Attention Deficit Hyperactivity Disorder

Introduction

Although regarded as a childhood disorder, Attention deficit hyperactivity disorder could also extend into adolescence and adulthood. It is characterized by difficulties in staying focused and paying attention among children, problems with control of behavior and more prominently, hyperactivity (National Institute of Mental Health, 2009, para. 1). The disorder has three main subtypes: predominantly hyperactive impulse, the predominantly inattentive type and combined hyperactive- impulsive and inattentive disorder. The essay will critically review the clinical description, comorbid psychological disorders, aetiology and the clinically supported psychological disorders and a summary of the Diagnostic and Statistical Manual of Mental Disorders (DSM IV) of mental disorders.

Attention Deficit Hyperactivity Disorder

Children suffering from predominantly hyperactive impulse have fewer than six symptoms of inattention presently. Most symptoms in this category are of hyperactivity – impulsivity type. In the predominantly inattentive subtype, the majority of symptoms fall in the inattention category. However, fewer symptoms of hyperactivity-impulsivity are normally present (Mick, Biederman, Faraone, Sayer & Kleinman, 2002, p. 381). Children exhibiting this subtype do not have problems related to getting along with other children (DSM-IV-TR workgroup, 1994). Children suffering from ADHD pay little if any attention to the environment around them. Consequently, there is the possibility for teachers and parents to overlook such children. Combined hyperactive-impulsive and inattentive subtypes are characterized by combined type of ADHD in most children. Inattention and hyperactivity –impulsivity symptoms are normally present in this subtype (National Institute of Mental Health, 2009, para. 1). According to national institute of mental health (2009), the symptoms may entail distractions, difficulty in comprehension and processing of information, fidgeting, inability to act quietly and impatience. However, the fact these symptoms are observed in many diseases and condition make the clinical description prone to ambiguity thus unreliable in diagnosis. This is mostly evident in schools where the children are taken to experience emotional and sometimes disciplinary problems.

There is a high chance for misdiagnosis owing to the lack of clear diagnosis of causative agents and factors, diagnosis and treatment procedures for ADHD (Allen, Avram, Mack, Ruth & Michael, 2000, p. 81). Various studies have shown how genes, environmental factors and brain injuries result in its development, but none has gathered enough evidence and supporting information to validate their case (Braun, Kahn, Froehlich, Auinger & Lanphear, 2006, p. 2006). The medications offered do not offer cure but act to minimize and lower the symptoms thus helping the children participate normally in daily chores. The medications have major side effects such as cardiovascular disorders which may lead to severe consequences to the children

The DSM IV was published in 1994 and includes a compilation of mental disorders affecting mainly children and adults. The manual is useful in outlining the major causes of the various mental disorders. Vital statistics of the prevalence and incidences in terms of several parameters are elaborated in order to help various in planning and management of the condition. Parameters such as age on onset, and the prognosis are clearly outlined in the manual. The manual acknowledges and utilizes research on recent developments on optimal treatment approaches in order to enable the physicians and psychiatrist to effectively review and utilize the knowledge. The psychiatric disorders have been sorted by name, the disorder code and category for ease of reference and retrieval. The DSM typically utilizes a multi dimensional approach in the diagnosis since an individual health is usually impacted by various factors. The five dimensioned approach is vital in the understanding and the diagnosis of the disorders.

One of the dimensions entails the diagnosis of the clinical syndromes which is enhanced by sorting of the various disorders by use of name, category and code (Biederman, 1998, p. 11). Axis II look into the developmental disorders and clinical syndromes associated with personality to help ascertain the impacts of the disorders. The physicians also rely on the physical conditions such as injuries to the brain to assess their roles in the development and perpetuation of the disorders. The DSM IV also takes note the severity of the stressors in psychosocial life and the impact on the developmental and clinical syndromes. The final axis is useful in helping in the rating of the level of functioning with the aim of informing the understanding of the overall impact of the other axis on an individual. The clinician is also able to deduce the changes expected in the individual (Allpsychonline, 2004).

Bipolar disorder and anxiety disorders are among the disorders commonly associated with ADHD. The disorder is widely known for causing varying shifts in the moods and the levels of activity thus impeding on the ability of the individual to carry out the normal daily activities. Severe symptoms ensue and may result in termination of social relationship and below average performance in school work. Suicidal occurrences have been reported to be high particularly when the bipolar disorder acts as a comorbid for other disorders (Jensen, Arnold & Swanson, 2007, p. 991). Bipolar disorders are unrecognized as a manifestation of a larger problem. The assumption that they are separate problems leads to misdiagnosis and ineffective treatment which spreads over several years before careful management takes place. Individuals experience manic and depressive symptoms that are identical to symptoms of other disorders. The lack of a clear diagnostic method makes it hard for doctors to detect the disease. The reliance of elimination procedures is not only cumbersome but also unreliable. Long term medications combined with psychotherapy is depressing and has severe side effects to the persons (Miklowitz, 2006, p.28-33).

