Introduction
Attention Deficit Hyperactivity Disorder (ADHD) is a psychiatric disorder characterized by behavioral symptoms such as inattentiveness, impulsiveness and hyperactivity. The exact reason for ADHD remains unknown. However, research indicates that ADHD runs through families, which means that the condition is inherited from one’s parents (Brown, 2005). Other cases are thought to be caused by an individual’s environment, although the environment plays a minor role compared to genetics. In the United States, American Psychiatric Association approximates that 5 % of children have ADHD (Brown, 2005). The percentage of children diagnosed with ADHD continues to increase, with statistics indicating that this percentage increased from 7.8 in 2003 to 11.0 in 2011 (Harpin, 2005). Research also indicates that boys are three times more likely to have ADHD as compared to girls (Farrar, 2010). The average age of diagnosis of ADHD is seven years.
Initially, it was thought that children outgrow ADHD, but recent research shows that 30-60 % of the individuals affected by ADHD carry it into adulthood (Brown, 2005). In the early stages (7-11 years), children affected by ADHD show low self esteem, disruptive behavior, poor social skills and delays in learning. After the age of thirteen, people with ADHD may show oppositional defiant disorder, lack of motivation, conduct disorder, complex learning abilities, criminal behavior and substance abuse. Dealing with ADHD is always a challenge, and this calls for patience when handling people with cases of ADHD. On many occasions, the people around persons with ADHD face challenges. These challenges include accommodating the person affected by ADHD, which may lead to psychological distress within family members.
Signs and Symptoms
The most common symptoms of ADHD include inattention, hyperactivity and impulsiveness. However, it is always a challenge in determining where to draw the line between normal levels of inattention, hyperactivity and impulsiveness and the significant levels that require attention. The most common tool for diagnosing ADHD is the Diagnostic and Statistics Manual of Mental Disorders (DSM). The International Statistical Classification of Diseases and Related Health Problems (ICM) from World Health Organization is also used to diagnose ADHD. Depending on the method used for diagnosing ADHD, prevalence rates in the country may vary.
According to DSM-V, the correct diagnosis of ADHD requires observation of the symptoms in two different settings for at least six months. Additionally, the symptoms should be to a degree that is greater than children of the same age. Depending on the symptoms observed, ADHD can be grouped into three categories. These subtypes include predominantly inattentive, predominantly hyperactive and predominantly impulsive. In some cases, individuals with ADHD show a combination of these criteria.
Individuals who show predominant inattention are easily distracted, cannot concentrate on one task, have difficulties in organizing and completing tasks, and also struggle to follow instructions. Individuals who are predominantly hyperactive, on the other hand, talk nonstop, fidget often in their seats, are constantly in motion and have difficulties in doing quiet tasks. Lastly, individuals who are predominantly impulsive are very impatient, they show difficulties in waiting for the things they want, they often give inappropriate comments and they act without thinking of the consequences. Other symptoms prevalent in people with ADHD include poor social skills drifting during conversations, delays in learning speech.
Cause
The exact cause of ADHD remains unknown. However, it is thought that ADHD is caused by the interaction by genetic as well as environmental factors. Research shows that genetics plays a major role in ADHD as compared to the environment (McBurnett & Pfiffner, 2013). The genes involved in causing ADHD affect the neurotransmission of dopamine. These genes are passed from parents to the siblings. Apart from genetic factors, certain environments play a role in causing ADHD. For example, the intake of alcohol during pregnancy causes conditions a spectrum disorder that has conditions that are similar to ADHD. The exposure to tobacco smoke during pregnancy also exacerbates the risk of developing ADHD. However, not all the children exposed to tobacco smoke during pregnancy develop ADHD. This explains why researchers think that there should be a genetic predisposition before environmental factors cause the development of ADHD (McBurnett & Pfiffner, 2013). Traumatic brain injury also leads to the development of ADHD.
