have difficulty remaining seated and are restless. Excessive running around and climbing, squirming or fidgeting with hands and feet, they can be seen wiggling their feet and tapping their pencil. They always seem to be on the go. They can not play quietly. Excessive, useless talking, difficulty waiting for their turn in the queue. They tend to be interrupting and intruding, blurting out answers before hearing the complete question. They lack self control, Pass inappropriate comments. They get agressive when they are upset. PREDOMINANTLY INATTENTIVE TYPE: Their attention span is very poor and they get bored easily. They are easily distracted and cannot stay focused on one thing. They forget things and miss details. Have difficulty in organizing themselves and school work as they are messy and have poor coordination. Failure to listen to and follow the instructions. They daydream and move slowly. They are confused, forgetfull and make careless mistakes. These kids tend to have severe mood swings and are hard to please. They have difficulty in completing a task or learning something new, as a result they have trouble in completing homework and submittingn assignments. COMBINED HYPERACTIVE-IMPULSIVE AND INATTENTIVE TYPE: When the child presents with six or more symptoms of hyperactivity and with six or more symptoms of inattention, he or she is said to have combined type Adhd. Majority of the cases of Adhd belong to this subtype. ADULTHOOD SYMPTOMS: About 60% children suffering from Adhd continue to experience the symptoms well into adulthood. The diagnosis of Adhd in adulthood is pretty difficult because of the complexity of adult behaviors and psychee. As well as the co-existance of other conditions like mood disorders, depression, anxiety and learning disability. Generally they are frustrated and impatient, disorganized and have difficulty managing time and tasks (Wender 1995). Adhd is diagnosed on the basis of psychiatric assesment and a detailed in depth discussion with the parents or teachers, and on the basis of a questionnare taken by the child if he or she is old enough. The data collected is compared with a standard list of signs and symptoms, termed as "Diagnostic And Statistical Manual of Mental Disorders IV" (DSM 4) for North America and with "International Statistical Classification of diseases and related health problems (ICD 10)" for European Nations, where adhd is given the name of "hyperkinetic disorder". Nevertheless, the condition should be diagnosed accurately, by meeting following three criteriae given by American academy of pedriatics clinical practice guideline: 1: The diagnosis made should meet the criteria of DSM-4. 2: The information about the childs behavior should be obtained in more than one setting. 3: The existance of comorbid conditions should be confirmed as they may complicate the diagnosis. The diagnosis of adhd requires physical examination, a detailed family history along with the current family situations and questionnaires. The physical examination is to rule out the comorbid conditions. Family history will reveal if there is a familial tendency to the development of adhd. The mothers pregnancy history and child's milestones will tell if there has been any developmental delay, if so then it is some other disease, because develomental delay is not a symptom of adhd. An insight to current situations that the family is going through will show if the child really is suffering from adhd or its just a normal emotional aggression that a person goes through when he is stressed out (Southall 2007). The changes in the childs behavior are considered over the past six months and the possible environmental causes of stress and aggression are ruled out to reach a diagnosis of adhd. Before making a diagnosis of adhd, certain conditions should be ruled out as they share certain symptoms with adhd. These conditions include hypothyroidism, Autism/ Asperger's syndrome, lead toxicity, mental retardation, nutritional deficiencis, food allergies, epilepsy, sensory disorders, anemia, chronic illness, substance abuse, and hearing and vision impairment. The children suffering from Adhd tend to have sleep disturbances. The conditions that result in sleep deprivation may present with typical symptoms of Adhd, such conditions must be ruled out. Owing to the overlap between the symptoms of adhd and sleep disturbance disorders, children with Adhd must regularly be checked to make sure if the conditions coexist. Adhd is often found in association with other disorders. These comorbid conditions include learning disorder (20-25% cases), conduct disorder, depression, anxiety, oppositional defiant disorder. The strategy for the management of adhd remains a controversy. According to some theories, it is a behavioral disorder so it should not be treated with medications, others suggest the use of stimulant medication to control the condition. The condition can be managed altogether by medications, long term behavior