Attention Deficit Hyperactivity Disorder (ADHD) is a severe public health problem that has affected a large number of children and adults as well. According to a research survey conducted by to American Psychology Association, 11% of children in age bracket 4-7 years were diagnosed with ADHD in 2011 (American Psychiatric Association 2013). The Association also agrees that the percentage estimates of children with ADHD vary and has considerably changed over time. Studies show that in America, there is a high rate of approximation in the community samples. The high rates show that ADHD is quite a serious problem to US children and society at large. When diagnosed using the DSM-IV criteria it is found that ADHD affects nearly 5-7% of the population below the age of eighteen. However, when the diagnosis is done using the ICD-10, the rates within the age of eighteen and below considerably change to 1-2% ( Willcutt, 2012) .
Globally, children in the North America region seem to have a higher rate of ADHD in comparison to those children in other regions such as Africa and the Middle East (Deberdt et al . 2015). Nonetheless, researchers contend that this difference arises from the differences in criteria used in diagnosis among regions. It is estimated that ADHD is three times in boys than in girls. The difference might come about either due to the difference in susceptibility or because females with ADHD are less likely to be diagnosed than males.
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Attention Deficit Hyperactivity Disorder can be defined as a brain disorder that is a type of neurodevelopment. ADHD is marked by a series of inattention and hyperactivity-impulsivity which often interferes with the full functioning or development of the brain (American Psychiatric Association 2013). Inattention min this case refers to the fact that the individual often veers off the task, shows inadequate persistence, has difficulty in maintaining focus, and shows general disorganization. On the other hand, hyperactivity is whereby a person seems to wander about frequently, even in situations that are not appropriate to move about. In adults, it might be excess restlessness and (or) exhausting others out with persistent activity. Impulsivity is when a person makes swift actions which happen in the instant minus first pondering them, and this might have a high possible harm, or a wish for instant rewards, or inability holdup gratification. As such, an impulsive individual might be socially disturbing and greatly disrupts others or makes essential decisions minus taking into consideration of long-term consequences. As such, ADHD can impose serious social problems to those suffering from it as well as the family and the society where they live. As a result, it is pertinent to examine and analyze the history of ADHD, its previous and current research, its characteristics, its signs and symptoms, its causes, diagnosis and finally how it can be managed through proposed effective strategies.
Historical Background
According to Sir Alexander Crichton, ADHD has for a very long time been part of the human being condition. In his book An inquiry into the nature and origin of mental derangement, he describes ADHD as a mental restlessness condition. However, ADHD was for the first time clearly described by George Still in 1902 (Mayes & Rafalovich, 2007). It is worth noting that the terminologies used to describe this condition have drastically changed over time. For instance, in ADHD was known as minimal brain dysfunction in the DSM-I in 1952, in the DSM-II of 1968 it was known as the hyperkinetic reaction of childhood, DSM-III of 1980, it was referred to as attention-deficit disorder (ADD) either with or without hyperactivity. However, ADD was altered in 1987 to ADHD in DSM-III-R and DSM-5 in the year 1994 divided the diagnosis into three subtypes. These subtypes included ADHD hyperactive-impulsive type, ADHD inattentive type, and the ADHD combined type. Other terms have embraced minimal brain damage, a term that was widely used in the 1930s (Mayes & Rafalovich, 2007). These three subtypes are therein contained in the DSM-5 of 2013 (American Psychiatric Association 2013).
Causes of Attention-Deficit Hyperactive Disorder
The cause of ADHD is no yet known; nevertheless, there is a belief that it involves interactions among genetic and environmental factors. Indeed, other cases have widely been associated with the previous infection of the brain or trauma to the brain.
Genetics Factors
According to research it has been established that the ADHD is more often associated to inherited genes from one’s parents (Franke et al . 2012) . The researchers contend that genes determine nearly 75% of the ADHD cases. Siblings of children with ADHD are 3-4 times more likely to develop the disorder as compared to siblings of children without the disorder. The researchers also argue that genetics factors also influence the fact whether ADHD perseveres into adulthood of those infected.
