In certain cases, parents might observe the energetic behavior of their child and conclude that their child is just hyper and that this is a natural phenomenon. Although parents that undergo this experience might not see their child’s hyperactivity as a problem, concerns for the child’s behavior could arise when the child begins to attend school. In fact, while at school, children with hyperactive tendencies may have problems staying focused or staying quiet. Also, these children may find it hard to wait their turn to speak and their patience overall might be weak in other situations as well. In psychology, symptoms like these can be identified as a mental disorder under the diagnosis of Attention-Deficit/Hyperactivity Disorder, also known as ADHD. ADHD is a brain disorder that is caused by genes, morphological brain abnormalities and adversity (Xenitidis, 2011). On most occasions, this mental disorder may carry over into an individual’s adult life or it may be resolved during adolescence. To diagnose this disorder, health care professionals use the American Psychiatric Association’s Diagnostic and Statistical Manual, Fifth edition (DSM-5). Statistics show that 5% of children have diagnosis of ADHD; however, other researchers confirm that this number ought to be higher (CDC, 2018). There exist three primary symptoms associated with ADHD that diagnosed individuals present, which include the following: hyperactivity, impulsivity, and inattention. Based on the pervasiveness of either one of the three symptoms within an individual, a certain type or presentation of ADHD can be identified. These presentations include the following: Combined Presentation, Predominantly Inattentive Presentation, or Predominantly Hyperactive-Impulsive Presentation. Overall, the number of people diagnosed with ADHD has become increasingly prevalent in recent years, more so than it has ever been in the past and many people, including experts, have begun to ask why.
Moreover, this specific mental disorder has not always been called Attention-Deficit/Hyperactivity Disorder. Indeed, ADHD’s original name was hyperkinetic impulse disorder. ADHD was finally recognized as a mental disorder during the 1960s by The American Psychiatric Association (APA). Sir George Still, a British pediatrician, first identified ADHD in the early part of the twentieth century. In his words, this condition was an abnormal defect of moral control in children (Healthline). In brief, he recognized that some children could not control their behavior, but he found out that this lack of control did not affect the child’s intelligence. Thereafter, the first edition of the DSM did not recognize ADHD as a mental disorder early on. However, when the second DSM was published in 1968, they identified the mental disorder and named it hyperkinetic impulse disorder. After the APA released the DSM-III, the mental disorder had its name changed from hyperkinetic impulse disorder to attention deficit disorder (ADD) in 1980. The APA found that there were two subtypes of attention deficit disorders: attention deficit disorder without hyperactivity (ADD) and attention deficit disorder with hyperactivity (ADHD). Scientist found that hyperactivity was not a common symptom. In 1987, the APA revised the DSM-III, removing the subtypes and changing the name to what is now known as attention deficit hyperactivity disorder. In 2000, APA released the DSM-IV including the three subtypes of ADHD as Combined Presentation, Predominantly Inattentive Presentation, or Predominantly Hyperactive-Impulsive Presentation (Healthline).
Although Attention-Deficit/Hyperactivity Disorder can be identified simply as a mental illness, other factors make this disorder more interesting, such as the individual’s genes and the environment surrounding the individual. Due to a lack of understanding of this mental disorder, there is a little information about what genetic factors contribute to ADHD. There exist only hypothetical ideas that attempt to explain these genetic factors. In his article on ADHD, Professor Paolo Curatolo argues that twins seem to genetically contribute to the disorder with heritability ranging from 60-90% (Curatolo et al., 2010). Another reasonable genetic hypothesis is that a mixture of major dominant and recessive genes contributes to ADHD. Additionally, others conclude that there are pre-, peri- and postnatal environmental factors that all play a role in this condition. For example, one of the prenatal factors of ADHD is the lifestyle of the mother during pregnancy. Consuming alcohol while pregnant is found to induce brain structure in the cerebellum. Another example accredits the condition to maternal smoking; this yields a 2.7-fold increase risk. It has been found that there is an interaction of the dopamine transporter (DAT1) and that the prenatal exposure was found mostly in males. In addition, peri-natal factors include the child having a low weight at birth and the mother having birth complications. Last, a postnatal example includes a shortage of proper and necessary nutrition and an imbalance of essential fatty acids intake. In some cases, scientist believe that iron deficiency plays a role for some children. Curatolo also reports that by using neuroimaging, it is found that patients with ADHD have reductions of total cerebral volume, the basal ganglion, the prefrontal cortex, the corpus collosum and cerebellum (Curatolo et al). Neuroimaging studies have noted other contributing factors, which include a reduction of white matter in the corpus collosum area and cortical thickness in these patients. Consequently, data from neuroimaging, combined with genetic and neurochemical studies, have assisted successful attempts to identify the pathophysiology of ADHD.
