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People, usually children or adolescents, who find it hard to keep still, sit down for a moment or maintain silence even for a brief period of time are generally labeled as someone with AD/HD. These are complex life situations that make it hard for the person to process new information that hinders him to learn new things. AD/HD is a complicated problem that requires awareness of the individual’s total world.
Attention Deficit Hyperactivity Disorder, usually referred to as AD/HD, is often associated with inattention or distractibility, hyperactivity and impulsivity (Silver, 2004). It is difficult to make a proper diagnosis that a child has AD/HD. Oftentimes, a child who finds it hard to focus on a certain activity or someone who becomes fixated with an activity, even though it is done already, and finds it difficult to move on to the next activity is labeled with AD/HD. This makes it difficult to set the boundaries of the disorder. However, according to the DSM-IV TR (American Psychiatric Association, 2000), it is described as “the persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequent and severe than is typically observed in individuals at a comparable level of development”. Inattention is characterized by having six or more of the following symptoms: making careless mistakes, having difficulty in sustaining attention, being unable to finish duties, having difficulty in organizing tasks assigned, finding it hard to listen when spoken to directly, avoiding work that requires maintaining mental effort, losing things necessary for an activity, getting easily distracted or being forgetful most of the time. Six or more of the following symptoms, on the other hand, manifest hyperactivity-impulsivity: fidgeting in seat, inability to follow simple instructions like keeping still in class where appropriate discipline is expected, having a hard time doing quiet activities, always feels the need to do something, talk excessively, has a difficulty in waiting turns, and often interrupts others.
AD/HD is a life disability. It is a life problem that interferes with a person’s family life, peer interactions, and successful participation in other activities. It distracts the child from performing well in the classroom. He preoccupies himself with other things rather than staying focus in class discussions and tasks assigned. It also interferes with a person’s family life and peer interactions since the person with the disorder finds it hard to regulate the proper behavior called for in particular circumstances. According to the book Attention Deficit/ Hyperactivity Disorder (Silver, 2004), there is a likelihood of 50% that another family member will have the disorder if one is diagnosed with such.
AD/HD is different from learning disability in that AD/HD results in behaviors that make it difficult for a student to sit, focus, and participate well in the present activity. Therefore, it interferes with the child’s availability for learning. Learning disability, on the other hand, concerns the student’s ability to process and use information. It interferes with his ability to learn. However, according to the book Attention Deficit Hyperactivity Disorder (Silver, 2004), 10%-20% of school-age population has academic difficulty and 30%-40% of children or adolescents with AD/HD have learning disability.
AD/HD is a complex problem and has many features. And because of this, it is classified according to the level of severity (Jordan, 1998): mild, moderate, and severe. Mild AD/HD is characterized by restlessness after beginning a task. It is hard for the person to understand what he hears. There is emphasis on supervision and reminder to do the task given and to finish it. The person can succeed if this direction is given. Moderate AD/HD displays most of the following features: struggles in social relationships, in work performance or classroom learning, tends to be emotional rather than logical, has to be frequently reminded of tasks assigned, and is often regarded as “difficult”. With the patience of the people around him, the person with this level of severity of the disorder will succeed. Severe AD/HD is exhibited by some of the following characteristics: finds it very difficult to form social circles, to behave in class or act accordingly in other situations, as in the workplace, because of ferociousness, self-centeredness, and immature behavior, has very vulnerable emotions that can be flared up by simple criticisms, is undependable and irresponsible.
More individuals are given this diagnosis than in the past when 15 years ago, a major effort was started to educate parents and teachers about this issue (Silver, 2004). Consequently, the children and adolescents of these adults were referred to for evaluation. After which, more professionals learned how to diagnose AD/HD using a certain criteria. Furthermore, it was found out that the disorder can continue to adulthood and that more and more adults are also given this diagnosis.
What makes the disorder a controversial issue is that there is no hard biological measure to make the diagnosis (Jordan, 1998). It is not possible to use laboratories or radiological studies to authenticate the diagnosis. The judgment is only based on the clinical history of the patient and on administering further behavioral assessment.
