Term Paper: Attention Deficit Hyperactivity Disorder ADHD

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Attention Deficit HyperactivITY Disorder (ADHD)

Attention Deficit HyperactivITY Disorder

Theories of child development and guidelines for parents are not cast in stone.

They are constantly changing and adapting to new information and new pressures.

There is no "right" way, just as there are no magic incantations that will always painlessly resolve a child's problems."

Lawrence Kutner (20th century) (Columbia, 1996)

Students Like C.J.

Something has to be done. C.J. cannot sit still.... His constant roaming around in the classroom disrupts the other students." Parents of ADHD students like C.J. frequently hear teachers' accounts similar to the one introducing this study. Student's like C.J. traditionally experience problems in school as rules, regulations and routines regularly require they remain seated at their desk, pay attention and focus on assignments and lessons. Some of these students "may receive some assistance from special education teachers who typically have smaller classes and who rely on the use of behavioral techniques in managing students. However, between 85% and 90% of ADHD students are still served in general education classrooms for all or part of the day (Montague & Wagner, 1997; cited by Webb and Myrick, 2003)

As a large number of students in a classroom simultaneously require a teacher's attention, teachers of students like C.J. may not know the "right" way to work with ADHD students. Teachers, as well as parents of children with ADHD, not only need training to help ensure children with ADHD develop to their best potentials, they also need information and support to help them and the ADHD child resolve related problems as painlessly as possible.

Diagnostic Label Attention deficit hyperactivity disorder (ADHD), a diagnostic label, identifies individuals with "developmentally inappropriate levels of inattention, hyperactivity, and impulsivity." (Webb and Myrick, 2003) Individuals with ADHD experience challenges completing routine tasks or concentrate for an extended period of time. They frequently fidget and have difficulty inhibiting behaviors that can distract others. An estimated 3% to 5% of the school age population has ADHD (American Psychiatric Association, 1994; cited by Webb and Myrick, 2003) with boys outnumbering girls. (Kauffman, 1993; Barkley, 1990; cited by Webb and Myrick, 2003) it is one of the most commonly diagnosed and studied disorders among children, and it is receiving increased attention by school administrators, teachers, and counselors. (Barkley, 1998; Shaywitz & Shaywitz, 1992; cited by Webb and Myrick, 2003) More than 100 Years Ago ADHD, as conceptualized today, does not constitute a new condition. More than 100 years ago, in three consecutive issues in the Lancet in 1902, Dr. Still described children displaying syndrome symptom, similar to the way researchers identify ADHD today.

When Dr. Still lectured to the Royal College of Physicians, he described children who "had an inhibition of the will....were not able to control themselves...not able to partake effectively as members of a group...seemed to have a moral defect and their defect...could not conform and be a contributing, supportive part of the group effort." (Prince, 1994-2008) Although the symptoms these children displayed, resembled challenges children with obvious brain injuries portrayed, neither the children nor the families of these children came from families with no apparent brain injuries. Consequently, two initial terminologies, "minimal brain disease" and "minimal brain dysfunction" evolved. Along with noting tics or "microkinesias," in these children, Dr. Still found they performed considerably better when working in smaller settings. He discovered that children experiencing traits resembling today's ADHD usually had someone else in the family also afflicted; that this problem ran in families, yet the affected children were primarily from "moral families." Numerous fathers of these children were reportedly 'smitten with' legal troubles; with alcoholism. Mothers were noted to be depressed more often than mothers of children who did not suffer from this malady and were prone to revealing struggles with suicidal ideations. Dr. Still initially described children displaying ADHD symptoms in England around 1900.

Basically, Dr. Still recognized and described the syndrome diagnosed today as ADHD more than100 years ago. The following figure (1) portrays a photo of Dr. Still.

Figure 1: Dr. George Still (Prince, 1994-2008)

In Time... In the 1930s, Benzedrine, a racemic mixture of dextro and levoamphetamine, sold over-the-counter to treat allergies and reactive airway disease became known as "the arithmetic pill," after children, initially given this drug for headaches related to a medical procedure, were noted to be able to complete their math problems better. One challenge test administered by physicians at this time involved giving Benzedrine to children displaying ADHD symptoms. If the child completed his/her math better, he/she was diagnosed as having minimal brain disease, and was put into this type treatment. If the child's math solving ability did not improve, he/she was sent into a different type of treatment. (Prince, 1994-2008)

Bradley and his colleagues wrote a series of articles over a long period of time looking at these treatments. It was met with skepticism at the time, much like today, but it was quite helpful. They first reported their findings in a study in the American Journal of Psychiatry in 1937. Decades later, methylphenidate was created in Switzerland as an alternative to the amphetamine.

