Attention-deficit hyperactivity disorder (ADHD) is described as the most common neurobehavioral condition of childhood. There is evidence that ADHD is not a disease but rather a group of symptoms representing a behavioral pathway for a range of psychological, emotional, and learning problems (Furman 2006). Some research has indicated that children with ADHD (with hyperactivity) are more likely to have behavioral problems, while the children with ADHD (without hyperactivity) are inattentive and more likely to suffer from anxiety disorder and depression. Escalating numbers of children are diagnosed with ADHD each year and further treated with stimulant medications according to a basic approach. Reported rates of ADHD in school-aged boys and girls are approximately 10% and 4%, respectively, and increasing numbers of children are prescribed stimulant medications. Professional organizations, including the American Academy of Pediatrics and the American Academy of Child and Adolescent Psychiatry have issued consent statements on the evaluation and treatment of ADHD, and most physicians accept ADHD as a primary diagnosis (Furman 2006).
A child receives a diagnosis of ADHD based on prolonged occurrences of eight (or more) of fourteen symptoms before seven years old. These symptoms have been identified as fidgeting with hands or feet or squirming in seat, difficulty remaining seated, easily distracted by extraneous stimuli, difficulty awaiting turns, blurts out answers without completed questions, difficulty in follow through, difficulty sustaining attention, shifting from one uncompleted activity to another, difficulty playing quietly, excessive talking, interrupting, lack of listening skills, and engages in dangerous activities without thinking of consequences (Jacquith 1996). Children with ADHD are not able to produce the chemicals necessary for the brain to create organized thoughts. Due to this deficiency, the organizing centers of the brain no longer function at regular capacity. This results in the symptoms that are prevalent with ADHD. There appears to be some genetic component to the disease since ADHD is more common in children who have a close relative (or relatives) with the disorder. Some recent research indicates a link between substance abuse (including smoking) throughout a pregnancy and the development of ADHD.
Psychosocial Development
Many skills are involved to produce flourishing social interactions. These skills are part of both the expressive and receptive domains, which are decidedly interconnected. Although social skills are often associated with language skills, many social skills are nonverbal. Especially, social comprehension is an under researched constituent in the social skills specialty. Social comprehension involves “empathy for others’ experiences and appropriate responses to nonverbal cues. It is both an accurate interpretation of nonverbal cues and awareness of one’s nonverbal responses” (Miller, Miller, Bloom, Hynd, & Craggs 2006). For example, when children are interrelating with other children, they need to respond in an appropriate way not only verbally to their conversational partner’s language and word choice but they must also respond nonverbally by monitoring facial expressions, maintaining eye contact, and surmising the concentration and emotional status the other person. It is often in these social situations that a child with ADHD finds great difficulty.
According to the National Institutes of Health consensus development conference statement, “Children with ADHD have significant social skill deficits that affect relations with peers and have long-term social consequences (NIH Consensus Statement, 1998). One study reported that children with ADHD had difficulty paying attention to others, were less likely to be liked by other children, and often daydreamed at inappropriate times. Some studies have found right-hemisphere abnormalities to be associated with ADHD (Miller et al. 2006). Specifically, Hynd and colleagues found 72.7% of children without ADHD have greater volume in the left hemisphere but 63.6% of children with ADHD have greater volume in the right hemisphere (Miller et al. 2006). In addition to the studies suggesting the role of right-hemisphere dysfunction in ADHD, numerous studies have also documented deficits in social skills that are often seen in children with ADHD. Furthermore, in a study of fifteen children with acknowledged right-hemisphere damage or abuse, fourteen were diagnosed with ADHD. This further suggests a link between right-hemisphere morphology, social skill difficulties, and ADHD (Miller et al. 2006).
Studies have shown that children with attention deficit hyperactivity disorder (ADHD) are at increased risk for developing antisocial disorders in adolescence and adulthood. Previous research by Mannuzza, Klein, Abikoff & Mouton (2004) reported that ADHD, alone, placed children at risk for the development of conduct disorder in adolescence. These findings emphasize the importance of identification and intervention even in mild conduct disorder-related behaviors in children with ADHD. No singular behavior predicted later conduct disorder. Instead, the combination of all childhood antisocial behaviors contributed to the later development of conduct disorder (Mannuzza et al. 2004).
Research shows that there are three major aspects of Physical Development that are affected in the child with ADHD. These are the processing of input through the five sensations, proprioception (spatial knowledge of ones body) and establishment of dominance (Munoz, Smeal & Witting 1999).
A child, who has not fully developed their tactility senses, may be more physically interactive with their environment to gain needed stimuli. In the development of tactility, there are two common areas where problems can occur. These include the ability of appropriately processing sensations of gentle touch, force and hurt, the other involves the lack of proprioception. Proprioception is the knowledge of where ones’ body is in space and the location and position of each individual part of the body and joint. If an individual has lacks the development of proprioception, the brain lacks the knowledge of where the body is at. Symptoms include: fidgeting or squirming around, bumping into things, and sometimes, engaging in physically dangerous activities with no knowledge of the body’s inability to complete the task. Decreased auditory and visual processing associated with ADHD may cause reduced short-term memory, ease of distraction , rapidly shifting attention and difficulty following through on instructions (Jacquith 1996). They also may participate in activities that are physically harmful, since the understanding of what the body is capable of is not specifically clear.