Commonly, various genes are engaged among these many directly affect dopamine neurotransmission. Such genes include DRD4 (5), DAT, MAOA, COMT, and TAAR1 (Franke et al . 2012) . Others that are associated with ADHD are SERT, GRIN2A, ADRA2A, and HTR1B among others. Typically, LPHN3 a variant gene is approximated to influence about 9% of cases, and when it is present individuals are responsive to a stimulant treatment. Also, DRD4-7R causes increased inhibitory defects that are provoked by dopamine and is related to ADHD. When DRD4-7R mutates it results in a wide range of behaviors phenotypes which include ADHD symptoms that reflect split attention.
Equally, evolution might have played a key role in the increasing rates of ADHD, more especially hyperactive and impulsive peculiarity in males. Ponders have hypothesized that women (some) might be attracted to males that are risk takers, thus heightening the frequency of genes that predispose to hyperactivity and impulsive in gene collection (Franke et al . 2012) . However, others have argued that these traits may be a version that enables males to face demanding or otherwise dangerous environments with heightened impulsivity and exploratory behaviors.
It is no doubt that in certain circumstances ADHD traits might be beneficial to society in general whereas it is harmful to the individual. The increased rates and heterogeneity of ADHD might have influenced the increased reproductive fitness and equally benefited society through the addition of diversity to the gene collection even though it is detrimental to the individual. Individuals who have Down syndrome are at a high chance to contract ADHD (Franke et al . 2012) .
Environmental Factors
Besides genetic factors, environmental factors can also play a major role in the development of ADHD condition in children. For instance, alcohol intake by expectant mothers can cause fetal alcohol range of disorders that can comprise ADHD and other associated symptoms. Equally, exposure of children to toxic substances like lead may develop problems which are similar to ADHD. Exposure to insecticides, chlorpyrifos, and dialkyl phosphate can lead to an increased risk of contracting ADHD though evidence brought forward is not conclusive. Studies have shown that exposure to tobacco smoke during pregnancy can affect the central nervous system development, consequently heightening the risk of ADHD to the unborn baby.
Related to environmental factors are premature birth, low birth weight, and neglect in early childhood (Thapar, 2012) . Also, abuse and social deprivation have been associated with increased ADHD risk. Equally, infections such as measles, rubella, enterovirus 71 and varicella-zoster encephalitis are contributing factors to ADHD in children. Studies show that nearly 30% of the children who have experienced traumatic brain injury later develop ADHD, and that almost 5% of ADHD cases are attributed to brain damage.
Although some studies have established that in a minority of children, food preservatives and artificial food dyes might be related to the increased prevalence of ADHD and its associated symptoms, the evidence has been weak, thus may only apply to children with food allergy (Thapar, 2012) . As a result, the UK and EU have put in place regulatory measures due to these concerns. Some ADHD cases in children have been aggravated by allergies and intolerances to particular foods. Even though research does not credit fashionable belief that ADHD is caused by intake of too refined sugar, poor parenting, high poverty levels or unhealthy relationships among family members, these factors may, however, deteriorate ADHD symptoms in various individuals.
Society Factor
According to the National Collaborating Centre for Mental Health the diagnosis of ADHD can signify a family dysfunction or a poor educational background or system relatively than a personal problem (National Collaborating Centre for Mental Health, 2009) . It is true that some cases can be clarified by enhancing academic expectations, with a diagnosis being a way for guardians to get additional financial and educational support for their children. Studies have shown that youngest pupils in a class are more likely to be diagnosed as having ADHD because they will be developmentally behind the older pupils in that particular class. Moreover, behaviors common to ADHD happen frequently in children who have had an experience of aggression as well as emotional abuse (National Collaborating Centre for Mental Health, 2009) .
Additionally, the social construct theory of ADHD postulates that since the line between normal behavior and abnormal behavior are constructed, for instant they are created or authenticated by all members of the society, especially by teachers, physicians, and parents, it then agrees to the fact that subjective assessments, evaluations, and judgments decide the diagnosis criteria to be used, and subsequently the number of persons affected. As a result of these circumstances, DSM-IV comes up with a level of ADHD that is 3-4 times elevated in contrast to those obtained with the ICD-10 criterion. A supporter of this theory, Thomas Szasz, argues that ADHD was invented rather than discovered.
