Among the most complicated organs in the animal kingdom is the human brain while arguably the most complicated process is the human psychological development. The complication and complexity are augmented when a problem arises within the said organ or system. It is perhaps for this reason that problems that arise during the process of human development are difficult to define or manage. ADHD is an example of such a development as has been defined as a neurodevelopmental condition that manifests in childhood between the ages of 6 and 12. The instant research paper reports in the outcome of a careful perusal and analysis of available research on the subject. Based on the said studies, there is very little consensus on what amounts to ADHD. Further, there are several diagnostic approaches that do not conform to each other. Finally, several treatment regimens exist, some based on pharmacological intervention and others on behavioral therapy. The only notable consensus in many of the perused articles is that pharmacological interventions are effective. There, however, seems to be some information gaps and inconsistencies in some aspects of the disease including on issues such as prevalence. A global prevalence estimate variance as low as 3% and as high as 20% is clearly untenable. Further and more substantive research is thus necessary to better understand ADHD.
Introduction
Attention deficit hyperactivity disorder (ADHD) can be defined as a neurodevelopmental condition that manifests in childhood and can remain persistent until adulthood. Among the common symptoms of ADHD include difficulty in paying attention for a duration of time or at all and hyperactivity (Friedman & Rapoport, 2015). Patients may also exhibit behavior that is not consistent with the age of the child and also that does not seem to consider adverse consequences. Although the primary focus on ADHD is in children, the condition has been known to subsist in adulthood too. However, most adult patients will develop coping mechanisms gradually but definitively but may still need professional help. (Friedman & Rapoport, 2015). ADHD is also an extremely controversial subject. For a start, there have been arguments that it is not a real psychological condition. However, most mainstream scholars believe in its existence but dispute its prevalence and diagnosis. ADHD is treatable through both pharmacological intervention and behavioral therapy (Friedman & Rapoport, 2015). However, the most important aspect of ADHD management is support from those closest to the patient such as parents, friends, and teachers. Despite the same, there seems to be an inordinate focus in pharmacotherapy (Yasumura et al. 2019). On a positive note, ADHD is not known to have major complications and if handled properly, most patients are able to have a productive life in spite of the condition (Friedman & Rapoport, 2015). ADHD is a major psychological issue affecting children and whose impact can adversely affect their futures yet despite its having been known to exist for decades, very limited substantive knowledge has been developed about it.
Delegate your assignment to our experts and they will do the rest.
Diagnostic criteria from the DSM
The diagnosis of ADHD is one of the most controversial aspects of the ailment with some experts arguing that ADHD is over-diagnosed while others argue that it is underdiagnose. A good example of the controversy can be found in Anhalt, McNeil, & Bahl, (1998) which states “ A review of research based on teacher-rated symptoms reported prevalence rates from 8.1% to over 20% ” (P. 397). The difference between 8.1% and 20% is monumental more so when it relates to a condition that can so adversely affect the child. Be that as it may, in the USA, diagnosis of ADHD is based on American Psychology association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) (de Zeeuw et al., 2015). The diagnosis is based on a set of six to twelve symptoms which must manifest between the ages of 6 and 12. The symptoms must manifest in more than one definitive environment. The process will involve observational instruments filled by two adult observers from each of the two environments such as home and school respectively (de Zeeuw et al., 2015). ADHD is controversial and other more definitive diagnostic tools are being developed. The said article de Zeeuw et al., (2015) then proceed to outline APA’s DSM process. The two sets of observers, mainly a teacher or a parent, without any understanding of psychology or diagnostics, are simply required to indicate what they have observed regarding the child. It is the specialized questionnaires themselves that will eventually reveal the diagnosis. However, differential diagnosis is also carried out to rule out any secondary explanations for the behavior that may be misinterpreted as ADHD.
