Attention All

ATTENTION ALL

An Essay on Attention Deficit Hyperactivity Disorder

Attention-deficit hyperactivity disorder (ADHD), one of the most prevalent childhood neurobehavioral disorders, affects 3% to 5% of the school-age population. Boys outnumber girls three or more to one. The research on the causes of ADHD is still in the early stages. There is a definite link between genetics and ADHD; however there may be other factors which contribute to the development of the disorder. Characteristic behaviors of children diagnosed with ADHD are inattention, hyperactivity and impulsiveness. Children with ADHD are at high risk for behavior problems, scholastic difficulties, and poor social relationships. Parental, professional, classroom, and/or pharmaceutical interventions may be necessary to promote the welfare and development of the child. ADHD is a chronic condition continuing into adulthood in approximately half of all childhood cases. Often the hyperactive-impulsive symptoms diminish in adulthood, however the attention problems may persist.

There is no definitive answer to the question, "What causes ADHD?" Despite years of research, the cause of Attention Deficit Hyperactivity Disorder still remains somewhat unclear or incomplete. Evidence does however indicate that there are many factors contributing to the disorder, among them genetic and neurobiological vulnerabilities. "While its precise neural and pathophysiological substrate remains unknown, an emerging literature suggests the presence of abnormalities in frontal networks or frontal-striated dysfunction" (Wilens). Although there are several theories to try to explain the causes of ADHD, most experts agree that it is most likely not any single cause, but instead a combination of factors. In addition to genetics, poor or inadequate prenatal nutrition and care, maternal alcohol or drug use during pregnancy, malnutrition, high levels of stress, and physical, neurological, or psychiatric conditionshave been suggested as contributing factors (Schwiebert).

Approximately 50% of ADHD cases can be explained by genetics. "Molecular genetic studies have implicated the dopamine D2,D4 receptors and the dopamine transporter as candidate genes" (Wilens). One study indicated that "the disorder tends to cluster in families" (Durston). Between 10-35% of children with ADHD have a first-degree relative with ADHD. Approximately half of parents, who have been diagnosed with ADHD themselves, will have a child with the disorder. Many twin studies have found a genetic link in ADHD. If one twin has the disorder, it is much more likely to be present in an identical twin than in a fraternal twin, even when the twins have been raised separately (Durston).

Some research suggests that a mother's lifestyle during pregnancy, such as smoking, the use of drugs, and stress, may contribute to certain characteristics of ADHD in children. One study found that prenatal nicotine exposure brought about structural changes and compromised the neuronal maturation. What is more important is that these initial changes profoundly influenced the development of cells that emerged later on during postnatal life. The nicotine led to the dysfunction of the dopaminergic system, which has also been observed in children with ADHD. To date, the evidence indicates possible biological mechanisms that could account for the ADHD-prenatal nicotine exposure link (Rodriquez).

There are a many medical problems that may also play a role in ADHD related symptoms. Such complications may include infections, poor hearing and eyesight, stomach problems, cerebral vascular accident, brain tumor, kidney disease, physical disabilities, hormonal and neurological disorders, learning difficulties, head injuries, and problems in utero and birth complications.

ADHD is still in the early stages of research. There remains many theories as to the cause and factors that lead to the development of ADHD. According to the most recent research the major contributor is genetics. However some research indicates that there could possibly be one or a combination of any of the other environmental factors discussed.

Most children display some of the same behaviors associated with ADHD at times, which makes diagnosing the disorder difficult and complex. Parents and professionals must observe a child over an extended period of time because ADHD children exhibit these symptoms much more consistently over time than a child at their developmental level. Although many of the signs of this disorder are present in toddlers and often earlier, most professionals and pediatricians do not diagnose ADHD until a child is in school, where the signs are often more prevalent.

"The Diagnostic and Statistical Manual of Mental Disorders," published by the American Psychiatric Association contains information on the common mental disorders "including: description, diagnosis, treatment, and research findings. This information is used by physicians and mental health providers in the diagnostic process" (Bailey). The DSM-IV states that in order to diagnose a child with Attention Deficit Hyperactivity Disorder, the child must exhibit six or more of the nine characteristics in the category of inattention, or six or more of the nine characteristics in the category of hyperactivity-impulsivity. These characteristics must persist for at least six months before the age of seven and they must have a negative affect or impairment in at least two areas of the child's daily life, either work, school, and or home (Carlson).

According to the Diagnostic Criteria from DSM-IV-TR, the primary characteristics of inattention include difficulty paying attention to details or activities, the inability to listen, the inability to follow through on or finish tasks, difficulty in organizational skills, lack of involvement in tasks involving mental effort, and distractibility and forgetfulness (Carlson). The primary characteristics of hyperactivity consist of fidgeting, squirming, excessive leaving of seats, running or climbing around in inappropriate situations, feeling of restlessness, the inability to participate in quiet activities, constant on the go attitude, and talking too much (Carlson). Impulsivity characteristics include constant blurting out, interrupting of others, and the inability to wait one's turn (Carlson).

According to Mrug, Hoza, and Gerdes, children with ADHD, display verbal and physical behaviors that are controlling, aggressive, and negative. They tend to command, tease, hit, become off-task, and be disobedient/disruptive. The study also showed they tend to be noisier than other children, cause more trouble, become angry or mad when things are not going his or her way, display more