Introduction
Attention Deficit Hyperactive Disorder (ADHD) is a psychological disorder that causes a person’s brain to be abnormally hyperactive than usual behaviour. Different scholars have tried to differentiate between ADHD and hyperkinetic disorder, arguing that the two terms are not synonymous. However, WHO uses the two terms interchangeably to refer to the hyperactive psychological disorder. People with ADHD normally have behavioural challenges and cannot remain focused on a specific task for an extended period (AlAnsari & Jahrami, 2020). This condition is mainly diagnosed among children but can progress to adulthood if left untreated during its initial stages. Adults suffering from ADHD often face difficulties maintaining normal and healthy relationships, which can lead to severe mental conditions such as depression.
ADHD is broadly theorized to result from altered inhibitory body processes in the brain. The level of the brain functioning inhibition varies from one person to another, causing different manifestations of the condition in victims (AlAnsari & Jahrami, 2020). Additionally, different scholars suggest several mechanisms of repression to explain the phenomenon propositions that lie between a distinction between the motivation brain system and repression under the executive brain system. ADHD is unlikely to be caused by a deficit in motivational repression control, a conclusion that other scholars widely dispute.
The number of school-aged children diagnosed with ADHD and hyperkinetic disorders is significantly high and is anticipated to double in the next twenty years as more people become more aware of the condition. Another factor contributing to increased rates of children suffering from ADHD is the use of more inclusive diagnostic criteria, thus accounting for more numbers. In a study conducted by Thomas (2015), the prevalence of ADHD among children below 15 years was 7.2%. These rates were significantly higher among children less than nine years. His study suggested that this condition usually develops when the fetus is forming inside the womb, within the first trimester, as this is the time the brain forms. The United States Census Bureau 2019 reported that 8.2% of the total population, representing one hundred and twenty-nine million people, suffer from ADHD.
Additionally, a meta-analysis of the clinical data collected over the past years by the National Health Interview Survey (NHIS) in the U.S. shows that children between the ages of 10 and 17 years have a high prevalence of ADHD compared to their equals below 12 years. In 2015 and 2016, boys were reported to have a higher prevalence of ADHD disorder at 14%, while girls were at 6.3% (Mooney, Ryabinin, Wilmot, Bhatt, Mill & Nigg, 2020). Research reports varied distribution rates of ADHD/ hyperkinetic disorder among different ethnic groups in the United States.
Common behavior for people with ADHD
Children with ADHD cannot control their impulsive behavior, pay attention, and often overdo a certain activity. For instance, when in school, the children play a lot taking the time that should be allocated for their studies. Others focus on one specific thing and want to do it repeatedly. According to Balbuena (2017), children with ADHD are unruly and usually mistaken for perpetuating school crimes, especially when their handlers do not understand their situation. In other cases, ADHD patients have been seen as defensive and violent, especially when they are in a new environmental setting or in a place where they think nobody understands them. Children with ADHD who get transferred from one school to another face more difficulties as they try to come to terms with their new environment. A similar scenario is witnessed among children facing the effects of separation, either from their families or friends. Most of them act without thinking about what could be the consequences of their actions.
Causes of ADHD
As mentioned earlier, ADHD develops during the initial stages of human development, especially in the first trimester. This is a developmental phase when the brain forms, and it requires an optimum supply of nutrients and other requirements. A slight alteration in the internal environment, either through intentional or unintentional causes, can significantly affect the process of brain development. According to Eme (2018), supplementation with nutrients such as folate and iron in the first trimester has been associated with reduced risks of development of ADHD in early childhood. Some researchers propose heredity as the main cause of this condition (Bonati, Scarpellini, Cartabia, & Zanetti, 2021). However, this has been disapproved through research over the past years as many scholars argue that ADHD is a major neurological disorder associated with neuro-motor functioning.
