What Is Attention Deficit Hyperactive Disorder?
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What is Attention Deficit Hyperactive Disorder?
You have probably heard and may even have used the term hyperactivity. The notion is a modern one: there were no hyperactive children 50 to 60 years ago. Today, if anything, the term is applied too often and too widely. The American Academy of Child and Adolescent Psychiatry (AACAP) estimates that all teachers have in their classrooms at least one child with ADHD (Simmons, RG. 1993).
Actually, hyperactivity is not one particular condition: it is “a set of behaviors” such as excessive restlessness and short attention span that are quantitatively and qualitatively different from those children of the same sex, mental age, and socioeconomic status (Gutskey, T.R. 1991).
Today most psychologists agree that the main problem for children labeled hyperactive is directing and maintaining attention, not simply controlling their physical activity. The American Psychiatric Association has established a diagnostic category called attention-deficit/hyperactivity disorder (ADHD) to identify children with this problem.
What are the signs of ADHD
Professionals who diagnose ADHD use the diagnostic criteria set forth by the American Psychiatric Association (1994) in the Diagnostic and Statistical Manual of Mental Disorders: the fourth edition of this manual, known as the DSM-IV, was released in May 1994 (Soar, R.S. & Soar, R.M. 1994).
The primary features associated with the disability are inattention, hyperactivity, and impulsivity. A child with ADHD is usually described as having a short attention span and as being distractible. In actuality, distractibility and inattentiveness are not synonymous.
Distractibility refers to the short attention span and the ease with which some children can be pulled off task. Attention, on the other hand, is a process that has different parts. We focus (pick something on which to pay attention), we select (pick something that needs attention at that moment), and we sustain (pay attention for as long as is needed). We also resist (avoid things that remove our attention from where it needs to be), and we shift (move our attention to something else when needed). When we refer to someone as distractible, we are saying that a part of that persons attention process is disrupted.
Children with ADHD can have difficulty with one or all parts of the attention process. Some children may have difficulty concentrating on tasks (particularly on tasks that are routine or boring). Others may have trouble knowing where to start a task. Still others may get lost in the directions along the way. A careful observer can watch and see where the attention process breaks down for a particular child.
Symptoms of inattention, as listed in the DSM-IV, are:
Often fails to give close attention to details or makes careless mistakes in schoolwork, or other activities
Often has difficulty sustaining attention in tasks or play activities
Often does not seem to listen when spoken to directly
Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions)
Often has difficulty organizing tasks and activities
Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)
Often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools)
Often easily distracted by extraneous stimuli
Often forgetful in daily activities (Soar, R.S. & Soar, R.M. 1993)
What causes ADHD?
ADHD is a neurobiologically based developmental disability estimated to affect between 3-5 percent of the school age population (Panksepp, J. 1998). No one knows exactly what causes ADHD. Scientific evidence suggests that the disorder is genetically transmitted in many cases and results from a chemical imbalance or deficiency in certain neurotransmitters, which are chemicals that help the brain regulate behavior. In addition, a landmark study conducted by the National Institute of Mental Health showed that the rate at which the brain uses glucose, its main energy source, is lower in individuals with ADHD than individuals without ADHD (Brooks, D. 1985).
The influence of heredity on temperament is increasingly considered, with activity level being one aspect of temperament that differentiates one child from another very early in development. Approximately four times as many boys as girls are hyperactive. This sex difference may be due to differences in the brains of boys and girls determined by genes on the Y chromosome (Brooks, D. 1985).
Prenatal hazards may also produce hyperactive behavior. Excessive drinking by women during pregnancy is associated with poor attention and concentration by their offspring at 4 years of age, for example. With regard to diet, severe vitamin deficiencies can lead to attention problems. Vitamin B deficiencies are of special concern. Caffeine and sugar may also contribute to attention problems (Burton, N.W. & Jones, L.V. 1982). Even though the exact cause of ADHD remains unknown, it is known that ADHD is a neurologically-based medical problem.
Treatment for ADHD
Today there is an increasing reliance on drug therapy for ADHD. According to a resent research (Friend, M. & Bursuch, W. 1996) 1.3 million American children take Ritalin, a 250 percent increase since 1990. Ritalin and other prescribed drugs such as Dexedrine and Cylert are stimulants, but in particular dosages they tend to have paradoxical effects on many children with ADHD. Short term effects of drug therapy include possible improvements in social behaviors such as cooperation, attention, and compliance.
Research suggests that about 80 percent of children with ADHD are more manageable when on medication. But for many there are negative side effects such as increased heart rate and blood pressure, interference with growth rate, insomnia, weight loss, and nausea (Friend & Bursuck, 1996). In addition, little is know about the long-term effects of drug therapy. There also in no evidence that the drugs lead to improvement