Attention Deficit/Hyperactive Disorder in children

Sam was your average 4-year-old boy. He had many friends and was well liked by everyone. All in all he seemed be well adjusted. However, when he started kindergarten, his teacher started sending notes home to his mother telling her that Sam was causing trouble and not following the rules. His mother was concerned, and would constantly try to get him to behave. But no matter how much he tried, Sam just kept on getting into trouble. Finally his mom took him to see a psychologist – maybe he would be able to tell her why Sam was always running around when he was supposed to be sitting, or why he was always fidgeting and not paying attention in class. After the conversation between the psychologist and Sam, which included Sam running around the room three times, knocking over a pile of papers, and a bit of conversing, the psychologist diagnosed Sam with ADHD. Sam’s Mom was relieved to hear that there was a reason for his mischievous behavior, but was anxious to learn more about it. This is what she found out: Attention Deficit Disorder, or ADD, as it is better known, is an inability to use skills of attention effectively.

This results in children who are restless and easily distracted. The situation can be further exacerbated if a child also shows signs of hyperactivity, or an abnormal need for activity. In this case, the disorder is referred to as ADHD. There are many more symptoms or signs that a child has ADD. For example, if a child, fails to pay close attention and constantly makes careless mistakes, gets easily distracted, talks excessively, is really impatient and relentlessly interrupts others, he most probably has ADHD. However, normal children also tend to have these tendencies, so how can one tell the difference between a normal child and one with this disorder? The National Institute on Mental Health addresses this question. “Behaviors can be judged as normal, or “problem” ADD by evaluating them in relation to the person’s age and developmental maturity. For example, the same behaviors that are acceptable in a 5-year old may be problematic for a 10-year old. Problem behaviors are also long lasting, tend to occur more often and create more problems as time goes on.

Children with ADD/ADHD will have more problems than other children their age experience in the same settings.”1 Note: Since all children, at times, behave in these ways, only a professional can diagnose a child with ADHD. ADD has a very interesting history. In 1902 the first clinical description of ADHD emerged, and was called “Morbid Defect of Moral Control.” Time progressed and by the 1920’s, ADHD encountered yet another name change. This time it was to be called, “Post-encephalitic Behavior Disorders.” The mid 1960’s were the years in which physicians first took into account that hyperactivity among children might be attributed to the structure of the brain, consequently the name was changed once again, this time to, “Minimal Brain Dysfunction”. In 1980 the National Institute of Mental Health labeled this syndrome as Attention Deficit Disorder. One can have this disorder with or without hyperactivity; the former is called Attention Deficit Hyperactivity Disorder or ADHD.

Amphetamines, a medication that was used to treat behavioral disturbances in children made its debut in 1937. In 1956, Methylphenidate, or better known as Ritalin was introduced as a treatment for hyperactivity. In the past decade prescriptions for stimulant medications to treat ADHD and Attention Deficit Disorder skyrocketed. The FDA approved 4 major treatments for ADD and ADHD. These treatments are: Concerta, Metadate, Focalin, and Strattera. Yet despite the long history of ADHD and millions of children currently taking ADHD medications, there is still a lack of adequate data on the long-term effects that ADHD treatments have on children. Although these medications may calm the child down, there are those who feel strongly against using them. I have had such an experience when dealing with an ADD child who was under my supervision during camp.

My co-counselor refused to give this child his Ritalin, because he felt that medication prevented the camper from being himself. I, on the other, felt that the camper needed his medication so as not cause harm to himself or others around him by acting up. This is one of the many moral issues that come up when discussing ADD. Many children with ADHD have additional conditions that can complicate the diagnosis and treatment. Learning disabilities are the most frequent of these conditions. They include difficulty with reading, mathematics and written expression. These disabilities can cause the children to have a low self-esteem and poor social skills. Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD) are also commonly found in children with ADHD, especially in boys. ODD is the defiant, negative and hostile behavior toward authoritative figures. CD is a disorder that includes aggression toward people and animals, destruction of property, deceitfulness, lying, or stealing, and serious violation of rules.

The American Academy of Child and Adolescent Psychiatry states, “research shows that youngsters with conduct disorder are likely to have ongoing problems if they and their families do not receive early and comprehensive treatment. Without treatment, many youngsters with conduct disorder are unable to adapt to the demands of adulthood and continue to have problems with relationships and holding a job.” 2 Another set of symptoms that is commonly found amongst those who suffer from ADHD are mood and anxiety disorders. These mood disorders can go unnoticed until the child reaches adolescence or adulthood. Many experts believe that the effects of ADHD themselves may cause this anxiety or depression and lower self-esteem. When present, a mood or anxiety disorder can be treated in addition to the ADHD. Due to the uncertainty of its origin many psychologists have theorized what the cause of ADHD may be.

The most popular of these misconceptions were those blaming food, excessive television watching, or parents for their child’s uncontrolled behavior. These factors were initially believed to be causes of ADHD because they appear to be connected. Parents claimed that when they fed their children sugar or various other foods, they became more hyperactive, while other diets claimed to eliminate hyperactivity. These and other mistaken beliefs were studied more in depth, and determined to be unfounded. For example, according to Robert D. Hunt, “contrary to parental beliefs, sugar did not make children significantly more hyperactive. No diet, in fact, was found to reduce ADHD symptoms. Parenting techniques did not improve symptoms; parental frustration was in fact found to be an effect, not a cause, of ADHD. Excessive television watching and video game playing also was determined to be a symptom, not a cause, of ADHD.

