With the research that has been found, it has given me a better understanding of ADHD. Starting this paper, I only knew that ADHD was a neurological condition, but not how it fully affected someone. It made me curious to learn more about this diagnoses because my brother, who I love dearly was diagnosed with ADHD. I never was fully aware of the actions he demonstrated, nor was I understanding why.
Learning about the criteria, prevalence, interventions, treatment and some community based resources, has made me more competent in dealing with individuals other than my brother with this diagnoses. ADHD has been around for approximately 200 years, thanks to Benjamin Rush who made the first description of the disorder (Nigg 2013). Since his description of ADHD, researchers, doctors, and other health professionals have been placing emphasis on concerns with under and over diagnoses of individuals. With future research, we may be able to find all components that affect individuals with ADHD.
Another community based resource is Private Care Management. They provide mental health services to individuals in the community they live in. Private Care Management, provides service such as Intensive in Community (IIC) and Behavioral therapy to individuals. Under the IIC service, using a team of licensed social workers, they provide counseling to individuals, groups or families to help them understand problems and develop treatment plans. The licensed social worker identifies the psychological, emotional or behavioral issue and diagnosed disorder. The licensed professional participates in the interdisciplinary treatment planning by developing an annual comprehensive psychosocial assessment and crisis intervention consultation. Under the IIC licensed social worker, the behavioral therapist follows the set plan to the youth in the community.
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Wraparound services provides community based programs, which offers more positive behavioral intensive services to youths and their families. They focus on the positive behavioral intensive service to children on schools by zoning in on the class room activities (Fallon & Mueller 2017). Wraparound’s positive behavioral intensive service such as Nurtured Heart teachings, not just focuses on children in a school setting but also in the home. Fallon and Mueller highlighted that wraparound services support focuses their delivery to youths and their families through an ecological and environmental ecology theory (2017). This means that their services go beyond a classroom and that they emphasize relationships between families, schools, and the community for support of individuals needing such services like those diagnosed with ADHD.
Positive behavioral intensive support such as Nurtured Heart under wraparound services is to help children in schools by providing positive support and reducing exclusionary discipline practices. Children whom gone under diagnosed with ADHD have faced multiple infractions in school for their behaviors, leading them to either getting expelled, having in-school or out of school detention, restricted from school functions and more. The school based positive behavioral intensive support contains four plans to assist in the reduction of behaviors and to aid families and educators in the multiple host settings a child is in.
The first plan is a three to five positively stated behavioral expectation, second, produce a systematically teaching appropriate behaviors to youths; third reinforce system to acknowledge appropriate behaviors and lastly four, produce a delivery consistent in consequences for inappropriate behaviors (Fallon & Mueller 2017). Of course these services under wraparound support can be altered to suit the youth and family more specifically, for example language so that the families receive services in their native tongue to fully comprehend what is going on with their youth.
Such services in the wraparound support are to continue in the home as well. It would benefit the youth or the individual to continue the positive behavioral intensive support in the home and in the community to utilize the plan to promote more positive and appropriate behaviors to be more integrated into the home and in the community. Family involvement at any level, would aid in reinforcing positive behavior and encourage such behaviors and this is where Nurtured Heart wraparound service is benefical. Wraparound services align to promote appropriate behaviors among youths in schools, in the home and in the community.
In New Jersey, we have wonderful services to supply aid to many individuals starting from the age of three years old and up. As we have previously discovered, ADHD becomes present in individuals prior to the age of 12. Is also been learned that, children spend most of their day in school. Fallon and Mueller noted in their article that, there has been tremendous efforts to integrate supportive practices in schools, to develop positive outcomes in children with mental and behavioral disorders, such as ADHD (2017). Wraparound services and Private Care Management are two community based resources that can supply the needs of outside sources for such individuals.
