Neurobiological Condition of Attention Deficit Hyperactivity Disorder - Essay Example

My Lot in Life al Affiliation My Lot in Life My lot in life is a child suffering from Attention Deficit Hyperactivity Disorder (ADHD) and it is a medical term that is used to define a neurobiological condition or disease that affects close to 12 percent of children in the world. The condition has impairing levels of hyperactive/impulsive or inattentive behavior. The diagnosis of the condition is based on developmental improper behavioral symptoms that start in pre-school years and persist throughout childhood, adolescence, and eventually adulthood (National Institute of Mental Health, 2011; Tannock, 2007). ADHD symptoms include impulsivity, hyperactivity, and inattention. Legal, educational, and medical organizations see ADHD as a behavioral condition. However, they acknowledge that most children with ADHD have learning disabilities (LDs). Most children with ADHD are at a greater risk of underachieving or failing academically despite having above average or average intellectual capabilities (Tannock, 2007). The condition is treated with stimulants like amphetamines (for instance, Adderall), methylphenidate (such as Ritalin), and forms of medication. Behavioral therapies have also proved to be very effective (National Institute of Mental Health, 2011). Causes of ADHD Most studies indicate that genes play a crucial role in the cause of ADHD. The condition results from a number of factors such as brain injuries, social environment, nutrition, and environmental factors. Results from various international studies indicate that ADHD runs in the family. Children with the condition carry a specific version of a gene, which makes thinner the brain tissue area associated with attention. However, research shows that difference in thickness is not permanent because when ADHD children grow up, the brain develops to the standard level of thickness. Other probable causes as aforementioned include environmental factors, brain injuries, sugar, and food additives (National Institute of Mental Health [NIMH], 2008). Diagnosis of ADHD No single test is capable of diagnosing a child with the condition. As an alternative, a licensed health practitioner is supposed to gather information concerning the child and his or her environment and behavior. This is because most of the symptoms of ADHD are not easy to recognize. Some of the pediatricians can examine the child but they may still refer the child to a mental health specialist who has the knowledge in childhood mental disorders like ADHD. Therefore, in most cases, a pediatrician or a mental health specialist has to assess the child for any clues that may suggest ADHD (NIMH, 2008). Psychological Theories and Concepts Theory comprises explanatory statements that are anticipated to explain, account for, and assist in the understanding of relationships among variables, the processes involved, and how they function. Its significance to clinical practice is irrefutable. A theory addresses preliminary conceptualizations about the clinical issues, and it informs us about why and how the treatment functions (Rapport, 2001). The main behavioral theories that I will use to explain the condition of the child include the Delay Aversion, Dynamic Developmental, State Regulation, and Executive Dysfunction theories. It is important to note that the four theories have undergone considerable changes in the last decade (Johnson, Kuntsi, & Wiersema, 2009). Executive dysfunction is the first theory that I will attempt to use to describe the condition of the child. It is a phrase used to describe deficits in higher-order cognitive processes like reasoning, working memory, selection of proper behaviors, inhibition of appropriate behaviors, sequencing, planning, and paying attention to a task. The aforementioned supervisory processes regulate, manage, and control the lower-level cognitive functions such as perception, learning, action, explicit memory, and language. Executive functioning entails the process of neural circuits that connect the basal ganglia, parietal cortices, and thalamus with the frontal cortices (Johnson, Kuntsi, & Wiersema, 2009). Functional and anatomical studies have indicated that there are structural differences and transformed activation of fronto-parietal, fronto-striatal, and prefrontal cortex circuits in children with the disorder. The theory proposes that ADHD symptoms arise wholly because of a decrease in executive control, which is because of abnormalities in the function, biochemical operation, and structure of the fronto-striatal and fronto-parietal neural networks. It is crucial to note that the theory only explains some of the symptoms of ADHD (Johnson, Kuntsi, & Wiersema, 2009). For instance, it largely ignores the hyperactivity element of the condition and explains inattention and impulsivity. The theory has one difficulty, which is the sophistication in defining and testing an executive function (Brown, Reichel, & Quinlan, 2011; Johnson, Kuntsi, & Wiersema, 2009). The State Regulation theory is the second theory that I have attempted to explain the condition of the child. The theory suggests that a non-optimal active state could explain performance discrepancies in children with ADHD. The hypothesis is established on research using the Sanders’ model of Cognitive Energetic model. In this model, the effectiveness with which a duty is performed is regarded to be a product of fundamental cognitive phases and their energy distribution. These elementary phases include motor preparation, memory search, stimulus encoding, and binary decision, and can be viewed as structural computational information processes. The accessibility of these processes is associated with the activation and arousal levels of the subject (Johnson, Kuntsi, & Wiersema, 2009). The state regulation hypothesis suggests that children with ADHD have problems in keeping an optimal level