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The diagnosis of Attention Deficit Hyperactivity Disorder has increased over the recent years. It is one of the most common diseases in children and young adults.
The diagnosis of ADHD has drawn a lot of attention from scientific and academic circles as some scholars argue that there are high levels of over diagnosis of the disorder. Gifted children and ADHD children display similar characteristics. It is also quite difficult to diagnose the disorder in adults. The difficulty in diagnosis is also compounded by the fact that some children have ADHD with other disorders.
There are also concerns on the high prescription of stimulant drugs given to children who are very young. This is an area where a lot of research has been conducted to find out the causes, prevalence and effective treatment methods. There is however need for further research to address the controversies in the diagnosis and treatment of ADHD since it affects children. The long term effects of stimulant medication could have serious repercussions in adult life.
Attention Deficit Hyperactivity Disorder
Attention Deficit Hyperactivity Disorder is a condition that is common in children and young adults. The symptoms of ADHD include patterns of inattention, impulsiveness and hyperactivity. The ADHD prevalence is high between 5 and 15% in children who go to school. The DSM-IV diagnostic tool is used to evaluate whether an individual has ADHD.
A person must display at least six of the nine inattentive and hyperactivity behaviours for a period of more than six months. The behaviour must be more severe or common comparable to people of the same stage in development. Behaviours that display inattention include difficulty in organizing tasks, forgetfulness, losing school items, failing to finish given tasks and avoiding mental tasks.
The individual may also be easily distracted or has difficulty in sustaining attention. The behaviours that display impulsiveness and hyperactivity include restlessness, impatience in waiting for their turn to speak and fidgeting. The behaviours should be noticed in the child before he is seven years old. It should also be demonstrated that the behaviours are interfering with the social, occupational and academic functioning of the child.
It is important that the disorder be diagnosed correctly. Lack of diagnosis presents various problems to the child. In adult life the individual will also have challenges. In academics, the child experiences learning disabilities in reading, spelling and performing math calculations.
It has been noted that children with ADHD are more likely to repeat a class, drop out or be suspended or expelled in school. Research studies have also indicated that these children have a high likelihood of being in automobile accidents or getting hurt physically while playing.
Analyses of diagnosis both in the USA and UK have shown that the disorder is more prevalent in boys than girls. Once the individual is an adult and the disease has not been treated, the person will have high levels of difficulty in employment, relationship challenges due to display of anti-social behaviour, driving offences and increased incidences of crime or substance abuse (Kuo and Faber, 1580). It is not a newly diagnosed disease as it has been treated for the last 100 years.
Under diagnosis of the disorder may be caused by various factors. There may be lack of awareness by the parents and teachers on what could possibly be the problem with the “difficult” child. There is also social stigma associated with mental conditions. The parent may fear taking the child for diagnosis as he does not want to be labelled “a bad parent.” Finally, the parent may not want to expose the child to consistent medication at such a young age.
Causes of ADHD
There are several factors linked to the development of ADHD in children. The main cause of the disease however is unknown. First of all, the disorder may be genetic. Research studies conducted on twins, families and adopted children have shown that the disorder is highly inheritable.
There are specific gene variants that have been identified that are involved in dopamine neurotransmission. There has also been evidence of brain dysfunction in individuals with ADHD. The researchers have used several cerebral imaging studies such as functional magnetic resonance imaging and single photon computed emission tomography. Many of the results have indicated that the prefrontal cortex and basal ganglia are affected (Kuo and Faber, 582).
Recent research studies have also indicated that children with ADHD have smaller cerebrum, grey and white matter volumes compared to non-ADHD children. The fact that pharmacological treatments especially stimulants have proved to be the most effective or superior treatments for ADHD also points to biological causes of ADHD. The stimulants increase the levels of extracellular dopamine.
ADHD may also be caused by neuropsychological functioning. Various studies have shown that children with ADHD have specific and global deficits in comparison with non-ADHD children.
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There have been arguments that there may be psychosocial and environmental factors that increase the prevalence of the disorder. This is due to the fact that the condition has been identified more in the Western than non-Western countries. This has been contested by the fact that there is no evidence to suggest that the disease has become more prevalent. It is only that there have been higher cases of diagnosis and not prevalence.
Controversies in ADHD Diagnosis
The diagnosis of the disease is complicated by the presence of other co-morbid psychological disorders in addition to ADHD in an individual. These disorders have similar symptoms with ADHD such as social awkwardness, risk-taking characteristics and impulsive behaviours.
These disorders include diseases such as Conduct Disorder and Oppositional Defiant Disorder. There is also lack of formal diagnostic criteria for older children and adults. Diagnosis therefore presents a huge challenge to the primary care and family practice physicians (Kube, Petersen, and Palmer, 462).
There have also been concerns that there are high levels of over diagnosis of ADHD. There are several factors that could lead to over diagnosis of ADHD. First of all the physicians want to prevent the negative consequences associated with ADHD in the event of misdiagnosis.
The drugs for treating the disorder are also readily available in the market and thirdly there has been a lot of media coverage on ADHD and the pharmacotherapy treatment methods for the disorder. It has been argued that the stimulant drug companies have been using the teachers and physicians as their salespeople to aggressively sell the drug with their diagnosis.
The companies are interested in making a profit. It has been estimated that the money brought in by the sale of stimulants is $670 Million annually. The tactics used by the ADHD drug company are also very alluring. They love mentioning the fact that famous people such as Einstein, Picasso and Michelangelo also had the disorder so as not to alarm the parents.
There are also negligent parents who may not want to work hard and develop strategies to handle their children in these active ages. They want a way out even if it will involve the administration of drugs. These parents should be able to use alternative approaches to handle their children such as behavioural therapy approaches, counselling for the family and parental advice.
