- Introduction
Attention Deficit Hyperactivity Disorder (ADHD) is the most common neuropsychiatric order in children. Its first diagnosis on children was done in 1980s. However, the condition had been described in various names for over one hundred years. For many years healthcare professionals and providers believed that this disorder only affected children. The diagnosis of adults with ADHD disapproved this belief. It is now universally accepted that ADHD affect both children and adults across all cultures. The world prevalent rate in 2007 was 3.4% (Knutson & O'Malley, 2010).
Definition
ADHD is a neurological disorder that is partly caused by the dysfunction dopamine and norepinephrine transport in the brain. Dopamine is a neurotransmitter while norepinephrine is a hormone that affects parts of the brain which controls attention. Consequently, ADHD affects the individual’s ability to control themselves, their behavior, and pay attention to their daily tasks.
Diagnostic criteria
The diagnosis of ADHD is done by various tools that follow the Diagnostic and Statistical Manual for Mental Disorders-Fourth Edition (DSM-IV). These tools are developed for both children and adults. These include Conners’ Continuous Performance Test and Adult Self Report Scale (ASRS). The DSM-IV has outlined, frequency, severity of symptoms and situational occurrence as key conditions that ADHD diagnosis must meet. For a child to be diagnosed of ADHD, he or she must show at least 6 symptoms of intension or hyperactivity (Daley, 2006).
In order for one to diagnose an individual with ADHD, they must seek advice from a licensed health professional; whom will then ask specific questions pertaining to the child’s behavior and the environment they are exposed to on a daily basis. To be proficiently diagnosed the behavior must be excessive and long-term, easily distracted, acts out impulsively, has a difficult time focusing.
Physical and Psychological signs
Physical and psychological signs and symptoms include inattentiveness, hyperactive, impulsive. They are often very emotional and aggressive. Some pathological features of ADHD include persistent inattention, high degree of impulsive and non-productive activities. Further, unpredictability in mood swings, hyper-activeness, careless mistakes, poor following of instructions, impatience and high level of forgetfulness are common symptoms of this disorder (Wilson, 2013).
Reason(s) why you chose this topic
I selected to research and discuss ADHD because my daughter was diagnosed with ADHD at the age of 5, prior to beginning kindergarten. I began noticing some of the sign of ADHD at the age of 3, but was uncertain and thought maybe her acts were of normal limits. She was very aggressive, had an impulsive rage, but was also very hyper and could not stay focused; easily distracted.
Epidemiology
Epidemiology is the study of the patterns, causes, and effects of health and disease conditions in defined populations.
Who is affected?
Attention deficit hyperactivity disorder affect, it most certainly can affect anyone, but it is most often diagnosed in children. This disorder is a well-known neurodevelopment disorder of children and is often times over looked, or parents are in denial about the behavior of their child.
Typically individuals with ADHD symptoms begin to surface between the ages of 3 and 6 years of age. Overlooked periodically because individuals associate toddlers with being hyper and easily distracted, this is true but with time this winds down and isn’t as impulsive.
Male or females
In many studies the prevalence of ADHD prevalence rate in boys has been found to be greater than the rate in girls. According to the Center for Disease Control – CDC (2012), 11.2% of boys aged 3-17 were diagnosed with ADHD, and 5.5% of girls were diagnosed. Another research done in Nigeria that involved primary school going children between 6 and 11 years established that the ratio of boys to girls diagnosed of ADHD was 2.1 (Adewuya & Famuyiwa, 2007). The gender difference in prevalence was also confirmed by another study conducted in US whose participants had a mean age of 4.4 years. This study titled “The Prevalence of ADHD, ODD, Depression, and Anxiety in a Community Sample of 4-Year-Olds” found that boy and girls had a prevalence rate of 16.2% and 10.3% respectively (Lavigne, LeBailly, Hopkins, Gouze, & Binns, 2009). Generally statistics state that boys are four times more prone to being diagnosed with ADHD than girls.