Signs and Symptoms
It is normal for children to irregularly act without thinking, forget things, daydream during class time or get restless during dinner time. However, impulsivity, inattention, and hyperactivity are major signs of Attention Deficit Hyperactivity Disorder (ADHD). Often ADHD can lead to difficulties at school, home and can also affect the child’s capability to learn as well as getting along with others (National Collaborating Centre for Mental Health, 2009) . However, the first step to managing the problem of ADHD and get the child the assistance he or she requires is to identify and recognize the signs and symptoms of ADHD. The sign and symptoms this disorder commonly emerge early before the age of seven. Nevertheless, it is difficult to make a distinction between the normal behavior of kids and those with ADHD. A few signs and symptoms may only appear in certain situations, this might not be a disorder, whereas if the symptoms appear nearly in all situations such as at school, at home, as well as during playing, it is important to take action. Until one gets to uncover the issues that the child is suffering and struggling with, for instance, problems with paying attention in school or forgetfulness, then one can find the best remedies for this condition (Skoog et al .2011).
Primary Characteristics of ADHD
ADHD has three major characteristics on which the signs and symptoms exhibited by children depend on that which is predominant. These characteristics include inattention, hyperactivity, and impulsivity. Essentially, children with ADHD condition may be inattentive, yet not hyperactive or impulsive; may be hyperactive and impulsive, yet not capable of paying attention and inattentive, hyperactive, and impulsive. The latter characteristic is the most common type of ADHD. Those children who suffer from inattentive symptom in most cases are ignored because they are not disruptive (National Collaborating Centre for Mental Health, 2009) . Despite this these children often get into trouble with teachers and parents for not following instructions, directions, poorly performing in academics and clashing with other pupils for not following playing rules.
Inattentiveness Signs and Symptoms of ADHD in Children
Children with ADHD pay attention to things that are interesting to them; in fact, they exhibit no problem with focusing and staying on the topic. Rather, when the topic or task is repeated overly or becomes (is) boring they fast tune out. Equally, children with this condition have trouble staying on track to finish the task. Instead of completing the task effectively they tend to skip steps and important procedures of the task, for instance, they do not follow instructions (Skoog et al .2011). Moreover, organizing their work and time and planning ahead is a difficult task for them in contrast to normal children. Children with this condition also have a problem with concentration especially when other things are going on around them. In fact, they require a very quiet and calm environment for them to stay focused. Unlike other children, those with ADHD tend to lose often or misplace their items such as books, pencils among others.
Hyperactivity Signs and Symptoms of ADHD in Children
Hyperactivity is the most noticeable sign of ADHD. Children with this condition are always on the move contrary to the normal children who are fairly active. They have trouble with sitting quietly and still and playing quietly (Skoog et al .2011). They equally try to do many things at a time, for instance moving from one task to another. Additionally, they talk quite excessively are quick to temper as compared to normal children.
Impulsive Signs and Symptoms of ADHD in Children
Children with ADHD often censor themselves less as compared with other children. As such, they are more likely to cause problems with self-control (Skoog et al .2011). They may interrupt conversations, ask irrelevant questions in class, and invade other’s space and often they may ask personal questions. These children also tend to be temperamental and overreact emotionally. This sign may lead others to think that the child is disrespectful. Additionally, children with ADHD often act swiftly without even thinking.
Signs and Symptoms of ADHD in Adults
Unlike in children where it is easy to spot ADHD symptoms, adults have more restrained symptoms. As such, many adults seem to struggle with ADHD and do not even have any idea about its presence in them. Some of the symptoms of ADHD in adulthood are for instance having problems getting organized and planning (Korb, 2014). They find it difficult to plan for the bills, jobs, children and other things. These troubles are more obvious in their adulthood than in childhood.
