Research shows that approximately four children between the age of 5 and 13 in the United States suffer from behavioral disorders in the United States. While many schools have developed structures to accommodate new behaviors and attitudes from these children, many still stigmatize the children without offering solutions. According to Zeitlin (2006), the behavioral disorder is a disability that is characterized by an inability to build or maintain a relationship with others. It is also characterized by an inability to learn which cannot be adequately be explained by intellectual, sensory or health factors. Children also suffering from this mental illness are identified as demonstrating predominately externalizing behaviors or internalizing behaviors. Externalizing behaviors include; lying, emotional outbursts, yelling, complaining and destruction of property. On the other hand, internalizing behaviors may consist of feeling or depression, threatening to physical harm, fantasies and limited peer interactions. This paper examines the various behavioral disorders in Joe's case study, causes, and treatment.
Behavioral Disorders
Attention Deficit Hyperactive Disorder (ADHD)
ADHD is a neurobehavioral disorder found mostly in school-aged children, but not exclusively. The disease presents itself in three significant symptoms; inattention, impulsivity, and hyperactivity ( Barkley, 2014). According to the DSM-IV, children affected by this condition differs with the rest of the children for being in constant movement, difficulties in participating in class activities as well and proper relationship with the peers /teachers. In the case study, Joe exhibits some of the symptoms associated with ADHD. One, Joe has difficulties sustaining focus and is often disorganized. His teacher at the beginning of the year admitted that he always seems distracted in class during learning. He does not follow through instructions that relate to how to behave while in class. Besides, he rarely can finish his homework due to his chaotic nature resulting in poor grades. Secondly, regarding hyperactivity, he is continuously in the moves including in situations that are not appropriate. It is noted that most of the times he often disrupts the class by talking excessively and loudly to his teachers and peers. He has difficulties respecting the authorities and respecting classroom rules. Lastly, Joe acts on impulse without thinking about the consequences of his action. In the company of his peers, slight provocations tend to make him angry to the extent of fighting with them. Many of his classmates have reported Joe for having fought or threatened them.
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Conduct Disorder (CD)
CD is one of the behavioral disorders that is that is characterized by a recurrent pattern of aggressive behavior as well as the non-aggressive rule of breaking prescribed codes of conduct ( Daley & Birchwood 2010) . Conduct disorder often manifests itself in childhood and adolescence, with boys outnumbering girls. CD manifests itself in four main symptoms according to the DSM-IV manual. First, the affected person lacks remorse or guilt for doing something that is not right. Some of the classmates have reported Joe for harassing and beating them, but he does not seem to feel guilty over the matter. He does show great concern about the negative consequence of his aggressive behavior such as being discontinued from his studies or punishment from the teachers. Moreover, he is callous as he disregards and is unconcerned about the feeling of the rest of the classmates. Most of the time, Joe disrupts the class by shouting, but that does not bother him. He does not even care that his aggressive behavior towards others many cause them injuries or other serious health complications. Joe appears that to be concerned more about the effects of his actions on himself rather than on others.
Most of the CD victims are always unconcerned about their performance in school and other related activities. Joe grades in schools continue to get poorer but, does not put forth the effort necessary to perform well. He continues to refuse to complete his school assignment regardless of his teachers and parents concern. He typically blames his siblings for his poor performance as well as his aggressive behavior. Lastly, individuals suffering from CD have problems following various rules. Joe has been in the spotlight for not following class rules as well as disobeying the teachers. He is always shouting and fighting in class disrupting the learning process. Similarly, he does not respect his teachers and often argues with them excessively and loudly. His parents also report that he blatantly refused to follow stipulated rules at home.
