Attention Deficiency-Hyperactivity Disorder
- With ADHD- is the duration requirement of 6 months for symptoms presence enough time? State any opinions and/or observations you may have regarding these considerations.
Children suffering from ADHD display a high degree externalizing behaviors. They exhibit off-task characteristics that are easily observed e.g. they may distract and disrupt other kids at school. Symptoms associated with Attention Disorders Deficiency Syndrome appear to be most apparent and problematic in educational setting. According to Atkins and Pelham (1991) ADHD is a “school based disorder” where kids exhibit academic underperformance, disorganization and social skills deficits.
The duration requirement of 6 months for symptoms to show does not present enough time as they persist for at least 6 months to a degree that is maladaptive and inconsistent with developmental level. According to analysis made on 39 research articles by Goodman and Poillion (1992) on ADHD, there are 69 unique characteristics that can be exhibited by students with ADHD. However, these characteristics are not unique to ADHD alone as other psychiatric conditions display them. Often it takes a longer period to diagnose a child for this disorder and prescribe a treatment.
For the symptoms of ADHD to be confirmed several key indicators ought to be verified. First, there must be a proof that some symptoms that led to impairment of the child when s/he was less than 7 years. Secondly, the diagnostician completing the evaluation must be able to document impairment from the ADHD symptoms in monitored from different places (for example, at home or at school). Thirdly, the child’s inattention or hyperactive-impulsive behaviors must be shown to alter with normal functioning in social, academic, or/and occupational areas (APA, 1994).
ADHD symptoms usually begin in childhood before the age of 7 and can vary depending on the type of ADHD. Inattention, hyperactivity and impulsivity are the main behaviors found in people with ADHD, According to NIMH, all children have these behaviors at times. But these behaviors are more severe and are found often in kids with ADHD.
Some of the traits exhibited by those suffering from ADHD may include, failure to give close attention to details, difficulty in sustaining attention, difficulty in playing or engaging in leisure activities quietly, talks excessively, interrupts or intrudes on others, and easily distracted by extraneous activities.
There are no direct tests that confirm that a child is suffering from ADHD and so it is very easy for the child with a condition that exhibits similar symptoms to be diagnosed for ADHD. Condition such as sleeping apnea has variously been misdiagnosed as ADHD. This condition can lead to irritability and impaired concentration. Although this condition is mostly found in obese middle-aged persons, children can also have it. It is estimated that about 25% of all cases of ADHD that have been confirmed in US are actually sleep apnea.
There are other conditions that can mislead and make people to believe that a child has ADHD. When a child is stressed, traumatized or has just received asthma treatment s/he is likely to react the same way children with ADHD behave. Before diagnosing a child for ADHD it is important to check other social stimuli that can result in behavioral changes that may last for a long time. When a child is misdiagnosed for ADHD s/he is likely to be subjected to wrong medication that may further complicate the condition.
It is important that a full medical history of the child be obtained before any diagnostic conclusions can be made. All other psychological conditions should be ruled out before the child is finally diagnosed for ADHD. Parents, especially those with children below six years, should be patient with their kids and observe their development for sometimes before event consulting a therapist. It is apparent that many medical practitioners can work with drug suppliers and then misdiagnose other conditions as ADHD to help improve sales of their drugs (1994). It is apt responsibility to ensure that his/her child is comfortable and psychologically stable and reduce instances where the child can be distressed and exhibiting symptoms that are far from their psychological nature.
- Discuss several cognitive and language factors which may be manifestations of ADHD?
ADHD manifests itself in different cognitive and language factors. The following are some of the most common features of the disorder:
Individual with this disorder may exhibit abnormal responses, controlling gratification and poor management of impulse. These characteristics can be observed in kids not having the patience to wait for their turns to play, their abilities to ignore distraction when they are engaged elsewhere, and their involvement in heavy and tedious jobs unlike other people that like lighter duties (Mash & Barkley 2005).
People with ADHD like engaging in irrelevant activities. Instead of using less strenuous methods to complete their assignments, many individuals with this disorder move up and down, shifting their sitting positions, moving things, tapping and lifting objects. Young kids can be found jumping, running, climbing, etc. as kids grow up, the level of activities decreases but still their motions and restlessness is above those of other kids. Most adults with ADHD do not show a lot of physical restlessness but may lack patience and wanting to be engaged in physical activities instead of sitting and resting. This may result in low outputs from their jobs as compared to other people doing the same jobs. As a result a lot of supervision over their responsibilities is required to ensure that they run according their prescribed responsibilities and they do not procrastinate.