One of the risk factors for the development of ADHD is prenatal exposure to toxic drugs such as alcohol and tobacco. Women who are heavy users of alcohol and cigarettes before conception expose their future pregnancies to risks of developing neurological disorders, including ADHD. Similarly, smoking and alcohol intake during pregnancy increases the risk of developing ADHD. Bonati, Scarpellini, Cartabia, & Zanetti (2021) explains this phenomenon due to the accumulation of toxins in the maternal system, which is transferred to the fetus after conception. Additionally, tobacco and alcohol inhibit the absorption and usability of some essential nutrients that are significant in the formation of the brain. Although iron and folic acid supplementation has been associated with a reduced risk of ADHD, it is ineffective for active smokers and alcohol users.
Second, heavy metals such as lead and mercury can cause significant damage to the brain. Pregnant women who are exposed to these heavy metals are at a higher risk of giving birth to children with ADHD. Exposure to heavy metals at a young age has been associated with this condition. Another cause of ADHD among children is the postnatal injury of the frontal region. Any trauma due to a fall or being hit with an object can cause partial damage to the brain and consequently affect its normal functioning (Eme, 2018). However, the severity depends on the extent of brain damage caused by the injury and the affected part of the brain.
Finally, stress during pregnancy and the birth of premature and very low birth weight infants is another risk factor. Stress affects the metabolism of nutrients, and this affects the fetus. On the other hand, premature infants can easily sustain head injuries and cerebral bleeding, damaging the brain. Therefore, it can be concluded that the genetic, maternal, and environmental factors associated with the development of ADHD affect the babies either during the fetal developmental stage or in early infancy.
Diagnosis of ADHD
There is no specific approach for diagnosing this condition as its causes are sometimes idiopathic, so doctors depend on multiple strategies. The overall criteria for diagnosing ADHD are the use of ICD 10 and DSM IV tools. According to Smith (2019), DSM IV diagnostic criteria mainly used in clinical settings only focus on specific questions and aspects of a child’s general behaviour. The descriptive terms used to classify whether a child has ADHD or not are ambiguous and are often misinterpreted by the respondents. For example, the use of ‘often’ to describe the number of occurrences of an event lacks specificity. As a result, many children who could be diagnosed as having ADHD are missed out. This diagnostic criteria only identifies one child in every two hundred d children with ADHD, thus making its scope very narrow.
On the other hand, ICD 10 diagnostic criteria are more inclusive with more direct and specific questions that enable clinicians to diagnose ADHD among children easily. This method identifies one child in a group of fifty children, thus making it more reliable. The use of ambiguous and unrealistic terms is less, and the questions are more specific to the description of a behaviour. Unlike the DSM IV diagnostic tool, ICD 10 criteria easily capture children with mild to moderate presentations of ADHD (Kooij, Bijlenga, & Michielsen, 2019). It is largely based on the interactionist theory and does not only seek to diagnose patients with ADHD but also looks at the causes and factors leading to relating symptoms when the diagnosis is not present.
A more comprehensive strategy is used to rule out all other possible causes of ADHD and coexisting diseases. This is achieved through the use of theories such as interactionist theory that looks at both sides of the hypothesis. Unfortunately, this candid approach is not largely used in the clinical settings where patients are diagnosed (Sidol & Epstein, 2020). The diagnosis comprises information collected from various sources, including a checklist for signs and symptoms, standard rating for behaviour, information from family members or closely related persons, and past and current functioning history (Eme, 2018). Therefore, when a child is suspected of having this condition based on the signs and symptoms, it is paramount to depend on a clinician for a diagnosis and involve a psychologist to ensure that nothing is missed.