Prevalence and Incidence
Due to the controversial nature of ADHD, its prevalence has been a matter of controversy. A peer-reviewed article published in 1998 indicates the estimated prevalence rates of ADHD at between 8.1 and 20% as has been quoted in the segment above. The article, however, is quick to clarify that the estimates are based on interviewing teachers. Further, the article also indicates that a failure to interview teachers can lead to a gross underestimation of ADHD prevalence. Over 8 years after the publication of the article above in 2006, another article Lauth, Heubeck, & Mackowiak, (2006) places the estimated prevalence of ADHD at between the very same 8.1% and 20% from a global perspective. The article proceeds to indicate that the variance between prevalence is mainly predated on the different diagnostic tools used for ADHD diagnosis. For example, prevalence made using the APA’s DSM has a prevalence of around 11% but another tool might give a much lower prevalence rate (Lauth, Heubeck, & Mackowiak, 2006). In a surprising twist, Weyers, Zemp & Alpers (2019), a very recent article places the prevalence of ADHD at a much lower 3%-5% citing a 2015 study. Considering the fact that ADHD is not a communicable disease or a lifestyle disease whose prevalence can be effectively diminished, the available statistics on the prevalence of ADHD reflect just how little is known about the issue. It is, therefore, necessary for proper research to be carried out so as to create a definitive understanding of ADHD prevalence. Most importantly, it is critical to streamline ADHD diagnostic procedures globally so as to enable a better estimation of prevalence.
A Review of Theoretical Perspectives on the Causes of the Disorder
There has not been any definitive confirmation for the causation of ADHD. However, theoretical perspectives on its causes can be developed based on its prerequisites. Most available research shows ADHD as a developmental disorder hence its causation must be a combination of nature and nurture. Conversely, according to Yasumura et al. (2019), ADHD does show physiological attributes such as decreased activation of the center and right prefrontal cortex (PFC). The argument made in Yasumura et al. (2019) is monumental in its impact on the causation of ADHD. If ADHD can be diagnosed using a physical test on the functionality of the brain, it means that it is tied to the actual physical development of the human brain. Conversely, ADHD can be controlled through behavioral therapy or even a kit that uses rewards and enforcement. (Anhalt, McNeil, & Bahl, 1998). The behavioral management of ADHD can connect causation to environmental factors. Yet another theoretical approach that would support the environmental causation of ADHD can be predicated on Irwin et al. (2019) which argues that functionally, children with ADHD perform at par with children who are developing normally. As per the research, the performance differences between children with ADHD and others are mainly based on their inability to focus or appreciate instructions. If proper instructions are presented and accepted, children with ADHD would perform at the same level even in complex physical tasks (Irwin et al., 2019). ADHD may thus not be a substantive mental problem but rather just a behavioral issue. It is important to note that despite the limited and even contradictory knowledge about the causation of ADHD, not much research is predicated on the same. To give a few examples of contradictions, the relatively new research articles of Irwin et al. (2019) and Yasumura et al. (2019) expressly state that new research shows that what was earlier believed about ADHD is wrong but without coming up with substantive findings about what actually causes ADHD. Instead of finding out the cause, most research is predicated on the treatment of ADHD and specifically pharmacotherapy (Hautmann et al.. 2018).
A review of Treatment Approaches
The treatment and management of ADHD are highly researched and published. Two main research regimens exist, one based in pharmacological intervention and the other on behavioral therapy. Treatment for ADHD has also to be combined with management which includes a lot of parental support and assistance at school. The importance of parental support is clearly outlined in Weyers, Zemp & Alpers (2019), an article that focuses on the impact of raising a child with ADHD on its parents. According to the research and analysis, parents who raise a child that is suffering from ADHD have a higher propensity for conflict and their conflict may affect their ability to take care of the child. ADHD management is thus an affair for the entire family. Parents who are raising a child with ADHD need to be at peace with one another so that they can take good care of the child.
Conversely, ADHD management also involves assistance from the teacher to prevent the condition from taking away the child’s ability to get an education. According to Anhalt et al., (1998), a teacher can develop simple innovative measures to assist a child to overcome the extremities of ADHD. Such measures can include, reward and punishment and peer-intervention by classmates. Having a good relationship with peers can also assist in the management of ADHD (Lauth, Heubeck, & Mackowiak, 2006). Such interventions can improve the behavior of the child in class enabling both the child and other children to get an education.
With regard to actual clinical attention, two main treatment approaches are available for ADHD, the first being therapy and the second, mediation. According to Hautmann et al. (2018), available research shows that behavioral therapy and cognitive therapy are effective treatments for ADHD. However, Hautmann et al. (2018) further indicate that there has been very limited actual research and publication on the impact and effects of cognitive and behavioral therapy. Instead, most of the research and publications have been focused on pharmacotherapy as is evidenced below. Indeed, as is engendered in the Saint Leo core value of respect, it has been argued that pharmacological intervention on children can be a form of abuse or treating children as a means to an end by pharmaceutical companies.
