Introduction
Attention deficit hyperactivity disorder (ADHD) constitutes one of the most prevalent brain disorders among children that progresses to later stages of life including teenage years and adulthood (Cormier, 2008). The symptoms associated with ADHD include difficulties in regulating behavior, paying attention, remaining focused, and hyperactivity (being overly active). Such symptoms make it extremely challenging for children having ADHD to excel in academics, accomplish tasks, and remain in friendly relationship with others. Research on brain imaging have pointed out that, in young people having ADHD, there is a normal but delayed maturing of the brain averagely by approximately three years. According to Anastopoulos & Shelton (2001), the delay in the maturing of the brain is most evident in areas that are responsible for planning, being attentive and thinking.
Recent research has revealed that the cortex – the outmost part of the human brain – exhibits an overall delayed maturation. In addition, the brain structure that helps in ensuring good communication between the right and left hemispheres of the brain exhibits the abnormal growth. Cormier (2008) asserts the abnormalities in brain growth and delays in brain maturity are likely to mark the ADHD symptoms and can help in explaining the development of the disorder (Erkulwater, Mayes, & Bagwell, 2009). Treatments have been established to be effective in relieving the ADHD symptoms. However, ADHD has no cure at present. Through treatment, people having ADHD can excel in academics and live productively. Research is underway aimed at coming up with interventions and treatments that are more effective. In addition, novel tools like brain imaging are helping in understanding ADHD and the development of more effective methods that can be used in treating and preventing the disorder (Cormier, 2008). Current paper explores the characteristics of ADHD, its prevalence, treatment, and controversial issues surrounding the disorder.
Characteristics
ADHD is an example of a heterogeneous behavioral disorder typified by the core symptoms associated with inattention, impulsivity and hyperactivity. Despite the fact that these symptoms are likely to be manifested together, some individuals are principally impulsive and hyperactive, whereas others tend to be predominantly inattentive. The main diagnostic criteria that are presently used for ADHD include the Diagnostic and Statistical Manual of Mental Disorders 4th edition (DSM-IV) and the International Classification of Mental and Behavioral Disorders 10th revision (ICD-10). DSM-IV employs a more inclusive and broader definition of ADHD including various subtypes of ADHD (Erkulwater, Mayes, & Bagwell, 2009). On the other hand, the ICD-10 makes use of a relatively narrow diagnostic category including individuals having severe impairments and symptoms.
ADHD symptoms are spread across the population with variations in terms of severity. The criteria for ADHD diagnosis is met only by those having considerable impairment. In addition, ADHD symptoms are likely to be similar with the symptoms of other associated disorders; however, ADHD cannot be viewed as a categorical diagnosis (Erkulwater, Mayes, & Bagwell, 2009). As a result, there is a need for care for various diagnoses. Some of the common conditions that coexist with ADHD in children include anxiety disorders, and disorders of communication, motor control, learning, conduct and mood. In adults, the disorders that are likely to coexist with ADHD include substance abuse, obsessive-compulsive, bipolar, and personality disorders (Polanczyk, de Lima, Horta, Biederman, & Rohde, 2007).
The symptoms of inattention, impulsivity and hyperactivity are not manifested in every individual suffering from ADHD. Nevertheless, for an individual to meet the criteria for ADHD diagnosis, his/her symptoms have to be related to at least a moderate impairment in occupation, educational, social and psychological domains (Erkulwater, Mayes, & Bagwell, 2009). Moderate ADHD occurs when the symptoms associated with inattention, impulsivity, and hyperactivity are manifested together and are related to at least moderate impairment in various settings (such as healthcare, school and home settings) and in various domains, in a way that is appropriate for the individuals age.
In this context, domains denote a form of personal or social functioning whereby individuals normally attain competence (such as excellence on academics); building positive relationships with friends and family; and handling physical risks as well as evading regular hazards (Cormier, 2008). Ascertaining the severity of ADHD is an issue of clinical judgment and is based on the social and familial context, individual factors, pervasiveness, and the severity of the impairment. In the course of teenage years and adulthood, the scope likely impairment is expanded to include dangerous driving; underachievement in occupation and education; difficulties in performing daily routines and activities such as childcare, making friends, keeping friends, completing household tasks, and problems with intimate relationships.
Severe ADHD is the same the diagnosis of hyperkinetic disorder using ICD-10, and is characterized by the manifestation of inattention, impulsivity and hyperactivity in various settings and severe impairment; this implies that ADHD affects various domains in various settings. ADHD is considered an example of a persisting disorder in the sense that majority of young people diagnosed with ADHD are likely to have considerable difficulties in the course of their adult life, which can include criminal behavior, unemployment, substance abuse, social and emotional problems, personality disorders, and ongoing ADHD (Cormier, 2008).
