A Parent Guide to- Attention-Deficit Hyperactivity Disorder Essay

A Parent Guide to- Attention-Deficit Hyperactivity Disorder Essay

A Parent Guide to- Attention-Deficit Hyperactivity Disorder

Attention-deficit/hyperactivity disorder (ADHD) is known as a brain disorder consisting of inattention and/or hyperactivity-impulsivity that can restrict functioning or development (Thomas et al, 2015). This disorder often is seen in children age group four through seventeen-year-olds.A Parent Guide to- Attention-Deficit Hyperactivity Disorder Essay. Although, children generally have a short attention span; when parents/ caregivers notice their child’s attention span is remarkably shorter-spanned for their age, or that their older child is not able to stay-put in their own chair and behaves more like a toddler-wandering-around the classroom- then clinical help would need to be explored to help the child appropriately.

Signs and symptoms

It is good to note that these problems are not due to defiance or lack of comprehension, but the normal progression of the signs and symptoms. Inattention- can be seen as the child wanders off task, lacks-persistence, has difficulty sustaining focus, disorganized, fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities, does not seem to listen when spoken to directly, avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework), loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools) and forgetful in daily activities (Thomas et al, 2015).A Parent Guide to- Attention-Deficit Hyperactivity Disorder Essay

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Hyperactivity the child seems to move about constantly, as well as in situations in which it is not appropriate; or leaves seat in classroom or in other situations in which remaining seated is expected, excessively-fidgets, taps, or talks. In adults, it may be extreme restlessness or wearing others out with constant activity. The child runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness, has difficulty playing or engaging in leisure activities quietly, “on the go” or often acts as if “driven by a motor” (Thomas et al, 2015).A Parent Guide to- Attention-Deficit Hyperactivity Disorder Essay

Impulsivity the child makes hasty actions that occur at the moment without first thinking about them and that may have a high potential for harm; or blurts out answers before questions have been completed, a desire for immediate rewards or inability to delay gratification. Has difficulty waiting for their turn, interrupts or intrudes on others (e.g., butts into conversations or games), the child may be socially intrusive and excessively interrupt others or make important decisions without considering the long-term consequences (Thomas et al, 2015).A Parent Guide to- Attention-Deficit Hyperactivity Disorder Essay

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Pathophysiology

The pathophysiology of ADHD is not completely understood. The current belief is that both genetic and environment play a role in children developing ADHD. One of the reasons we assume a genetic factor is due to the fact that monozygotic twins have shown a 55%-90% concordance rate in ADHD diagnosis (Dopheide, 2018). However, other studies on monozygotic twins have suggested only a 60 percent likelihood of ADHD diagnosis in both children. Adults with ADHD have an increased risk of having children who are diagnosed with ADHD. One study showed that 84 percent of adults with ADHD who did have children had at least one child who would be diagnosed with ADHD (Farone & Biederman, 2017).A Parent Guide to- Attention-Deficit Hyperactivity Disorder Essay

Brain studies have shown that individuals with ADHD overexpress dopamine transmitter-1, which is responsible for transporting both dopamine and norepinephrine to the presynaptic nerve terminal. Dopamine’s functions involve regulation of mood and impulsivity. Norepinephrine’s functions include regulation of mood, attention, and arousal. Therefore, an overload of these neurotransmitters at the nerve terminal may lead to the hallmark symptoms of ADHD (Dopheide, 2018).

Many theories on the pathophysiology of ADHD implicate a deficiency in reward processing. Imaging studies in ADHD patients have shown lower activation in the ventral striatum during reward anticipation as compared to controls (Albrecht, Uebel-von Sandersleben, Gevensleben, & Rothenberger, 2015). There is also some research suggesting that catecholamines play a role in ADHD. One human study looked at the catechol-O-methyltransferase gene which is involved in breaking down dopamine and norepinephrine. An allele of this gene, the Val allele, may cause an increase in the gene’s activity, in turn causing increased breakdown of the aforementioned neurotransmitters.A Parent Guide to- Attention-Deficit Hyperactivity Disorder Essay. The “Catecholamine Hypothesis” asserts that catecholamines mediate the expression and the onset of ADHD symptoms. Studies supporting this theory include those that implicate DRD4 and DAT in the origin of ADHD and those that show deficits in the catecholaminergic systems. Imaging studies in mice and monkeys that reveal lesions affecting the dopaminergic pathway also support this theory. Lastly, the fact that anti-ADHD medications modulate dopaminergic and nonandrogenic activity suggests that there is truth to the Catecholamine Hypothesis (Farone & Biederman, 2017).

In addition to the overexpression of DAT1, a defect in the dopamine receptor, D4, has been noted in brain studies. Dopamine receptor 4 also regulates dopamine and norepinephrine in order to control one’s reactions to their environment.A Parent Guide to- Attention-Deficit Hyperactivity Disorder Essay. Environmental factors such as socioeconomic status, psychosocial distress, parental criminality, and parental mental disorders are positively correlated with ADHD diagnosis in children (Dopheide, 2018). However, it’s important to note that other external factors, particularly diet, have not demonstrated a link to ADHD. The theory that ingestion of lead can cause ADHD is also unproven.A Parent Guide to- Attention-Deficit Hyperactivity Disorder Essay. Studies have indicated that lead contamination positively correlates with some ADHD symptoms including restlessness, hyperactivity, and distractibility. On the other hand, research has shown that many children with high lead exposure are never diagnosed with ADHD and most children who are diagnosed with ADHD do not have lead contamination. Another factor that has received much attention is maternal nicotine use during pregnancy. Smoking when pregnant places the fetus at a higher risk for low birth weight and increased carboxyhemoglobin, which can lead to hypoxia, thus increasing the risk of cognitive and behavioral impairments when the child is born. Studies in pregnant mice and rats further demonstrate the link between nicotine receptors and dopaminergic dysregulation. Smoking leads to an increase in nicotine receptors, which play a role in modulating dopaminergic activity. While this relationship does not prove causation, it is considered enough to implicate maternal smoking as a risk factor for ADHD.A Parent Guide to- Attention-Deficit Hyperactivity Disorder Essay