They lack concentration needed to complete tasks. This often happen when an individual is assigned an activity that is not interesting to him/her, instead of looking at the importance of the activity at hand s/he may drop from doing the activity and start doing something totally different. Unlike other people who realize importance of certain activities that may not be interesting to do but must be accomplished, people with ADHD do not realize the same need. Lacking attention may mean that they need to be supervised to complete important tasks because they may be easily distracted (2005).
They have impaired working memory. Working memory helps individuals keep track of activities that are supposed to be completed now or in future. People with ADHD lack the concentration to keep track of their activities and consequently they are often late to complete their assignments, they have poor or no plans for the future and accomplish lesser goals than others within the same time duration. This problem is manifested in both children and adults with this disorder (2005).
They exhibit slow development of internal (subconscious voice in the mind) language. It has been established that many individuals with ADHD during their growth take longer to develop the subconscious voice that constructs speech, reaction and impulse. As a result most people with this disorder have problems following instructions, following their plans/timetables, forming conceptual ideas. Sometimes these individuals lack concentration to read and follow long stories/comprehensions.
Individuals with ADHD often have problems controlling their emotions. Their inability to control their emotions and feelings makes them appear to be less mature than others of their age. This condition may manifest itself in the way they get angry quickly (hot tempered) and can easily cry out of frustrations. They lack a self motivating consciousness that can help them withstand provoking situation and motivate them when things are not moving their way (2005).
According to a research conducted by Warner-Rogers, Taylor, Taylor, and Sandberg (2000) on behavioral characteristic of children with ADHD, most inattentive kids mostly come from families where the father earns little money and does not take overall control of his father. As a result of low inattention, such kids were found to take much time in development of language. Although inattentive kids may not be disruptive in class or at home, majority of them have reading problems and as a result they develop low self esteem (Warner-Rogers, Taylor & Sandberg 2000).
- Examine the diagnostic criteria for ADHD in the DSM-IV. Some professionals believe that not only is ADHD over diagnosed but it is also misdiagnosed due to some of the factors discussed in the text. Take one of these factors and explain how ADHD may be either a misdiagnosis or a co-morbid condition.
Diagnostic criteria for ADHD-IV
The DSM-IV-Diagnostic and Statistical Manual 4th edition is a tool used clinically for diagnosing ADHD. Using this tool, it is possible to identify 3 ADHD subtypes.
- Predominantly inattentive type
- Predominantly hyperactive-impulsive type
- Combined type
Predominantly inattentive type is identified with lack of attentiveness, regular distractions, forgetting and/or carelessness.
Predominantly hyperactive-impulsive type is recognized through exhibition of inability to follow through fun activities e.g. films, games, etc, talking too much and fidgeting.
Combined type can be distinguished when an individual exhibit symptoms of both subtypes.
An individual is considered to have ADHD disorder if 6 or more of the symptoms below are elaborate in him/her;
The following is the criteria used for diagnosing Attention-Deficiency/Hyperactivity Disorder
- When either criteria i or ii are noted.
- At least 6 of the following inattention symptoms are noted to have persisted for more than 6 months and are not consistent with normal growth and development;
When an individual often:
- Is careless about details whether at school, work or other activities
- Is unable to sustain attention to ongoing activities
- Is not attentive when someone else speaks directly to him.
- Is not careful to follow all provided instructions and as a result is unable to deliver required results.
- Is unable to organize his/her activities/duties
- Is not careful to engage in activities that require thinking and time.
- Is careless and loses important tools/items
- Is easy carried away by little details
- Forgets regularly about route activities
- At least 6 of the following hyperactivity-impulsivity symptoms are noted to have persisted for more than 6 months and are not consistent with normal growth and development
When an individual often;
- Is constantly fidgeting and keeps moving in his seat
- Can leave his/her sitting position although instructions require people to be sited.
- Is full of running, climbing tapping and other inappropriate behaviors that are not expected of his/her age.
- Is not able to enjoy leisure activities because of restlessness
- Is restless throughout
- Is talking too much
- Can shout out answers before the teacher/coordinator asks the question
- Cannot wait for his turn when everyone is following a queue.
- Interferes and disrupts other conversing people or other kids while playing.
- Some of the inattentive and hyperactive-impulsive symptoms were noted to have existed before the individual was 7 years.
- Some symptoms are found to manifest themselves in more than one setting; e.g. at work/school and at home.