Assessment
As with others behavioral disorders, the approach to clinical evaluation should be systematic and comprehensive. Depending on the information collected from Joe's parents, teachers, and his history, Joe manifests more symptoms of ADHD as compared to those of CD. According to the current Diagnostic and Statistical Manual of Mental Disorders DSM-IV TR, for an individual to be diagnosed to be suffering from ADHD, they must experience two dimensions of symptoms either inattention, hyperactivity or impulsivity for more than six months( Daley & Birchwood 2010) . Moreover, the symptoms causing the impairment must also be present before they are seven years and must be observed in two sets. Similarly, the signs must have significant implications in the social and academic functioning of the patient. All these criteria fit into Joe's situations; first, he manifests symptoms of impulsivity, inattention, and hyperactivity in his daily activity. The symptoms started revealing themselves as he was still in kindergarten. The teachers would occasionally complain about his behavior, but he did not show any improvement. In elementary school, his impulsive behaviors continued, and his teachers described him as being immature and argumentative with authority figures. This kind of behavior has made him perform well in school due because of his low concentration and failure to complete assignments. His social interaction with his peers and teachers is also very poor due to his aggressive behavior and failure to respect the authority. This is in contrast with Conduct Disorder (CD) that mainly delves into aggressive behavior such as threatening, physical violence, and property destruction. This disorder occurs mostly in adolescents over the age of 16 years who are trying to show their muscle power. This is a contrast with Joe's behaviors which started when he was in kindergarten and progressed to elementary school which is the primary criterion for the diagnosis of ADHD.
Causes
For many years, it has been a challenge to define the exact cause of the disorder in children as well as in adults. Often, accurate clinical diagnosis is costly as it requires extensive lab test for an extended period. Recent studies, however, show that the brain is the leading causes of ADHD. The brain is composed of four main parts. The frontal lobe of the cerebrum is one part of the brain that helps individuals solve their problems, restraint on impulses and understand the behaviors of others. The basal ganglia interconnect the cerebrum and the cerebellum to allow motor coordination of various pulses. In most cases, children who have ADHD have an abnormally small volume of the white matter as compared to healthy children ( Moon, 2012). This kind of development in the brain happens due to early exposure to drugs and environmental toxins at a young age and during pregnancy. The brain tissue of the children develops with sustained effects hence exposing them to inadequate regulation of motor activity and impulses. The result is the development of children and adolescents with hyperactivity, inattention, and impulsiveness the core symptoms of ADHD.
Research studies show that ADHD is more likely to be prevalent in the United States as compared to other countries. 8.4 percent of children between the ages of 3 and 17 are likely to have received the ADHD diagnosis at some point in their lives ( Biederman et al. 2010) . In the recent years, the percentage of children suffering from the illness has increased to 22 percent ( Biederman et al. 2010) . The differing cultural constructions are said to some extent contributed to the increasing cases of ADHD. The cultural emphasis on individuality and competitiveness has played a substantial role in creating the necessary precondition for ADHD to thrive. Children in most encouraged to live without having meaningful interaction with their peers. The result is loneliness which causes some irritability especially if anyone provokes the child. The children, therefore, end up forming aggressive behavior to compensate their inadequacies.
The pharmaceutical industries, as well as a hospital in the United States, are profit driven. Most of them may end up being misdiagnosed with an illness hence receiving inappropriate treatment. The medications may expose the children to other forms of diseases rather than preventing them. Further diagnosis can potentially create negative expectations for child behavior. Besides, children may also apply the stereotype associated with the determination further harming their self-esteem and confidence.
Studies conducted in many clinical setting reveal that boys are likely to be diagnosed with ADHD than girls. In many cultural backgrounds, males are known to exhibit aggressive behaviors especially when confronted with a situation. In most cases, therefore, clinicians do not use the diagnostic criteria for ADHD but often allow cultural stereotypes to influence their clinical judgment. Recent studies show that even if the same behaviors were found between males and female, a male patient was likely to be perceived as suffering from ADHD by the clinician ( Moon, 2012).
Treatment
In most cases, teachers are the first to notice the symptoms of ADHD in children as compared to the caregivers. It is important at first to furnish the parents with appropriate information on the behaviors of the children to help with the diagnosis and treatment. To treat ADHD, teachers can work with the doctors to help solve the problems facing the child. The teacher can use specific instructional and behavioral strategies in the classroom to help the child concentrate more in class. He or she can suggest various homework strategies to improve the complete student assignments at home. The teacher should communicate daily with the parents of the child as a way of monitoring his progress to achieve both behavioral and academic goals.