Adults with ADHD are extremely distractible. This makes them had to complete tasks on time. Equally, due to this distractibility it highly influences their underperformance at work, especially if they are working in busy offices or noisy places. Coupled with this is that they have poor listening skills (Korb, 2014). Adhd is often associated with problems with attention, thus troubles with attention result to poor listening skills. Poor listening skills often lead them to numerous misunderstanding.
ADHD more often than not leads to difficulty with controlling of emotions. As such, adult individuals with ADHD are quick to burst over minor problems since they have no control over their emotions (Stieglitz, 2010). In many accounts, the anger just disappears as quickly as it emerged, long before the individual who dealt with the burst have gotten over the confrontation.
Also, adults with ADHD have problems with prioritizing issues (Stieglitz, 2010). In many cases they is-prioritize, thus failing to meet big obligations such as deadlines at work simply because they are busy doing insignificant things.
Diagnosis of ADHD
Diagnosis of ADHD requires a comprehensive evaluation and assessment of an individual’s childhood behavioral and emotional development (Skoog et al .2011). This will enable ruling out the effects of medication, drugs and other various psychiatric problems as explanations of the signs and symptoms. For children diagnosis of ADHD often takes into consideration feedback from teachers and parents. Most of the diagnoses begin after the teacher and guardians have raised concerns about the child’s behavior. Evaluation should be carried out by a qualified professional pediatrician, psychologist or psychiatrist with expertise in ADHD.
For an individual to receive a diagnosis of ADHD, the signs, and symptoms of hyperactivity-impulsivity or inattention must be chronic or impairing the individual's normal functioning, eventually making the person fall behind his normal development age (Skoog et al .2011). It is important for the doctor to ensure that the symptoms are not influenced or caused by any other psychiatric or medical condition. A doctor can do this through an extensive therapeutic examination by integrating an extensive physical evaluation that encompasses hearing and vision test. For children, most of them get diagnosis during the early ages of elementary school ages. However, for a teenager to receive a diagnosis the symptoms need to have been evident before the age of twelve.
Symptoms of this disorder can appear between the ages of 3-6 and then persist through adolescence and adulthood. However, ADHD symptoms can be mistaken for disciplinary problems or emotional or missed completely in quiet and well-behaved kids. This will consequently lead to delayed diagnosis. Adult individuals with undiagnosed ADHD may show a history of failed relationships, troubles at work or dismal academic performance (Skoog et al .2011).
ADHD signs and symptoms often can change over time as the individual grows. However, in children, the most predominant symptom is hyperactivity-impulsivity. By the time the child reaches elementary school level, the symptom of inattention might become more predominant thus causing the child to struggle academically. In teenagers, restlessness may seem to be predominant as compared to hyperactivity. Nonetheless, impulsivity and inattention may remain. A high number of adolescents with ADHD struggle with relationships and antisocial behaviors. In adulthood, impulsivity, inattention, and restlessness seem to persist (Stieglitz, 2010). Despite who does the assessment and evaluation, the utilization of the Inductive and Factual Manual IV (DSM-IV) criteria is important.
Management of ADHD
The management and treatment of ADHD commonly involve medication, psychotherapy, education, and training or a combination of treatments (Skoog et al .2011). It is argued that treatment may improve the individual’s long-term results, even though it does not do away with negative results completely. Medication for ADHD individuals greatly reduces hyperactivity, impulsivity and improves capacities to focus on work and learning. Those ADHD persons taking medication should be carefully monitored by their prescribing physicians.
Psychotherapy
Combining psychotherapy with the treatment of ADHD can help patients and their relatives to cope up better with daily troubles. Psychotherapies include behavioral and family and marital therapy.
Behavioral Therapy
This therapy aims to help an individual to have a change of behavior. It involves the practical assistance given to a patient, for example like assisting them to organize tasks, plan ahead, work through their emotional difficulties, as well as complete their academic assignments. Behavioral therapy is also aimed at teaching the patient on how to control and monitor their behavior (National Collaborating Centre for Mental Health, 2009) .
Teachers, parents, as well as family relatives, may give positive or negative feedback for particular behaviors and assist in establishing rules and other structured routines to assist the person monitor and controlling their behavior (Korb, 2014). Therapists may as well teach young kids social skills like sharing toys, asking for assistance and being patient for their turns.