Effects of ADHD on the Brain
ADHD causes many functional changes in the brain. In children, ADHD is associated with reduced brain volume. For children with ADHD, the left side of the prefrontal cortex is significantly reduced. This causes a change in the brain pathways that connect the striatum and the prefrontal cortex. As a result, people with ADHD exhibit inattention, hyperactivity and impulsiveness because of dysfunction in the frontal lobe of the brain. Brain parts that control attention are also affected.
ADHD also affects neurotransmission. People with ADHD respond to stimulation in an abnormal way. The arousal threshold for people with ADHD is also low, and affected persons compensate for this abnormality with increased stimuli. The result is that the dopamine system responds to stimuli in an abnormal manner, which results into inattention and hyperactivity. ADHD also affects neurotransmission by interfering with serotoninergic and adrenergic pathways. The executive functions of the brain are also affected. Executive functions of the brain include mental processes, organization and planning skills. By interfering with executive functions, ADHD results into time keeping problems, lack of concentration, irregular emotions and lack of short memory. However, some of the problems caused by interference with executive functions may not manifest themselves in the early stages of life; they may be delayed until later into adult life.
Treatment
ADHD has no cure but the condition is manageable. Management of ADHD involves providing educational support and advice to the affected individual, parents and guardians. In some cases, medication is necessary. Counseling and medications can either be used alone or in combination. However, care should be taken when using medication. For example, it is not advisable to use medication on children aged below six years because the long-term effects of medication on this group are not known. The common medications used to manage ADHD include anti-depressants, stimulants and atomoxetine. Adjustment of the individual’s diet may also help. For example, use of foods rich in free fatty acids and less food color has a positive effect on people with ADHD (Tuckman, 2007).
In many cases, stimulant medications are the most preferred in managing ADHD. These stimulant medications improve most of the ADHD symptoms in the short-term. The most common non-stimulants include atomoxetine, clonidine and buproprion. Although there are few studies comparing the effects of those drugs on the people with ADHD, the medications have more or less the same side effects.
Apart from the use of medications, psychosocial therapies are also good for people with ADHD. The most common psychosocial therapies include behavior therapy, cognitive behavioral therapy, family therapy and training in social skills. Many these forms of therapy focus on behavioral modification and improvement of social skills. This helps in reducing psychosocial problems such as depression, criminality and use of drugs.
Effects of ADHD on Family
ADHD affects not only the individual, but also the persons around those individuals - especially family members. The most common effects include disrupting family systems and social networks. For example, members of the family have to change their way of life in one way or another in order to accommodate the person diagnosed with ADHD. The accommodations made affect family members and the roles they play. As a result, families of individuals diagnosed with ADHD face distress and frustration on a day to day basis.
Research shows families of people affected by ADHD are likely to develop their own psychological distress as compared to families of people who are not affected by the disorder. These challenges affect both the parents and siblings of a person diagnosed with ADHD. The people who bear the biggest burden of ADHD within the family are the parents. Parents of children affected by ADHD have greater stress than parents of children with normal development (ref). The level of stress experienced by parents diagnosed with ADHD is likely to increase with the problems experienced by the child (McBurnett & Pfiffner, 2013). The most common manifestation of stress is low self-esteem. The parents are most likely to feel overwhelmed by the negative reactions of the behavior of their children. Parental stress and frustration reduces the efficacy of parenting.
Parents with children affected by ADHD are also likely to be concerned because their children do not respond to behavioral advice and parental requests. Poor sleeping patterns of children with ADHD also concern parents especial in the primary school years. The parents will also get worried when they find out parents of other children going to school with their child or living in the same neighborhood do not encourage their children to play with the child diagnosed with ADHD. This may strain relationships with neighbors.
The struggles increase as parents try to manage the behaviors of their children in school and at home. Concentration turns from other children to the child affected by ADHD. The parents may also become overly-protective and overly-involved in the life of the child. In some cases, the parents maybe so immersed with the difficulties of the child with ADHD such that they begin to experience blame and guilt. This may also cause frustrations and reactive responses from the parents thus leading to ineffective and negative communication. The ineffective and negative communication may be evident when the parent blames the child for his/her difficulties. The parenting challenges are also likely to affect their marriage.
