Attention deficit hyperactivity disorder: historical perspectives and neurobiological understanding

Abnormal and Child Psychology - Perspective on ADHD

ADHD

The disorder of Attention deficit hyperactivity disorder - ADHD relates to inattention and hyperactivity. It is a type of minimal brain dysfunction. It is seen in adults and children. There are many theories that are current as to why this condition exists. The person suffering from this disease shows symptoms like having a very short attention span and is over impulsive. A broad spectrum of this disorder is categorized in the order of ADHD. The symptoms vary with person to person and with age groups. One of the common causes for anxiety with children is the behaviour problem associated with this condition. Earlier classification of the disorder tended to be classified as inhibitory volition in the previous era. The corrective methods in those times included correctional punishments. In modern times researchers have gone deep to understand the problem better. Heinrich Hoffman back in 1865 wrote about the disease, and was followed by Stewart in 1970. Alfred Treadgold and George Sill were however the first to classify the disease or condition and cause clinical analysis of the malady. Though they did not identify the extent of the malady they were able to classify the spectrum by pinpointing the self-awareness, and the cognitive relations between individuals and the perceptional variance of the people with this condition. (Barkley, 2006)

The frontal and prefrontal brain systems are said to be involved in this syndrome. Sometimes the cerebellum and the parietal lobe are also areas that are related to this disease. This is evident in clinical scans of brain activity of the patients. (Chang, 2005) the early symptoms are seen in children in the pre-school or early school days Dr. Heinrich Hoffman while diagnosing the disease far back in 1845, used his poetic sentiments to describe the syndrome in a book of poems and a particular poem - "The Story of Fidgety Philip" gives the first exact description relating to this disease with complete observations from the clinical viewpoint of a doctor. Later the disease was recognized, not as behaviour and parenting control problem but as a condition of the mind by the work of Sir George F. (the National Institute of Mental Health, 2008)

The child affected with this disease is faced with a very difficult task of adjusting to the conditions of the mind and the normal behaviour and reflexes required of him or her. The disease is noted to be prevalent more in boys, than in girls. The patient requires the care and attention and counsel of teachers, parents, psychiatrists, educators, friends, peers and siblings. The most important features of this condition are that: a) it is the most chronic condition in childhood, more found in boys than girls. b) it is also likely to persist in adolescence and into adulthood. The child will have adjusting in school and will develop behaviors that can harm the patient as well as those who are associated with him or her. (Wender, 2000) the disease has been diagnosed a century before and medication is available - amphetetamines, and the recent Ritalin are being used for reflective control. It is probably transmitted genetically and is a hereditary disorder. It may also be caused by malfunctioning of the chemical parts of the brain. Medication can reduce and sometimes overcome the disorder. Psychological programs can help the child have control over him. It will also aid in curing some learning disorders. Such children have a very small attention span. (Wender, 2000) the behavior pattern and requirements of children both at home and in education are different from normal children.

Attention deficit hyperactivity disorder (ADHD) in perspective

Attention deficit hyperactivity disorder is also called attention deficit disorder -- ADD, and it is revealed by the patient's condition of being unable to focus the mind on tasks for longer or normal periods of time and the impairment of the development of social skills and a healthy confidence in the self. (eMedicine Health, 2005) Those affected by ADHD will have no control over the reactions to stimuli and will blurt out or speak in a way that is not masked with social etiquette. They do not have the ability to restrain their emotions. They do neither have the perception of the consequences of their acts. They act on impulse and disregard the requirement of waiting for their turn and aggressively may interfere in group activities and games by doing to of turn actions as fancies them from moment to moment. They rather tend to choose actions that result in immediate rewards rather than delayed gratification. (the National Institute of Mental Health, 2008)

The symptoms of this disease can also be seen in normal individuals and those suffering from other disorders. These behaviors like forgetfulness, impulsive behaviour, inappropriate behavior and other evidence is manifest in all human behavior at some time or other, the diagnosis of the disease must follow a course of observation that can demonstrate the behaviour as chronic and prevalent most of the time. The behaviour displayed must be inappropriate for the age of the persons. There will be a marked lag and change in the patterns of learning during the preschool and early school days. Those persons who do show these behaviors but have social interaction of their age level may not be suffering from ADHD. Doctors observe to see if the behaviour complained of is excessive. Those suspected of the disease is then subject to intense observation of behaviour over a period of time. (the National Institute of Mental Health, 2008)

This is the most common disorder noticed in childhood. The children display a marked amount of impairment in functioning. There is a need to diagnose the disease early and treat it as far as possible. The available researches in this issue have been centered on elementary school children aged between six to twelve years. There are many possibilities of identifying the children with this disease even at the pre-school level. There is also a very pertinent need to see that the diagnosis of this condition is valid and perfect and is not a symptom that could be the result of other diseases also. The diagnosis of the disease ought to be attended with care. (Delcarmen; Carter, 2004)

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)

Conclusion

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.