The establishment of dominance is important in the acts of processing, storage and utilization of information and perception. If a child with ADHD does not establish a dominant side, the child may not use their brain in the most effectual manner in the dealing with outside stimuli. (Munoz et al. 1999). Nearly everyone is either right-handed or left-handed. For the brain to take in information as effectively as possible, it is exceptionally necessary to consider if a child is right or left handed, eyed, eared, and footed (Jacquith 1996).
Children with Attention-Deficit/Hyperactivity Disorder (ADHD) are physically hyperactive as of early childhood and have been shown to exhibit higher levels of motor activity than normal (Holtkamp 2004). However, this has not been shown to be protective against obesity and adiposity in children. In contrast, the rates of overweight and obesity in children with ADHD is significantly higher with greater BMI-SDS (Holtkamp 2004). This is likely a result of the medications administered to control the behavioral issues associated with the illness.
Learning disability and ADHD are reported to be completely divided conditions, although learning disability (or low cognitive ability) can lead to inattentiveness and aggravation in the classroom and thus impersonate ADHD. Children with reading disability and ADHD who are medicated with stimulants show improvement in reading scores, however those with reading disability alone do not; this finding is used to support an approach of treating all distracted learners who have academic failure with stimulant medication (Furman 2006). However, some studies indicate that 50% of those with ADHD also have a learning disability. One study has determined this number to be as high as 70% (Munoz et al. 1999).
Many cognitive symptoms are prevalent among children, which contribute to the more widespread problems. These include “blinking”, “scanning”, “multi-tracking”, “flooding”, “radial thinking” and “hyper-focus” (Munoz et al. 1999). “Blinking” is the rapid loss of focus and certain refocusing on a discussion or task. When this occurs during conversations, or in the classroom, the child misses vital information. They are presented with the embarrassing chore of requesting the person to repeat themselves, or ignoring the problem and subsequently, not understanding the lesson or what has been spoken. In “Scanning”, the mind fails to filter environmental stimuli. ADHD children may become overwhelmed with excess information from a teacher, in addition to an insect flying about the room, another student having a conversation, and even the sound of the teacher writing. They are not capable of singling out one item which to give their attention. This is often perceived as lack of attention, or lack of interest in the person or subject. “Multi-tracking” also relates to multiple stimuli affecting the child. In multi-tracking however, the child is able to follow one of the inputs at a time instead of being overwhelmed, but rapidly jumps back and forth between them. This causes a perception of disjointed dialogue with others, and loss of stability in work. “Flooding”, is “The porous system of the ADHDer instantly absorbed all that is in his environment, in such an intense and pervasive way that it floods the person, causing them to overreact when compared to most people” (Munoz et al. 1999). This causes the person to remove themselves from a situation that is painful or too interesting, even though others do not perceive this in such a way. In “Radial thinking”, a person with ADHD attaches topics laterally instead of the normal sequential fashion. They start new topics without apparent connection due to a thought that was triggered by a solitary word in a conversation. When attempting to communicate these ideas to others in the conversation, understanding becomes difficult, and frustrations result between both the listener and the child with ADHD. Finally, “hyper-focus” is the reverse of the perception of ADHD. When a person with ADHD and hyper-focus begins to focus on a topic, they may become so intensively engaged that they lack any time for other pursuits; they often go without sleep as well. Due to this behavior, family, friends and even other projects are all ignored in this obsession with one task. The coexistence of cognitive problems with ADHD is just starting to get more attention from the media.
Conclusion
ADHD is a serious issue with children and adults. The developmental delays seen in cognitive ability, psychosocial issues and physical development can compound the issue. ADHD is defined as a DSMIV disorder and is included with disorders that may have multiple etiologies. Evidence has accumulated that the disorder (and all attention disorders) is a neurophychological function and that these disorders are biologically based. Much research has helped contribute to the current understanding and even a model has been proposed that indicates the pathways responsible for attention. The social skills lacking in a child with ADHD make them feel vulnerable and lonely. The physical delays may cause the ADHD child physical harm due to lack of proprioception. The many physical manifestations of the child with ADHD can leave them all-consumed or overwhelmed and cause them to further withdraw from the world around them. There is a tremendous amount of debate regarding the diagnosis and treatment of ADHD in the extremely young. It is recommended that no diagnosis should be made, nor medication prescribed, for any child under the age of six. Furthermore, many long-term side effects exist for these medications including impeded growth and liver toxicity. For Attention Deficit Hyperactivity Disorder to be fully understood and properly treated, all aspects of care must be understood. Treatment is only successful if all developmental problems are considered.
References
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