Controversy surrounds the diagnosis and treatment of ADHD as an illness. Some critics maintain that the condition is a work of fiction by the psychiatric and pharmacists who have taken advantage of distraught families’ attempts to comprehend the behaviour of their children to dramatise the condition.
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Others claim that ADHD is a viable condition only not very well known in the scientific world. In an ADHD documentary, Drugging our Children in 2005, drugs have been discredited as being inadequate and immoral in addressing the disorder.
Controversy and medication not withstanding, families still find it hard to cope with children suffering from ADHD. As a result, there is need to identify means through which ADHD can be managed without being overly dependant on medication. (Blackman 1011-1025).
This paper seeks to discuss ADHD disorder, its probable causes and the advantages and disadvantages of using medication to contain the condition. It most importantly seeks to emphasis helpful application of other alternatives to medication in addressing the controversial yet increasingly common phenomena.
Attention Deficit Hyperactivity Disorder (ADD / ADHD)
Attention deficit hyperactivity disorder is psychiatric complication affecting normal growth and development. This condition is common in children though it can persist through other stages of development like adolescence and adulthood.
The condition is based on a combined sequence of behaviour but is basically marked by attention difficulties and or pathologically intense levels of activity (Diagnostic and Statistical Manual of Mental Disorders). ADHD is divided into three special types;
- overbearingly hyperactive and impulsive
- majorly inattentive and
- A blend of hyperactivity, impulsiveness and inattention.
Overly hyperactive-impulsive ADHD children may also exhibit lack of attention while the inattentive ADHD ones may also show symptoms of hyperactivity and impulsiveness. Both signs are however minimal compared to the dominant ones. Combined ADHD is the most common among children.
It is quite hard to define the symptoms of ADHD since it is difficult to clearly delineate between normal and clinical levels of hyperactivity, lack of attention and impulsiveness. However, the most common manifestations of ADHD are not being able to direct and maintain one’s mind on something for long, distractive tendencies, and or being overly active and acting unpredictably.
These symptoms recur constantly making it difficult for the individual to function normally across all spheres of life. This is because people with ADHD are mostly restless, easily distracted, cannot organise themselves, act and talk before considering the repercussions and are very impatient, have poor memory and cannot maintain permanent relationships.
Potential causes if ADHD
Various theories have been propounded to shed some light into the probable causes of ADHD. Among the common theories are the evolution theories, environmental theory, neuro diversity theory, social construct theory, low arousal theory, social theory and diet.
However, according to Bailly Lionel a lecturer in Child and Adolescent Psychiatry, the exact causes of the condition are not yet established. Meanwhile, scientific studies indicate that the condition is brought about by a blend of various factors.
ADHD is believed to be a hereditary disorder that can be carried on amid members of a family. Though it is yet to be known just what genes lead to the condition, research is still on to determine the exact genes or the mixture of genes that could make an individual prone to the disorder with the hope of developing a cure or curbing the disorder way before its symptoms manifest themselves.
ADHD is also thought to originate from the different substantial properties of the brain parts. Studies show that the condition is eminently inherited though the genetic factor is dismal. ADHD is an unfathomable synergy of genes and other external and internal factors (Acosta, Arcos-Burgos and Muenke 1-15).
Environmental factors are also likely to contribute to the condition. Cigarette smoke and alcohol abuse by expectant mothers affect the unborn making them prone to developing ADHD. This is because nicotine could cause oxygen deficiency to the foetus hence affecting the brain.
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Children born prematurely are also likely to suffer from ADHD while infections in the course of pregnancy, at the time of birth and viral and bacterial childhood infections like measles could also cause the condition. Similarly, exposing young children to lead and some pesticides puts them at risk of developing the condition (van Cleave and Leslie 28-37).
To a small extent, ADHD is also associated with trauma suffered from brain injuries. Children with ADHD constantly sustain head injuries. However, this does not imply that that they developed the condition as a result.
The presumption that refined sugar is a likely cause of ADHD or worsens manifestations of the condition is widespread. However, research dismisses the notion as myth since studies indicate that there is no notable behavioural difference between children who took sugars or substitutes or even more than the required amounts of sugar.
Diet has also been identified as one of the probable causes of ADHD. According to a study by McCann, Barrett and Cooper, there is a connection between children’s consumption of various popular food additives (food colours and preservatives), with hyperactivity.
Sodium benzoate is a common preservative found in salad dressings, carbonated drinks, jams and fruit juices which has been pointed out among others to prompt symptoms of ADHD. However, more research is still on to fully establish just how they are related (McCann, Barrett and Cooper 1560-7).
