Social Stigma of ADHD

Humans have always been critical towards discussing mental ailments. With globalization, mental disorders have increased exponentially and is predicted to increase even further. Most mental disorders are complex that their origins remain anonymous. Throughout the world studies are being conducted to identify the origins of mental disorders so that a permanent cure could be devised. Studies even shows us that each disorder presents new symptoms in each individual which makes it difficult to identify. This may be caused due to the particular environment of the individual, the genetic makeup, and overall health and wellbeing of the individual. Among the predominant mental disorders, Attention Deficient Hyperactivity Disorder (A.D.H.D) has riddled scientist for centuries. With advancements in genetics and DNA splicing, scientists are able to get closer to understanding what causes ADHD. The usual symptoms of ADHD include inattention, hyperactivity, and minimal social skills. These symptoms may vary from person to person and can even vary with ageing. Although ADHD is characterized as a mental disorder, it has now been recognized as simply a hurdle meant to be crossed. Studies have shown that a person with ADHD could recover from the severe stages with intense training and self-discipline. Mental disorders and their treatment have been frowned on by society and there exists a societal stigma that prevents patients from acquiring proper medication and help. Even in the 21st century, the stigma continues to linger and creates challenges for people with ADHD to receive help and proper medication. Social awareness of the mental disorder is a necessity and is being explored.

Attention-deficit/hyperactivity disorder, ADHD, is a common and highly heritable neuropsychiatric disorder that is seen in children and adults as well. ADHD in adults has only recently become the focus of widespread medical attention. For over 20 years, ADHD has been viewed as comprising three primary symptoms, these being poor attention, impulsiveness, and hyperactivity but has lately been brought down to two, hyperactivity and impairment. The first case of ADHD was recorded in the year 1902 by a British pediatrician named George Still. He described the condition as an abnormal defect of moral children . Dr George discovered that the children who suffered from ADHD could not control their behavior as a typical child of the same age. However, he recorded that the patients suffering from ADHD were identical in intelligence and resolved problems similarly to other patients of the same age.

Early treatment of ADHD consisted of the use of Benzedrine, which became an approved drug in the year 1936 by the U.S Food and Drug Administration (FDA). After treatment with the drug, it was recorded that an unexpected side effect of Benzedrine helped patients suffering from ADHD perform better in academics. Unfortunately, these findings were ignored and remained anonymous until researchers began to identify the benefits of the drug. The disorder was not identified as a mental disorder up until the year 1987 when the APA recognized it as a mental disorder and included it in the Third edition of Diagnostical and Statistical Manual which listed the known mental disorders. In the year 1955, the FDA approved the psychostimulant Ritalin (methylphenidate). It has now become the most popular treatment of ADHD and to this date, is being prescribed to patients.

ADHD, although prominent among children, was not given the recognized as a mental disorder until the publication of the DSM 2 in the year 1968. The disorder was titled Hyperkinetic Impulse Disorder. Later, in the year 1980, the name of the disorder was revised to Attention Deficiency Disorder (ADD). Even though the title was revised, it was widely believed that hyperactivity was not a common symptom. This led to the creation of 2 Subtypes of ADD - ADD with hyperactivity and ADD without hyperactivity (Healthline, 1). This led to conflict among researchers and in the year 1987, the title was changed to Attention Deficit Hyperactivity Disorder or commonly know today as ADHD in the revised edition of DSM 3. This definition combined the preexisting research and combined three of the dominant symptoms of the disorderhyperactivity, inattentiveness, impulsiveness. Although the definition was revised in later years, it provided the foundation for the current research of ADHD.

One of the most predominant issues faced by ADHD patients is be considered dumb or less intelligent than a typical human being. Studies conducted by Maria Keilow using the Danish admirative registry data proves that children with ADHD exhibited similar intelligence to other typical children of their age. Using administrative register data on children, who begin medical treatment, Keilow conducted a series of natural experiment's and exploited plausible exogenous variation in medical nonresponse to estimate the effect of medical treatment on school-leaving GPA. After numerous stages of treatment, Keilow compared the GPA of the students who were under treatment to that of other typical students. She also compared a typical student's grade to that of patients who had discontinued the treatment - partly of completely and found that there existed around .18 to .22 deviation from the standard among participating patients. Keilow proved that students suffering from ADHD may be able to reduce the negative social consequences of ADHD. Several studies similar to Keilow have proved that the effects of ADHD could be reduced in patientsespecially in children and teens and could one day lead to a permeant cure. In studies trying to find causes of Attention-Deficit Hyperactivity Disorder (ADHD), relatives of ADHD children were found to be at high risk for the disorder. Half-sibling, twin, adoption, and segregation analysis studies suggest that genes mediate this familial aggregation. This suggests that genetic studies may be helpful in clarifying the etiology of ADHD. A chief obstacle that is that the research must face is the problem of genetic heterogeneity: For common disorders like ADHD, several genetic and nongenetic factors may independently cause the disorder. This heterogeneity complicates genetic research, because the patterns observed in a heterogeneous group of families may obscure each of the specific mechanisms that independently causes ADHD.

