Abstract
Attention-deficit/hyperactivity disorder otherwise known as ADHD, is a common behavior disorder diagnosed during childhood. ADHD is considered a chronic condition manifest by fidgeting, lack of restraint, difficulty focusing, anger and boredom. Treatment is obtainable; however, the disorder is not curable. Treatment consist of medication and rarely therapy. Many diagnosis are treated in a holistic manner, however behavioral issues are treated as such, purely behavior without keeping the whole person in mind.
Introduction
Attention-deficit/hyperactivity disorder (ADHD) is commonly diagnosed in adolescent children, and can continue into adulthood. According to the CDC, in 2016 approximately 9.4% of children between the age of two and seventeen had been diagnosed with ADHD (Centers for Disease Control and Prevention [CDC], 2016). ADHD is not a relatively new behavioral health issue; however, the treatment has not been updated. Behavioral health disorders cannot be defined adequately in definite terms leading to disagreements among criteria for diagnosis and treatment (Stein et. all, 2010). In many ways, ADHD is classified and treated as a behavior disorder, while others deem it better to be treated holistically.
Pathophysiology
Attention deficit hyperactivity disorder (ADHD) is portrayed at an early stage during childhood and often continues into adulthood. The cause if ADHD is unknown, it is assumed that many factors such as genes, smoking, alcohol, or drug use during pregnancy, low birth weight, brain injuries, and exposure to environmental toxins at a young age can all lead to ADHD (National Institute of Mental Health [NIMH], 2016). ADHD is a heterogeneous condition, that makes pathophysiology hard to pinpoint (Albrecht et. all, 2015). As of today, ADHD is categorized under neurodevelopmental disorder, meaning impairments in the growth and development of the brain (Albrecht et. all, 2015). Attention deficit hyperactivity disorder can be associated with many insufficiencies in the neurophysiological field (Albrecht et. all, 2015). Making cognitive functioning dysfunctional and the interworking of the neuronal networks that are responsible for processing tasks and frequent attention lapses inadequate (Albrecht et. all, 2015). There have been many cognitive studies to explain deficiencies in decision-making functions as a fundamental problem in ADHD (Albrecht et. all, 2015).
In 1997 Barkley completed a study with findings that a child with ADHD may show an essential insufficiency in behavioral reserve, that leads to defects in operational memory, internalization of speech, self-regulation and reorganization (Albrecht et. all, 2015). According to Diamond, (2013) the decision-making system liable for cognitive flexibility, inhibition, and working memory control show a core discrepancy (Albrecht et. all, 2015).
Issues in cognitive functioning corresponding to ADHD has been reported in several studies with different undertakings (Albrecht et. all, 2015). Assessment of children with ADHD while preforming the Wisconsin Card-Sorting Task, Tower-of-Hanoi paradigms used to evaluate planning and problem solving, and the Stroop- or Simon task needed for interference control, proved to have negative results (Albrecht et. all, 2015). The findings proved that ADHD may be related to several cognitive deficits, while not being the “cause” of the disorder rather than the effects of having the disorder (Albrecht et. all, 2015).
Signs and symptoms
Inattention and hyperactivity/impulsivity are the major behaviors related to ADHD (NIMH, 2016). Symptoms of inattention may often include but not limited to careless errors in schoolwork, does not listen when spoken to, and easily distracted by unrelated thoughts (NIHM, 2016). Symptoms of hyperactivity/impulsivity can include but are not limited to fidgeting and squirming in seat, running in inappropriate situations, talking nonstop, and appear to have trouble waiting for his/her turn (NIHM, 2016). According to the National Institute of Mental Health males suffer from ADHD more commonly than females. Attention deficit hyperactivity disorder symptoms can change over time leading to many cases of misdiagnosis where the child may outgrow symptoms (NIHM, 2016). Symptoms can appear as early as 3, and last into adolescence through adulthood (NIHM, 2016). Many times, adults who failed to be properly diagnosed during adolescents struggle to maintain relationships, hold jobs, and appear to be antisocial, restless and impulsive (NIHM, 2016).
Diagnosis
Diagnosis is the correlation of the nature of a disorder by consideration of the present symptoms. To be diagnosed with attention deficit hyperactivity disorder, symptoms of serious and inappropriate aged levels lacking attention and hyperactivity with impulsivity that presents for longer than six months in two areas of life are needed (Albrecht et. all, 2015). In the Diagnostic and Statistical Manual-IV- TR (DSM-IV) symptoms must be present before the age of six (Albrecht et. all, 2015). In 2010, the DSM-IV-TR was updated and is now known as the DSM-V-TR the age was changed from six to twelve before the onset of symptoms to be diagnosed in ADHD (Albrecht et. all, 2015).