therapy, counselling, life style changes that are more suitable for the child and help him gain control over his symptoms (CHADD). Medications for short term improvement of symptoms and then behavioral therapy to keep the improvement sustained has been the most promising method of controlling Adhd so far. The basic treatment starts with changes in home environment that minimize distractions, better diet and exercise plan, counselling and extra support at home and school make them feel better about themselves. Behavior therapy is the main intervention that allows the child to lead a more or less normal life on long term basis. There are a number of psychological and behavioral therapies that are effective in different individuals depending upon their specific focus of problem. They include Psychoeducational input, cognitive behavior therapy (CBT), and interpersonal psychotherapy (IPT). Family counselling helps improve communication between the child and parents and shows them the ways to help control the situation. Teens need counselling to understand their behavior and learn coping skills. Adhd is not the result of bad parenting, though good and effective parenting skills can improve the condition dramatically. These kids need love and encouragement and time and attention (Berger et al 2008). Proper evaluation of their weaknesses and strengths at school can help the teacher formulate a separate plan for an individual suffering from Adhd, which helps them focus and stay engaged in a particular task. Medications provide a prompt improvement in the symptoms but are not the choice in the long run. Stimulant drugs like Methylphenidate (Concerta, Ritalin, or Metadate) increase the level of dopamine in the brain. They have also been found to increase norepinephrine. Both of which improve focus and attention by allowing effective signalling among the neurons. Methylphenidate is also available in the form of a cutaneous patch, called Daytrana. Which when placed on skin results in direct absorption of the drug. Amphetamines can be used as alternative drugs. Non-stimulant drugs include Atomoxetine(strattera) and certain antidepressants (Tricyclic antidepressants, MAOIs, and SNRIs). Another non-stimulant drug is modafinil, but it is not prescribed in children because of its side effects. Apart from improving the symptoms of hyperactivity and inattention, Adhd medications also improve the general attitude of the patient, especially teens as there have been evidences showing a decrease in the rate of smoking, substance abuse, injuries and accidents and an improvement in social as well as personal relations. Adhd is a very common psychiatric disorder that often misses diagnosis. The suffering children are either thought to be bull-headed and stubborn or mentally weak. This condition needs to be high lighted and brought to the notice of normal population, so that the suffering people are accomodated in the society according to their needs. Adhd kids need careful handling and proper counselling. With love, attention and encouragement, these kids learn to gain control of their behavior and activities. Diagnosing and managing adhd is particularly difficult in adults. Their behavioral complexity and individual intricate thought patterns are a barrier to diagnosis. Apart from that, because of being adults, they are expected to take responsibilty for their actions, which gives Adhd individuals a hard time. Its proper diagnosis, especially differentiating it from depression is necessary. The environment surrounding an Adhd individual, which comprises of school or workplace, home, family and friends, should have a general awareness of Adhd and should be open enough and prepared to accomodate these individuals as a part of their behavior therapy. BIBLIOGRAPHY: JOURNALS: 1. Berger, I., Dor, T., Nevo, Y., & Goldzweig, G. (2008). Attitudes Toward Attention-Deficit Hyperactivity Disorder (ADHD) Treatment: Parents' and Children's Perspectives. JOURNAL OF CHILD NEUROLOGY. 23 (9), 1036-1042. 2. Faraone SV, Biederman J, Chen WJ, Milberger S, Warburton R, & Tsuang MT. (1995). Genetic heterogeneity in attention-deficit hyperactivity disorder (ADHD): gender, psychiatric comorbidity, and maternal ADHD. Journal of Abnormal Psychology. 104 (2), 334-45. 3. Miller, S. R., Miller, C. J., Bloom, J. S., Hynd, G. W., & Craggs, J. G. (2006). Right Hemisphere Brain Morphology, Attention-Deficit Hyperactivity Disorder (ADHD) Subtype, and Social Comprehension. Journal of Child Neurology. 21 (2), 139. BOOKS: 1. Southall, A. (2007). The other side of ADHD: Attention deficit hyperactivity disorder exposed and explained. Abingdon, UK: Radcliffe. 2. Wender, P. H. (1995). Attention-deficit hyperactivity disorder in adults. New York: Oxford University Press. WEBSITES: 1. NINDS Attention Deficit-Hyperactivity Disorder Information Page (http://www.ninds.nih.gov/) 2. Understanding AD/ HD CHADD (Children and adults with attention deficit/ hyperactivity disorder) (http://www.chadd.org/) Read More