Child Behavior: Attention Deficit and its controversies



Attention Deficit Hyperactivity Disorder is a chronic neurobehavioral disorder of childhood characterized by inattention, possibly combined with over activity (hyperactivity) and/or impulsivity. Though diagnosis and treatment for ADHD has increased in recent years, it has been identified and written about for centuries. Historically these children were labeled “brain-injured,” “minimal brain-damaged,” and “experiencing minimal brain dysfunction.” Even in the early 1900s over-activity and poor impulse control were associated with organic brain damage in youngsters.

 

ADHD is the most frequent diagnosis for children referred for psychiatric treatment, affecting over 4 million American children between the ages of 4 and 18, with boys being diagnosed three to six times more often than girls.

Statistically, that puts one child with ADHD in every classroom in America. Kids with ADHD are at risk for falling behind in academics when they enter school. Their peers may also begin to ostracize them because of their poor social skills, and possible aggressive behavior. They may also be at risk for depression.

 

Symptoms will vary

 

Not all children with ADHD show all of these symptoms to the same degree. Some children are primarily hyperactive while others are inattentive and impulsive with no signs of hyperactivity. This disorder is identified as either ADHD inattentive type, (displaying primarily inattentive behaviors), or combined type (displaying a mix of these behaviors).

 

Research on the cause of ADHD has been a source of controversy. Over the years researchers have attempted to find the one variable common to all children manifesting these behaviors. The most promising biological theory explains the problems these youngsters exhibit not as damage but rather as a “difference” in the way their brains work. Specifically there appears to be an imbalance between the arousal or excitory mechanisms of the brain and the inhibiting or control mechanisms. This imbalance results in these children’s inability to regulate their responses to what a situation might warrant.

 

There also might be an imbalance of neurotransmitters (chemical messengers of the brain) in the brains of children with ADHD, which may explain why medication seems to be an effective, although controversial, means of treatment for many children with this disorder.

 

Role of genetics not fully understood

 

ADHD children have a high percentage of siblings having similar characteristics, but the exact role of genetics is difficult to determine—there might be one gene that can account for over activity, impulsitivity or inattention or it may be an interaction between a numbers of genes. There is no one answer to the question, What causes ADHD? Rather it appears that it is a multiplicity of interactions between biological, genetic, environmental, family factors and stresses that increase the vulnerability of a particular child to exhibit the symptoms of ADHD.

As there is a lack of agreement on the causes of ADHD, and due to the persistent nature of ADHD, multiple treatment strategies have been developed and many have proven helpful for the majority of children with ADHD. The most commonly prescribed treatment is the administration of a stimulant medication such as Ritalin, Concerta, or Strattera.

Paul Schwartz, Ph.D., is a professor of psychology and education at Mount Saint Mary College in Newburgh.

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