Mental Health and Psychopathology- I Assignment

Submitted By: Hina Naukhaiz

Registration No.: FUI/FURC/S-18-BSCP-019
BS Psychology 5A
Topic: Attention Deficit Hyperactivity Disorder (ADHD)
 ADHD-Attention Deficit Hyperactivity Disorder

ADHD is referred as “developmental disorder” which means that an individual displays

inappropriate symptoms according to their age. The symptoms of this disorder occurs in two
areas of psychological development. The first of these areas which do not develop on schedule is
“inattention”. The second dimension that doesn’t develop properly is “hyperactive-impulsive
behavior” often referred to as difficulties with inhibition.

These symptoms develop early in childhood, are relatively persistent over time, are pervasive
across no. of situations and result in significant impairment in a number of major life activities.

History of ADHD Discovery

It was discovered several hundred years ago.

 In 1798, paper on “Diseases of Attention” was published in which Alexander Crichton

elaborated two attention disorders:
i. ADHD……associated with more distractible hyperactive and impulsive patterns of
behavior.
ii. ADD…. of what many researchers now referred to as sluggish cognitive temper.

This second disorder is characterized more by day-dreaming, starring and spontaneous mental
confusion and hypo activity rather than hyperactivity.

 In 1902, George Still elaborated no. of cases with ADHD symptoms and called it
“defective moral control” or the inability to regulate one’s behavior. These papers were
marked as the beginning of ADHD and also discussed difficulties associated with ADHD
such as aggressive behavior, problems with relationships, stressful family relationships,
difficulty with school performance and so on.
 Throughout the early 1900’s, there were number of papers appeared that described
children with ADHD symptoms who apparently had developed their behavioral
difficulties as a consequence of having suffered various diseases of the brain or brain
injuries. As a result, during this time the symptoms of ADHD were sometimes referred to
as “post-encephalitic disorder” if they had developed following brain infections that the
 child has been to survive or they be referred to as brain injured child symptoms if the
child’s difficulty develops from some sort of brain injury, trauma, disease or brain tumor.
Some children will be referred to as having restlessness symptoms as number of these
children have mental retardation.

Nevertheless, we can see that during the early part of 1900’s, cases of ADHD were being
described even if the term ADHD or Attention Deficit Hyperactivity Disorder had not yet been
invented.

The name for ADHD has changed a no. of times over the past century. They are being discussed
in the following section.

When did it became ADHD?

 In 1950’s, ADHD was reflected as minimal brain damage as there was no evidence of
brain injury in most children.
 In 1960’s, scientists move rather than naming on basis of causes to symptoms of disorder.
One of the first description using this sort of symptomatic description was that of
hyperkinetic reaction of childhood or hyperactivity. By focusing on the symptoms, this
downplayed the cause of the disorder which at that time was largely unknown and
downplayed the possible reason, the brain damage might be giving rise to all these cases.
It also focused attention on the behavioral manifestations of the disorder which were
easier to describe and to confirm research studies.
 In the 1970’s, the name was simply changed to “hyperactive child syndrome” and
hyperactivity was clearly the symptom after which the disorder was named, the actual
syndrome itself included a variety of symptoms including difficulty in attentiveness,
distractibility, problems with inhibition and poor impulse control, and difficulty in
controlling one’s emotions particularly impulsive emotions.
 In the 1980’s, the disorder came to be known as “Attention Deficit Disorder” sometimes
it is sub-typed as ADD with or without hyperactivity depending upon whether or not
hyperactive symptoms are present but;
  In the 1994, the disorder was renamed again as “Attention Deficit Hyperactivity
Disorder” recognizing that many cases of ADHD did include hyperactive symptoms
particularly during the childhood years. This is the current name for the disorder.

Current View and Clinical Nature of ADHD

As mentioned earlier, there are 2 psychological traits that are not developing on schedule in the
child with ADHD:

1. Hyperactivity- Impulsivity: One of these dimensions is that of poor inhibition which is

also manifested in symptoms of hyperactivity and impulsiveness. Other symptoms are
described as follows:
 Verbal impulsiveness i.e., talking excessively, interrupting others.
 Hyperactive impulsiveness or fidgeting behavior i.e., a child responds to events more
quickly than do other children.
 Cognitive impulsiveness i.e., they don’t seem to think about their actions before deciding
what to do.
 Inability to do wait for anything or defer gratification i.e., they can’t work overtime to get
larger rewards instead they prefer smaller but more impulsive consequences.

