Term Paper on "ADD ADHD and Use of Stimulant Drugs to Treat Children"

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Attention Deficit Hyperactivity Disorder in Children

Attention deficit hyperactivity disorder (ADHD) is one of the most commonly diagnosed mental disorders among children, although it is sometimes diagnosed in adults if there is an indication that the symptoms were present in childhood. The official definition of ADHD according, to the United States (U.S.) Surgeon General and the International Classification of Disease Revised Edition 2005 (ICD-9-CM) is a neurological deficit classified as "metabolic encephalopathy" affecting the release and homeostasis of neurological chemicals and the functioning of the limbic system. The definition of ADHD found in the American Psychiatric Associations Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV-TR), defines it as "a Disruptive Behavior Disorder characterized by on-going inattention and/or hyperactivity-impulsivity occurring in several settings and more frequently and severely than is typical for individuals in the same stage of development," and identifies three subtypes of ADHD: predominantly inattentive, predominantly hyperactive-impulsive, and the combined type.

There have been a number of attempts to provide a consensus name for ADHD, with little success. Some of the various names that have been applied to this disorder are attention deficit disorder (ADD), which was first introduced in DSM-III, the 1980 edition. It is considered by some to be obsolete, and by others to be a synonym for the predominantly inattentive type of ADHD. Another name applied is attention-deficit syndrome (ADS). It is considered equivalent to ADHD, but used to avoid the connotations of a "disorder." Hyperkinetic syndrome (HKS) and Minimal cerebral dysfunction (MCD) are also equivalent to ADHD, and although largely obsolete in the United States, they are still used in some places internationally. Minimal brain dysfunction or Minimal brain damage (MBD), once considered similar to ADHD, is now an obsolete term. For consistency, and to avoid confusion, throughout this paper I will refer to the disorder as ADHD.

The first reaction of most pediatricians after diagnosing ADHD is to prescribe drugs. However, the long-term effects of drugs on children's biology has not been fully studied, and to prescribe powerful stimulants is dangerous, until further research is concluded. Children should not be exposed to drugs such as stimulants and antidepressants or any other form of drug to treat ADHD. The symptoms of ADHD are not solid enough to just prescribe a drug to treat children who may or may not have a serious mental or social disorder. This paper will review both sides of this argument and present expert opinions to support the thesis.

The proximate cause of ADHD is not conclusively known, although research is ongoing in many areas. Most scientific evidence suggests that, in many cases, the disorder is genetically transmitted and is caused by an imbalance or deficiency in particular chemicals that regulate the efficiency with which the brain controls behavior. Brain scan technology has indicated differences in the symmetry, metabolism, chemistry, and size of the brain in those who have ADHD, although there is as yet no clear determination of the source of these differences. A 1990 study from the National Institute of Mental Health connected ADHD with a series of metabolic abnormalities in the brain, providing evidence that ADHD is a neurological disorder. "There appears to be a link between a person's ability to pay continued attention and the use of glucose -- the body's major fuel -- in the brain. In adults with ADHD, the brain areas that control attention use less glucose and appear to be less active, suggesting that a lower level of activity in some parts of the brain may cause inattention."

While heredity as a cause is indicated, some researchers believe that problems in prenatal development, birth complications, or later neurological damage may contribute to ADHD. Some of the additional causes being investigated include genetic factors. It has been shown that children who have at least one parent diagnosed with ADHD have a higher probability of having ADHD themselves, and research is examining which genes may be involved in ADHD. Some other research indicates that environmental factors, passed down from generation to generation, may initiate the symptoms associated with ADHD. There is also the possibility that data on heredity may be skewed because a family with one diagnosed member may have a heightened awareness of the disorder, along with an increased motivation to seek formal diagnosis, which could make detection and diagnosis more likely.

There have also been indications that ADHD may result from a poor diet and external factors, rather than from any physiological source. Studies of changes in diets of children provide some scientific evidence of this, but the majority of researchers currently seem to believe that the available evidence is not enough to prove or disprove this. It has been noticed that a number of children with ADHD seem to be addicted to milk, and there is speculation that the cause of the disorder can be attributed to additives in foods. It has been proposed by Norwegian and British scientists that this is due to the casomorphins, which are peptides formed by incomplete digestion of the whey protein. Studies have shown that there is an adverse effect on the behavior of children, which is detectable by parents, caused by of artificial food coloring and benzoate preservatives. In addition, the brain development in utero, and throughout the first year of life, may possibly be related to drug use during pregnancy or environmental toxins.

Determining if a child has ADHD is a complicated process. Because there is no agreement on the exact cause of the disorder, that makes it very difficult to diagnose. Many other biological and psychological problems can lead to symptoms similar to those shown by children with ADHD. As an example, depression, anxiety, and certain types of learning disabilities may cause symptoms that are similar.

Again because the cause for ADHD is unknown, there is no single test to diagnose it. An extensive evaluation is required to establish a diagnosis, rule out other causes, and determine the absence or presence of co-existing conditions. This evaluation requires much time and effort, and must include a clinical assessment of the individual's social, academic and emotional functioning, and the child's developmental level. A complete history should be taken from the parents, teachers and the child, whenever possible. Clinicians often use checklists for rating ADHD symptoms and ruling out other disabilities.

In addition to pediatricians, there are several other types of professionals who can diagnose ADHD, including nurse practitioners, school psychologists, private psychologists, neurologists, clinical social workers, psychiatrists, and other medical doctors. No matter who does the evaluation, the use of the Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnostic criteria for ADHD is important. An examination by a medical professional is also necessary and should include a complete physical examination, along with a hearing and vision assessment to rule out other medical problems that might be causing symptoms similar to ADHD. One of the other medical problems that may be misdiagnosed in rare cases for children with ADHD is a thyroid dysfunction.

Getting the right treatment for ADHD is very important. There could be very serious negative consequences for children with ADHD who do not receive appropriate treatment. These consequences can include academic failure, low self-esteem, substance abuse, and a possible increase in the risk of antisocial and criminal behavior.

Treating children with ADHD requires educational, medical, psychological and behavioral interventions, and should be tailored to the unique needs of each child and family. This complete approach to treatment, called "multimodal," consists of child and parent education about treatment and diagnosis, stimulant medication, specific behavior management techniques, and school programs and supports. Behavior interventions are often a major component for children who have ADHD. Psychosocial treatments that have been found helpful for ADHD include strategies using consistent, positive reinforcement, and teaching problem-solving, communication and self-advocacy skills. Children, particularly teenagers, must be actively involved as integral members of the school program planning and treatment teams.

Many children with ADHD can be taught in the regular classroom with minor adjustments to the environment, but success in school may require a number of different interventions.

Some children may require additional assistance provided by special education services. These services may be provided within the regular education classroom setting or may require a special placement of the child outside of the regular classroom that fits the child's particular learning needs.

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