of activation because of ineffective extra effort allocation. Based on the Cognitive Energetic model, event rate affects the level of motor activation and effort motivation and allocation are strongly related. Therefore, the sensitivity for strengthening contingencies in children suffering from ADHD can be interpreted in state regulation phrases as evidence for lacking effort allocation in the condition (ADHD) (Johnson, Kuntsi, & Wiersema, 2009). The state regulation theory indicates that symptoms of ADHD can decrease or increase depending on the child affected by the disorder. For instance, inattention symptoms can occur when tasks are boring or slow. Children can become hyperactive or impulsive in an effort to increase stimulation, which is self-stimulation. This explains findings like increased error levels, higher intra-subject variability of response, and longer RTs (response times) in children with the condition (Johnson, Kuntsi, & Wiersema, 2009). The third theory is Delay Aversion theory and it accounts for the finding that children having ADHD symptoms can wait, but they do not often want to. The initial delay aversion theory predicted that ADHD children are not impulsive when they choose immediate rewards instead of the overall rewards, but they behave so only in situations that lead to shorter overall delay. This theory is a motivational ADHD account, which is in contrast with the other theories that mainly focus on cognitive deficits. Hyperactivity and inattentiveness are regarded as reflecting efforts to minimize subjective experience of delay in circumstances where delay is unavoidable (Johnson, Kuntsi, & Wiersema, 2009). The key focus of this theory is on the impulsiveness symptom. The theory only focuses on one symptom (impulsiveness) of the condition. The last theory is the dynamic developmental theory and Sagvolden and colleagues generated it two decades ago. The theory has been the subject of a previous major review process. The theory attempts to elucidate the behavioral indicators of ADHD from the neurotransmitter to the societal level. The theory also attempts to elaborate all the symptoms of ADHD (Johnson, Kuntsi, & Wiersema, 2009). The theory proposes that there are two key behavioral mechanisms underpinning most of the ADHD symptoms. These mechanisms include deficient elimination of inadequate behavior and altered reinforcement of new behavior. The theory is based on the delayed reinforcement gradient between a reaction to stimulus and strengthening of that reaction or response. It is theorized that, in the disorder, the crucial window of opportunity for the stimulant to take place is smaller than for a normal child. The ultimate effect is that socially required behavior is not stimulated in time, resulting in most symptoms of ADHD (Johnson, Kuntsi, & Wiersema, 2009). Unlike the other theories, this theory covers all the symptoms of ADHD, that is, inattention, impulsivity, and hyperactivity (Johnson, Kuntsi, & Wiersema, 2009). Based on my research, the dynamic developmental theory is the only theory that explains my lot of life, that is, the child with ADHD. This is because it attempts to give me all the symptoms of an individual with ADHD. For instance, I found out that the child was hyperactive, impulsive, and paying little attention to what was happening. Therefore, I was able to conclude that the child had ADHD. Treatments and Interventions There are a number of treatments and intervention that I was able to use. The body functions that are assessed in the child with ADHD include sustained attention, intelligence, affect activities, memory, or executive functions including applying knowledge and increasing learning and improving attendance and finishing tasks; or enhance involvement, which include moving across learning levels, successive in the educational program, and exiting school for work (Feldman & Loe, 2007). I found out that medical treatments (psychopharmacological treatments) particularly with stimulant medication reduced the core symptoms at the level of body functions. Additionally, I found out that the treatment improved the child’s ability to handle general demands and tasks. Research indicates that the medication improves academic productivity as indicated by improvement in quality of scores on quizzes note taking and worksheets. Stimulants are not, however, associated with normalization of skills in the domain of applying knowledge and learning nor with the improvement in reading abilities (Feldman & Loe, 2007). Longitudinal studies do, however, demonstrate poor outcomes compared with controls whether they received medication or not. Caution is crucial when interpreting these findings as it cannot be determined whether the outcomes would have been any worse without the treatments, because of the fact that studies regularly lacked the right non-treatment group with ADHD. Another problem that was associated with this was that of attrition. The subjects that were lost due to follow-ups were probably among those with the worst outcomes (Feldman & Loe, 2007). Apart from treatments, I also used interventions such as behavioral intervention, which included parental training, positive reinforcement, behavioral classroom interventions, and cost contingencies. I found out that they were effective in reducing core ADHD symptoms. However, in comparison, behavior management techniques were less effective as compared to psychostimulant medication in reducing the main symptoms. It has been realized that behavior management is the same and even better off than medication in improving aspects of functioning. The problem with this is that most behavioral management studies do evaluate the effects of short-term outcomes on behavior and not educational and academic outcomes. The effect of behavioral treatment on long-term educational and academic outcomes is yet to be carefully studied (Feldman & Loe, 2007). Although I detected the symptoms at an early