In addition, the World Health Organisation advances that the manifestation of ADHD is a consequence of the malfunctioning of the society and not an individual problem.
It attributes the condition to failures in the family institution and flaws in the education system. Others conceive that thrusting children to care givers and the subsequent correlation impact a lot on the abilities of the child to pay attention or take care of themselves. At the same time, children in foster care are more likely to develop symptoms closely associated with ADHD.
Furthermore, (Cuffe, McCullough, Elizabeth and Pumariega 327-3) advance that children who are victims of violence and psychological trauma are prone to developing ADHD. Psychological illnesses like Complex post Traumatic Stress Disorder can end up causing attention problems that resemble ADHD.
According to a recent CNN article, children adopted across nations are more likely to develop psychological illnesses like ADHD/ADD. This has o some extent been attributed to the long duration it takes to be adopted during which time they could be violated or disregarded.
ADHD Treatment/ management
ADHD is a condition that needs to be treated and monitored. This is because if neglected, it can result in serious complications for an individual such as poor grades at school or ineffectiveness at the workplace, problems in forming and maintaining lasting relationships and low self evaluation.
There is no known cure of ADHD. Treatments only serve to alleviate the symptoms and make life better for the individuals suffering from the condition. This way, ADHD victims can lead a relatively normal life. However, research is still underway to discover more fruitful treatments for the disorder.
Stimulants are the most widespread medications for ADHD. Stimulants provide calm to children with the condition. They can either be pills, capsules, syrups or skin patches. The most conventional stimulant medications are Ritalin, Concerta, Dexerdrine, Metadate, Adderal and Focalin.
It should however be noted that these medications are not applicable to all individuals hence a matter of careful prescription when it comes to individual choice. This is because what goes well with one person may not fair well with another (The Diagnostic and Statistical Manual of Mental Disorders 284-287).
There are also other preferable medications other than stimulants such as atomoxetine, tricyclic anti-depressants, and bupropion and also generally prescribed medications for children from 3 to 6 years of age. However, not all the medications are sanctioned to be used in grown ups.
Pros and cons of medication
Medications serve to alleviate cases of hypersensitivity and impulsiveness in children. They also help children to focus more and be able to do constructive work and learn properly. Drugs also do help make physical interaction of the individuals better.
However, it has been reported that these drugs cause acute side effect like lack of appetite, sleep disorders, anxiety, irritability, stomach problems or headaches. Majority of these side effects are not severe and usually go away with time or when the dosage administered is lowered or by changing medications.
Sometimes the use of stimulants may result to drug abuse and over-dependence on the drugs as some of the drugs make individuals feel “different”. According to the National Institute for Drug Abuse Community Epidemiology Work Group, methylphenidate is reported to be abused among teenagers in the USA and the UK. They administer the drugs orally while some inhale the crushed drugs or mix with heroin and cocaine to have a more powerful effect.
Similarly, using stimulants on individuals suffering from other complications like heart conditions may prove catastrophic as they make cause strokes, heart attacks or even sudden death. Medications may also cause other psychosocial problems like hallucinations, delusions, moodiness, and being overly suspicious. The use of some non stimulants like strattera atomoxetine in teenagers and children prompts suicidal tendencies and they therefore need to be observed strictly.
Even when some medications are safe and have minimum or no side effects, they still do not cure ADHD. The symptoms of the conditions are only controlled and depending on if the medications are adhered to, monitored and regulated. It is also not guaranteed that medications help boost children’s learning abilities and academic performance.
Alternatives to medication
According to Van Cleave and Leslie, effective treatment and management of ADHD involves a combined process of medication and complementary treatment. This is because medicines alone cannot guarantee efficacy. In some countries like the UK and the US, use of medication is only advised in cases of intense manifestation of ADHD.
Similarly, children under three years are not sanctioned to use medications owing to the un-ascertained lasting effects of the drugs. Moreover, owing to the controversies on whether ADHD is an illness or a scam by psychiatrists and pharmaceuticals, there has been need to identify other ways through which the condition can be contained.
It involves a variety of psychological and social curative processes that focus on helping ADHD children alter their behaviour. It includes behavioural therapy, psycho educational assistance, interpersonal psychotherapy, family therapy, group therapy, cognitive behaviour therapy, training in social skills, school based interventions among others.
It ranges from literary helping the child organise tasks, finish homework to assisting the children go through events that are emotionally draining (Van Cleave and Leslie 28-37).
Behavioural therapy imparts children with skills that can help them supervise and regulate their actions. It also aims at teaching children to learn to evaluate themselves positively for behaving in an admirable way. It involves having clear and precise set of rules, activities and a variety of systematised customary procedure that exercise restraint to a child’s behaviour and a feedback mechanism.