Psychopharmacological treatment is usually the first line of intervention for those diagnosed with ADHD. Psychostimulants through research have been viewed to show significant affects to minimize ADHD symptoms. Some psychostimulants that are commonly known of are Ritalin and Adderall. Methylphenidates, such as Ritalin is a highly effective medication. These medications are typically digested in the morning and taken once per day. It is to suppress some of the ADHD symptoms for majority of the day. The psychopharmacological is to allow the individual to be productive during school hours or work day.
Some adverse effects when consuming a methylphenidate such as Ritalin and Adderall is headaches, loss of appetite, nausea, and stomachaches. Another concern is that individuals digesting these methylphenidate is the growth suppression. In contrast, Sadock, Sadock and Ruiz notes that, individuals can make up the growth through “drug holiday growth” (2015). This means the individual make up for the loss on holidays, summer vacation and weekends, when they do not need to consume the medication for functionality.
For youths diagnosed with ADHD benefit from psychosocial and psychopharmacological interventions. Youths, children, and even adults would benefit with a Cognitive Behavioral therapy (CBT) intervention. Behavioral therapy first of all is defined as a broad set of specific interventions, where the common goal is to reduce physical and the social environmental behaviors (Ahmann, Savat & Tuttle 2017). With that being said, CBT has lasting affects beneficial to the individual. CBT is to assist in the individual to establish a thought-out plan that is reflexive to thinking and behaving. Cognitive Behavioral Therapy a psychosocial intervention to alter behavior and provide a more appropriate behaviors for individuals. It is to teach ADHD individuals to have productive attitudes to task and problem solving while having self-control (Serrano-Troncoso, Guidi & Alda-Diez 2013).
Another theory that could explain the etiology of ADHD are neurochemicals. This involves the neurotransmitters in the brain. As referenced from previous articles, dopamine affects the prefrontal cortex of the brain and it inhibit the individual to control impulses and retain attention. Treatments that aid in regulation of neurochemicals in an individual would be medication such as methylphenidates or other stimulants (Sadock Sadock & Ruiz 2015). It affects the dopamine levels in the brain allowing the individual to better regulate attention and impulsivity.
According to the Sadock Sadock & Ruiz book, ADHD has been predominately been explain through genetic factors. Evidence has shown that there is a link between genetics to ADHD that has stemmed from family studies. These studies revealed that increased risk of 2 to 8 times for siblings to be diagnosed with ADHD alongside the parents getting the same diagnoses later on in their adult life. Several theories have been proposed for the genetic connection between ADHD. Unfortunately, more research needs to be conducted to discover the true genetic connection and treatment plans.
It is equally important to mention how the ADHD diagnoses impacts the individual with the disorder itself. Youths diagnosed with ADHD exhibit more behavioral challenges and functional impairment compared to the typical developing youth. Youths demonstrate high activity functioning, little attention span and impulsivity verbally, emotionally and behaviorally (Walerius, Fogleman & Rosen 2016). Youths face obstacles while in school.
Such obstacles may be that they get detained or expelled from their behaviors, they may also have poor academics due to the fact they cannot focus and their attention span is inadequate. Due to the fact that these youths demonstrate impulsivity verbally, emotionally and behaviorally, they may have lack of peer relationships, which could leave them vulnerable to bullying not just at a familial stance. Youths who are aware of their diagnoses may lead them to become antisocial or have an increased in risky behavior such as fighting, sexual acts, isolation from family and friends, and perhaps drug use. To the wide range of impact both child, youth, family and community suffer from the individuals social functioning of ADHD.
Another thing is, if the individual with ADHD has siblings, they too are affected. Peasgood et al mentioned, that siblings have reported they are less happy in the home and with life. Siblings have even been reported in the increase in familial bullying. Siblings feel that their family dynamic is greatly impacted due to the constant interruptions of the child with ADHD. Thus parents have to constantly focus on the demands of the child with ADHD in the home and in schools. In addition to the constant interruptions, sibling may also feel that the familial lifestyle displeases them and could be due to sibling bullying (Peasgood et al 2016).