Children with ADHD appear to disregard the future consequences of the actions, they also
display the excessive task, irrelevant movement and verbal behavior. Hyperactive symptoms
here include fidgeting, squirming, running, climbing and frequently touching things.

This hyperactive behavior or restlessness declines more quickly with age as the children develop.
By adolescence, it is barely visible. By adulthood, it is of no value in helping to identify adults
with ADHD. The problems associated with ADHD will be more obvious in adolescence and
adult period. Adults with ADHD have internal or subjective type of restlessness that they often
show a need to be busy, a need to do a lot of things even if they don’t finish them, climbing on
things or behaving in a particular fidgety or restlessness fashion.

Impulsiveness in ADHD people can also be seen in their emotions, people with ADHD cannot
inhibit their feelings as well as others. They are not able to show better self-control over the
strong emotions that they may be experiencing and so they show their raw emotions much more
quickly and much more often than do other people. These emotional symptoms cause their own
difficulties or risks over development in addition to the problems with hyperactive and impulsive
behavior.

2. Inattention: The second dimension of psychological development that is not progressing

on schedule in people with ADHD is the domain of “inattentiveness”. However, calling
someone inattentive is not very helpful clinically and allowing professionals to make a
diagnosis and that is because many learning disorders are associated with inattentiveness
and s if someone claim that they are inattentive, one does not really know what disorder
they have.

There are six different kinds of attention that are provided to us by different networks in the
brain:

I. Arousal
II. Level of alertness
III. Selective attention (the ability to choose what is important)
IV. Divided attention (the ability to do multiple tasks at the same time)
V. Span of apprehension (the extent to which a person can process large amount of
information at one time)
VI. Persistence or sustained attention

ADHD doesn’t involve problems all six of these kinds of attention instead it mainly involves
problems with sustained attention or persistence over time towards goals or tasks that one is
being assigned to do. Children and adults with ADHD cannot persist revering on tasks and
activities that can be impaired in other individuals. Associated with persistence, there are no. of
problems that an individual may have to face such as:

 Persisting distractors
 Problem with re-engaging with things not yet completed

This difficulty with re-engaging tasks is not so much a problem with attention as it is a problem
with working memory. ADHD involves more than just hyperactive, impulsive and inattentive
behavior, it involves working-memory and as working-memory is one of the brain’s executive
ability so ADHD might well be a disorder of the brain’s executive functions more than it is a
disorder of attention. Many researchers believe that ADHD is actually an “executive function
deficit disorder” rather than just a problem with paying attention.

ADHD Diagnosis according to DSM-IV Criteria

DSM-IV manual includes two lists of symptoms:

i. The 1st list contains symptoms of inattentiveness. There are 9 symptoms on this list each
of them describes a particular kind of attention problem and that attention problem must
be occurring frequently in order to count as a symptom. A person have at least six
symptoms in order to be diagnosed as having ADHD or considered to have sufficient
symptoms of inattention.
ii. There is a 2nd list in this manual and it contains 9 symptoms of hyperactive and impulsive
behavior. Once again, these symptoms have to occur often or more frequently in order to
count as clinically significant symptoms, at least 6 of these 9 symptoms in order to
qualify as having the disorder.

There are other criteria that clinicians are required to follow besides identifying symptoms on
these two lists which are as follows:

 Symptoms should have last 6 months or larger.

 Life impairing symptoms must be developed prior to 7 years of age or approximately 12
to 16 years which is to say that symptoms have to develop sometime in childhood or in
adolescence. 98% of all cases of ADHD have developed by age 16.
 The symptoms must also occur across various situations.
 The symptoms must have led to impairment

Finally, these symptoms cannot be more easily explained by the presence of another mental
disorder. ADHD can only be added to person’s diagnosis list only if those symptoms cannot be
accounted for by another disorder. ADHD is diagnosed by multiple criteria not just by having
some symptoms of inattentiveness or some occasional symptoms of restlessness or impulsive
behavior. If a child meets all of these criteria, they are given a diagnosis of ADHD.

