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Free Research Paper on ADHD

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Attention Deficit Hyperactivity Disorder, or ADHD, is a very complex condition that generates a great deal of debate. The debate surrounding this disorder is intense. Debates encompass issues such as, what causes it, how to assess ADHD, and how to deal with it effectively. This essay deals with some of the debates in an attempt to simplify the issues. The first question that needs to be answered is what is ADHD? It is behavioural problems revolving around three main symptoms. One main symptom that an ADHD person displays is the inability to keep their attention focused on something. They are easily distracted, forget instructions and have a poor short term memory. The second main symptom prevalent among those with ADHD is their impulsiveness. They act or shout out inappropriately. They have a short fuse which can lead to temper tantrums. The third main symptom is that those with ADHD are hyperactive. They are unable to sit still and are often restless and fidgety. These factors usually cause problems within the sufferer’s families. ADHD symptoms also cause problems for the sufferer in educational settings, (for children) and in occupational settings, (for adults). There are three subtypes to ADHD. The first subtype is someone who is both hyperactive and impulsive. The second subtype is one who is inattentive only. For example, studies show that at least 40% of people with ADHD have the “Inattentive Type” only. The third subtype is one who shows all of these symptoms combined. Statistics show that in the UK, 1% of children show ADHD symptoms. In Australia it is 2%. In the USA it is 3-5%. Also, statistics show that the problem prevails in boys as they outnumber girls 3:1.