Treatment alternatives for ADHD
The treatment of this condition requires the integration of various approaches to achieve the best results. These approaches are pharmacological, behavioural therapy, psychological, and learning aid intervention. First, pharmacological approaches involve the use of psychostimulants to reduce and manage the symptoms of ADHD. For instance, the use of Methylphenidate, also known as Ritalin, increases the noradrenaline and dopamine levels in the pre-frontal cortex. The increase of these hormones affects the reticular activating system, which mediates a person’s responsiveness to stimuli (Eme, 2018). Unfortunately, the effect of pharmacological agents is short-lived as it only lasts for about five hours. Thus, patients under this kind of treatment must always depend on these prescription medications for behaviour control.
Different studies have shown that the negative impacts of long-term use of psychostimulants are minimal compared to their benefits. However, psychologists are hesitant to allow patients to use prescription medicines as they change the perception of one’s behaviour. In contrast, most parents with ADHD children prefer the use of prescription medicine as they find the professional advice tiring and exhausting to follow. Due to the need to achieve quick results, they find the use of medication more appealing and a quick fix (Kooij, Bijlenga, & Michielsen, 2019). The availability of little evidence on the matter that ADHD is a neurological disorder makes the pharmacological approach a questionable management therapy for patients with this condition. Even so, due to psychostimulants’ effect on responsiveness to stimuli, clinicians continue to prescribe these medications even when the cut-off line for diagnosing ADHD is quite blurry.
Another treatment alternative for children with ADHD is behaviour therapy, which focuses on changing the negative behaviour aspects and promoting positive behaviour. Often, children diagnosed with ADHD come from economically and socially deprived families. In other words, it is not always true that the immediate cause of ADHD is neurological factors. According to Smith (2019), children from low economic backgrounds suffer psychologically due to deprivations faced at home and also the teasing at school from their peers from financially stable backgrounds. As a result, this affects learning, children start failing in class, and educators may interpret this as disturbing behavior. Similarly, children who face violence and trauma due to abuse can develop characteristics that are often mistaken for ADHD. In a retrospective study by Sidol & Epstein (2020), 8% of the children diagnosed with ADHD and who had no psychostimulants therapy faced challenges due to social factors such as separation, divorce, and sexual abuse.
Therefore, behavioral therapy is important in assisting the patients in improving their undesirable behavior instead of treating the symptoms. This approach focuses on the root cause of the problem and is mainly used by psychologists. Most psychologists agree that the use of medication should be the last approach to treating ADHD, and it is only a safe approach when all other intervention plans have proved ineffective.
The third treatment option for ADHD is psychodynamic family and individual therapy. This approach focuses on both the children and caregivers as both are affected by the condition. Taking care of a child with ADHD can sometimes be quite difficult, especially when a child’s behaviour is unruly or when he/she becomes violent. The family and individual therapy sessions allow both parents and their children to process what they go through daily and develop solutions (Nachamai, 2016). This approach is more effective when used in conjunction with behavioural therapy. Similarly, education enhancement helps students keep up with learning, especially those whose ADHD diagnosis warrant special needs in education (Kooij, Bijlenga, & Michielsen, 2019). Children with ADHD exhibit certain behaviours in settings like classrooms which easily disrupt their learning process. However, with the help of learning enhancement, they can keep up with what other students without the disease are doing in the class.
Contribution of educational psychologists to the management of ADHD
Educational psychologists play an important role in directing children’s behaviour and implementing changes in their general well-being. Children with ADHD spend most of their time in school, and this opens an opportunity for teachers and educational psychologists to help with behaviour change. The impact of these professionals can be felt through the following contributions to the children with ADHD. First, they can help the learners with creating and maintaining relationships. ADHD patients suffer from low self-esteem because they are not able to relate well with other students (Eme, 2018). Children with disruptive behaviour or those that are violent are usually avoided by their peers. As a result, they underperform the tasks assigned, feel lonely in relationships, and sometimes easily give up on difficult situations.