Through therapy, children learn social skills like waiting their chance in play, sharing, requesting for assistance, or how to react towards others. They also become able to interpret facial and tonal variations and what is required in response.
Guidance and counselling
Children with this condition require a lot of love, kindness, guidance and most of all, understanding from the people around them. This involves teachers, parents, siblings, neighbours, caretakers, friends and anyone who comes in contact with them.
This enables them be the best they can ever be. The children should not be blamed or made to feel guilty of their condition. Instead, they require special assistance to deal with the condition effectively.
Exchanging opinions and making consultations gives individuals with ADHD a forum to express their feelings and come up with effective ways of coping with ADHD such as low self esteem, lack of friends, inability to form and maintain relationships and other frustrations.
Social Skills Training
Through this approach, individuals suffering from ADHD learn more acceptable ways and skills of interacting with others that were previously unknown to them. This way, they ameliorate their fundamental ways of associating with others. Parents are trained on skills and attitudes that can help change the behaviour of the children in a loving and understanding manner.
This involves rewarding good behaviour and ignoring or redirecting unpleasant behaviour; in essence, focusing more on the child’s abilities and strengths rather than their weaknesses and disabilities. If for instance a child becomes uncontrollable, the child is driven away from the scene that upsets them and is given time alone to cool off. This way, even those around them get to learn how to manage their emotions.
It is about finding strength through association with people affected by ADHD. This not only refers to ADHD individuals but also parents and the loved ones. Through sharing with people facing the same situation, people learn from others and get encouraged to move on.
Alternative sleeping patterns
Children with ADHD have sleeping problems yet sleep is a natural requirement for normal growth and a remedy for many ailments. Sleep is achieved through developing a consistent sleeping schedule regardless of the day so that a child gets used to sleeping and getting up at a given time.
This also includes regular timing for meals, resting and going to bed and minimising or doing away entirely with any form of disturbing noises that would distract the child.
There are other approaches that compliment treatment like changing diets to involve food that are less in saturated sugar, artificial additives, caffeine, chocolate, tea and some energy beverages. This reduces chances of stimulating conditions related to the disorder (McCann, Barrett and Cooper. 1560 -7).
ADHD diagnosis is still largely dependant on the explication of the psychiatrist or clinician and in most cases a third party. Its probably caused by an amalgamation of internal and external factors. While the real diagnosis remains a bone of contention, ADHD remains an increasingly common childhood disorder for which research indicates a combination of medications and alternative can prove effective in controlling it.
There are risks in over-dependence and misuse of medication and medication on its own cannot effectively alleviate the problem. There is need therefore to focus on other ways of making those affected with the conditions cope easily and be able to lead a normal life.
After all has been done failure in these combined approaches in alleviating the problem means going back to the beginning and reviewing the diagnosis. Either there would be an error in the diagnosis or there may be other factors present at the time that also lead to lack of positive response. That will mean a total evaluation of all those factors.
Acosta, Maria T., Arcos-Burgos, Mauricio and Muenke, Maximillian. “Attention Deficit/hyperactivity Disorder (ADHD): Complex phenotype, simple genotype?” Genetics in Medicine 6.1(2004): 1–15. Print.
Bailly, Lionel. “Stimulant Medication for the Treatment of Attention-deficit Hyperactivity Disorder: Evidence-b(i)ased Practice?”. Psychiatric Bulletin (The Royal College of Psychiatrists) 29.8(2005): 284–287. Print.
Blackman, John. “Attention-deficit/hyperactivity Disorder in Preschoolers. Does it exist and should we treat it?” Paediatric Clinics of North America, 46 (1999): 1011 -1025. Print.
Cuffe, S.P., McCullough, Elizabeth L. and Pumariega, Andres J. “Comorbidity of attention Deficit Hyperactivity Disorder and Post-Traumatic Stress Disorder”. Child and Family Studies 3.3 (1994): 327–336. Print.
DSM-IV-TR workgroup. The Diagnostic and Statistical Manual of Mental Disorders, Washington, DC: American Psychiatric Association, 2007. Print.
McCann John D., Barrett Agnew and Cooper Anderson. “Food additives and Hyperactive Behaviour in 3-year-old and 8/9-year-old Children in the Community: A Randomized, Double-blinded, Placebo-controlled Trial”. Lancet 370.9598(2007): 1560–7. Print.
Van Cleave Jeanne, Leslie LK.”Approaching ADHD as a chronic condition: implications for Long-term Adherence”. Psychosocial Nursing and Mental Health Services 46.8(2008): 28–37. Print.