However, there are certain possible causes that trigger the occurrence of the disorder. One of these is the generic pattern, which falls under familial patterns. It is more likely for an individual to acquire the disorder had there been a family member who was diagnosed with AD/HD. Another issue that falls under familial patterns is adoption. In Third World countries where people are exposed to impoverished settings, the likelihood of adoption is higher. Children who were born in these countries are more probable to have this disorder given the kind of environment they have (Silver, 2004). The socio-economic status of the child’s parents plays an important role in this concern. The kind of food the mother eats during pregnancy, and the type of environment the mother lives in during the pregnancy and after the birth of the child place a risk on the health of the child not only physiologically but also mentally and psychologically.
Other causes include mental retardation, emotional problems, academic difficulties, and difficulty in maintaining focus (Silver, 2004). Mentally retard patients are those individuals whose IQ fall below normal capacities, and therefore, will always function academically below the normal range. Emotional problems, on the other hand, interfere with the person’s ability to learn and his availability for learning. Those with academic problems may or may not have average or even above average intelligence but have difficulty in performing well academically and this abnormality can be attributed to the wiring of the neurons and the functions of the brain. Lastly, maintaining focus includes difficulty in sitting still, observing proper behaviors, keeping attentive and thinking through answers before cutting the question or before answering.
Children with AD/HD may acquire one or more of the neurologically based disorders (Silver, 2004). It is so because of the wiring of the brain. As a person grows into maturity, more and more process and behaviors are learned; an old task which used to be so hard and tasking can become a simple job that doesn’t require much though overtime. Soon enough, the person seems to master the job and gets ready to learn another hard task. But this is only possible if there be a normal wiring of neurons in the brain. As a result, the individual is now capable of doing things that used to be difficult before. However if the neurons are wired differently, the individual will encounter new problems instead of solving old ones. It is but rightful then to say that when different part of the brain gets affected, different diagnosis is given. Still, if a person is diagnosed with one disorder, there is higher likelihood that he will have another. According to the study conducted by Larry Silver (2004), there seems to be a 50% probability for this phenomenon called the pattern of comorbidity. AD/HD was used as a constant variable for other dysfunctions as cortical and regulatory.
Cortical dysfunctions focus on complex functions as language, motor, learning, and organizational. The language functioning part of the brain is responsible for language disability. When this occurs, there seems to be a delay in the language development among children. It is usually manifested during age 3 when the child only gets to speak only a few words. Furthermore, at the age of 4 or 5, there is a difficulty in processing or comprehending what was heard. As the child grows, he can also develop reading problems in congruent with understanding what he has been told to do and what he was reading. There is also a difficulty in organizing thoughts. Motor functions are responsible for the muscles. The problems in this condition relates to the ability of the person to harmonize or use teams of muscles all at the same time like running, skipping, climbing. Or, there is a difficulty coordinating small muscles for fine motor skills like zipping a jacket or tying shoes. This can evolve to become a sensory integration disorder. As for the learning functions, this transmits to the doling out of information for learning functions. This can become what we call the learning disability. Lastly, the organizational functions arrange the behaviors. It helps in decision-making and in evaluation of the task provided.
Regulatory dysfunctions are often associated with modulation problems. Under this scope lies anxiety disorders, mood disorders, anger control disorders, obsessive-compulsive behaviors, and tic disorder. The anxiety disorders requires the fight-or-flight sympathetic response during which the individual experiences panic attacks where he breaks into sweat, heart ponds, and feels weak. In the mood disorders, there is a problem with mood regulation ++
It is hard to estimate the prevalence of AD/HD given the various settings and situations the different locations have (Silver, 2004). But in a general pediatric setting, 10% of the behavioral problems result in AD/HD. 50% of the children with behavioral problems has AD/HD in the child and adolescent psychiatric setting. 30%-40% of the children or adolescent who are diagnosed with AD/HD have learning disability. The ratio between boys and girls who have this disorder is 3:1. Boys appear to demonstrate disruptive behavior than girls.
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