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 Dr. Parker first told me of the school  that Anna June and Doris B’s children as well as his own child by stating that it was in the southwest suburban area of Cincinnati, Ohio, and this particular school was not hurting for money. He then began to explain the different children in his practice that he was treating. There were twenty-eight patients from a variety of different backgrounds. All were suffering with ADHD.

The questions I asked in my interview are commonly asked by people who are unfamiliar with ADHD, attention-deficit hyperactivity disorder. ADHD children have specific symptoms, in which no one is certain as to what causes these symptoms to occur. Some ADHD children do have other problems associated with this disorder, for example behavioral and social problems. Children with ADHD might stand out from other children, only if they have not had the proper treatment prescribed for them.

ADHD is the “developmental failure in the brain circuitry that underlies inhibition and self-control” (Barkley, 1998), or “inability to inhibit thoughts”(NIMH, 1996), that affects about five percent of school age children (McEwan, 1998). Loss of control and thought may be believed to be caused by certain impaired brain functions that are important for children to maintain attention. The prefrontal cortex, caudate nucleus, and Globus pallid us are three parts of the brain that are involved with regulating attention (Barkley, 1998).

In a Scientific American article, entitled “Attention-Deficit Hyperactivity Disorder“, is a picture of the brain structures, which is shown below. It shows the cerebellum, in which the prefrontal cortex is located, in the frontal lobe, just behind the forehead. It serves as the brain’s command center, which helps with “editing” behavior, resisting distractions, and developing awareness (NIMH, 1996). The caudate nucleus and Globus pallid us, which are more commonly known as the basal ganglia, are located near the middle of the brain. They are “at least two of the clusters of nerve cells deep in the brain” (Barkley, 1998). The caudate nucleus and globus pallidus translate the commands, given by the prefrontal cortex, into action (NIMH, 1996). Researchers have found that these parts of the brain, which are in the right hemisphere of the brain, are smaller in children with ADHD than in children without this disorder (Barkley, 1998). The right hemisphere of the brain is normally larger than the left hemisphere, but some researchers have thought that due to this abnormality in ADHD children that this could be a cause of the disorder (Barkley, 1998).

 

Another hypothesis that has been considered for the cause of ADHD is genetic inheritance. It is stated in Barkley’s 1998 article in Scientific American that, “ADHD is a polygenic disorder—that is, more than one gene contributes to it.” There has been many studies done with twins to help support this hypothesis. One of the largest studies was conducted by Helene Gjone, Jon M. Sundet, and Jim Stevenson, in which it involved many identical twins who had inherited the same genes. This study also included fraternal twins who are “no more alike genetically than siblings born years apart” (Barkley, 1998). “Up to eighty percent of the differences in attention, hyperactivity, and impulsivity between people with ADHD and those without the disorder can be explained by genetic factors”, was found in this study (Barkley, 1998). There are other studies that have suspected genetics to be the cause of ADHD, but not one of them has been declared as the cause.

The final questionable cause of ADHD is non-genetic factors; like smoking while pregnant, premature birth, and maternal alcohol use while pregnant (Long, 1995-2000). Exposure to high levels of these non-genetic factors have only been accounted for in about twenty to thirty percent of ADHD cases among boys, and an even smaller amount among girls (Long, 1995-2000). Even though maternal smoking and alcohol use while pregnant are not very strong factors to the cause of ADHD, they can still cause other problems relating to birth and childhood.

ADHD has very specific symptoms, that may or may not be caused by the factors recently discussed. Inattention, hyperactivity, and impulsivity are the three symptoms that are characteristic of ADHD. These attributes cannot be seen in an x-ray and they also very from person to person (NIMH, 1994). In order for a child to be diagnosed with ADHD these symptoms must appear before age seven and continue for at least six months. These also must appear frequently, be severe, or create a handicap in at least two areas of the child’s like; for example, in school, in home, or in social settings (NIMH, 1994).

“People who are inattentive have a hard time keeping their mind on any one thing and may get bored with a task after only a few minutes” (NIMH, 1994). Children that experience inattention have problems focusing premeditated, conscious attention to organizing and finishing a task or learning something new. Although, these children might give effortless, automatic attention to activities and things they take pleasure in doing (McEwan, 1998). Some signs of inattention that can be associated with ADHD children are becoming easily distracted by irrelevant sights and sounds, failing to pay attention to details and making careless mistakes, rarely following instructions carefully and completely, or losing and/or forgetting things at home and at school. (NIMH, 1994) If a number of these signs are noticed, then the parents should check for characteristics of the next two symptoms of ADHD that will be discussed.

Hyperactivity is the second symptom of ADHD, in which the child or adult is always in motion. Being on a consistent move can consist of talking out in a non-appropriate situation, changing the subject of conversations spontaneously, and being unable to sit still. (NIMH, 1994) Sitting still is one of the hardest challenge for children with ADHD, which include “squirming while sitting, roaming around the room, wiggling their feet, touching anything within reach, or tapping utensils” (McEwan, 1998). These signs along with others, for example fidgeting, or even having problems waiting in lines, need to be controlled in order for ADHD children to be non-distracting for other children in a classroom setting.

The final symptom that is associated with ADHD is impulsivity. “People who are overly impulsive seem unable to curb their immediate reactions or think before they act” (NIMH, 1994). Impulsivity is usually connected with hyperactivity because the characteristics that are associated with these symptoms are the same. As stated in earlier paragraphs, the signs of hyperactivity are; feeling restless, fidgeting, squirming, roaming around rooms, and struggling with waiting in lines, are also characteristics of impulsivity. Impulsivity also includes blurting out answers before hearing the entire question, which is the major reaction that identifies this symptom with ADHD (McEwan, 1998).

