ADHD Mental Illness

University of Phoenix

Hca/ 240

By Tara Hamilton

8/16/2010

The Mental Illness I chose is ADHD I found that Illness to be interesting because I have two boys ages 8
and 6 one child is calm and my other child is hyper active doing this research will help me understand a
lot about this illness and will tell me if my children has any of these symptoms this is a illness that should
be taken very seriously.

ADHD is not a new condition, but appears to have been around for centuries. In 1798 hyperactivity was
described by Sir Alexander Crichton as “mental restlessness” (Hartmann, 2003). Although opponents
suggest that stimulant medication has not been shown to be safe for treating ADHD these medications
have been used for nearly a century. Stimulant medications were first reported to be used to treat ADHD
in 1937 (Hartmann, 2003). The confusion may be fueled by the frequent changes in the diagnostic
labeling of the disorder. ADHD has been termed to be “minimal brain damage”, “minimal brain
dysfunction”, ”learning/behavioral disabilities”, a “hyperactivity”. It first appeared in the DSM-II in 1968 as
”Hyperkinetic Reaction of Childhood” (Hartmann, 2003). The DSM III referred to the condition as “ADD
with or without hyperactivity” (Hartmann, 2003).

Attention deficit hyperactivity disorder is a neurobehavioral developmental condition effecting both

children and adults marked by the presence of inattention and/or increased activity (VanCleave & Leslie,
2008). Delays in impulse control are also present. The condition appears to impact brain areas involved in
problem solving, planning, and comprehension. The condition is thought to impact 3-5% of school age
children (Greenhill, Posner, Vaughan, & Kratochvil, 2008). This condition was previously thought to be a
psychiatric condition limited to childhood, but neurological evidence has been found for the condition
being present in adults. It is a chronic disorder with a majority of those diagnosed as children continuing
to demonstrate the signs and symptoms of ADHD throughout adulthood (VanCleave & Leslie, 2008).

Studies of the causes of ADHD have produced varied answers. One study showed delay in the
development of the frontal cortex and temporal lobe thought to be involved in the ability to exercise
control and focus (Joshi, 2002). Other studies have shown ADHD subjects to have areas within the brain
that mature sooner than others. The motor cortex of ADHD subjects appears to mature faster accounting
for the need for slower development to control ADHD behaviors (Joshi, 2002). Stimulant medication
affects the growth of structures within the central nervous system (Joshi, 2002).

The low arousal theory exerts that ADHD patients suffer from a state of abnormally low arousal and self
stimulate or engage in excessive activity to relieve the anxiety this produces (Incredible Horizons, n.d.).
The patients are thought to be unable to exert self management and only gain control of their attention
through external stimuli (Incredible Horizons, n.d.). When the environment does not produce enough
stimulation the subject will augment the stimuli with self stimulation or excessive activities. This theory
provides evidence for the therapeutic effect of stimulant medication in calming subjects and provides
documentation for the dopamine connection.
The neurotransmitter associated with the disorder appears to be dopamine. Variants of the dopamine
receptor have been found in ADHD patients (NIMH, 2002). Higher concentrations of dopamine
transporters have been noted in the striatum of ADHD subjects (Dresel, Kung, Plossl, Meegalla, & Kung,
1998).

Since the 1970’s ADHD and its treatments have been shrouded with controversy. Opponents of the
disorder typically disagree with stimulant treatments and question the existence of the disorder. Others
believe the disorder has a genetic basis. Health professionals today generally accept the disorder, but
have disagreements regarding the diagnosis method and appropriate treatment.

The DSM-IV is viewed as the definitive handbook for diagnosing disorders of this type. According to this
reference individuals must have either 6 symptoms of inattention or 6 symptoms of
hyperactivity/impulsivity present for a minimum of 6 months (Greenhill, Posner, Vaughan, & Kratochvil,
2008). Inattention is documented by such behaviors as making careless mistakes on schoolwork, not
appearing to listen when spoken to, not following instructions, difficulty organizing, not wishing to engage
in activities requiring sustained mental effort, frequently losing items, easily distracted, and forgetful.
Hyperactivity is documented by the present of behaviors such as feeling restless, having difficulty
remaining seated, and talking excessively. Impusiveness is demonstrated by blurting out answers, having
difficulty waiting one’s turn, and interrupting others. According to the DSM-IV some of the symptoms must
have been present before the age of 7 years (Greenhill, Posner, Vaughan, & Kratochvil, 2008) . Evidence
of significant impairment in social, school, or work must be present. The condition must negatively impact
a minimum of 2 areas within the child’s life (Greenhill, Posner, Vaughan, & Kratochvil, 2008). These areas
include classroom, playground, home, community or social settings. The symptoms must not be due to
another mental disorder.