- There are clear indications that really impairment caused by ADHD existed.
- The impairment and symptoms are not covered by other psychotic disorders.
When an individual with ADHD has other psychiatric conditions diagnosing for ADHD can be complex. The other psychiatric condition may exhibit symptoms similar to those of ADHD. Apparently, many kids that suffer from Attention Deficiency-Hyperactivity Disorder are always at a greater risk of having conduct disorder, depression, substance abuse and anxiety disorder. The probability of ADHD coexisting with another psychiatric condition varies between 0.15 and 0.30. Actually most clinical testing for ADHD uses the other four psychiatric conditions to test for ADHD (Warner-Rogers, Taylor & Sandberg 2000).
- Why many parents and caretakers rule out ADHD disorder citing their proper behaviors?
A parent may argue that his/her child does not have ADHD disorder because s/he plays video games and watches television. Video games and television sets are not monotonous and they are full of activities that can keep the minds of the kid busy. It has variously been suggested that video games be used for treatment of this disorder. According to Owens a clinical psychologist (2006) video games can work well in treating inattention and a patient can learn to be patient out of playing video games. Attention is controlled by brain waves that are in turn triggered by neuro-feedbacks. Concentration can be enhanced in these patients through prolonged playing. Some analysts however are adamant stating that games might not be a long term solution for kids with ADHD and parents/caretakers should not stop medical treatments.
ADHD children that are inattentive can spend long hours gazing at television sets. Research has shown that most inattentive kids take longer to develop such important aspects as language and thus they may not understand what is happening on the television channel but on the other side they may enjoy looking at the screen. This is a dangerous practice as it will deny the child an opportunity to interact with others and learn. Alternatively the child may learn few but separate ideas from television watching and consequently try to mimic the sounds and characters shown on the television (Owens 2006).
Parents and caretakers may argue that kids behave almost the same as other kids of the same age. Some of the symptoms of ADHD are not unique and they may not be elaborate in the kid. Other symptoms of this disorder may not be fully manifested at tender ages and that does not mean that the kid doesn’t have ADHD. It can also be noted that small kids do not have many activities that can elaborately show that the kid had ADHD. For this reason, diagnosis process of ADHD in kids requires more time before a conclusion can be made.
During child development many social aspects found in his/her surrounding may alter personality traits. Behavioral changes in the child are likely to be translated to be ADHD disorder but that might not be true. Although parents are charged with the responsibilities of ensuring that they bring up their children in the best environment possible, it is also up to them to ensure that they attend to their kids and ensure that unfavorable environmental stimuli do not take a stall on their children (2006). Such behaviors as domestic quarrels, fighting and negligence amongst parents may affect children psychologically.
Child behaving differently when handled by different individuals e.g. father, mother or specific teacher cannot be used as evidence that the child does not have ADHD disorder. Kids with ADHD sometimes learn lessons and adapt routines and different ways of reacting while in specific environments. One parent might be strict and the child might fear being scolded and thus behave well when that parent is present. The parent may also be friendly to the child to such an extent that the child develops great affection him/her. This may translate to behavioral alteration while this parent is present but should be used vividly to mean that the child is not ADHD (2006).
Same case applies at school where there are some strict teachers that the child can fear to face and as a result s/he may tone down his/her activities because of the teacher. There are teachers are friendly to kids and use personalized approached to deal with different kids. These teachers may alter behavioral characteristics of the ADHD kids to such extents that parents and caretakers might be coaxed to believe that the kids do not have ADHD. Periodic changes in child’s behaviors should not be used to misguide the diagnosis process ADHD.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders. Washington, DC: Author.
Biederman J, Faraone SV, Lapey K. (1992). Comorbidity of diagnosis in attention deficit hyperactivity disorder. Child Adolesc Psychiatr Clin North Am. 1:335-60.
Goodman, G., and Poillion, M. J. (1992). ADD: Acronym for any dysfunction or difficulty. Journal of Special Education. 26(1): 37-56.
Jenks, S. (2006). ADHD patients play video games as part of treatment. Retrieved on June 23, 2012. http://www.usatoday.com/tech/gaming/2006-03-09-game-therapy_x.htm
Mash, E. and Barkley, R. (2005). Treatment of childhood disorders. New York: Guilford.
Warner-Rogers, J., Taylor, A. and Seija S. (2000). Inattentive behavior in childhood: Epidemiology and implications for development. Journal of Learning Disabilities. 33 (4): 520-536.