ADHD in Children in the United States

Introduction
Attention-deficit hyperactivity disorder (ADHD) is one of the most common neurobehavioral childhood disorders with 5% of school children being affected by the disorder (Czamara, Tiesler, Kohbock et al., 2013). According to the DSM-V (2013), ADHD is characterized by inattention, hyperactivity and impulsivity, all of which interfere with the child’s ability to engage in quality “social, academic, or occupational functioning” (p. 2) for an extended period of time—at least 6 months or more. This paper will discuss the symptoms that a child with ADHD may exhibit, age of onset and gender differences, etiology, course, prognosis and current treatment and a differential diagnosis for the disorder as well.
Symptom Picture
Prevalence rates in the world for ADHD stands at 5.29% (Smith, 2017). This is roughly consistent with rates in the U.S. where one out of every twenty children are affected by ADHD (Faraone, Sergeant, Gillbert & Biederman, 2003).
A child who has ADHD typically experiences a range of emotions and impulses that often prevent the child from limiting his or her train of thought to a single idea or subject. In many cases, a child with ADHD will see numerous corollaries to a single idea and feel compelled to explore them. At the same time, the child may experience the underlying problem of engaging in so many tangential sequences, but—feeling frustrated by his or her inability to prevent the mind from exploring these tangents—the child can easily become upset, distracted, and annoyed. These feelings may be directed inward or outward.
At the same time, the child may want to focus on a single activity while wanting to do several others too. This produces tension and conflict within the body, mind and will of the child. The challenge for the child is to understand these conflicting impulses and develop the ability to control them, which can in all fairness be at times beyond the child’s grasp (Caye, Swanson, Thapar et al., 2016).
Children are also faced with the challenge of developing relationships with peers, which is a task that can be quite difficult for children with ADHD (McQuade & Hoza, 2015). Misbehavior often stems from the child’s inability to control impulses, which can upset other children and cause the child with ADHD to feel isolated, feel cut off, disliked, unloved and even despised. It is difficult for children with ADHD to comprehend why they marginalized and their responses to feelings of marginalization can increase the distance between them and their peers even more—especially if those feelings are represented confrontationally. This can easily carry over into school performance where the child with ADHD may perform poorly.
Cultural Variables
When it comes to variations among different cultures, there is basically no variance as Davis, Cheung, Takahashi, Shinoda & Lindstrom (2011) show. Whether it is among children in the UK, children in Japan, children in Ukraine, or children in Central America, the findings show that ADHD is a universal disorder that affects all children of all cultures and is not more prevalent in any one culture or among any one ethnicity. According to Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD, 2018), prevalence among children ages 2-17 in the U.S. is:
· 8.4 percent White 
· 10.7 percent Black 
· 6.6 percent Other 
· 6.0 percent Hispanic/Latino 
· 9.1 percent Non-Hispanic/Latino
There is wide disparity among states in the U.S., however. For example, Nevada has the lowest rate of ADHD prevalence at 4.2% while Kentucky has the highest rate at 14.8% (CHADD, 2018).
Age of Onset and Gender Features
The average age of when symptoms start is anywhere between 2-17 years of age, with most children being diagnosed between ages 6 and 11 and most children demonstrating signs of it between the ages of 11 and 14, with symptoms dwindling the older they get if appropriately treated (CHADD, 2018). The majority of children with ADHD are also boys, with 13.3% of boys having ADHD and only 5.6% of girls having ADHD (CHADD, 2018). Onset is typically gradual and can range in severity from mild to moderate to severe. 5.1 million children currently are diagnosed with ADHD in the U.S., and the average age of the child when diagnosis is made is 6 years old. Mild ADHD is most commonly diagnosed at 7, Moderate ADHD at age 6, and Severe ADHD most commonly at age 4.5 (CHADD, 2018).
Etiology
Voeller (2004) notes that ADHD can be both inherited and acquired and that it is not possible for physicians to distinguish between inherited ADHD and acquired ADHD. It is considered to be “a disorder of neurotransmitter function, with particular focus on the neurotransmitters dopamine and norepinephrine” (Voeller, 2004, p. 799). Research indicates that dopamine plays a major role in the regulation of the impulses that the child reacts to and has an impact on the learning process, behavior, and motivation. It also factors into memory-related tasks and dopamine can modulate neuronal activity that is related to motor processes as well. As Voeller (2004) states, “dopamine plays an important role in the function of the prefrontal-subcortical system” (p. 800). Norepinephrine is also a major player in the impact of the child’s ability to be alert and maintain focus or to maintain attention with tasks. Environmental factors can also play a part in the onset of the disorder: for example, children who grow up or come of age in environments or family situations that are chaotic tend to show signs of ADHD more than children who grow up in stable environments. Voeller (2004) states that “the risk of ADHD is proportional to the number of adverse factors (eg, poverty, maternal psychopathology, paternal criminality) that are present” (p. 804).
Course
ADHD is not a lifelong chronic course as most children tend to be treated for it through any one of the number of methods that are available, or they find it easier to regulate their emotions and impulses over time on their own, even if their parents or guardians do not treat them for it. However, if not treatment is provided, ADHD can lead to problems for the child as he or she grows that turn into worse issues, such as anti-social behavior, drug or drinking problems, and so on. Kumperscak (2013) states that “untreated ADHD is also a risk for a range of other mental disorders such as conduct disorder, oppositional defiant disorder, depression, and substance abuse or addiction.”