Among the studies that may fly in the face of the Saint Leo core value of respect is McLennan, & Sparshu, (2018) that advocates for the resumption of pharmacotherapy for whom it has been stopped for a variety of reasons. Among the reasons given in the study for stopping pharmacotherapy is extreme side effects or ineffectiveness. However, according to McLennan, & Sparshu, (2018), after the children have been taken off one pharmacotherapy option after another and for some reason each of the options has failed, it would be recommended to retry the pharmacotherapy options that had been tried and rejected before as they might just work during the second effort. It is evident that some researchers are determined to support pharmacotherapy at all costs.
Yet another research that expressly supports pharmacotherapy is Courtabessis et al., (2018) which seeks to vindicate prescription of stimulant drugs to children. In Europe, the rules for prescribing pharmacotherapy for children are quite stringent, unlike the USA where stimulants can be prescribed as first-line drugs. However, according to Courtabessis et al., (2018), an evaluation of a collection of children who had been prescribed with the stimulant methylphenidate clearly revealed that such a prescription was warranted and within the European Union guidelines. The article also reflects the effectiveness of stimulants in the mitigation of the extreme symptoms of ADHD even for children. As evidenced by the research and analysis above, three main approaches to the treatment of ADHD exist being behavioral or cognitive therapy, pharmacotherapy, and management therapy from friends, teachers, and parents. Although most research focuses on pharmacotherapy, all three approaches are necessary for proper treatment and management and should if possible be used contemporaneously (Hautmann et al. 2018).
A Case Example
Donny Gibbon is an eleven-year-old male Caucasian and a sixth-grader in a public school. His mother, Agnes Gibbon is single and has been for some time, having separated with Donny’s father. The separation can be attributed to Donny’s condition whose stresses precipitated a conflict between his two parents. For the first seven years of his life, Donny was an ordinary child, charming and playful. His playmates, however, would sometimes contend that he would sometimes get extreme during playtime. But everyone lived Donny and he was fun to be around hence his transgressions would be quickly forgiven and forgotten. Things, however, took a turn when Donny was seven years old. He would be extremely irritable and would throw a tantrum with the least of provocation and in some cases, without any provocation. Further, the accusation of taking games went too far including pushing a playmate down the staircase. Donny also wanted to play all the time including when he was supposed to be eating or sleeping.
His mother was further consternated to learn that Donny’s behavior at home was being replicated at school. Finally. Donny’s teacher suggested that he needed help. His mother was in denial but also extremely apprehensive. Few people were aware but the cause of Donny’s mother's apprehension was because she had developed signs of ADHD when she was Donny’s age, being diagnosed and treated for years. Gradually, Agnes had overcome her handicap, gotten a job as a paralegal and able to live a comfortable and productive life.
Eventually, Agnes took Donny to a psychologist who after careful evaluation of Donny’s behavioral history suggested diagnosis for ADHD. The psychologist prepared two forms, one to be filled by Donny’s mother and the other by the by his teacher. It is upon careful evaluation of the two forms and the undertaking of other tests to rule out any other causation that Donny was diagnosed with ADHD. By this time, Donny’s mother was extremely distressed by Donny’s situation hence her conduct led the doctor to believe that she was yet to overcome her ADHD. The psychologist had off course become aware of Agnes’ medical history during the inquiry about Donny’s medical history.
The psychologist happened to belong to the school of thought that held that in the case of an ADHD mother and child situation, the right approach to treating the mother first, then treat the child. Agnes was placed in Adderall XR and weekly behavioral therapy for 45 days. It was only after her sessions ended that management for Donny begun and during the 45 days, his condition had deteriorated, more so because he noticed and sensed changes in the character of his mother. Donny was put on behavioral therapy while his mother and teacher were advised on how to treat him.
Donny’s mother and teacher sought to assist him to get better organized at home and at school and also took the time to guide him, mainly through rewards for good behavior. Gradually, Donny’s behavior begun to improve and he had more good days than bad ones. However, several months later, he banged a toy on the head of a playmate with neither provocation nor warning, sending the playmate to the hospital. It was at this point that the psychologist prescribed methylphenidate for Donny, which was combined with the behavioral therapy regimen.