stage, it is imperative to state that the chronic nature of the disorder at times calls for multiple treatment approaches. This has an adverse effect on the long-term academic and educational outcomes, as it has not been well studied. Combined treatment in the multimodal treatment study of children with the medical disorder was found to be better than behavioral treatment. A two-year study was done to determine the performance and academic achievements (Feldman & Loe, 2007). The study compared therapy with methylphenidate, to therapy with methylphenidate in combination with multimodal psychosocial treatments. It was found that there was no advantage of combined medication over the treatment alone for any academic results. The combined treatment includes the academic assistance, individual psychotherapy, organizational skills, and social skills training. In the studies, the medication and behavior management whether used alone or in combination, did not improve academic and learning results of ADHD (Feldman & Loe, 2007). According to Feldman and Loe (2007), the educational interventions to help children with the disorder have not been successful in finding whether there exists an impact of remedial educational facilities on academic and educational outcomes. Most of the known and available treatment result studies have not been conducted in general education classroom setting. The study has focused on reducing challenging behavior rather than on improving educational status. The current rates of use are difficult to define because ADHD itself is not an admissible criteria for special education as advocated for it to be under the Individuals with Disabilities Education Act of 1990 (IDEA). Children with the disorder mainly qualify for special education services only if they are qualifying for another IDEA category like emotional disturbance, but they are never disaggregated from the students without ADHD (Feldman & Loe, 2007). Current research According to Tannock (2007), longitudinal epidemiological research conducted in the United States and Canada showed evidence that childhood ADHD (in particular, childhood inattention) projected subsequent lower achievement scores in reading and mathematics. The survey also indicated an increased risk for high school incompletion and grade repetition as well as poor work place performance and underemployment in adulthood. ADHD is not only associated with subtle but also with important functional and structural differences in the brain. It mainly affects those areas that support crucial psychological processes such as memory, learning, executive function and the speed of information processing. Mental research showed that individuals with ADHD process information rather slower than their peers and have a problem with decision-making functions specifically working memory (Tannock, 2007). Research conducted on treatment of the disorder showed that psychological and medical interventions are important in reducing the off-task and disruptive behavior in students with the ADHD disorder. These interventions include parental training in behavior management, medication, social skills training, and multimodal approaches and lastly classroom based behavior training (Tannock, 2007). For instance, reports from scholars, teacher, and parents suggest that single bouts of aerobic exercise can have positive effects for aspects of inhibitory control and neurocognitive function in children with ADHD (Hillman, Picchietti, Pontifex, Raine, & Saliba, 2013). According to some laboratory tests, it was found that medication might increase processing speed and some characteristics of executive functions in children with the medical condition. It is unfortunate that, after much research, there has been no robust evidence found to suggest that these approaches benefits educational results. However, school based interventions in which the teachers have amended their instructional practices and utilized behavioral management methods have been found to enhance both literacy and behavioral outcomes in students with the disorder. Additionally, systematic and intense computer based training with working memory has expressed promise for both behavioral and cognitive enhancement in children with the condition (Tannock, 2007). References Brown, T. E., Reichel, P. C., & Quinlan, D. M. (2011). Executive function impairments in high IQ children and adolescents with ADHD. Open Journal of Psychiatry, 1, 56-65. doi: 10.4236/ojpsych.2011.12009 Feldman, H. H., & Loe, I. M. (2007). Academic and educational outcomes of children with ADHD. Journal of Pediatric Psychology, 32(6), 643-654. doi: 10.1093/jpepsy/jsl054 Hillman, C. H., Picchietti, D. L., Pontifex, M. B., Raine, L. B., & Saliba, B. J. (2013). Exercise improves behavioral, neurocognitive, and scholastic performance in children with attention-deficit/hyperactivity disorder. The Journal of Pediatrics, 162(3), 543-51. doi:10.1016/j.jpeds.2012.08.036 Johnson, K. A., Kuntsi, J., & Wiersema, J. R. (2009). What would Karl Popper say? Are current psychological theories of ADHD falsifiable? Behavioral and Brain Functions, 5(15), 1-11. doi:10.1186/1744-9081-5-15 National Institute of Mental Health. (2008). Attention deficit hyperactivity disorder (ADHD). Bethesda, MD: National Institute of Mental Health. National Institute of Mental Health. (2011, September 28). Prescribed stimulant use for ADHD continues to rise steadily. Retrieved from http://www.nimh.nih.gov/science-news/2011/prescribed-stimulant-use-for-adhd-continues-to-rise-steadily.shtml Rapport, M. D. (2001). Bridging theory and practice: Conceptual understanding of treatments for children with attention deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), autism, and depression. Journal of Clinical Child Psychology, 30(1), 3-7. doi: 10.1207/S15374424JCCP3001_2 Tannock, R. (2007). What works? Research into practice. The Literacy and Numeracy Secretariat, 1(3), 1-4. Read More