Ethnicities
Culture play a critical role in structuring environmental context in which ADHD children lives. It also influences behavior, attachment, personality and parenting. Hyperactivity among children is common in minority families who live in very stressful environment (Banhatti & Dwivedi, 2005). The culture differences are reflected in ethnicities. Therefore, the different prevalence rates are expected from different ethnicities. In United for instance, ADH prevalence rate for differs across major ethnicities namely Whites, Hispanic and African Americans (Pastor & Reuben, 2005). This was supported by another study that established that Caucasians had rate of 7.6% of ADHD, African Americans have a rate of 7.4%, and Hispanics have a 5.1% rate of being diagnosed with ADHD.
Discussion
Attention Deficit Hyperactivity Disorder is a neurobiological disorder usually in children. It is very heritable, about 0.7 heritability index (Pinto, Rijsdijk, Frazier-Wood, Asherson & Kuntsi, 2012). It is mainly characterized by abnormal level of inattention, hyperactivity or impulsivity. Consequently, people suffering from ADHD act inappropriately (behavior) have a poor attention span, act on impulse, and often times are very hyper. Most children diagnosed with ADHD show signs well before the age of 7. These children often have low self-esteem, poor social skills and poor academic performance.
This disorder is associated with structural and chemical differences in the brain that sustains attention in normal activities. Researchers have also established that lack of monoamines and dopamine chemical in the brain may also contribute to ADHD. These chemicals transports signals within the brain. Researchers have also established that ADHD is closely associated with central nervous system (CNS) and prefrontal cortex (PFC), that is, striatum and cerebellum which regulates behavior and attention. Other possible causes of this disorder include lifestyle, environmental factors such as drinking and smoking, nutritional factors such as iron deficiency and toxins disorders as well as hereditary (genetics) factors (Wilson, 2013).
Signs and symptoms
The signs and symptoms of ADHD are closely related to those of anxiety and depression. According to Rowland, Lesesne & Abramowitz (2002), the neuropsychologist must first conduct initial diagnosis test and rule out these other mental and psychological disorders such as anxiety, depression, stress and mental illnesses. Key symptoms include inattentive, hyperactivity, and impulsivity. These should be seen at least for 6 months or more in order to diagnose a child with ADHD.
The doctor must also study the behavior and lifestyle of the individual to ascertain if there are changes and their causes. To get more clarity on this, the doctor can also interview some of the family members and close friends to understand the ADHD behavioral changes. Further, family and medical histories are important in this step. The last step includes conducting the Electroencephalograph (EEG) tests to check if there are abnormal brain wave patterns. The American Psychiatrists Association’s Diagnostic and Statistical (DSM-5) process is also used in confirming the presence or absence of ADHD in an individual (Millichap, 2010).
Epidemiology
ADHD is the most frequently diagnosed neurological disorder in children. It prevalence varies with, age, ethnicity, socio-economic status and sex. The disorder is more prevalent in boys, people from ethnic minorities and children. The epidemiological studies of this disorder have concurred that it largely occurs in children and is detected within three and seven years of age. Some of the children have shown signs of recovery but to some the disorder has continued to their adulthood. Epidemiology has also revealed that this is one of the highly overlook disorders since most parents and teachers associate toddlers with being hyper and easily distracted
ADHD diagnosis relies on parent teacher reports. There is no laboratory test that cans accurately diagnose ADHD. Consequently, the disorder has proved difficult to develop case definition for epidemiological researches. Nonetheless, the global prevalence rate documented by most international health organizations quote a figure between 4 and 7% for children below 18 years of age. The disorders affect most children in preschool age and may persist to adulthood if no treatment is done. The most prevalent type is the combined type (ADHD-C). The prevalence also varies geographically and according to sources of information used for diagnosis.
Subtypes of disorder
DSM-IV defines ADHD as a childhood neuropsychiatric disorder which has three subsets (Huey-Ling, 2010). The three listed subsets in the manual are Predominantly Inattentive (ADHDI-I), Predominantly Hyperactive (ADHD-HI) and combined type (ADHD-C).
Manifestations and outcomes result from a cycle of interactions between the biology of the child as well as their environment
How the disorder develops over time with treatment – Medications are given to the patients used to treat ADHD. Stimulants are used to activate the brains circuits which monitor attention and provide focus. In children it reduces their levels of hyperactivity and impulsivity actions. While in school it allows them to focus and pay close attention to what is being said or taught so that they can learn. Medications come in pill or capsule form, liquid, and patches.