How the Disorder is Diagnosed

The Diagnosis of Attention-Deficit/Hyperactivity Disorder involves three major categories which include the following; Combined presentation (If both criteria for inattention and hyperactivity-impulsivity are met), Predominantly Inattentive presentation (If only the criterion for inattention is met), and Predominantly hyperactivity/Impulsive presentation (if only the criterion for hyperactivity and impulsivity are met) (American Psychiatric Association (APA), 2013)A Parent Guide to- Attention-Deficit Hyperactivity Disorder Essay. For a child to be diagnosed with Attention-deficit/Hyperactivity Disorder, the symptoms manifested by the child must meet the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders, 5th ed., (DSM-5). According to the DSM-5, the child must manifest at least six symptoms in either the inattention criterion, or at least six symptoms in the hyperactivity and Impulsivity criterion, or at least six symptoms each in both criteria (APA), 2013).A Parent Guide to- Attention-Deficit Hyperactivity Disorder Essay. In addition, the symptoms must have persisted for at least six months, and present in at least two different settings (at home, school, or work environment; or during interaction friends or relatives). Furthermore, the symptoms should interfere with the child’s ability to function effectively such as poor academic performance, poor job performance, or difficulty in social interaction with peers (APA, 2013). Worthy of note is that adolescents and adults age 17 and older are required to meet only a minimum of five symptoms in either category (Inattention or hyperactivity and Impulsivity), or at least five symptoms in both categories to qualify for a diagnosis of either Inattentiveness, Hyperactivity-impulsivity, or combined presentation respectively (APA, 2013).A Parent Guide to- Attention-Deficit Hyperactivity Disorder Essay

To ensure the accuracy of the diagnosis, a comprehensive mental health and medical history of the child should be obtained and should include prenatal, perinatal, and toddler information of the child (Sadock, Sadock, & Ruiz, 2014)A Parent Guide to- Attention-Deficit Hyperactivity Disorder Essay. The age of onset of symptoms should be indicated which should be before age of 12 (APA, 2013). Medical conditions (petit mal epilepsy, hearing, visual impairments, thyroid problems, and hypoglycemia) and mental health conditions (oppositional defiant disorder, intermittent explosive disorder, disruptive mood dysregulation disorder, bipolar disorder, substance abuse disorder, anxiety disorders, autism spectrum disorder, intellectual disability or other neurodevelopmental disorders) that may mimic the symptoms of ADHD should be assessed and ruled out (Felt et al, 2014).A Parent Guide to- Attention-Deficit Hyperactivity Disorder Essay. Also, the use of standardized assessment tools such as the American Academy of Pediatrics, National Initiative for Children’s Healthcare Quality Vanderbilt Assessment Scale (NICHQ) can be used for children who are six to 12 years of age (NICHQ, 2002). This scale provides a reliable way of rating the symptoms presented by the child and consist of both the parent and teacher version. Both the parents and teachers complete the forms and the clinician complete the scores and used all information gathered in the history and physical examination including his or her own personal observation to come out with a diagnosis. Other rating scales can also be used.A Parent Guide to- Attention-Deficit Hyperactivity Disorder Essay

In addition to ruling out other physical and mental health conditions, the clinician should ensure that the symptoms presented by the child are not normal compared to what is expected for his age and developmental level before labeling the child with a diagnosis.A Parent Guide to- Attention-Deficit Hyperactivity Disorder Essay

Treatment Options

Once a child or adolescent has been diagnosed with attention-deficit hyperactivity disorder (ADHD), parents are often faced with the daunting task of deciding how to proceed with helping their child. Controversies remain regarding whether to introduce medications or not for treatment. Treatment goals are aimed at decreasing ADHD symptoms, improving functional abilities, and tackling behavioral difficulties (Felt, Biermann, Christner, Kochhar, & Van Harrison, 2014). The (American Academy of Pediatrics[AAP], 2011), suggests treatment options may vary depending on the child’s or adolescent’s age.A Parent Guide to- Attention-Deficit Hyperactivity Disorder Essay

Children six years of age and younger should begin with behavioral therapy. Behavioral therapies are useful as it incorporates specific strategies for training parents on ways to modify and alter behaviors by implementing rewards and appropriate consequences (AAP, 2011). Therapies may be challenging at first as resistance is expected, however, consistency remains an important factor in achieving behavior changes. Psychostimulant medications such as methylphenidate may be prescribed in the event behaviors modifications remain unsuccessful (AAP, 2011).A Parent Guide to- Attention-Deficit Hyperactivity Disorder Essay

FDA approved stimulant medications including methylphenidate, dexamphetamine, and mixed amphetamine salts are considered the first line of therapy and have shown to be effective in managing symptoms of ADHD in children older than six years of age through adolescence (Felt et al., 2014)A Parent Guide to- Attention-Deficit Hyperactivity Disorder Essay. Side effects are typically associated with medication dosing and may include decreased growth, diminished appetite, abdominal discomfort, agitation, and sleep difficulties (Felt et al., 2014). However, medication outcomes show approximately 70% of patients have a positive response to one stimulant medication and over 90% response rate by incorporating two stimulants (Felt et al., 2014).A Parent Guide to- Attention-Deficit Hyperactivity Disorder Essay