Nevertheless, there still happens to be a lot confusion about how to properly diagnose someone with ADHD which has increased the number of people diagnosed with ADHD. Centers for Disease Control and Prevention (CDC) states that the estimation of children with ADHD has changed over time. The American Psychiatric Association believe that 5% on children have ADHD; however, other studies show that this number is higher in community samples. Clearly there is a lot of confusion surrounding ADHD, specifically with its diagnosis process. In Addicted to Adderall, Osman Moneer et al. argue, defining and diagnosing ADHD is a fairly difficult and subjective process. They later point out that the National Institute of Medical Health does not provide an explanation for the origins of ADHD. Consequently, Moneer et al. contend that the lack of knowledge surrounding the origins of this disorder makes it difficult to diagnose someone with an actual ADHD disorder (Moneer et al, 2018). Therefore, this difficulty in the diagnosing process causes an increase in the spread of someone being diagnosed by doctors and as a result, this has led a growing amount of people diagnosed with ADHD due to a lack of clarity. In a study done by the CDC, approximately 380,000 children between the ages 2-5 had ever been diagnosed. However, this number increases into the millions as age increases. For instance, it was found that the number of children of ages 4-17 years, that had ever been diagnosed with ADHD, starting at 7.8% in 2003 survey, increasing to 9.5% in a 2007 survey, and further increasing to 11.0% in a 2011 survey. The CDC also reports that approximately 2 of 3 children that currently have ADHD are diagnosed with an additional mental or emotional behavior disorder (CDC, 2018). Also, it has been revealed that males are three times more likely to be diagnosed with ADHD than females with an average age of 7 years for both (ADDRC, 2017). Clearly, broad speculations about ADHD exist in various forms, specifically in narrowing down the exact proper diagnosis of ADHD, and subsequently, this has contributed heavily to the rising number of individuals diagnosed with ADHD.
For diagnosing a child with predominately inattentive ADHD, children up to 16 years of age must present six or more symptoms, or five symptoms for children 17 and older (CDC, 2018). Some of the DSM-5 symptoms for inattention include the following: the person often fails to pay close attention to details, it seems like they are not listening when being spoken to, has trouble being organized or organizing tasks and activities. Symptoms also include often being forgetful in everyday activities, being easily distracted, not following instructions fully, and not completing tasks. These symptoms must be present for a minimum of 6 months to be diagnosed with inattentive ADHD (CDC, 2018).
In addition, the other two common symptoms for ADHD include hyperactivity and impulsivity. Similar to inattention the same age requirement and amount of symptoms are necessary to be diagnosed with this type of ADHD. Symptoms that must be present for hyperactive and impulsivity include fidgeting with hands or feet, leaving the seat often, talking uncontrollably, and interrupting other people (ADD, 2018). Some symptoms that all of the three sections present include blurting out answers for uncompleted questions, waiting turns and remaining still. Also, according to Attention Deficit Disorder Association, other conditions must also be met. These conditions must include the following: having the six symptoms (in the subtypes) before the age of twelve, these symptoms being present in two or more different environments, and the symptoms interfering with the quality of social or school life.
The third subtype of ADHD is called the combined type and it is diagnosed the same way as the other two types. This combined presentation is the most common type to be diagnosed with and it is the one that is most researched on. Children that present symptoms from both inattentive or hyperactive-impulse will be considered to be diagnosed for combined ADHD. This means that the child will have to be diagnosed with six or more symptoms from both lists (Sinfield, 2018). Additionally, a person who is 17 years old or older will need to present five or more symptoms from both lists. Having ADHD combined does not mean that it is more severe compared to someone with only one presentation. Dr. Russell Barkley writes in his book Taking Charge of Adult ADHD, that a predominantly hyperactive presentation could be an early developmental stage of combined ADHD. He states that most people diagnosed with majority might eventually develop combined within 3 to 5 years (Barkley, 2013).
On the other hand, before the age of twelve, symptoms may look differently from someone with ADHD that is older. There is also an underdiagnosis and under-treatment of ADHD in adults. Research says that about 60 percent of children with ADHD will continue to have symptoms in their adult life (Friedman, 2016). Symptoms that are found in adults include; problems with reading, attending important meeting, not being able to time manage, and frequently getting fired or changing jobs (Xenitidis, 2011). Chances of getting ADHD increase in adulthood possibly due to pregnancy and delivery complications or prematurity. Unfortunately, there is not much research on treatments for adults with ADHD.
At this time, there is no cure for ADHD, there are only treatments that help those with this condition. It is common for parents to have concerns about the best way to help their child. Treatment options include behavior therapy and medication. Behavior therapy is available for both the child and parents, or the adult with ADHD. The American Academy of Pediatrics (AAP) recommends behavior therapy and medication together for children 6 years or older. While for children under 6, it is recommended that the child first try behavior therapy, before trying medication (CDC, 2018). However, there is new research that argues medication alone will not improve these symptoms (Haggerty, 2018).
Nonetheless, medical doctors treat individuals diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) with prescribed medication to alleviate the symptoms associated with this disorder. Specifically, these medications come in pill form and include Adderall, Concerta, Focalin, Ritalin, and Vyvanse, each of which act in slightly different ways to control the symptoms of ADHD including hyperactivity, inattentiveness, and impulsivity (Haggerty, 2018). Adderall often represents this entire drug family due to it being the most commonly prescribed. In effect, these drugs work by targeting activity of the neurotransmitters dopamine and norepinephrine in the brain, thus the brain thinks as if it is being rewarded for doing an otherwise unpleasant task, and allows intense focus for the drug user (Moneer, 2018). Overall, prescription pills have powerful effects that relieve symptoms of ADHD, but they certainly do not provide a full cure.
The number of people diagnosed with ADHD has increased more over the recent years and this can be attributed to a wide variety of information required to fully grasp this mental disorder. Clearly, research on ADHD has expanded in various studies; however, a lot of confusion still exists, and new research continues to discover more information, which sometimes challenges previous confirmed ideas on ADHD. Therefore, the lack of clarity surrounding this mental disorder has evidently led to confusion on the diagnosis process, and subsequently, an increase in the number of people diagnosed with ADHD. A cure for ADHD does not exist due to its widespread speculation and only treatment options for ADHD are endorsed, which are behavioral therapy and prescription medication. Although these two treatment options give alleviation to ADHD’s symptoms, they are continuously required to sustain the alleviating effects and do not permanently remove them. Ultimately, ADHD remains a relatively newly discovered mental disorder and much research is still required to understand it completely, despite the vast amount of research in recent years.
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