Attention Deficit Hyperactivity Disorder impacts the individual’s social function in many ways. It may impact their work, home, family, school, and relationships. An individual whom has been diagnosed with ADHD is not the only one affected by social functioning issues. For example, youth’s, their parents and siblings would be widely impacted by the expected behaviors of the youth demonstrating ADHD symptoms. Walerius, Fogleman and Rosen article highlights the hassles of parent’s day to day life of having a child with ADHD. That parents with youths who have ADHD have incomparably higher levels of stress than other parents whose youths do not have mental health problems (Walerius, Fogleman & Rosen 2016).
This is very true due to the fact that my brother has ADHD and I have noticed the stress my parents go through with him. Walerius, Fogleman and Rosen explains two categorical stressors; one being parental tasks, consisting of the day to day responsibilities of parenting and two, stressors related to the youths behavioral challenges (2016). It is said that youths with ADHD encounter dysregulation of emotion. Hence, the greater the emotion, less likely the youth can sustain and regulate it. It also means that youths can be more irritable, hot-tempered and are unpredictable. Youths who have been diagnosed with ADHD have poor ability to control their emotional state, leaving their parents or caregivers to manage it. For this reason, parents have to control such behaviors and exert that energy is a hassle, they seem to have great difficulty trying to manage it and they themselves would get irritable.
Attention Deficit Hyperactivity Disorder also has been found to be more prevalent among the African American and Latino population. As reported by the Lefler et al article, ADHD is not just limited to one or two specific racial or ethnical group. What the authors do suggest is that African American and Latino individuals exhibit more ADHD symptoms than the non-Latino white individuals. African American and Latinos already have been reported to being at a disadvantage to many aspects in life, now throw in an ADHD diagnoses, they become at a greater risk, they just do not get a break from factors affecting these populations.
Such factors that leaves both populations at a disadvantage for ADHD diagnosis is familial struggles, environmental dilemmas and other factors that may contribute to the likelihood of ADHD (Hinojosa et al 2012). Even though some authors have found that African Americans and Latinos seem to have higher prevalence in being diagnosed with ADHD than the non-Latino whites, more research needs to be conducted to further attest such cultural disparities.
The prevalence rate of Attention Deficit Hyperactivity Disorder is increasingly growing in the United States. According to the DSM-V of American Psychiatric Association, ADHD occurs in about 5% of individuals (2013). Within the United States alone, it has been estimated that millions of children are diagnosed with ADHD (Mahone 2012). Similarly, Eric Taylor highlighted that approximately 8.9% of United States population meets the DSM-V diagnostic criteria (2017). Since 2004’s representative study was conducted of children being diagnosed, new research has found that there has been an increase in children from ages 4-17 years from 8.9% to 9.5% prevalence during 2005-2007 (Taylor 2017).
Many articles has noted that the prevalence for ADHD is more common among boys than girl. That boys tend to demonstrate more ADHD symptoms, especially in school host settings and girls were most likely to go under diagnosed. Lately, in the past decade or so, researchers have found that the diagnoses of ADHD has increased in girls rapidly and are near to similar percentage as boys. Previously, the male to female ratio in the 1990’s has been 9 to 1 in clinical setting and in a general population setting 3 to 1 (Mahone 2012). Mahone illustrates in his article that women not girls have been reportedly diagnosed more. The reason as to why women have been increasingly been diagnosed more could be due to the onset of maturation. Unfortunately, ADHD is still geared towards more males rather than females.
Autism Spectrum Disorder (ASD) is another diagnoses that shares similarities with ADHD. Often times, when clinicians observe individuals, they miss diagnose ASD with ADHD due to the impulsivity and behavioral difficulties (Mendell et al 2009). Both Individuals with ADHD and those with ASD exhibit similar features such as inattention, social dysfunction, and difficult-to-manage behavior. To further differentiate between ASD and ADHD amongst individuals is the strong isolation from others, facial structures and communication skills. Such characteristic are seen in individuals with ASD and may express tantrum due to change, where as those with ADHD have tantrums during major transitions due to impulsivity and or self-control (American Psychiatric Association 2013).