Faraone et al. (2003) note that “in approximately 80% of children with ADHD, symptoms persist into adolescence and may even continue into adulthood” (p. 104). This means that ADHD can “significantly impact on the individual throughout childhood and well into adult life, especially if not managed optimally” and this impact results in the child growing up to “have a lower occupational status, poor social relationships, and are more likely to commit motoring offences and develop substance abuse” (Faraone et al., 2003, p. 104).
Prognosis
The end result of the symptom picture is that if treated symptoms would disappear or the child as an adult would know how to regulate his or her system so as to not suffer any of the symptoms. If left untreated, the adult with ADHD could have severe depression or suffer from substance abuse. If behavioral intervention and/or medication are used, the client should be able to manage symptoms effectively.
Current Treatment
Pharmacological intervention and behavioral intervention are both ways to treat ADHD in children, and parents can also take counseling sessions to learn how to better parent children with ADHD and what to be aware of when they are raising these children. This is also a good idea for parents because it allows them to understand what their children are going through physically and mentally and how they are trying to cope with their own disorder and why that coping process causes them to act out in different ways that can seem bothersome for parents.
Drug treatment can be an option that is successful but there are also drawbacks to this type of intervention as well. Drugs for ADHD diagnoses can lead to drug addiction because the drug has addictive properties. Chambers et al. (2014) show how “developmental changes in neurocircuitry involved in impulse control” for instance serve as the biological basis for the addiction (p. 1041). Indeed, the researchers note that “psychiatric disorders commonly identified with disturbances in reward motivation and substance use disorder comorbidity are associated with impulsivity” (Chambers et al., 2014, p. 1042). Voeller (2004) shows that “sychostimulant medications that increase the amount of central dopamine and norepinephrine are typically the most effective way to treat ADHD” (p. 801).
Another form of intervention is behavioral and this can be especially helpful and positive because children who suffer from ADHD require special, individualized attention and care that engages them in a one-on-one format. Siegel and Bryson (2012) state that “our brain has many different parts with different jobs” and because the brains of children are still developing, their environments and the people with whom they interact can have a very formative impact on how they perceive themselves and their world. For that reason it is important that children with ADHD receive care from people who show that they love them and will be patient with them. Behavioral intervention focuses on the child and ensures that they not feel abandoned, neglected, or marginalized during this difficult time in which they are learning to cope with their own ADHD and the struggles that go along with it (p. 6). A child who experiences undue stress because of a tense environment or because of tense relationships with peers and parents will undoubtedly feel the consequences in terms of psychosocial development (Sandstrom, Huerta, 2013). Providing children with a consistently loving, positive and supportive environment in which the child receives one-on-one attention from the parent can be one of the most supportive and helpful ways of helping the child to cope with his or her impulses and show the child that he or she is still loved by the parent.
Differential Diagnosis
Oppositional defiant disorder (ODD) is commonly linked with ADHD and the latter may actually be mistaken for the former. According to Morin (2018), ODD can show up in children before they are 8 years of age and the common symptoms include: being disobedient, not following the rules, deliberately being uncooperative, arguing about everything even if it is not important or meaningful, being irritable and having a negative attitude. As is often the case, ADHD and ODD coincide in the child, but ODD can sometimes stem from other environmental issues that are not related to ADHD. It is important to find out if the child’s negative attitude is a result of the mental disorder and inability to concentrate on one single task at a time or if it is the result of some other issues that the child is having.
Conclusion
ADHD is a common mental disorder that impacts children universally and is prevalent among roughly 5-8% of the world’s children no matter their ethnicity or culture. It is more prevalent among boys than it is among girls, and it is commonly diagnosed around age 6. Most children receive treatment for ADHD either through drug intervention or through behavioral intervention. If left untreated, the disorder can lead to serious depression and/or to substance abuse issues for the child later on in adulthood and can lead to anti-social behavior as well.

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