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Attention Deficit Disorder

Attention Deficit Disorder Attention Deficit Disorder Five year old Danny is in kindergarten. It is playtime and he hops from chair to chair, swinging his arms and legs restlessly, and then begins to fiddle with the light switches, turning the lights on and off again to everyone’s annoyance–all the while talking nonstop. When his teacher encourages him to join a group of other children busy in the playroom, Danny interrupts a game that was already in progress and takes over, causing the other children to complain of his bossiness and drift away to other activities. Even when Danny has the toys to himself, he fidgets aimlessly with them and seems unable to entertain himself quietly. To many, this may seem like a problem; and it is. Danny most likely suffers from what is called Attention Deficit Disorder.

Recent controversy has erupted as to whether Attention Deficit Disorder in fact deserves the title of disorder. Some people, like Thomas Armstrong, a psychologist and educator, believe Attention Deficit Disorder is merely a myth; ..a dumping ground for a heterogeneous group of kids who are hyperactive or inattentive for a number of reasons including underlying anxiety, depression, and stresses in their families, schools , and in our culture. (Armstrong 15) However, he and those who question the validity of Attention Deficit Disorder are mistaken. Attention Deficit Disorder is in fact a disorder because it is recognized as such in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition), it is treatable through prescription medication and therapy and if left untreated inhibits one from functioning properly in society. Before delving into the ways in which Attention Deficit Disorder matches the criteria established for what a disorder is, it is important to first understand the disorder and have some background information on it.

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The symptoms of Attention Deficit Disorders (ADD for short) exist on a continuum. Everybody has some of these symptoms some of the time. However, individuals with ADD have more of these symptoms more of the time and to the point that it interferes with their ability to function normally in academics, work and social settings, and to reach their potential. People with ADD are often noted for their inconsistencies. One day they can do it, and the next they cannot.

They can have difficulty remembering simple things yet have steel trap memories for complex issues. To avoid disappointment, frustration, and discouragement, do not expect their highest level of competence to be the standard. It is an unrealistic expectation of a person with ADD. What is normal is that they will be inconsistent. Typically, they have problems with following through on instructions, paying attention appropriately to what they need to attend to, seem not to listen, be disorganized, have poor handwriting, miss details, have trouble starting tasks or with tasks that require planning or long-term effort, appear to be easily distracted, or forgetful.

In addition, some people with ADD can be fidgety, verbally impulsive, unable to wait their turn, and act on impulse regardless of consequences. However, it is important to remember — not all people with ADD have all of these difficulties, nor all of the time. Due to the fact that society has traditionally thought of a person with ADD as being hyper, many children who have ADD with no hyperactivity are not being identified or treated. Individuals with ADD without hyperactivity are sometimes thought of as day-dreamers or absent-minded professors. The non-hyperactive children with ADD most often seem to be girls (though girls can have ADD with hyperactivity, and boys can have ADD without hyperactivity). Additionally, because of the ability of an individual with ADD to over-focus, or hyper-focus on something that is of great interest or highly stimulating, many untrained observers assume that this ability to concentrate negates the possibility of ADD being a concern, especially when they see children able to pay attention while working one-on-one with someone, doing something they enjoy, or who can sit and play an electronic game or watch TV for hours on end. ADD is not a learning disability.

Although ADD obviously affects the performance of a person in a school setting, it will also affect other domains of life, which can include relationships with others, running a home, keeping track of finances, and organizing, planning, and managing most areas of one’s life. ADD is considered to be a neurobiological disorder. The most recent research shows that the symptoms of ADD are caused by a chemical imbalance in the brain. To understand how this disorder interferes with one’s ability to focus, sustain attention, and with memory formation and retrieval, it is important to understand how the brain communicates information. Each brain cell has one axon, the part of the cell that sends messages to other cells; and many dendrites, the part that receives messages from other cells. There is a space between the axon and the next brain cell called a neural gap.

Since these nerve endings do not actually touch, special chemicals called neurotransmitters carry (transmit) the message from the end of the axon to the dendrites that will receive it. With ADD there is a flaw in the way the brain manages the neurotransmitter production, storage or flow, causing imbalances. There is either not enough of them, or the levels are not regulated, swinging wildly from high to low. When diagnosing ADD, a thorough evaluation is very important. In order for an individual to be diagnosed with ADD, comprehensive evaluations must be administered that include a complete individual and family history, ability tests, achievement tests, and the collection of observations from people who are close to the person who is being assessed.

It is also extremely important to have an assessment that is individualized and designed to uncover co-existing conditions, such as learning disabilities and behavior, mood or anxiety disorders (depression, generalized anxiety, obsessive-compulsive disorder, oppositional defiant disorder, etc.), or any other problem that could be causing symptoms that look similar to the symptoms of ADD. A thorough evaluation includes gathering information from a variety of sources. A thorough review of the person’s medical, academic and family history is essential. In the case of a child this is done through a detailed, structured interview with the parents. Behavior rating scales should be filled out by parents and teachers to provide information on types and severity of ADD symptoms at home and at school, as well as types and severity of other emotional or behavior problems.

Depression, anxiety and other emotional disorders are tested through a comprehensive psychological screening. Intellectual and achievement testing is used to help screen for and then assess learning problems, and areas of strength and greatest struggle. For decades, stimulant medications have been used to treat the symptoms of ADD. For many people, these medicines dramatically reduce their hyperactivity and improve their ability to focus, work, and learn. The medications may also improve physical coordination, such as handwriting and ability in sports. Recent research by National Institute of Mental Health (NIMH) suggests that these medicines may also help those with an accompanying conduct disorder to control their impulsive, destructive behaviors.

Current statistics show that about 1% to 3% of the school-aged population has the full ADD syndrome, without symptoms of other disorders. Another 5% to 10% of the school-aged population have a partial ADD syndrome or one with other problems, such as anxiety and depression present. Another 15% to 20% of the school-aged population may show transient, subclinical, or masquerading behaviors suggestive of ADD. (Reason 85) A diagnosis of ADD is not warranted if these behaviors are situational, do not produce impairment at home and school, or are clearly identified as symptoms of other disorders. It is the validity of the diagnosis of ADD which has sparked recent controversy. According to Richard Bromfield, Ph.D., a psychologist on the faculty of Harvard Medical School: ADD exists as a disorder primarily because a committee of psychiatrists voted it so. In a valiant effort, they squeezed a laundry list of disparate symptoms into a neat package that can be handled and treated.

But while attention is an essential aspect of our functioning, it’s certainly not the only one. Why not bestow disorderhood on other problems common to people diagnosed with ADD, such as Easily Frustrated Disorder (EFD) or Nothing Makes Me Happy Disorder (NMMHD)? (Bromfield 22) His view illustrates the most controversial belief about Attention Deficit Disorder which is that it does not really exist and that children with the disorder are no different from their peers. There is also great controversy surrounding the stimulant most commonly used to treat ADD, Methylphenidate, more commonly known as Ritalin. According to Bromfield, Ritalin is being dispensed with a speed and nonchalance compatible with our drive-through culture, yet entirely at odds with good medicine and common sense. (Bromfield 22) These issues have been at the core of the debate over the validity of ADD; other issues up for debate in …


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