Understanding of the condition evolved over the next few decades -- from minimal brain disease to minimal brain dysfunction. In the mid 1960s, Sam Clements, in a meeting for the Easter Seals, listed the different signs and symptoms of the condition, and noted that attention was a primary deficit. Up until that time, hyperkinesis had been the focus.

Later, these ideas were incorporated into the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III), where...[physicians; psychiatrists; psychologists; mental health professionals] were able to diagnose patients with attention deficit disorder (ADD) with or without hyperactivity. This is evolved in the DSM-III-R, and now the DSM-IV-TR (Fourth Edition, Text Revision), into ADHD. Although in the 1930s someone's response to a stimulant was thought of as diagnostic, that is certainly no longer the case. (Prince, 1994-2008)

The following figure (2) denotes a timeline depicts milestones related to ADHD.

Figure 2: ADHD Historical Timeline (Prince, 1994-2008; Writing Matters, 2008)

Contemporary Consensus Regarding Diagnosis of ADHD

Clinical Presentation ADHD in School-Aged Child (6-12 Years Old):

May have a sense of inner restlessness (rather than hyperactivity)

School work disorganized and show support to follow-through; fails to work independently

Engaging and "risky" behaviors (speeding and driving mishaps)

Poor self-esteem

Poor peer relationships

Difficulty with authority figures (Prince, 1994-2008)

American Academy of Pediatrics: Guidelines for ADHD Assessment

The American Academy of Pediatrics relates the following guidelines for the diagnosis and evaluation of the tile with attention deficit hyperactive disorder.

Evaluate children (age 6 to 12 years) the exhibit the following:

Inattention

Hyperactivity

Impulsivity

Academic underachievement

Behavioral problems

DSM-IV criteria

Evidence from parents/caretakers in teachers/school officials of core symptoms of ADHD in school, home, and social settings

Assessment for co-existing conditions

Other diagnostic test are not routinely indicated (AAP. Clinical practice guidelines: diagnoses an evaluation of the child with attention deficit hyperactivity disorder. Pediatrics. 2000; 105:1158 -1170; cited by Prince, 1994-2008)

Diagnosis of ADHD DSM-IV- TR Criteria

Symptoms of inattention or impulsivity/hyperactivity (hyperactivity is not required for a diagnosis)" have persisted for more than six months are more frequent and severe than is typical of the individuals level of development have onset prior to age seven cause some impairment in two or more settings

Cause significant impairment in social, academic, or occupational functioning are not better accounted for by another mental disorder (Diagnostic and Statistical Manual of the American Psychiatric Association, Fourth Edition, Text Revision, 2000; cited by Prince, 1994-2008)

Three primary types of ADHD have been identified and include:

ADHD Combined Type, the most common type ADHD, approximately 80%, is indicated with symptoms of impulsivity/hyperactivity, along with inattention.

ADHD Predominantly Inattentive Type, the second most common, is indicated when patients display symptoms of inattention without hyperactivity/impulsivity.

ADHD Predominantly Hyperactive/Impulsive Type, noted as the least understand type, predominantly occurs in preschool children. (Prince, 1994-2008)

The following figure (3) depicts the three primary types of ADHD currently diagnosed:

Figure 3: Three Primary Types of ADHD (Prince, 1994-2008)

The following depicts the SNAP-IV Teacher and Parent Rating Scale, developed by James M. Swanson, Ph.D.

The SNAP-IV Teacher and Parent Rating Scale

James M. Swanson, Ph.D., University of California, Irvine, CA 92715

Gender:

Age: ____ Grade:

Ethnicity (circle one which best applies): African-American Asian Caucasian Hispanic

Other

Completed by:____ Type of Class:

Class size:

For each item, check the column which best describes this child:

Not at Just a Quite

Bit

Much

1. Often fails to give close attention to details or makes careless mistakes in schoolwork or tasks

2. Often has difficulty sustaining attention in tasks or play activities

3. Often does not seem to listen when spoken to directly

4. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties

5. Often has difficulty organizing tasks and activities

6. Often avoids, dislikes, or reluctantly engages in tasks requiring sustained mental effort

7. Often loses things necessary for activities (e.g., toys, school assignments, pencils, or books)

8.… [END OF PREVIEW]

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