However, through the support of educational psychologists and teachers, these children can build relationships with other learners, which helps them not to be lonely and motivate them to continue with behaviour therapy. Good relationships also allow children with ADHD to conquer their fears and at least rebuild their self-esteem. Second, these professionals constantly remind these children what is expected of them inside and outside the classrooms. Children with ADHD tend to forget more and need to be constantly reminded of everything they are supposed to do (Kooij, Bijlenga, & Michielsen, 2019). Additionally, these children easily misplace items and present with seemingly careless behavior. Understanding the cause of their situation and constantly reminding can them help with improving their behavior.
Finally, offering encouragement to the children suffering from ADHD is a significant contribution of educational psychologists and other practitioners. These children usually have mood disorders and become easily annoyed, irritated, or overly excited (DuPaul et al., 2016). While in school, this is quite destructive as they cannot focus on learning and also disrupt other students. Others cause chaos in the classroom and are unruly. When these children are behaving in such manners, it is difficult to keep up with the positive behaviour that is being encouraged. Therefore, it is significant to encourage them whenever they seem to be emotionally down and lonely.
Other than the supportive approaches discussed in the above paragraphs, educational psychologists and other practitioners can respond to the increasing rates of ADHD among children by improving the diagnostic criteria for ADHD. Most of the patients diagnosed with ADHD usually have other coupling factors such as childhood trauma and abuse. According to Wesley (2019), children who have suffered trauma of any kind and at any stage of life often present with defensive behaviour, poor school performance, and violence. When appropriate history is not taken during diagnosis, these children can end up misdiagnosed or even started on treatment therapy for a condition that they do not have.
Additionally, misdiagnosis diverts attention from the main issue that requires special attention to minor issues. In the end, these children lack the help they need, and their unresolved childhood trauma can affect them later in adulthood. Therefore, the professionals should advocate for appropriate diagnostic criteria for ADHD to prevent leaving out needy children or including those that are not qualified for selection (Wesley, 2019). This can be achieved if the clinicians who conduct the primary diagnosis can work in collaboration with the psychologists. Unfortunately, where these steps are not included, there will always remain a conflict of interest as different professionals use different diagnostic tools.
Another factor to be considered by educational psychologists and other practitioners is the social-cultural factors. As mentioned earlier, social and cultural factors determine greatly how family systems operate. In areas where the family systems are broken, the children are more susceptible to trauma and abuse. In contrast, children from social-cultural backgrounds that are stable are less likely to be categorized as ADHD patients. For example, Afro-Caribbean pupils were often excluded from schools due to behavioural issues (Nachamai, 2016). Similarly, the blacks often find themselves expelled from school due to unruly behaviours in most U.S. schools.
Dysfunctional social-cultural systems expose certain ethnic groups to behavioural crises due to the multicultural and pluralistic cultural settings that cause dynamism in the definition of appropriate behaviour. These cultural dynamics need to be considered when diagnosing ADHD among children so that factors such as economic status, behavioural conceptualizations, and culture are not excluded when doing basic assessments (Smith 2019). This is a way in which educational psychologists can respond to ensure that ADHD is not a social-culturally based disorder.
Media coverage is another area causing controversy regarding ADHD. The general public is becoming more aware of this condition, and parents are more concerned with their children’s behaviour. Unfortunately, most of the information is sceptical and sensationalized, leaving the people to consume uninformed and scientifically irrelevant information concerning ADHD (Smith 2019). To ensure that the information captured by media is reasonably true and scientific, educational psychologists and other practitioners should be on the front line to advocate for the right diagnostic criteria and treatment approaches.
Finally, educational psychologists and other practitioners can influence consumerist attitudes against professional advice. In ADHD treatment, the basic approach is behavioural therapy, which focuses on changing a patient’s behaviour and improving their response to environmental or physical stimuli. Family and individual therapy support help the patients to keep up with the recommended behavioral patterns. Consequently, through these approaches, the negative behaviour is suppressed, and the patient picks the new appropriate behaviour (Smith 2019). The increase in consumerist behavior has led many parents to opt for medication instead of behavioural therapy. This leads to inconsistency in the management of the condition since the effect of medication is short-tem.