It has also been argued that the current educational system is facilitated by children sitting for long periods of time just listening to the teachers. The passivity and conformity levels expected of a child causes him to be restless and inattentive after some time. Interestingly some of the symptoms associated with ADHD are behaviours that are basically prevalent in children at a certain age. They are forgetful and fidget a lot.
Their attention spans are for a limited period of time. It is argued that a disease has been invented as an excuse for children failing to do their homework and chores at home. There could also be a challenge with the assessment procedures. When the physician is diagnosing a child, he is supposed to use multi-method approaches in order to ensure that the diagnosis is correct.
There should be interviews with the child, teacher and parent. There should also be a review of the child’s school records and physical observation of the child for a suitable period of time. Research studies have indicated that only 15% of the physicians use all the recommended approaches.
Many of them only rely on the clinical interviews while others do not use the standard instruments in assessment (Sciutto and Eisenberg, 108). There is therefore a danger in misdiagnosing a gifted child as one having ADHD. Gifted children have similar characteristics with ADHD symptoms.
They are usually intense when it comes to things such as relationships, sibling rivalry, responding to authority and mental tasks. They are also very hyper and restless. They tend to question the status quo a lot as they see numerous possibilities or alternatives. They are also very sensitive and easily moved to tears. It is a catastrophe when gifted and normal children are diagnosed with ADHD and put on medication.
The qualities of gifted children are appreciated in business settings especially on technical tasks. It is sad that when such qualities are displayed in children it becomes an issue that needs to be addressed. The gifted children could be restless as they wait for the other children to catch up. They should not be penalized.
Treatment of ADHD
The disorder is mostly treated by the administration of stimulants such as Ritalin (methylphenidate) in recommended doses. It addresses the condition by activating the central nervous system which includes the brain. It has been noted to reduce hyperactivity and impulsiveness. It also helps the children sustain attention in their school while being taught and doing their assignments. Due to the side effects associated with stimulants, researchers have advocated for other treatment methods that are natural in nature.
A research study was conducted on children with ADHD across different ages, gender and income groups. There were two treatment strategies. Some of the children were engaged in green outdoor activities while the others were subjected to indoor and built outdoor activities. The results indicated that the green outdoor settings for after-school and weekend activities reduced the ADHD symptoms after considerable time regardless of the age, gender and socio-economic class of the children (Kuo and Faber, 582).
The researchers argue that the symptoms of attention fatigue and ADHD are similar. Interestingly, ADHD is regarded as a disorder while attention fatigue is a temporary condition where once the person rests he will be fine. They therefore advocate for after-school and weekend activities in a naturalized settings where the children can get rejuvenated.
Controversies in treatment of ADHD
There have been controversies in the treatment of ADHD as several scholars are concerned with the high levels of stimulants being consumed by children. There is a perception that ADHD is being over diagnosed leading to high levels of stimulant consumption. Research conducted on Ritalin prescriptions in the 1990s showed that the prescriptions for the children aged between two and four years had tripled during this period (Zuvekas, Vitiello and Norquist, 580).
The use of the stimulant had increased by over 6% in America during the same period. It is an area of concern since 6% of the people diagnosed with ADHD are very young children. There have been arguments that the stimulants do not have significant side effects in the children which have been refuted.
There are research studies that have showed stimulants have side effects such as insomnia and anorexia. The stimulants are also being abused by teenagers. There are children and teenagers who are taking the drugs to enhance their cognitive performance yet they do not have ADHD (Mayes, Bagwell and Erkulwater, 155).
This is dangerous as the possible long term effects of the stimulant abuse have not been fully investigated. Researchers are concerned with long term side effects such as cardiovascular effects, reduced growth rates and carcinogenic effects. There have also been arguments against the effectiveness of the stimulant drugs in children by teachers.
There are teachers who feel that the drug makes the children have a zombie look in their eyes. It has also been noted that at times the drug causes the children to become withdrawn and isolated. They are over-interested in tasks that are boring and non-inspiring. It is argued that the drug suppresses the part of the child’s brain that assists with creativity, energy and freedom. Different scholars have suggested consideration of different treatment methods that do not require stimulants.
The discussion shows that ADHD is a serious condition that affects the academic and social development of a child if not treated. The symptoms will cause more problems to the individual even later in life. Physicians should adequately diagnose otherwise there will be over diagnosis.
Young children will be exposed to consistent doses of stimulants at a young age. There needs to be more research carried out on the use of adequate instruments in the diagnosis of ADHD. What mechanisms should be employed to ensure that the physicians carry out the assessments properly to prevent misdiagnosis and over diagnosis?
There needs to be further research on alternative treatments of ADHD. Currently, stimulants have been found to be the most effective. More research also needs to be carried out on the diagnosis of ADHD in adults in order to address adults with social and employment challenges.
Kube, David, Mario Peterson and Fredrick Palmer. “Attention deficit hyperactivity disorder: Comorbidity and medication use”. Clinical Paediatrics, 41(2002): 461-469. Print.
Kuo, Frances and Andrea Faber. “A Potential Natural Treatment for Attention-Deficit/Hyperactivity Disorder: Evidence from a National Study.” American Journal of Public Health, 94.9(2004): 1580-1586.
Mayes, Rick, Catherine Bagwell and Jennifer Erkulwater “ADHD and the Rise in Stimulant Use among Children”. Harvard Review of Psychiatry 16(2008):151–166. Print.
Sciutto, Mark and Michael Eisenberg. “Evaluating the evidence for and against the over diagnosis of ADHD”. Journal of Attention Disorders, 11(2007): 106-113.
Zuvekas, Samuel, Benedetto Vitiello and Grayson Norquist. “Recent trends in stimulant medication use among U.S. children”. American Journal of Psychiatry, 163(2006): 579-585. Print.