Because ADHD has such symptoms, children experience behavior and social problems in almost all environments they are put into. The most common behavioral problem associated with ADHD children is a lack of self-control, which leads into other behavior problems. Social problems associated with ADHD can have more of a long term effects on children, because these children do not interact well with other children.

“Self-control-or the capacity to inhibit or delay one’s initial motor responses to an event- is a critical foundation for the performance of any task” (Barkely, 1998). As children grow up they are more able to engage in mental activities, which are known as executive functions that help deflect distractions, recall goals, and take the steps needed to reach them. (NIMH, 1994) Executive functions are performed more externally when children are in their younger years of life, which may include talking out loud to themselves while remembering a task or puzzling out problems. (NIMH, 1994) As children get older they internalize executive functions, or make these functions private, so others will not know what they are thinking. For ADHD children, they lack the restriction needed to inhibit the public performance of these functions. (NIMH, 1994)

Executive functions are commonly grouped into four mental activities: working memory, private speech, control of emotions, and reconstitution. Working memory is “holding information in the mind while working on a task, even if the original stimulus that provided the information is gone” (Barkley, 1998). This type of remembering is important for goal-directed behavior, but is impaired for children with diagnosed with ADHD. (Barkley, 1998) The next executive function is private speech, which is internal self-directed speech. As stated by Barkley, in the 1998 issue of Scientific American, before a child is six-years-old, they will speak out loud a lot to remind themselves to perform tasks. As children get older they use this speech to reflect on situations, to follow directions and instructions, or to use as a self-questioning technique. Researchers have found that private speech is delayed in children with ADHD. The third function is controlling emotions, motivation, and the state of arousal. “Such control helps individuals achieve goals by enabling them to delay or alter potentially distracting emotional reactions to a particular event and to generate private emotions and motivation” (Barkley, 1998). ADHD children may lack more in one of these controlling areas and less in others, but they are all affected. The final executive function is reconstitution, which involves two processes: breaking down observed behaviors and combining the parts into new actions not previously learned from experiences. (Barkley, 1998) Reconstitution gives people flexibility, creativity, and fluency. Also, “it permits children as they mature to direct their behavior across increasingly longer intervals by combining behaviors into ever longer chains to attain a goal” (Barkley, 1998). Studies have shown that children with ADHD are less capable to acquire reconstitution than other children. The lack of executive functions in ADHD children do cause them many behavioral issues, but social problems are other concerns they have to deal with also.

Some social problems that ADHD children are faced with are: socializing with peers and authority figures, and poor control of impulses. ADHD children have difficulty maintaining attention during interactions with adults, which causes them to miss important parts of conversations. (McEwan, 1998) In a school environment, this can cause ADHD children to miss directions or even have trouble following directions. Some adults may also think that ADHD children have memory problems, which is not the case, because these children do not have the attention span to pay attention to a long list of directions. (McEwan, 1998)

ADHD children also have a hard time controlling their impulses, which is very recognizable in a classroom setting. During play time, ADHD children might be seen playing uncontrollably because they get carried away with the game or activity and do not know how to stop themselves when it is time to finish. (McEwan, 1998) Their level of intensity is much higher than the average child, which causes them to not fit in with other children. (McEwan, 1998)

Social and behavioral problems that ADHD children face have been made easier for children to handle because of certain drugs and non-drugs that help with controlling ADHD. The drug that is most commonly prescribed for children with ADHD is Ritalin. It has been known to be over prescribed and possibly too harsh for some children, so parents and teachers have come up with other alternatives for treatments to help with ADHD.

Ritalin is a drug that “boosts a child’s capacity to inhibit and regulate impulsive behaviors” (Leutwyler, 1996). Ritalin has been found to improve an ADHD child’s behavior between seventy and ninety percent, as stated by Kristen Leutwyler in an Scientific American issue titled “Paying Attention”, in 1996. This drug helps children “control impulses, restlessness, causing distractions; and holding important information in mind, being more academically, and having more internalized speech” (McEwan, 1998). Helping ADHD children feel as if they fit in with other children is another use of Ritalin. Ritalin is a helpful drug, but cannot be used alone. Most ADHD children also need to be involved in special programs within their school environment.

Even though Ritalin is a useful drug used for ADHD children, it has been known to be over prescribed by doctors. There have been some doctors that have given children too many milligrams of Ritalin, which causes them to be overly relaxed. (Barkley, 1998) Some parents and teachers have found other problems with Ritalin, so other alternative treatments have been found to help ADHD children. A more structured environment aids children by forcing them to have control over what they are doing and the way they might act during certain situations (McEwan, 1998). Special education programs are also another option to control ADHD children. These programs are structured, and with help from specialized teachers these children can be better controlled. The final alternative treatment is to better educate and train parents and teachers on ways to help and control ADHD children. All of these different ways to help treat ADHD children, without the use of Ritalin or other drugs, are helpful, but have been found to work even better with the proper dosages of the suitable drug or drugs.

Attention-deficit hyperactivity disordered children have many problems they have to deal with in and out of the home environment. These issues must be dealt with in the appropriate ways by the parents, teachers, doctors, and child in order for the correct help to be received. Even though doctors do not have any certainty as to what causes this disorder, different ways have been found to help control it for children. This is a disorder that has been taken for granted in some cases, because some teachers and some doctors seem to believe that if a child has a few of the symptoms then he or she is automatically an ADHD child. Not all situations have been handled in this way, and some ADHD children have received the proper treatment and care, and have been able to live a remotely normal life.

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