Unfortunately, many parents choose to go for less involving treatment options such as the use of pharmacological agents while at the same time denying their children an opportunity for behavioural change. When children are allowed to go through the natural healing process with the help of educational psychologists and other practitioners, they do not feel overwhelmed with their behaviour. The use of prescription medicine makes them feel entitled to negative behaviour and believe that they must always take medication to control how they respond to stimuli (Nachamai, 2016). In other words, the use of pharmacological agents may tend to worsen a negative behaviour instead of correcting it.
Conclusion
In conclusion, ADHD is a psychological disorder that causes hyperactivity of the brain leading to changes in how a person responds to stimuli. Although it commonly affects children, ADHD can also be diagnosed in adults. The diagnostic criteria for this condition require the incorporation of multiple factors such as psychometric tests, behavior observation checks list, and detailed history from a close person. However, this diagnostic criterion is not often used, and this may cause some patients to be missed out or inappropriately included. For instance, the use of the SMD IV diagnostic tool focuses on a very small group of potentially suffering from ADHD as compared to ICD 10, which is a more inclusive tool. Behavioural therapy, individual and family therapy, and medications are some of the commonly used treatment methods. Therefore, educational psychologists should encourage behavioral change among children with ADHD since this is a sustainable and effective intervention. The use of prescription medications should be only limited to incidences where the primary interventions have failed or cases where there is a need for the use of multiple interventions.
Bibliography
AlAnsari, A. M., & Jahrami, H. A. (2020). Screen-Based Media Use among Children with Autism Spectrum Disorder, Attention Deficit Hyperactive Disorder and Typically Developing Siblings. Autism-Open Access, 10(1).
Balbuena, F. (2017). High Prevalence of ADHD: How Best can we Identify Cases of ADHD from the General Population? Bipolar Disorder: Open Access, 03(01).
Bonati, M., Scarpellini, F., Cartabia, M., & Zanetti, M. (2021). Ten Years (2011–2021) of the Italian Lombardy ADHD Register for the Diagnosis and Treatment of Children and Adolescents with ADHD. Children, 8(7), 598.
DuPaul, G. J., Power, T. J., Anastopoulos, A. D., & Reid, R. (2016). ADHD rating scale? 5 for children and adolescents: checklists, norms, and clinical interpretation. Guilford Publications.
Eme, R. (2018). Greater Male Prevalence of Juvenile ADHD: Recent Research on Possible Biological Causes. The ADHD Report, 26(8), 1–9.
Gu, Y., Xu, G., & Zhu, Y. (2018). A randomized controlled trial of mindfulness-based cognitive therapy for college students with ADHD. Journal of attention disorders, 22(4), 388-399.
Kooij, J. J. S., Bijlenga, D., & Michielsen, M. (2019). Assessment and Treatment of ADHD in People Over 60. The ADHD Report, 27(4), 1–7, 15–16.
Mooney, M. A., Ryabinin, P., Wilmot, B., Bhatt, P., Mill, J., & Nigg, J. T. (2020). Large epigenome-wide association study of childhood ADHD identifies peripheral DNA methylation associated with disease and polygenic risk burden. Translational psychiatry, 10(1), 1-12.
Nachamai, M. (2016). Sub-Type Discernment of Attention Deficit Hyperactive Disorder in Children using a Cluster Partitioning Algorithm. Indian Journal of Science and Technology, 9(8).
Sidol, C., & Epstein, J. N. (2020). Identifying Potential Moderators of ADHD Summer Treatment Program Outcomes: A Systematic Review. The ADHD Report, 28(3), 1–9.
Smith, L. (2019). Common Childhood Psychiatric Disorders with Prevalence of Attention Deficit Hyperactive Disorder (ADHD). 22(07.2019).
Wesley, J. (2019). Assessment of Probiotics Lactobacillus in the Management of Attention Deficit Hyperactive Disorder. Case Medical Research.