Recent studies show major differences in clinical presentation in relation to age and gender. Many research studies surfacing recently, shows how symptoms of ADHD might differ among males and females. In the early ages, marked differences are observable in the prevalence of ADHD between the two genders even though symptoms of ADHD emerge early in childhood in both genders, with a mean age of onset between infancy and 7 years. A prevalence of 5“7% has been reported in boys and 2“4% in girls. In addition, research has found that girls have fewer symptoms of ADHD than boys, although several investigations have reported contrary results.As for treatment for patients with ADHD, in the most recent analysis year (2005), 4.4% of children received one or more prescriptions for ADHD medications. Use of these medications was more common among older children (ages 10 to 19) than younger children (ages 0 to 9), and boys were 2.3 times more likely to use these medications than girls. Older boys (ages 10 to 19) showed the highest prevalence of use; 8.1% of boys in this age range used ADHD medications during 2005. During the 6-year study period (2000 to 2005), the intensity of ADHD medication treatment increased for patients in most demographic groups. Use grew most rapidly for younger children (ages 0 to 9) and for adults (ages 20 to 64). Lower growth rates were observed for older children (ages 10 to 19) and for seniors.

The continuing disparity between ADHD treatment rates for boys and girls may be due, in part, to underdiagnosis of the condition in girls. The condition may be less visible or less identifiable in some girls which may lead to a delay in diagnosis or a failure to identify the condition at all. The age distribution of medication use shows a disparity in treatment rates between boys and girls at all age levels, although the disparity narrows markedly for older teenagers. The age distribution provides suggestive evidence that the diagnosis and treatment of ADHD in girls typically occurs later than in boys. The peak treatment range for girls (ages 12 to 14) is somewhat later than the peak treatment range for boys (ages 10 to 13), and treatment rates do not decline among older girls as rapidly as they decline for older boys.

Another study was carried out to test the parental knowledge and opinions on ADHD and their symptoms. The method they used to find attain the result was to basically give the parents a MCQ test with questions assessing the parents' knowledge of ADHD symptoms, causes, diagnostics, medications, treatment options called AKOS (ADHD Knowledge and Opinion). The subjects were comprised of 81 families, the mothers' mean age was 37 years. The majority of families were ""blue-collar workers"" (65.2%), with a smaller proportion of ""white-collar workers"" (17.5%) and unemployed families (17.3%). Single parents constituted 30.9% of the sample. The range of education of mothers included having completed elementary school or some high school (17.3%); having completed high school (22.2%); having had at least some post-secondary education (60.5%). Each child initially went through 3- or 4-week blind titration phase. The dose of medication or placebo started at 5 mg twice daily, once in the morning and once at lunch. The dose was increased weekly in 5 mg steps, to a target dose of 0.7 mg/kg body weight in a single oral dose administered twice daily. The dose of medication could be increased or decreased as deemed necessary by the study physician to minimize side effects while trying to reach the target dose. Parents were told it was appropriate for children to take the medication 7 days weekly, including but were given discretion to omit weekend and holiday doses. If families asked to change to the alternate medication (MPH or placebo), a second blind titration was undertaken to achieve the target dose.

After the parents took the AKOS, 68 families (84.0%) enrolled into the medication treatment, and 52 families (64.2%) enrolled into the parent-group treatment. (A program that followed an approach of coping-modelling and problem-solving, in which participants formulated solutions to specific child-management problems after observing videotapes depicting these problems.)

Although numerous studies have been published and social awareness of teens has been increased, ADHD continues to be a disorder that is socially disliked. ADHD in adults creates an interesting new argument. A study conducted by Anselm B. M. Fuermaier provided participants with a survey questioner to find the depth of the effect of social stigma of ADHD in adults. The study utilized mathematical equations to back up his findings and calculate the results. Fuermaier classified the responses from adults as a factor called Reliability and Social Functioning factor. Fuermarier stated that stigmatizing attitudes as measured by reliability and social Functioning factor, therefore represent a depreciation of the individual's social abilities and may lead to social rejection and exclusion ( Measurement of Stigma towards Adult ADHD,7) Fuermaier compared the response between the general population with that of teachers and physicians. He stated that the general population were more prone to stigma while teachers recognize the potential among individuals suffering from ADHD. Fuermaier's studies also proved the existence of several profiles of stigmatism in the society. This means that a stigma towards ADHD exists in various forms throughout society at varying levels. Fuermaier suggested that mentoring and teaching people with ADHD from a young age to early adulthood helps in reducing the social stigma surrounding ADHD in the society.

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