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The problem is, many ADHD children do not outgrow the symptoms and carry it on into adulthood. For example, two thirds of 158 ADHD children in the 1970’s were found to still have the disorder when they were in their twenties. Also, according to Corydon C. Clark, M.D., two-thirds of childhood cases of ADHD continue into adulthood. He claims that “the symptoms may be as severe at age 45 as they were at age 5 or 10”. Thus, ADHD is a problem which effects children and adults alike. One of the debates surrounding ADHD is how to assess and diagnose ADHD successfully. In the DSM IV, (Diagnostic & Statistical Manual of Mental Disorders – 4th Edition, 1994), it is stated that in order to properly diagnose ADHD, a child must show at least six symptoms. Some examples of symptoms are, one, difficulty in sustaining their attention to tasks or play activities. Two, does not appear to listen when spoken to directly. Three, talks excessively, and four, runs and climbs in inappropriate places. These symptoms must have existed for at least six months “to a degree that is not consistent with developmental level”. Some of these symptoms must have appeared before the age of seven. These symptoms must be present in two or more settings. There must be clear evidence of social, and academic problems. These symptoms must not be part of another disorder such as autism. The need to have a specific guideline to diagnose ADHD is that children can show many of these symptoms due to other reasons. For example, exceptional students in unstimulating academic situations become bored and, therefore, become inattentive. Children with learning difficulties, such as dyslexia become disengaged with work and, therefore, cannot keep up. So, they find it difficult to pay attention in reading. Therefore, these problems could be seen as ADHD symptoms, when infact they are not. Hence, the need for a specific guideline for assessment, in order for a proper diagnoses of ADHD to be made. Statistics show that there are 70,000 children, aged six to sixteen in England and Wales who meet the diagnostic criteria for ADHD. The debate on what causes ADHD is a fairly broad one. The bottom line is, there is no exact known cause. There has been many theories, and even some evidence to back up these theories. However, there has not been strong enough evidence to pinpoint an exact cause of ADHD. One theory is that there is a problem in the neurology of the brain in an ADHD person. The lower portion of the brain contains an area known as the Reticular higher activating system. This keeps the brain centres alert and ready for input. Some evidence shows that in ADHD people, this part of the brain is not working properly. Thus, it is believed that hyperactivity, then, is the brain’s attempt to generate new stimulation to maintain alertness. A man named Larry Stein in 1964 performed research into the neurophysiological aspect of the brain. He showed that humans experiences are hinged on their past, present and future experiences. This is because the brain stores memories of these experiences. When this mechanism is working properly, people are organised in time and in their behaviour. This is because people tend to repeat good behaviour if their reward is satisfactory. They avoid bad behaviour because of the possible punishment they will receive. Also, when this mechanism is working properly, people have the ability to connect their feelings to events, behaviour and objects, therefore, are able to identify with others. However, when this mechanism is not working, problems occur. For instance, a person becomes impulsive due to the brain’s failure to check impulses in regards to reward and punishments. This was said succinctly, by a mother who kept a diary of ADHD son’s activities. One day the child, Stefan, insults his music teacher. The mother states that “This unpremeditated behaviour is so typical of children with ADHD. It is as if a filter is missing between thought and action.” Thus, Stefan’s brain appears to have failed to check his impulses. Another problem that occurs when this mechanism is not working properly is the inability to keep focused on any one activity. According to Larry Stein, this is because there is no stored memory, therefore, each event or environmental stimulus is reacted to as if it is new. Thus, the child is unable to concentrate and complete tasks. Another problem is that the person seeks instant gratification. During the present moment the child does not remember that a reward for their behaviour could be delayed, thus, they seek instant gratification. Also, the child has no expectation of punishment, therefore, tends to repeat the same unacceptable behaviours. For example, there was a test used to gauge a child’s reaction time. Children with ADHD were found to be less able than other children “to ready themselves to press one of several keys when they see a warning light. According to the researchers, this then shows that ADHD children do not respond to punishment. Another problem if this mechanism is not working properly is that the person is unable to bond with others. Therefore, they cannot empathise with others, so their behaviour tends to be selfish, bossy and bullying towards others, because they see only themselves at the centre of their existence. However, it must be pointed out, that most children tend to be like this to some degree, it is only with maturation that a child begins to empathise with others. The problem for an ADHD child is that, even with maturation, this social skill does not seem to improve. There is an argument against the theory that ADHD is neurologicaly based. Rita Kirsch Debroitner and Avery Hart, both psychotherapists, state that “there is no definitive or consistent physical neurological impairment ever been determined.” They argue that if ADHD problems were genetic or neurological based, then symptoms would be in effect at all times. For instance, they point out that some parents claim that their ADHD children can pay attention when there is something interesting to do. Also, some parents claim that on a one to one basis their children function very well, and that they only have problems in a group situation. This shows then, that in some ADHD children, their symptoms are not always in effect. These psychotherapists also claim that ADHD is prevalent among first born children. They do not believe that birth order can be affected by genetics or neurological impairment. Thus, they believe that this is another factor which proves their argument. These psychotherapists claim that recent studies show that brain chemicals and genes can be changed by experiences. Therefore, they believe, to alter ADHD symptoms, everyday experiences must alter. Another theory about what causes ADHD is the genetic factor. Debroitner and Hart also believe that ADHD runs in families. This is because, they claim, there is strong evidence that 43% children who have ADHD have parents who also suffer from this. There is other evidence to prove this. For example a study was performed by a Dr Biederman at Massachusetts General Hospital in 1990 in an attempt to prove this theory. They examined 457 first degree relatives (biological parents or siblings). They compared these relatives with ADHD to relatives of children with other mental health disorders. The findings proved that 25% of first degree relatives of children with ADHD also had this disorder. However, only 5% of first degree relatives of children with other mental health disorders had mental problems. Therefore, this shows that there is a 500% increase in risk to other members of the family with an ADHD child. Some people believe that this evidence proves the theory that ADHD is genetic. However, Debroitner and Hart believe that this is not conclusive evidence. This is because they believe that many behaviours in children are learned from their parents, rather than inherited. Thus, they believe that ADHD children could have learned their behaviour from their ADHD parents. However, the theory of learned behaviour does not tie in with other studies done. For instance, recent research has started to show that ADHD is genetically linked to other mental disorders such as Tourette’s Syndrome (TS), Obsessive Compulsive Disorder (OCD), mood disorders, anxiety disorders, as well as others. The studies have shown that children with ADHD often have relatives with one of these other disorders mentioned. So, if a child learns behaviour from the adults around him, as Debroitner and Hart have suggested, why do children not mimic the symptoms of the adults particular mental disorder rather than display symptoms of ADHD? Another debate surrounding ADHD is how best to treat people with this disorder. It is widely recognised that those with milder symptoms need only be given psychological, social & educational help. For instance, Rita Kirsch Debroitner and Avery Hart believe that learned behaviour can be unlearned. They claim that ADHD sufferers are not centred or grounded, thus they have to be shown the skills to be able to centre themselves. They believe that these sufferers are missing a vital development stage, for whatever reason, of experiencing him or herself as the primary power in his or her life. Therefore, they move through life unable to find their deepest and authentic self. Their aim is to take ADHD sufferers from a negative state into a positive state. Such as being from, all over the place to self-possessed. Ungrounded to centred. However, many doctors believe that the best way to treat ADHD sufferers, particularly those with acute symptoms, is with drugs. Two such drugs which are widely used to treat ADHD is Ritalin and Dexedrine. There are guidelines for the use of drugs. For instance, it must be shown that “remedial measures alone have proven insufficient.” It has also been proven that medication is a very effective form of therapy for those with ADHD. For instance, “most ADHD clinics report a success rate of 80-95%.” Medication appears to have a beneficial effect on improving symptoms such as impassivity, hyperactivity and concentration. The improvement of these core symptoms have a beneficial effect on other problems. For instance, a child’s confidence improves, and therefore, his self-esteem. The core symptoms can improve within 20 minutes of taking the medication, however, the other symptoms can take weeks or even months to improve. However, there are some short term side effects such as lower appetite, sleeping difficulties and sometimes headaches. These are usually short lived and the benefits appear to outweigh these side effects. There are some feared long term effects from taking these drugs. For example, some experts worry that there could be possible growth retardation. There have been many studies that disprove this theory. Studies have been done by, Dupaul & Barkley, 1990, also Klein & Mannuzza, 1988. Also, Dr. Ploof, routinely measured the heights and weights of children on drugs over a two year period. They found no evidence of growth suppression. However, there are a group of parents in the US who are in the process of taking legal action against a company called Novartis Pharmaceuticals. Their claim is that this company failed to inform the parents of the possible impact on their children’s cardiovascular and nervous systems. Another possible long term effect is the possibility of drug addiction. Again, studies by Hinshaw in 1994 & by Barkly in 1998 prove otherwise. Just like any drug, Ritalin is expensive. It costs roughly ?200 per year for a child on an average daily does of 30mg. This cost rises to ?1,000 with assessments and follow-up costs. Prescriptions for this drug have increased. For instance in 1998, there were 126,500 prescribed Ritalin. In 1999, this had increased to 157,900. This essay only scratches the surface of the debates surrounding ADHD. However, it does clarify a few points, and has attempted to simplify the issues surrounding this problematic disorder.

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