(the National Institute of Mental Health, 2008) Though we are able to identify some external factors, like drug use, and development problems in the womb, mainly it is the genes which determine the occurrence of this disease. We may say that it is a biological disorder. The persons suffering by this disease are largely affected by programs on TV, games, bad environments food intake and similar occurrences. It is Genes that have control over the chemicals in the neurotransmitters and the affected child has these chemical output out of balance. The scans conducted reveal that these defects can be noted in the areas of the brain that deals with psycho motor reflexes. This imbalance creates and distorts the functions of the person in changing focus of thought, organization of things and methods, planning out things, memory, and emotion and reasoning and differentiating between the two. They have impairments of speech and movements. (eMedicine Health, 2005)
Treatments and therapy
There must be a through evaluation before the course of treatment is decided because the symptoms shown in this disease are also prevalent in some cases like Bi-polar disorder. This disease is amenable to treatment. This disease is a heterogenic one and exhibits a significant level of co-morbidity. The symptoms therefore may be an indicator of a later possibility of some other disorder including schizophrenia. (Chang, 2005) the good news is that the children who are the victims of this disease will respond to medicines. There need be a trial of medication in children with this disease. In most cases however medicine alone will not cure or have effect unless accompanied by parental care, and adjustment, co-operation between the school and the other interactions and doctors. Special educational assistance must also be given. The disease has been diagnosed a century before and medication is available - amphetetamines, and the recent Ritalin are being used for reflective control. (Wender, 2000)
Some of the current and approved medicines for the treatment are the following: The Stimulants used to treat the disease include "Methylphenidate (Ritalin, Metadate CD, Methylin ER and Ritalin SR)" (Chang, 2005) However it is addictive. Another drug is "Dexmethylphenidate (Focalin, Focalin XR) which blocks norepinephrine and dopamine reuptake into presynaptic neuron and increases release of these monamines into extraneuronal space. To allow once-daily dosing, the simple drug Magnesium pemoline (Cylert) produces CNS and respiratory stimulation. The CNS effect may occur in the cerebral cortex and reticular activating system. May have direct effect on both alpha- and beta-receptor sites in the peripheral system as well as release stores of norepinephrine in adrenergic nerve terminals." (Chang, 2005) "Dextroamphetamine (Dexedrine) used first or in case of methylphenidate failure. Approved by FDA for use in children aged 3 years or older. Available in sustained-release forms, which may allow for daily dosing." (Chang, 2005) "Bupropion (Wellbutrin) inhibits neuronal dopamine reuptake in addition to being a weak blocker of serotonin and norepinephrine reuptake. Some Alpha-adrenergic agonist's centrally acting antihypertensives clonidine and guanfacine have been used to treat children with ADHD. Inhibition of norepinephrine release in brain may be mechanism of action." (Chang, 2005) These treatments have to be complimented by education the parents and peers with the necessary interaction and care needed to enhance the effects of the medicines.
Effects of treatment and the methods
Medication could steer the child to normalcy in daily life. The anger, frustration and other problems have to be overcome by the parents and children. They may need help from specialists and experts like doctors, therapists and, mental health professionals. They must receive counsel to develop new methods of behaviour and approach to the problems of the child and identify and build on the strengths. The additional approaches by way of intervention complimentary to the drugs given include psychotherapy, for the patients, which help them find self-esteem and better awareness of their conditions and adapt to it. The therapist encourages the child to talk about his feelings and helps him adjust and modify the behaviour. The behavioral therapy is given to accommodate immediate issues and in changing the thinking pattern of the patients. This could take the form of practical assistance that is physical assistance in doing something or directions on how to do it, making the patient perform. This keeps the mind thinking in proper sequence. Similarly for the development of social skills special training for identifying and defining social relationships, "like waiting for a turn, sharing toys, asking for help, or responding to teasing, then gives children a chance to practice. For example, a child might learn to "read" other people's facial expression and tone of voice in order to respond appropriately. Social skills training help the child to develop better ways to play and work with other children." (Teel, 2007)
For the parents and other who wish to help the child special training is necessary from experts where the parents and other educators imbibe the skills needed to accommodate and train the child. The age old system of the stick and the carrot, or reward and punishment appears to have a very good effect on the conditions. The rewards to the child are given when he performs inside the accepted norms of behaviour and punishments and sanctions are awarded when there is a reversion to the hyperactive state. These children however may need more of rewards to encourage and progressive lessening of sanctions. (Teel, 2007)
There are experts who maintain that children with this syndrome grow out of it in adulthood. However the children with this disease who have it at adulthood are in the range of over thirty percent. The symptoms decrease with advance in age, and as the person matures they have better control of themselves. The inattention symptoms also fade with the advance in age. (Chang, 2005) Some of the patients are likely to develop other symptoms that can create complications like "learning disorders, restless legs syndrome, ophthalmic convergence insufficiency, depression, anxiety disorder, antisocial personality disorder, substance abuse disorder, conduct disorder, and obsessive-compulsive behavior." (eMedicine Health, 2005)
Occurrence and frequency
United States has three to seven percent of school children in this group. In Britain it is reported to be one percent. The occurrence of ADHD is globally is considered to be twelve percent. (Chang, 2005) the prevalence of the condition is reported to be 1.4% in Japan, but has 8% of children in this group. Columbia and Venezuela have 7 and 11% respectively. In Germany it is 16%. The types of the disease vary in nature. There are many subtypes of the disease. (Nass; Leventhal, 2004) "It is hard for these children to control their behavior and/or pay attention. It is estimated that between 3 and 5% of children have ADHD, or approximately 2 million children in the United States. This means that in a classroom of 25 to 30 children, it is likely that at least one will have ADHD." (American Academy of Child Adolescent Psychiatry, 2008) Those having neurological problems in infancy and first month of life are prone to get the disease. A research at Hawaii suggested that the chance of such a syndrome at home which is in conflict is almost 200%. ADHD may occur in high risk factors and even in normal situations. (Nass; Leventhal, 2004)
The prevalence of the syndrome is universal and it is genetic which means to great extent prevention is impossible. However there are external causes also like alcohol and other environment causes. Care must therefore be taken in pregnancy. Pregnant ladies ought to eschew drugs, alcohol, and other chemicals that may cause the disease to the child. The most important problem is the proper diagnosis of the disease at the early stages. The disease has similar symptoms with many other diseases and hence careful expert evaluation is necessary. Proper treatment along with guidance to parents and cooperation of the education institutions and experts are a part of the treatment. Medications are important to create control and balance. The most important element that can help the patient is psychotherapy as well as proper education. This is to be followed with the important psychotherapy which is useful in building a proper self-image and curing attendant maladies like depression. When a person is made to realize the truth about the condition he or she may succeed in creating a goal in life that can make positive use of their strengths to achieve things in life that may seem impossible to normal individuals.
Adler, Lenard. (2007) "Scattered Minds: Hope and Help for Adults with Attention Deficit..."
American Academy of Child Adolescent Psychiatry. (2008) "Child and Adolescent Mental
Illness and Drug Abuse Statistics" Retrieved 27 February, 2008 at http://www.aacap.org/cs/root/resources_for_families/child_and_adolescent_mental_illness_statistics
Barkley, Russell a. (2006) "Attention deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment" Guilford Press.
Chang, Kiki D. (2005, Dec) "Attention Deficit Hyperactivity Disorder" Retrieved 27 February, 2008 at http://www.emedicine.com/MED/topic3103.htm
Delcarmen, Rebecca; Carter, Alice. (2004) "Handbook of Infant, Toddler and Preschool
Mental Health Assessment" Oxford University Press. New York.