It is a form of stimulation that helps children with the disorder sustain focus and control internal feelings of agitation via a mechanism similar to that at work with medication.”3 To this day, experts are not certain as to the cause of ADD. However, they mainly suspect that it is due to a weakness in the brain’s use of its chemicals, or neurotransmitters. This can be due to exposure to toxins, alcohol or drugs before birth. Poor nutrition, chemical or food allergies, and toxins in the environment may be the cause of the low levels of norepinephrine and dopamine, which in effect causes them to seek stimulation to raise the arousal in their central nervous system. Increasingly it has become clear that ADHD is a neurological disorder that requires a medical diagnosis and treatment. Before treating ADHD, one should realize that there is no cure yet. These are only treatments that help a child with this syndrome behave better for a short period of time, so that he can develop and learn normally. The two main treatments for ADHD are stimulant drugs and a talking treatment called behavioral therapy.

Medication such as methylphenidate (Ritalin) and dextroamphetamine (Dexedrine) can help your child concentrate, which will in effect cause him to feel calmer and to think before acting. Due to the fact that stimulant drugs affect the central nervous system, they do occasionally have side effects. Holly Hanke, Tula Karras, and Annette Spence explain that the most common of these “include decreased appetite, stomachache or headache, mild insomnia, and jitteriness. Children also report feeling moody when the drug wears off (this is called “rebound”) or strangely subdued when their dose is too high.”4 Another important factor as stated by Saul Kassin, is that “if Ritalin is prescribed, one should make certain to combine its use with psychologically oriented therapy”5. Behavior therapy recognizes the limits that ADHD puts on a child. It focuses on how the important people and places in the child’s life can adapt to encourage good behavior and discourage unwanted behavior.

Unlike play therapy or other therapies that focus mainly on the child and his emotions, the aim of behavioral therapy is to change the child’s physical and social environments, and to help the child improve his behavior. One very interesting treatment that I found was implemented by Alan Pope, Ph.D. who is the NASA psychologist and electrical engineer who invented virtual reality biofeedback, and Olafur Pallson, Psy.D. They have invented a way for Nintendo and Play Station games to be used to treat Attention Deficit Disorder. “When players produce faster brain waves – beta waves – the game pad or joy stick for the video game works better, and they can better control the characters on the screen When players use slower, more lethargic brain waves – theta waves – the game pad is more sluggish. Now your youngster can play their favorite video game and learn to pay attention better at the same time.”6 Interestingly enough there are those people who deny the whole idea of ADD completely.

In his article “The Great ADD Hoax”, David Kiersay tries to convince his readers that there is no such thing as Attention Deficit Disorder. He reasons that the whole disorder is based on so called symptoms that can be observed. His objection to this is that attention isn’t something that can be observed, “rather it’s something that we guess is going on in the brain of the person we’re observing, when all we can see or hear is what the person is doing. When a schoolboy is observed just sitting and seemingly doing nothing it’s impossible to tell what he’s paying attention to. Of course it’s obvious he’s not actively engaged in doing his assignment; whatever he’s thinking about can only be a matter of conjecture.”7 His other point of argument is that he says that medics seem to believe that Attention Deficit is caused by symptoms. He feels that the medics are mistaken, “It’s preposterous to say that the symptoms of attention deficit cause the deficit of attention.

Even though preposterous, the medics seem to mean what they say. For example they say that some hyperactive-impulsive or inattentive symptoms that cause impairment must have been present before age 7 years.’ Also they say that “Some impairment from the symptoms must be present in at least two settings (e.g. at school [or work] and at home).”7 At my professors suggestion, I put some thought into a very intriguing question, has ADD always been around and just not identified, or did it evolve with the humans? Although I did not any find evidence proving one way or another, I did come up with my own conclusion. I believe that there have always been people with ADD, but it was never identified. Back in the day, children would spend a lot their time doing their chores, either in the fields or in their homes.

Whatever the circumstance, they where constantly moving about and using up their energy. Skipping ahead to the 21st century, children are now required to sit in a classroom for long periods of time; being dictated what they must do. Teachers demand that children use their energy mentally as opposed to physically. Some children just aren’t cut out for this; they need to employ their energy by doing physical activities. So the natural result is that these children cannot concentrate on what their teacher is saying, they start fidgeting, and get into trouble. This syndrome is becoming more evident now than any other time in history. Three and a half million children under the age of 18 are now diagnosed with ADD; it only makes sense that the rest of us should educate ourselves about this issue.

Bibliography

1) Chris, (August 23, 2002). The National Institute on Mental Health entitled “Attention Deficit Hyperactivity Disorder (ADHD) – Questions and Answers.” Retrieved Oct.17, 2004, http://www.faqfarm.com/Health/ADD/61 2) The American Academy of Child and Adolescent Psychiatry, (May 1999). CHILDREN WHO CAN’T PAY ATTENTION/ADHD, Retrieved Oct.17, 2004, Kania Enterprises, Inc., http://www.metrodaycare.com/main.asp?content=articles/aacap/conduct-33 3) Robert D. Hunt, (March 2001). Causes of ADHD, Retrieved Oct.17,2004 Pediatric Annals http://www.strattera.com/1_3_childhood_adhd/1_3_1_1_1_causes.jsp 4) Holly Hanke, Tula Karras, and Annette Spence, (2004). What are the possible side effects and what can we do about them?, Retrieved Oct.18, 2004, Baby Center LLC, http://parentcenter.babycenter.com/refcap/bigkid/gspecialneeds/67397.html 5) Saul Kassin, (2004). Psychology and Education – ATTENTION-DEFICIT HYPERACTIVITY DISORDER. New Jersey: Pearson Education, Inc. 6) Leonard Holmes, PH.D. (2004). Video Games to treat ADD? Retrieved Oct.18, 2004, A PRIMEDIA Company, http://mentalhealth.about.com/cs/biofeedback/a/videoadd.htm 7) David Keirsey, THE GREAT A.D.D. HOAX, Retrieved October 18, 2004, http://keirsey.com/addhoax.html