The diagnosis of Adult ADHD is controversial due to the lack of developmental information available.
Adults with this disorder tend to be disorganized and have hectic lives. They are impulsive often acting
without thinking, moving from one activity before completing another and interrupting conversations.
Hyperactivity may be demonstrated through restlessness and fidgeting, as well as sleep disturbances.
Inattentiveness may be evident in the individual frequently engaging in day-dreaming, having difficulty
concentrating and listening, and not finishing assignments.

Diagnosis for both children and adults is primarily limited to practitioner observation and reports from
teachers and other professionals involved with the individual. Other means of diagnosis are expensive
and reserved for research settings. PET scans have shown differing results making them unreliable for
diagnosis (Jadad,Booker, Gauld, et al, 1999).
Treatment often includes combinations of behavior modi
fication, medication, life-style changes, and counseling interventions. The most effective treatment has
been found to be a combination of pharmacological treatments and management and behavioral
interventions (Jadad,Booker, Gauld, et al, 1999). Psychological treatments include pscyoeducational
interventions, behavior therapy, cognitive behavioral therapy, interpersonal psychotherapy, family
therapy, social skills training, and parent management training. Parent training and education decrease
the stress associated with raising children with ADHD. This intervention has been found to have short
term benefits. A higher rate of divorce is found with parents of children with ADHD than those without
(Jadad,Booker, Gauld, et al, 1999). ADHD support groups are available to provide information and help
families cope with ADHD.

Many alternative treatments have been suggested for ADHD. Specialized diets and dietary supplements
were one of the first interventions suggested to address the symptoms of ADHD. The effectiveness of
these interventions is in question due to the preliminary studies involving only small populations or follow
up studies reporting conflicting results (Jadad,Booker, Gauld, et al, 1999).

Attention, impulsivity, and hyperactivity have been effectively treated using neurofeedback or EEG
biofeedback (Jadad,Booker, Gauld, et al, 1999). One advantage of this approach over medication is the
lack of side effects found with biofeedback. A disadvantage are the 40-80 sessions required to impact the
condition.

Aerobic fitness is thought to improve cognitive functioning and neural organization during pre-adolescent
development. Studies show that male athletic performance increases peer acceptance when fewer
negative behaviors are present (Jadad,Booker, Gauld, et al, 1999) .
Environment appears to have a definitive impact on this disorder. The disorder appears to illustrate
normal behavioral strategies until the child reaches the structured classroom setting at which time the
behaviors are perceived as maladaptive (Brewis, Schmidt, & Meyer, 2002). Behaviors that are tolerated in
other settings are not permitted in this arena. ADHD appears to depend on the perception of the
individuals serving the child.

Five features of the disorder may contribute to its controversial nature. First, there are no laboratory or
radiological tests to confirm the clinical diagnosis. Second, diagnostic criteria are frequently changed.
Third, long term treatment is required due to the lack of a cure. Fourth potentially addictive stimulant
medication is often used to treat the condition. Finally there are substantial differences across countries in
the diagnosis and treatment rates (Jadad,Booker, Gauld, et al, 1999).
References

Brewis, A., Schmidt, K.L. & Meyer, M. (2002) Does School, Compared to Home, Provide a Unique
Adaptive Context for Children's ADHD-Associated Behaviors: A Cross-Cultural Test. Cross-Cultural
Research, Vol. 36, No. 4, 303-320.

Dresel SH, Kung MP, Plössl K, Meegalla SK, Kung HF (1998). "Pharmacological effects of dopaminergic
drugs on in vivo binding of [99mTc]TRODAT-1 to the central dopamine transporters in rats". European
journal of nuclear medicine 25 (1): 31–9.

Greenhill LL, Posner K, Vaughan BS, Kratochvil CJ (April 2008). Attention deficit hyperactivity disorder in
preschool children. Child Adolesc Psychiatr Clin N Am 17 (2): 347–66, ix.

Hartmann, T. (2003). The Edison gene: ADHD and the gift of the hunter child. Rochester, VT: Park Street
Press.

Incredible Horizons (n.d.). Attention deficit hyperactivity disorder is a neurologically based disorder.
Incrediblehorizons.com Retrieved on 8/16/10 from http://www.incrediblehorizons.com/understandingadd

Jadad AR, Booker L, Gauld M, et al. (December 1999). The treatment of attention-deficit hyperactivity
disorder: an annotated bibliography and critical appraisal of published systematic reviews and
metaanalyses. Canadian journal of psychiatry 44 (10): 1025–35.Retrieved on 8/16/10 from PMID
10637682. https://ww1.cpa-apc.org/French_Site/Publications/Archives/CJP/1999/Dec/jadad.htm

Joshi SV (2002). ADHD, growth deficits, and relationships to psychostimulant use. Pediatr Rev 23 (2):
67–8; discussion 67–8.

NIMH (2007). Gene predicts better outcome as cortex normalizes in teens with ADHD. NIMH Press

Van Cleave J, Leslie LK (August 2008). Approaching ADHD as a chronic condition: implications for long-
term adherence. Journal of psychosocial nursing and mental health services.