The process of diagnosing an adolescent with ADHD requires that six or more DSM symptoms relating to either inattention or hyperactivity/impulsivity, and impairment be observed on more than one occurrence by the age of twelve (Sibley et. all, 2012). The parameters and methods used to obtain information for a diagnosis of ADHD should not be completed in a secondary school setting, using information beyond the adolescents’ knowledge or learning ability, and past information prior to established symptoms (Sibley et. all, 2012).
To investigate the raised points above adolescents in the Pittsburgh ADHD Longitudinal Study known as PALS, were examined in relation to symptom and impairment data collected to validated a diagnosis of ADHD (Sibley et. all, 2012). The findings of the study performed by PALS, determined that many adolescents had met the criteria for ADHD in childhood, and had clinically a substantial impairment but did not meet the qualifications for diagnosis of ADHD as an adolescent (Sibley et. all, 2012). Per the results of the PALS study it was recommended that the diagnostic process to determine ADHD in adolescents be improved (Sibley et. all, 2012.
In response to the raised parameters and methods to obtain information for a diagnosis of ADHD, PALS determined that it would be beneficial to combine parent and primary teacher reports of symptoms, to lessen the rigorous level of symptoms that is required per DSM standards without increasing the rate of false- positives, and maintained the established report of not relying on retrospective information (Sibley et. all, 2012).
Pittsburgh ADHD Longitudinal Study results implied that roughly 70% of children diagnosed with ADHD continued to meet DSM criteria for the disorder throughout childhood and further into adulthood (Sibley et. all, 2012). The findings of the PALS study are essential in the treatment of ADHD. Adolescents may not qualify for educational modifications through the Individual Education Plan known as IEP or section 504 Plan without a certified ADHD diagnosis. Individuals without a valid diagnosis but meet all criteria for medical practitioners may not refer adolescents to the treatment needed (Sibley et. all, 2012). Many insurance companies will not reimburse clients without proper referral relating to not appropriately meeting diagnostic criteria for payment (Sibley et. all, 2012). Further adding to the common belief that ADHD remains in adolescence and hampers treatment of development in this population (Sibley et. all, 2012).
Treatment
While ADHD is a behavior health issue, the disorder is categorized as a mental health illness but does not follow the treatment as such. Mental illness is treated as a life long illness in a holistic manner. Holistic is characterized by the treatment of the whole person, considering mental and social factors rather than just the physical symptoms of a disease or disorder. Treatment is the way care is given in relation to an illness or injury. Many adolescents and adults who are diagnosed with ADHD are prescribed stimulants along with no further treatment plan or course of action (Bird, 2015). In treatment of ADHD medication allows a decrease in the stimulus and effort needed to complete a task, however it does not seem to allow the individual to make the complicated task easier with repeated exposure (Bird, 2015).
The treatment of ADHD has been inadequate pertaining to the whole person and the long-term adjustments needed to be successful. According to Phillip Bird (2015), whom currently holds a patent for the treatment of ADHD feels there is a need for an improvement in the treatment of the disorder (Bird, 2015). The CDC recommends that children aged six and younger receive behavior therapy (CDC, 2017). Behavior therapy is recommended to re-enforce positive behaviors and reduce problematic behaviors (CDC, 2017). While behavior therapy is a necessary tool, adolescents diagnosed after the age of six would not be recommend for this treatment (CDC, 2017).
Adolescents diagnosed with attention deficit hyperactivity disorder are still in the stages of brain development. Proper care and early interventions can be made with long term success. ADHD is often tied to adolescents and treated as though it does not continue into adulthood, leading to profound neglect in psychosocial and cognitive development (Bird, 2015). Information obtain from the longitudinal (PALS) study suggest that the hyperactivity and impulsivity declines over time, however the symptom of inattention continues into adulthood (Bird, 2015).
Adults and adolescents with ADHD have implied that many experience a range of cognitive deficiencies that reach beyond the typical behavioral symptoms that DSM-V-TR has outlined in the diagnostic criteria (Bird, 2015). The functional day-to-day implications of living with ADHD makes maintaining alertness, self-discipline, establishing and keeping routines, and completing task unmanageable (Bird, 2015). In the holistic treatment of ADHD medication, psychotherapy, education or training, or a combination of treatments should be used to give the patient the best opportunity to be successful (NIHM, 2016).
Living with ADHD
Adolescents and adults living with ADHD struggle with everyday task that many people preform without a second thought. Adults with ADHD change jobs more frequently, accumulate more speeding tickets and are at risk of having more vehicle accidents that adults living without ADHD (Bird, 2015). When adults with ADHD were tested, they did significantly worse on reading comprehension then those of their counterparts without the disorder (Bird, 2015). Many of the cognitive functions found to be impaired in ADHD are needed in reading comprehension and therefore Samuelsson concluded that the results are consistent (Bird, 2015).