Anxiety disorders also complicate the management of ADHD. The anxiety disorders are usually the normal reactions to situations that are stressful such as cumbersome office work or a demanding examination revision. Its symptoms include restlessness and lack of sleep is confused with other conditions to initiate the correct therapy. Treatment is dependent on the situation and sometimes on the person’s preferences. The need to combine several therapies such as medication and psychosocial therapy and their high probability of failing is detrimental in the effective management of the disorder (Hyman & Rudorfer, 2000).

The biopsychosocial model is an approach that is important in the understanding

of the biological, social and the psychological factors are integrated particularly in the causation and perpetuation of diseases. The intertwining of the three factors help in explaining a slight deviation of body processes brought about out by injury or attack by pathogenic microorganisms (Engel, 1977, p.129). The model is based on the presumption that the empirical literature which denotes that the patients perceptions and the barriers that impede the accessibility of health care have an overall impact in the health seeking behavior of the individuals. The cultural factors and social relations are vital in dictating whether medication and other physical therapy will be adhered to. In the case of attention deficient hypersensitive disorder, the causation revolves around the three factors. The role played by the biological factors such as genetic make up is not adequately evidenced. This has complicated the prevention and control efforts since the genetic makeup would enhance the scientists to know the persons who are typically susceptible to the disorder. However, neuroimaging by the national institute of mental health have tried to explain the embryonic and the early child development by relating the dopamine levels and the size of the thickening of the brain.

Environmental factors have been found to cause huge impacts to the development of ADHD due to the high levels of substance abuse witnessed in the world. Braun et al found that the exposure to environmental contaminants is a risk factor in the development and perpetuation of ADHD. Exposure to tobacco and to some extent environmental lead, particularly in unborn babies, in the United States has led to increased cases of ADHD in children (Braun et al, 2006, p.1904-9). Case control studies have indicated a four fold increase in the association between the prenatal tobacco smoke exposure and the increased risk of contracting ADHD (Mick et al, 2002). Moreover, the study indicated that the development of externalizing factors in children thus exposing them to symptoms associated with ADHD.

Treatment of ADHD takes many forms that include combinations of several therapies and medications that are either short or long term. The most effective include the utilization of lifestyle changes, counseling and modifications in behavior to help the patient receive maximum benefits (Gentile, 2004, p.24-30). Although the mechanisms have been shown to have mixed effects and outcomes in varying lengths of time, they actually help the patients to cope with the different situations they find themselves in.

Medications offer the most viable and cost effective measure for the management of the disorder. However, it lengthy utilization for periods more than one year offers the person no added value compared to other forms of treatment (Jensen, Garcia & Glied, 2005, p.1475-88). There is also no documented evidence to ascertain the comparative effectiveness of the various medications used in the management. This means that there lacks substantial evidence regarding the association of the effectiveness of the drugs on one hand and the performance and uptake of social behaviors on the other hand (Jensen, Arnold & Swanson, 2007, p.132). Little literature to support the use of stimulants in ADHD treatment disproves the effectiveness that is thought to be offered by them. That the continued exposure to these stimulants are possible causes of increased cases of bipolar disorders tends to justify why the stimulants is not among the safest remedial procedures (Schatcher et al, 2001, p. 1475-88).

Conclusion

There is a high chance for misdiagnosis children with ADHD owing to the lack of clear diagnosis of causative agents and symptoms (Schaffer, 1996, p. 328).

Bipolar and anxiety disorders have similar symptoms that make it hard to differentiate with ADHD. The biopsychosocial model has helped in understanding the causation while analysis of the treatment procedures is vital in selecting the best alternative.

Reference

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AllPsych Online (2004). The Virtual Online Classroom. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Web.

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Jensen, P., Arnold, L., Swanson, J. ( 2007). 3-Year Follow-up of The NIMH MTA Study. Journal of the American Academy of Child and Adolescent Psychiatry, 46(8): 989–1002.

Mick ,E., Biederman, J., Faraone, S., Sayer, J., Kleinman, S. ( 2002). Case Control Study of Attention Deficit Disorder and Maternal Smoking, Alcohol Use, and Drug Using During Pregnancy. Journal of American Academy Child Adolescent Psychiatry, 41(4): 378–384.

Miklowitz, D. (2006). A Review of Evidence-Based Psychosocial Interventions for Bipolar Disorder. Journal of Consultancy Clinical Psychology, 67(11): 28-33.

National Institute of Mental Health (2008). Transforming the Understanding and Treatment of Mental Illness Through Research. Attention Deficit Hyperactivity Disorder. Web.

Schachter, H., Pham, B., King, J., Langford, S., Moher, D. (2001). How Efficacious and Safe is Short-Acting Methylphenidate For the Treatment of Attention-Deficit Disorder in Children and Adolescents? A Meta-analysis. CMA Journal, 165(11): 1475–88.

Schaffer, D. (1996). A Participant’s Observations: Preparing DSM-IV. Canadian Journal of Psychiatry, 41(2): 325–329.

DSM-IV-TR workgroup. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC: American Psychiatric Association. Web.