The second characteristic for Attention Deficit Hyperactivity Disorder, is hyperactivity and impulsivity. For an individual to meet criteria for hyperactivity and impulsivity, they have to meet six or more symptoms according to the DSM-V. Under this criteria for ADHD specified by American Psychiatric Association, the symptoms have to have been lingering for approximately six months that also have affected the individual’s developmental stability, colliding with the individual’s social, academic and occupational lifestyle. Those who have been diagnosed with ADHD with the onsets of hyperactivity and impulsivity often experience fidgetiness such as tapping of the hands and squirming in the seat or the feet.
The most common onset that society notices about ADHD is that individuals cannot stay seated and are constantly leaving their seats. With such frequent fidgetiness, squirming and inability to remain seated, individuals tend to distract and agitate others surrounding them. ADHD when diagnosed needs to be specified if it is partial remission, meaning that it meets the full criteria but lacks the amount of time the taken. Also to be conscious of the severity of ADHD, such as mild or severe. Attention Deficit Hyperactivity Disorder shares similar signs and symptoms with Oppositional Defiant Disorder and Autism Disorder.
Individuals with oppositional defiant disorder (ODD) experience characteristics such as a lack in school task and slacking in work performance. Just like those with ADHD, individuals whom have been diagnosed with ODD model negativity, hostility and defiant type behaviors. For an individual to have an ODD diagnoses the must be present within the last 6 months (Pomeroy 2015). In addition to that ODD in individuals need to experience 4 out of 8 symptoms (Pomeroy 2015). Symptom to differentiate ADHD from ODD are angry/irritable mood, defiant behavior, and vindictiveness. To further differentiate ADHD and ODD, the symptoms must be in contrast from dissatisfaction of school, the inability to utilize their mental intellect fully, attaining retention, and impulsivity that occurs with ADHD diagnoses (American Psychiatric Association 2013). Although those whom have been diagnosed with ADHD may according to many articles and scholars, get a second diagnoses of ODD.
The American Psychiatric Association has specified that Attention Deficit Hyperactivity Disorder usually has an onset of symptoms prior to the age of 12 years old. To be diagnosed with ADHD, there are criteria’s that an individual needs to meet. An individual that presents a persistent inattention and or hyperactivity impulsivity, has two characteristics. A diagnoses with ADHD with inattention, must have six or more symptoms demonstrated by the individual. As well the individual needs to be presenting the symptoms within a duration of six month. Such characterization ADHD of inattention, has to dramatically impact the individual’s social, academic, and occupational activities.
Individuals sometimes may make hasty mistakes in multiple settings such as work, school and other activities pertaining to the individual. With such lack in attention and making thoughtless decisions, individuals often have complications with completing task, so much so that individuals would often avoid such activities that would utilize a great capacity of their mental intellect (American Psychiatric Association 2013). This in return is also followed by the individual’s inability to listen when being spoken too and the tendencies to get distracted quite easily as compared to others.
Attention
Deficit Hyperactivity Disorder (ADHD), can go under or even over diagnosed in youths. It has long since been a growing concern for educators, health professionals, parents and researchers over that past two decades or so. ADHD has similar characteristics to other psychopathological disorders. ADHD presents key features that affect youths and other individual’s ability to function in the home, school, socially, occupationally and in the community. It is a disorder that is considered to be a neurological condition. Eric Taylor highlighted in his article that ADHD is characterized as a neurological, psychological medical syndrome (2017).
ADHD has long term affects that begin in children as early as preschool, interrupting their intellectual, emotional and behavioral development. For individuals diagnosed with ADHD, researchers continue to investigate the dopamine levels that affects the brain functioning. In the brain, the prefrontal cortex is what utilizes high volumes of dopamine more than any other region in the brain. With the high volume of dopamine utilization in the prefrontal cortex and some other sections near the prefrontal cortex inhibits the ability of attention, response, decision making, and working memory.