Cognitive behavioral therapy can be useful in teaching individual mindfulness techniques. An ADHD individual learns how to be aware of other people’s views as well as learning how to accommodate them (National Collaborating Centre for Mental Health, 2009) . Equally, they learn how to enhance their focus and concentration. Therapists also teach and encourage individuals with ADHD condition to effectively adjust to life changes and also to think before acting and to defy the push for taking avoidable risks.
Family and Marital Therapy
Family and marital therapies can benefit the family members and spouses on best practices and ways to handle disturbing behaviors (Korb, 2014). They can also help in encouraging behavior changes as well as improve interactions with individuals suffering from ADHD among family members.
Education and Training
Individuals with ADHD require guidance and understanding from teachers, guardians, and their families to realize their full potential to prosper. Studies show that blame, frustration, and anger might have built up within the family before diagnosis was done for the child. As such, parents, as well as children, may require special assistance to overcome pessimistic feelings (Skoog et al .2011). This can be done by mental health specialists through educating guardians and parents about ADHD and its effects on the family. They may also educate both parents and children on new strategies, skills, and attitudes of relating to one another.
Parent Training
Parental training enables parents to learn new skills that they need to encourage and reward positive behavior in their children (Skoog et al .2011). Parents are taught to give instant and positive response for behaviors they want to encourage as they ignore behaviors that they want to discourage. The parents also get to learn ways to structure situations in ways that support desired behavior. In general, parents are familiarized with the system of using rewards and consequences to alter the behaviors of their children. Additionally, stress management strategies can help parents of children suffering from ADHD by enhancing their capability to handle frustration to respond calmly to their child's behavior. Sharing of information through regular meetings of families with this disorder can be very beneficial.
Analytical Summary of the Relevant Sources
American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition: DSM-5. Washington: American Psychiatric Association.
This source discusses how the DSM-5 method is used to calculate the rate of ADHD prevalence in various regions in the world.
Deberdt, Walter, Thome, Johannes, L. & Arif, Muhammad. (2015). Prevalence of ADHD in nonpsychotic adult psychiatric care (ADPSYC): A multinational cross-sectional study in Europe . (BioMed Central Ltd.) BioMed Central Ltd.
This source is relevant to this analytical paper since it examined the estimated prevalence of ADHD in adult psychiatric outpatients in various European countries. It also made use of DSM-5 and DSM-5-RT methods of diagnosis of ADHD.
Franke B, Faraone SV, Asherson P, Buitelaar J, Bau CH, Ramos-Quiroga JA, Mick E, Grevet EH, Johansson S, Haavik J, Lesch KP, Cormand B, Reif A (October 2012). The genetics of attention-deficit/hyperactivity disorder in adults, a review". Mol. Psychiatry. 17 (10): 960–987
The source examines and evaluates the causes of ADHD, more especially the genetic factors, and the genes that play key roles in its inheritance.
Korb, F. A. (2014). ADD/ADHD in adulthood. Mental Health Matters, 1, 2, 23-25.
The source examines and evaluates ADHD symptoms in adulthood and gives a remedy on how to cope up with ADHD in adulthood.
Mayes, R. & Rafalovich, A. (2007). Suffer the restless children: the evolution of ADHD and pediatric stimulant use, 1900—80. History of Psychiatry, 18, 4, 435-457.
This source takes a look at the historical background and evolution of ADHD through the ages.
National Collaborating Centre for Mental Health (2009). Attention Deficit Hyperactivity Disorder: Diagnosis and Management of ADHD in Children, Young People, and Adults. British Psychological Society. pp. 19–27, 38, 130, 133, 317
The source examines diagnosis strategies, causes, signs, and symptoms of ADHD and also proposes management strategies
Skoog, Maria, Per, Gluud, Christian, & Simonsen, Erik. (2011). Randomized social skills are training and parental training plus standard treatment versus standard treatment of children with attention deficit hyperactivity disorder - The SASTRA trial protocol . (BioMed Central Ltd.) BioMed Central Ltd.