Psychosocial treatments, such as behavioral and cognitive therapies are essential in the treatment of ADHD. Cognitive Behavioral Therapy (CBT) is one of the psychological therapies that target at treating disruptive behaviors, irritability, and depression which are the major systems of ADHD. On such a therapy program, the child is expected to attend therapy classes where various intensive behavioral strategies are used to lessen the impact of the symptoms on the child. Besides, the parents of the child are taught on policies that will help them cope with the child while at home. Behavioral programs are also designed for the child to increase good classroom behavior such as obeying rules, interacting with others, paying attention and controlling impulses ( Fabiano et al., 2009) .
To help children cope up with the symptoms of ADHD, various medications have been assessed to reduce impulsivity, hyperactivity and improve attention. Stimulant medications over the years remain useful in the treatment of ADHD in combination with various behavioral therapies. Some of the medications approved by the Food and Drug Administration (FDA) such as methylphenidate and amphetamines are effective in treating ADHD. The drugs are very safe in school going children and should be used under medical supervision.
Controversial issues Treatment and Diagnosis of ADHD
Over the years, many discussions have ranged on whether the age-of-onset criterion is essential in the diagnosis of ADHD. Most of the clinicians have argued that ADHD is a lifelong disorder that can occur at any stage at an individual life, particularly in adults. Studies conducted that only half of the adults diagnosed with ADHD symptoms had the same symptoms at the age of 7( Zeitlin, 2006). The other half did not experience the same symptoms when they were young but occurred during adulthood. The specific age requirement of seven years, therefore, is essential in the diagnosis of ADHD. Studies in children suggest that the prevalence of ADHD is higher in males than in females. Females are likely to be less symptomatic when it comes to impulsivity and hyperactivity as compared to boys (Graetz et al. 2005).
In the treatment of ADHD, there has been a lot of disagreement for a long time over the treatment of the condition. Arguments have it that ADHD is the condition which its outcome and response to treatment is not well known. Therefore, children should not be given treatment or medications for behavioral malpractices. Thus, clinically, not all children showing the DSM-IV criteria prescribe symptoms should be subjected to therapy without satisfactorily determining whether their behavior is dysfunctional or dangerous ( Zeitlin, 2006). Treatment should only happen if the signs are lowering adaptive functioning, poorer social interaction and low academic performance as compared to normal controls.
In conclusion, ADHD has been established as a behavioral disorder that occurs in children and young adults. The disorder manifests itself in symptoms such as hyperactivity, impulsivity, and inattention. As the symptoms progress, they cause significant impairment in the academic performance of children, social and occupation interaction as well as adaptive functioning. Despite having been recognized as a fairly impairing disorder, the illness is treatable through various medications and psychosocial strategies. For a clinician, it is essential to do the right diagnosis subsequent treatment to provide the proper relief to the patient, teachers as well as the families.
References
Barkley, R. A. (Ed.). (2014). Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment . Guilford Publications.
Biederman, J., Petty, C. R., Evans, M., Small, J., & Faraone, S. V. (2010). How persistent is ADHD? A controlled 10-year follow-up study of boys with ADHD. Psychiatry research , 177 (3), 299-304.
Daley, D., & Birchwood, J. (2010). ADHD and academic performance: why does ADHD impact on academic achievement and what can be done to support ADHD children in the classroom?. Child: care, health, and development , 36 (4), 455-464.
Fabiano, G. A., Pelham Jr, W. E., Coles, E. K., Gnagy, E. M., Chronis-Tuscano, A., & O'Connor, B. C. (2009). A meta-analysis of behavioral treatments for attention-deficit/hyperactivity disorder. Clinical psychology review , 29 (2), 129-140.
Graetz, B. W., Sawyer, M. G., & Baghurst, P. (2005). Gender differences among children with DSM-IV ADHD in Australia. Journal of the American Academy of Child & Adolescent Psychiatry , 44 (2), 159-168.
Moon, S. (2012). Cultural perspectives on attention deficit hyperactivity disorder: A comparison between Korea and the US. Journal of International Business and Cultural Studies , 6 , 1.
Zeitlin, H. (2006). Attention Deficit Hyperactivity Disorder: Legal and Ethical Issues. Medico-Legal Journal , 74 (4), 166-168.