How the disorder develops over time without treatment – Inattentiveness, impulsivity, and hyperactivity continue often times worsening. Most often times the child begins to suffer with other disorders, to include the most known one; bipolar disorder which coincides with ADHD.
Methods used to diagnose, evaluate, and manage the disorder
Initial diagnosis
Unlike many other illnesses or disorders, ADHD does not have one specific method of testing to diagnose a child with ADHD. A medical exam is given to thoroughly examine the child; information is collected based on the child’s medical history, family history, and school records. This involves questioning of both family members and teachers. “The American Psychiatrists Association’s Diagnostic and Statistical (DSM-IV) is used by mental health professionals to help diagnose Attention Deficit Hyperactivity Disorder.”
Ongoing management
Ongoing management is used by prescribing the child with medications (stimulants), providing education and training to both the child and parents, therapeutic counseling. Other forms of therapy are provided to the child, to include: behavior therapy, psychotherapy, family therapy, and social skills training. While at home the parents can assist the child by being very patient, showing the child an adequate amount of attention, work on organization skills with the child, boosting self-esteem, and creating a daily schedule to be followed.
Risk factors
Genetics
There have been many studies done to find out the link between gene and ADHD. These studies show repeated evidence for this association. It has now accepted that genetic factors are critical in the etiology of ADHD (Thapar, Cooper, Eyre, & Langley, 2013). Phenotypic analyses of monozygotic and dyzygotic twins revealed that 91% of the variance in ADHD was attributed to genetic contribution. Only 8% was attributed to environmental contributions (Merchán, Arango, Galvis, Gómez, Aguirre, Lopera, & Arcos-Burgos, 2007).
Lifestyle
This are mainly associated with dietary habits such as eating foods that are deficient in zinc, magnesium, iron or eating surpluses foods that have provide surplus sugar into the body. It is important to note that strong correlation has not been established between dietary habits and Environmental factors
ADHD is associated with many environmental factors which are present before birth and after birth. The disorder is more prevalent in children from mothers who experienced miscarriage, viral infections during pregnancy, and head injuries. Other factors include exposure to nicotine and alcohol during pregnancy. Moreover, low birth weight (LBW) is also a high risk factor. Children suffering from this disorder are three times more likely to have low birth weights ((Merchán, Arango, Galvis, Gómez, Aguirre, Lopera, & Arcos-Burgos, 2007).
Other causative factors
Known
There is no known cause of ADHD. However, the disorder is brought about by a combination of environmental and genetical risk factors. The genes in focus are those associated with dopamine transportation.
Theorized
Complications during pregnancy are considered as possible causes of ADHD. These include premature birth, viral infection, and miscarriage symptoms.
Nervous system
The nervous system associated with Attention Deficit Hyperactivity Disorder is the central nervous system (CNS). ADHD is associated with the prefrontal cortex (PFC) and it is connected with the striatum and cerebellum. The PFC is very important for the regulation of behavior and attention. PFC is located in the right hemisphere is most important in behavioral inhibition.
The brain chemical associated with ADHD is dopamine. Dopamine is an important chemical that carries signals between the nerves within the brain. Norepinephrine is also associated with ADHD; there are multiple neurotransmitters that play a part in attention and thinking resulting in ADHD. The receptors are normally considered D1, D2, and D3 and there are more.
It is possible with brain scanning technology to monitor the brain structure of children with ADHD. The results of this scanning show that brain circuits joining prefrontal cortex, striatum and cerebellum are malfunctioning in children with ADHD (Daley, 2006).
Current treatment options
Drug (pharmacologic) therapies – stimulants, these are the most used treatments for ADHD, and most often times they provide a positive response in children, 70-80%. Non-stimulants are used but were only approved by FDA in 2003, they provide a longer lasting result, and have fewer side effects. They are preferred for patients who suffer from drug abuse. Stimulant medications include Ritalin, Adderall, Concerta, Daytrant (patch), and Dexedrine. The side effects are loss of appetite, lack of sleep, high levels of anxiety, stomach aches, headaches and very rare Tics.
Non pharmacologic therapies (including psychological and other therapeutic services)
The main non pharmacologic therapies include behavioral therapy, emotional counseling, psychotherapy, social skills training, and support groups
Type of care providers
They are a number of caregivers and healthcare facilities that can be used in the administration of these medications. Some of the healthcare givers include psychologists, psychiatrists, doctors, neurologists, nurse practitioners and social workers all can provide assistance and diagnose ADHD.