The key behaviors associated with ADHD are impulsivity, hyperactivity and inattention. Being impulsive, hyperactive or inattentive is normal for children. However, for children having ADHD, these behaviors tend to be more server and manifest frequently. The diagnosis of ADHD requires a child to exhibit these symptoms for at least six months (Erkulwater, Mayes, & Bagwell, 2009). In addition, these symptoms have to exceed the behaviors exhibited by children with the same age. Inattention is characterized by:
- being easily distracted, regularly changing activities and missing details;
- difficulties in concentrating on one thing;
- being uninterested in a task just after a short time;
- difficulties in paying attention with respect to task completion and learning new things;
- difficulties in completing assignments;
- failing to listen when being spoken to;
- struggling adhering to instructions;
- problems with processing information in a quick and accurate manner;
- and being easily confused.
Impulsivity is characterized by being extremely impatient; uttering comments deemed inappropriate; showing one’s emotions without control; interrupting conversations or activities being undertaken by others; and acting without taking into consideration the outcomes of one’s actions. Hyperactivity is characterized by talking continuously; having problems with performing tasks that require quietness; being always in motion; having problems staying still; and dashing around and playing with everything that is accessible (Cormier, 2008).
There is a possibility of confusing ADHD with other problems. Teachers and parents might ignore the point that children exhibit signs of inattentiveness due to having ADHD because of the fact that they are usually silent and unlikely to act. Inattentive children may opt to sit silently and pretend to be working when in fact they do not focus on what they perform (Cormier, 2008). In addition, inattentive children may perhaps also get along with other children. However, children who are impulsive or hyperactive are likely to exhibit social problems. Nevertheless, children having inattentive ADHD are not the only ones who are likely to be mistaken. For instance, it is common to consider hyperactive and impulsive children as having disciplinary problems (Cormier, 2008).
ADHD is also characterized by problems with a number of social skills such as establishing and keeping relationships, and social interaction, which is the case for all the subtypes of ADHD (Combined Type, Predominantly Inattentive Type, and Predominantly Hyperactive-Impulsive Type). About 50 percent of adolescents and children having ADHD undergo social rejection. It is relatively small rate when compared to 10-15 percent of adolescents and children who do not have ADHD. In addition, attention deficit is a characteristic of ADHD, which results in problems in processing nonverbal and verbal communication, which in turn, has a negative impact on social interaction. In addition, ADHD individuals are unlikely to identify social cues and doze off when conversing (Cormier, 2008). Anger management difficulty is also a feature of ADHD among children. Other symptoms include delays in motor, language and speech development as well as poor handwriting. Despite the fact that ADHD results in considerable impairment, the majority of children with ADHD show good attention span, especially for interesting activities (Cormier, 2008).
Prevalence
When diagnosing using the DSM-IV, it is approximated that the prevalence of ADHD is about 6-7 percent among people aged 18 years and below. However, when diagnosed using the ICD-10 criteria, the prevalence of hyperkinetic disorder – the equivalent of ADHD – is about 1-2 percent for people aged 18 years and below (National Resource Center on ADHD, 2014). The prevalence of ADHD is higher in North America than Middle East and Africa; such discrepancy can be attributed to the use of different diagnostic methods in different regions. Similar diagnostic methods could result in almost the same prevalence rates for ADHD for various countries. In the United States, the prevalence of ADHD has been diagnosed in about 2-16 percent of school going children. According to the National Resource Center on ADHD (2014), the east coast US has higher treatment and diagnosis rates of ADHD than the west coast. In addition, there are differences in terms of frequency of diagnosis between female children (4 percent) and male children (10 percent); such gender difference may be an indicator that male children are more at risk of ADHD or that female children are unlikely to be diagnosed for ADHD when compared to their male counterparts. In addition, in all the three types of ADHD, the prevalence of male children is higher than the prevalence of female children (National Resource Center on ADHD, 2014).
Treatment
At present, ADHD cannot be cured. However, treatments can be used to lessen the symptoms associated with ADHD and help enhance productive functioning. The treatments for ADHD include medication, psychotherapy, training and education, as well as combining treatments.