Prevalence of ADHD
  ADHD occurs normally about 3 to 5% of children.
 In the beginning of 1980’s, the figure is closer to 7-8%

Researchers and clinicians began to recognize that there was another type of ADHD which we
now called inattentive type or ADD and they included that in their diagnostic criteria and so this
broadened the definition of ADHD to include yet another subset of children and that increased
the prevalence of ADHD to about 7% of this age population in the U.S using the criteria in
DSM-IV manual.

 3 to 4 million children in the U.S having a diagnosis of ADHD.

 The disorder has been studied in a variety of countries and has been found that at least 5
to 6% of children worldwide probably have ADHD.

The reason that ADHD maybe slightly lower in other countries may have to do with the quality
of medical care, particularly pre-natal medical care because we know that some cases of ADHD
are raised through pregnancy complications.

 Adults of ADHD indeed have at least two third of children with ADHD will persist in
having their disorder into adulthood.
 This helps to explains why we say that about 4-5% of all adults in the U.S will qualify for
diagnosis of ADHD. This is approximately 12 to 15 million adults in U.S.
 Adults with ADHD have 3-4% prevalence worldwide.

Other countries may not have quite the same level of ADHD as developed western countries like
US that has to do with medical care.

Prevalence of ADHD in a country varies as a result of no. of different demographic features like
ADHD is related to individual’s age, social class differences, population density, occupations of
parents but every ethnic group has ADHD and so far we have not been able to identify any major
ethnic differences in the prevalence of ADHD. It is believed that it has to do with social class,
poverty and medical care.

Variance of ADHD Symptoms by Setting

ADHD symptoms do not occur with equal severity across all situations which is to say that the
symptoms can fluctuate markedly depending upon the setting or the situation that the child is in.

The symptoms of ADHD are better in following certain situations:

 Fun activities rather than boring situations

 Situations where immediate consequences are provided rather than delayed consequences
 Salient situations having a high value for the child
 Having situations with frequent feedback rather than infrequent feedback
 Situation at the start of the day rather than late in the day
 Supervised situations rather than un-supervised situations
 One-on-one relationships with somebody than any group situations
 New situation rather than familiar situations
 Fathers than mothers
 Situation with someone stranger than to whom they are familiar with such as parents or
peers
 Examining room rather than waiting room

The symptoms of ADHD are worst in situations alternative to the better situations. These
situations require a child to have more self-control or self-regulation.

More about ADHD

ADHD is a problem with brain’s executive functions. There are several of these executive
functions and all of them are used to help an individual control their ow behavior and direct their
behavior over time in getting ready for the future. Children with ADHD have significant
problems with these executive functions. Following are some of important executive functions:

 Self-awareness…. the ability to see ourselves in our mind and to see what we are doing
and how we are performing.
 Inhibition…. inability to stop one’s behavior as quickly as others.
 Non-verbal working memory (visual imagery) …. the ability to hold images in a mind
known as the mind’s eye.
  Verbal working memory (internal speech) ……allows us to talk to ourselves privately
without other people hearing us in order to direct our own behavior.
 Emotional control…. the ability to inhibit strong emotions and to use our ability for self-
regulation to be socially acceptable.
 Planning/ problem-solving……ability to entertain multiple possible ways of doing
something, multiple plans used to achieve a goal and to play with information about
future.

All of these executive abilities help us to control our own behavior. They develop slowly over
time, one at a time, across childhood then to adulthood. Adults have at least 6 executive abilities.

Executive functions are a combination of various tools that can be used for regulating our own
behavior in order to prepare for the future. ADHD interferes with all six of these executive
abilities. It disrupts their development and leaves the ADHD child at least 30% or more behind
in their executive development.

Children with ADHD

 Problems with self-control and self-discipline.

 Reduced appearance of self-awareness and self-monitoring as other children.
 Children with ADHD have positive bias in their self-evaluation and they appreciate
particular deficits they may be having.
 Poor ability to look back in past experiences before deciding what to do in particular
situation. They have difficulty in thinking about what could if they do certain action.
 No ability to look ahead, anticipating and no sense of time.
 Not able to manage their activities relative to time.
 Trouble in following commands, rules and instructions given by other people.
 Difficulty in understanding what they have heard or read.
 Unable to regulate their emotion as well as others. They show their strong emotions more
impulsively.
 They are not able to sustain their motivation over time toward particularly boring
activities.
 Symptoms of poor executive functions.
 Not able to simulate or think about multiple possible options for dealing with problems.