Type of healthcare setting
The healthcare settings include hospital, private practice office, outpatient, a nursing home, or a behavioral health clinic.
Future areas of research
Treatment options
There is need for research aimed at diversifying the treatment options, which includes developing better cognitive behavior training, better time management plans between parents and children as well as better and more efficient medication
Evaluation and diagnostic methods for initial diagnosis
There is also need for better evaluation and diagnosis of ADHD at its initial stages through early testing and imaging the brain
Increasing knowledge relating to etiology and pathologic processes
It is important to increase the knowledge and awareness on ADHD, as well as etiology and pathologic process of ADHD. If these mechanisms are put in place early enough, ADHD can be cured at its initial stages avoiding its recurrence at an old age.
Conclusion
In conclusion it is important to mention that Attention Deficit Hyperactivity Disorder is very common and often times overlooked by many individuals to include parents as well as medical professionals. This is a very chronic disorder that can lead to several other disorders that have many of the same symptoms and signs.
References
Adewuya, A., & Famuyiwa, O. (2007). Attention deficit hyperactivity disorder among Nigerian primary school children Prevalence and co-morbid conditions. European Child & Adolescent Psychiatry, 16(1), 10-15.
Banhatti, R.G., & Dwivedi, K.N (2005). Attention Deficit/Hyperactivity Disorder and Ethnicity. Archives of Disease in Childhood, 90 (1), 110-112.
Daley, D. D. (2006). Attention deficit hyperactivity disorder: a review of the essential facts. Child: Care, Health & Development, 32(2), 193-204.
Huey-Ling, C., Susan Shur-Fen, G., Hsing-Chang, N., Yen-Nan, C., Chi-Yung, S., Yu-Yu, W., & Wei-Tsuen, S. (2010). Association between symptoms and subtypes of attention-deficit hyperactivity disorder and sleep problems. Journal of Sleep Research, 19(4), 535-545.
Knutson, K. C., & O'Malley, M. (2010). Adult attention-deficit/hyperactivity disorder: A survey of diagnosis and treatment practices K.C. Knutson & M. O'Malley Adult ADHD. Journal Of The American Academy Of Nurse Practitioners, 22(11), 593-601.
Lavigne, J. V., LeBailly, S. A., Hopkins, J., Gouze, K. R., & Binns, H. J. (2009). The Prevalence of ADHD, ODD, Depression, and Anxiety in a Community Sample of 4-Year-Olds. Journal Of Clinical Child & Adolescent Psychology, 38(3), 315-328.
Merchán, V, Arango, C, Galvis, A, Gómez, M, Aguirre, D, Lopera, F, & Arcos-Burgos, M 2007, 'Environmental influences that affect attention deficit/hyperactivity disorder', European Child & Adolescent Psychiatry, 16, 5, pp. 337-346.
Millichap, J. (2010). Attention Deficit Hyperactivity Disorder Handbook a Physician's Guide to ADHD (2nd ed.). New York, NY: Springer Science
Pastor, N.P., & Reuben, C. A. (2005). Racial and Ethnic Differences in ADHD and LD in Young School-Age Children: Parental Reports in National health Interview Survey. Public Health Reports, (120) 383-392
Pinto, R. R., Rijsdijk, F. F., Frazier-Wood, A. A., Asherson, P. P., & Kuntsi, J. J. (2012). Bigger Families Fare Better: A Novel Method to Estimate Rater Contrast Effects in Parental Ratings on ADHD Symptoms. Behavior Genetics, 42(6), 875-885.
Rowland, S., Lesesne,A., & Abramowitz, A.(2002). The epidemiology of attention- deficit/hyperactivity disorder (ADHD): A public health view. Retrieved on January 10, 2014 from http://www.ncbi.nlm.nih.gov/pubmed/12216060
Thapar, A., Cooper, M., Eyre, O., & Langley, K. (2013). Practitioner Review: What have we learnt about the causes of ADHD?. Journal Of Child Psychology & Psychiatry, 54(1), 3-16.
Wilson, J. F. (2013). Biological basis of behavior. San Diego, CA: Bridgepoint Education, Inc.