The source gives background information about children with ADHD as well as proposes management and treatment strategies such as social-skill training and medication.
Stieglitz, R. D. (2010). Attention-deficit hyperactivity disorder in adults: Diagnosis and prevalence. Attention-deficit Hyperactivity Disorder (ADHD) in Adults, 105-125.
This source examines and discusses the diagnosis of ADHD in adults and the prevalence among adults.
Thapar, A.; Cooper, M.; Jefferies, R.; Stergiakouli, E. (March 2012). What causes attention deficit hyperactivity disorder? Arch Dis Child (Review. Research Support, Non-U.S. Gov't). 97 (3): 260–5
The source discusses and examines causes of ADHD more especially the environmental factors.
Willcutt, EG (2012). The prevalence of DSM-IV attention-deficit/hyperactivity disorder: A meta-analytic review. Neurotherapeutics. 9 (3): 490–9.
The source gives statistics of regions that are prevalent with ADHD across European countries
Conclusion
As has can be noted from the foregone discussion, Attention Deficit Hyperactive Disorder can be a serious medical and social problem to the individuals affected and those that they interact with on their daily basis. From the historical background, it can be established that ADHD had existed for many years even before it was discovered. ADHD has been associated with various causes such as genetics, social factors, and environmental factors. The signs and symptoms are particularly influenced by the predominant subtypes such as inattention, hyperactivity-impulsivity or a combination of both. This condition more often starts to get recognized as early as 3-6 years and continues to adulthood through adolescence. The paper also captures the ADHD signs and symptoms that are evident in childhood and adulthood. Treatment and management strategies have also been examined; they include medical and therapeutics programs for an individual suffering from ADHD. An extensive evaluation is essential before starting medication. Finally, the relevance of the sources used has been analytically summarized.
Reference
American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth edition: DSM-5. Washington: American Psychiatric Association.
Deberdt, Walter, Thome, Johannes, L. & Arif, Muhammad. (2015). Prevalence of ADHD in nonpsychotic adult psychiatric care (ADPSYC): A multinational cross-sectional study in Europe . (BioMed Central Ltd.) BioMed Central Ltd.
Franke B, Faraone SV, Asherson P, Buitelaar J, Bau CH, Ramos-Quiroga JA, Mick E, Grevet EH, Johansson S, Haavik J, Lesch KP, Cormand B, Reif A (October 2012). The genetics of attention deficit/hyperactivity disorder in adults, a review". Mol. Psychiatry. 17 (10): 960–987
Korb, F. A. (2014). ADD/ADHD in adulthood. Mental Health Matters, 1, 2, 23-25.
Mayes, R. & Rafalovich, A. (2007). Suffer the restless children: the evolution of ADHD and pediatric stimulant use, 1900—80. History of Psychiatry, 18, 4, 435-457.
National Collaborating Centre for Mental Health (2009). Attention Deficit Hyperactivity Disorder: Diagnosis and Management of ADHD in Children, Young People, and Adults. British Psychological Society. pp. 19–27, 38, 130, 133, 317
Skoog, Maria, Per, Gluud, Christian, & Simonsen, Erik. (2011). Randomized social-skills are training and parental training plus standard treatment versus standard treatment of children with attention deficit hyperactivity disorder - The SOSTRA trial protocol . (BioMed Central Ltd.) BioMed Central Ltd.
Stieglitz, R. D. (2010). Attention-deficit hyperactivity disorder in adults: Diagnosis and prevalence. Attention-deficit Hyperactivity Disorder (adhd) in Adults, 105-125.
Thapar, A.; Cooper, M.; Jefferies, R.; Stergiakouli, E. (March 2012). What causes attention deficit hyperactivity disorder? Arch Dis Child (Review. Research Support, Non-U.S. Gov't). 97 (3): 260–5
Willcutt, EG (2012). The prevalence of DSM-IV attention-deficit/hyperactivity disorder: A meta-analytic review. Neurotherapeutics. 9 (3): 490–9.
The source gives statistics of regions that are prevalent with ADHD across European countries