Because of concentrating on the life of a child with ADHD most of the time, the parents may experience high levels of dissatisfaction in their marriages. The dissatisfaction results into unnecessary conflicts. For example, it is possible for one of the partners to complain that the life of the other partner revolves around the child affected by ADHD thus leaving or no time for marriage life. Loss of intimacy may also occur because of concentrating with the child affected by ADHD. Consequently, the partners may experience feeling of disconnection. The problems exacerbate in the cases whereby there is poor co-parenting.
Apart from the parents, siblings also experience some challenges when one of their own is diagnosed with ADHD. Although each of the sibling may react differently to a child with ADHD, some of the common problems observed include distancing themselves from their brother or sister. They may feel that the experiences of their brother or sister are embarrassing hence dissociating themselves with from that specific brother or sister. In other cases, siblings express high levels of aggression toward their brother or sister affected by ADHD. Often, these are expressions of stress and frustration.
Siblings may also express anger toward the sibling diagnosed with ADHD because they feel that parents give them much attention. This results into feelings of being rejected or left out and this anger is likely to be taken out on the sibling diagnosed with ADHD. Therefore, cases of physical violence, attempts to manipulate and control the sibling with ADHD and victimization maybe evident with such siblings. Verbal aggression may also be evident. All these negative forms of treatment demoralize the child with ADHD and may facilitate the development of antisocial skills. Research indicates that cases of sibling conflict is much more likely to happen in families with a child affected by ADHD as compared to siblings with normal development. In the case of older siblings, they may feel obliged to empathize with the struggles of their brother/sister and their parents. Consequently, such siblings are likely to face higher levels of distress and frustration compared to siblings whose brothers and sisters show normal development.
The problems experienced by families with a child who is affected by ADHD can be reduced or eliminated altogether through counseling and family therapy. Through these approaches, conflicts between siblings are reduced, parents know how to communicate with the child affected by ADHD and the social skills of the persons affected by ADHD are improved (Barkley & Murphy, 2006). Additionally, family members understand that it is not their fault to have a child, brother, or sister with ADHD. Therapy also helps to avoid victimization of a child with ADHD. The improved environment within the confines of home has a positive correlation with reduced signs of ADHD, at least in the short time. Nonetheless, caring for a child affected by ADHD is not an easy task because it requires every member of the family to overcome their challenges and channel all their energies into activities that promote calmness within the home. The good thing is that it can be done and the whole family will no longer be hurt by the child’s behavior.
Conclusion
ADHD is a psychiatric disorder that is often characterized by inattention, hyperactivity and impulsivity. It is a condition that affects boys more than girls, and it is managed through counseling and medication. The counseling and medication can be used either alone or in combination. However, the use of medication for children under the age of six is discouraged because the long-term effects of medication on this group remain unknown. ADHD affects both the individual as well as the people around him/her. Family members are more likely to be affected by ADHD because they spend much of their time with the person with ADHD. Some of the common effects of ADHD on the family include stress and frustration, which may exacerbate family conflicts. However, these problems can be avoided through counseling and family therapy. Therefore, it is advisable for families with a child affected by ADHD to consider therapy as one of the means to cope with the condition because of the positive benefits it has on both the affected individual and the family as a whole.
References
Barkley, R. A., & Murphy, K. R. (2006). Attention-deficit hyperactivity disorder: A clinical workbook, volume 2. New York, NY : Guilford Press.
Brown, T. E. (2005). Attention deficit disorder: The unfocused mind in children and adults. New Haven, CT : Yale University Press.
Farrar, A. (2010). ADHD. Minneapolis, MN : Twenty-First Century Books.
Harpin, V. A. (2005). The effect of ADHD on the life of an individual, their family, and community from preschool to adult life. Diseases in Childhood , 90 (1), 2-7.
McBurnett, K., & Pfiffner, L. (2013). Attention deficit hyperactivity disorder: Concepts, controversies, new directions. Boca Raton, FL : CRC Press.
Tuckman, A. (2007). Integrative treatment for adult ADHD: A practical, easy-to-use guide for clinicians. New York, NY : New Harbinger Publications.