Gradually but definitively, the combination of therapy, mediation, and assistance from his mother, his teacher and a teaching assistant hired by his mother begun to bear fruit. Currently, Donny will sometimes portray excessive behavior and act like a six-year-old. In a rare occasion, he will also seem detached from reality in his actions, more so when playing hence his mother has to be careful about the toys he is exposed to. However, Donny has generally been able to live a relatively normal life, pursue his studies at par with his peers and also make many friends. Donny aspires to become a psychologist and everyone agrees that he is up to the challenge.
Conclusion
The primary conclusion from the sub-total of the above is that a lot of research and analysis has been undertaken regarding ADHD but there is no definitive information about it. Most experts agree on its existence but not its cause, prevalence, diagnosis or management. With regard to the cause, available research seems to contradict one another in their theoretical approaches. Some go as far as to suggest that in ADHD, there is the actual physical impact on the brain specifically on the prefrontal cortex (PFC). Other experts believe it is a combination of nature and nurture and yet others that it is a behavioral issue. Similar contradictions exist regarding the prevalence of the condition with estimates ranging from as low as 3% to as high as 20%. The fact that there is no definitive globally accepted diagnostic tool is also an important issue that needs to be resolved. The only area that most research seems to focus on and indeed agree is on how effective pharmacotherapy is. Be that as it may, available research does provide important details about ADHD. This includes the fact that ADHD is a neurodevelopmental condition that manifests in childhood between the ages of 6 and 12. The condition may be existent in the life of an individual for a lifetime but during adulthood, effective coping mechanisms are developed. Most importantly as reflected above including in the case study, ADHD is manageable through a combination of cognitive or behavioral therapy by an expert professional, pharmacotherapy and management/support therapy. The support therapy can be gotten from parents, teacher, and peers. It is important to note that ADHD also has an adverse impact on those who interact with the patient, more so family members, classmates, and friends hence they may also need help. An interesting aspect about ADHD research is the contradictions involved. For example, new research has starred debunking already existing research yet only recommending for further research. It is imperative that a substantive set of knowledge about ADHD be developed through proper and effective research strategies.
References
Anhalt , K., McNeil, C. B., & Bahl, A. B. (1998). The ADHD Classroom Kit: A whole‐classroom approach for managing disruptive behavior. Psychology in the Schools , 35 (1), 67-79.
Courtabessis , E., Pupier, F., Surig, L., Picot, M. C., Nogué, E., Macioce, V., ... & Purper-Ouakil, D. (2018). Clinical factors associated with decision to recommend methylphenidate treatment for children with ADHD in France. European child & adolescent psychiatry , 27 (3), 367-376.
de Zeeuw, E. L., van Beijsterveldt, C. E., Lubke, G. H., Glasner, T. J., & Boomsma, D. I. (2015). Childhood ODD and ADHD behavior: The effect of classroom sharing, gender, teacher gender and their interactions. Behavior Genetics , 45 (4), 394-408.
Friedman, L. A., & Rapoport, J. L. (2015). Brain development in ADHD. Current opinion in neurobiology , 30 , 106-111.
Hautmann, C., Döpfner, M., Katzmann, J ., Schürmann, S., Metternich-Kaizman, T. W., Jaite, C., ... & Hennighausen, K. (2018). Sequential treatment of ADHD in mother and child (AIMAC study): importance of the treatment phases for intervention success in a randomized trial. BMC Psychiatry , 18 (1), 388.
Irwin, L. N., Kofler, M. J., Soto, E. F., & Groves, N. B. (2019). Do children with attention-deficit/hyperactivity disorder (ADHD) have set shifting deficits?. Neuropsychology .
Lauth, G. W., Heube ck, B. G., & Mackowiak, K. (2006). Observation of children with attention‐deficit hyperactivity (ADHD) problems in three natural classroom contexts. British Journal of Educational Psychology , 76 (2), 385-404.
McLennan, J. D., & Sparshu , S. (2018). Returning to stimulants in children with treatment resistant ADHD: A case series. Journal of the Canadian Academy of Child and Adolescent Psychiatry , 27 (1), 62.
Weyers, L., Zemp, M., & Alpers, G. W. (2019) . Impaired Interparental Relationships in Families of Children With Attention-Deficit/Hyperactivity Disorder (ADHD). Zeitschrift für Psychologie .
Yasumura, A., Omori, M., Fukuda, A., Takahashi, J., Yasumura, Y., Nakagawa, E., ... & Aihara, M. (2019). Age-related differences in frontal lobe function in children with ADHD. Brain and Development .