Medications
Stimulant medications have been used as a pharmaceutical treatment for ADHD, and have been shown to be effective, in the short-term, in improving symptoms associated with ADHD. Medication stimulants work by activating the circuits in the human brain that are used in supporting focused behavior and attention, which in turn, reduces hyperactive behavior (Anastopoulos & Shelton, 2001). Some of the stimulant medications that are currently in the market and can be used in managing the symptoms associated with ADHD include clonidine, guanfacine, bupropion and atomoxetine among others. There are no empirical research studies that have tried to compare the outcomes of using various stimulant medications; nevertheless, they seem more or less the same with regard to the side effects. Stimulants have been established to help in improving the academic performance of children with ADHD. However, atomoxetine has been reported to be ineffective in improving academic performance (Cormier, 2008).
There is scanty evidence regarding the impact of these stimulant medications on social behaviors of children with ADHD. In addition, it is not recommended for pre-school children to use stimulant medication owing to the fact that long-term effects of these medications on this specific age group are yet to be determined. According to Cormier (2008), the long-term effects of using stimulant medications are still unclear, with some studies reporting benefits, others reporting no effects while others reporting harm. Studies performed using magnetic resonance imaging have revealed that long-term medication treatment using methylphenidate or amphetamine can help in reducing the abnormalities found in brain structure for people with ADHD. Despite the fact that stimulant medication is safe for treating ADHD, there are a number of side effects, which may include psychosis, reduced appetite, and sleep problems (Anastopoulos & Shelton, 2001; Erkulwater, Mayes, & Bagwell, 2009).
Psychotherapy
Empirical evidence affirms the effectiveness of behavioral therapies in the treatment of ADHD. Behavioral therapies are often recommended as the first treatment option for individuals with mild symptoms of ADHD as well as for pre-school children. Some of the psychotherapies employed in the treatment of ADHD include parent management training, social skills training, interventions that are school-based, family therapy, interpersonal psychotherapy, cognitive behavioral therapy, and behavior therapy (Cormier, 2008; Anastopoulos & Shelton, 2001). Psychotherapy has the main objective of helping a person with ADHD to change his/her behavior and entail the use of practical assistance like helping the person with ADHD to complete his/her tasks. Behavioral therapy also seeks to teach the person with ADHD ways of monitoring his/her behavior and teaching him/her social skills. Short-term benefits have been reported for the case of parent education and training. In addition, family therapy has been proven effective in helping families to cope with children having ADHD (Anastopoulos & Shelton, 2001; Cormier, 2008).
Controversies
The controversies surrounding ADHD are related to a number of issues regarding the existence of ADHD as a disorder; the causes of the disorder; the diagnostic methods (Anastopoulos & Shelton, 2001); treatment methods especially using medication stimulants among children with the disorder; the possibility of over-diagnosis; the possibility of misdiagnosis of ADHD resulting in the lack of treatment of the underlying condition (Cormier, 2008); and negative stereotypes associated with children having ADHD (Erkulwater, Mayes, & Bagwell, 2009). Cormier (2008) points that such ADHD controversies commenced during the 1970s. With respect to whether ADHD can be considered a disorder or not, the media, policymakers, teachers, parents, scientists and clinicians have divergent opinions regarding the physiological and genetic causes of ADHD.
Despite the fact that there is an agreement that ADHD exists, there is a controversy regarding the high ADHD diagnosis rates among young people and children; the medical, legal and educational treatment of people with ADHD; and whether or not treatment has to be maintained as one progresses into adulthood. In addition, there are conflicting theories regarding the cause of ADHD; it is further compounded by the fact that the pathophysiology of ADHD is still vague. There are those who consider ADHD as a biological condition associated with either a structural or a chemical flaw in one’s brain. On the other hand, there are those who ascribe to the social construct theory of ADHD, which posits that ADHD is not an instance of an actual pathology; instead, the diagnosis of the disorder is a social constructed elucidation used in describing behaviors that are not consistent with the agreed social norms (Cormier, 2008).
Conclusion
ADHD forms one of the most prevalent brain disorders, with an approximated global prevalence of 6-8 percent among individuals aged below 18 years. The main behavioral symptoms associated with ADHD are impulsivity, hyperactivity and inattention. In order for a person to be diagnosed of ADHD, these symptoms must be inappropriate for their age and manifested more frequently than others of the same age. ADHD cannot be healed; however, interventions can be used to minimize the symptoms associated with ADHD and help in enhancing functioning. The treatments for ADHD include medication, psychotherapy, training, education, and combining treatments. Lastly, a number of controversial issues associated with ADHD exist, which include whether or not ADHD is a disorder; the causes of ADHD; the methods employed in diagnosing ADHD; using medication stimulant as a treatment option for ADHD among children; and the negative stereotypes that people associate with ADHD.
