ADHD stands for
attention-deficit hyperactivity disorder and is a biological condition, which
requires a medical diagnosis, that prevents your child from being able to sit
still and/or focus on tasks (National Institute of Mental Health [NIMH], 2016). Even though ADHD is a biological condition,
whose cause has been linked to genetics, environmental factors, and
neurotransmitter imbalances (like dopamine), there a lot of unfair and
incorrect beliefs and perceptions regarding ADHD that still persist (Morin, n.d.; NIMH, 2016).
According to
the Center for Disease Control and Prevention (CDC), as many as 11 percent of
kids ages 4-17 have been diagnosed with ADHD, my younger brother included
(Morin, n.d.). Despite some common
claims, ADHD is not a result of bad parenting or your child being “lazy” and/or
“disobedient" (Morin, n.d.). ADHD
patients have differences in their brain structure (decreased prefrontal
cortex, basal ganglia, and cerebellum size) and chemical composition (decreased
dopamine levels) which play vital roles in the ability to concentrate and sit
still (Curatolo, P., D'Agati, E., & Moavero, R., 2010; NIMH, 2016; Brookshire,
2017).
Another aspect
of an ADHD diagnosis that is not widely known includes while an ADHD diagnosis
may occur in childhood, ADHD is not a curable condition (Curatolo et al., 2010;
NIMH, 2016). Children diagnosed with
ADHD will still have ADHD as adolescents, adults, and the rest of their lives; although, the presentation
and treatment plan may be altered due to hormonal and developmental changes
individuals go through during the natural aging process (NIMH, 2016; Morin,
n.d.).
Following the
diagnosis of ADHD, medications are available to help ADHD patients to focus,
work, and learn better by decreasing their impulsivity and hyperactivity (NIMH,
2016). As of today, the first choice and
most effective ADHD medications are stimulants, which increases the levels of
dopamine in the brain (Curatolo et al., 2010; NIMH, 2016). Other medications, including non-stimulants
and anti-depressants (alters dopamine and norepinephrine levels) are
also available to treat ADHD, either independently or in conjunction with other
medications (NIMH, 2016).
I have personally witnessed the negative effects that stigmas and misunderstandings can
cause an individual diagnosed with ADHD.
The best way to help ADHD patients is to educate ourselves, understand
the biological causes behind ADHD, and support these people, so they can receive
an accurate diagnosis as well as develop an appropriate treatment plan without fear
or shame.
Attention-Deficit/Hyperactivity
Disorder (ADHD): The Basics. (2016). Retrieved October 15,
2017, from https://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder-adhd-the-basics/index.shtml#pub3
Brookshire, B.
(2017, January 17). Explainer: What is dopamine? Retrieved October 15, 2017,
Curatolo, P., D'Agati, E.,
& Moavero, R. (2010, December 22). The neurobiological basis of
ADHD. Retrieved October 15, 2017, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3016271/
Morin, A. (n.d.).
Understanding ADHD. Retrieved October 15, 2017, from
https://www.understood.org/en/learning-attention-issues/child-learning-disabilities/add-adhd/understanding-adhd
I completely agree that ADHD has been receiving an increasingly negative stigma. I did not know that brain structure is altered by ADHD, I only thought that ADHD occurred due to problems with synapses; thus, I found this post very interesting. Although I agree with you that ADHD has been misunderstood, I also believe that this misunderstanding has to do with the misuse of drugs such as Adderall. According to a study done by Barbra Prudhomme White (2003), undergraduate and graduate schools, over 15% of 1,025 students reported not being prescribed adderall and abusing the drug for academic enhancement. With such a high abuse rate, the United States might want to consider creating laws that increase the amount of screening and "security" on ADHD or ADD drugs. Smaller prescription sizes to those who have ADHD could also help decrease the amount of ADHD medication being sold to others for abusive purposes.
ReplyDeletePrudhomme White, B., & Et al. (2003). Stimulant Medication Use, Misuse, and Abuse in an Undergraduate and Graduate Student Sample. Retrieved from http://www.tandfonline.com/doi/abs/10.3200/JACH.54.5.261-268
As you mentioned, ADHD has been linked to genetics, environmental factors, and neurotransmitter imbalances, and has physiological indicators of disease. Perhaps it is receiving negative attention as of late in part due to misuse of drugs as Emily F. mentioned above. However, the real issue seems to stem from a more pressing problem: the misdiagnosis of the condition in childhood and adolescence. It has been shown in various student populations that the younger students in a class are diagnosed significantly more often than their older counterparts (Chen et al., 2016; Elder, 2010; Evans, Morrill, & Parente, 2010; Karlstad, Furu, Stoltenberg, Håberg, & Bakken, 2017; Morrow et al., 2012).
ReplyDeleteMost of these studies followed a similar procedure, so I will use the most recent study from Karlstad, Furu, Stoltenberg, Håberg, and Bakken (2017) as an example. Researchers examined all children born in Norway between 1998 and 2006 (N=509,827) from the year they turned 6 years old until December 31st, 2014. Using the Norwegian annual cut-off birthdate of December 31 for school enrollment, the researchers compared the youngest children in a grade (born in December) with the oldest (born in January) and assessed whether age was associated with being diagnosed with ADHD and/or being medicated. As previously mentioned, the researchers demonstrated that younger children were diagnosed significantly more than their older counterparts. Because medical professionals cannot realistically follow children around, teachers are often referred to for behavioral indicators of ADHD. With this in mind, the data suggests that a lower perceived level of maturity in younger students relative to older students in the same grade corresponds with the increased diagnosis of ADHD. Thus, misdiagnosis may be due to a difference in mental developmental stage as a result of age instead of differences in brain structure as a result of biological deviance from the expected norm.
While ADHD patients have markedly different physiology, how can we limit misdiagnosis to ensure that children are not being medicated for simply being children? You mentioned that dopamine levels are increased in children with ADHD, but are there non-disease factors which may result in elevated dopamine levels, or are levels significantly different in affected individuals (statistically speaking)? Does the altered brain structure result in differences that may be detected with a hormone panel or biomarkers that a blood test may indicate?
Chen, M. H., Lan, W. H., Bai, Y. M., Huang, K. L., Su, T. P., Tsai, S. J., . . . Hsu, J. W. (2016). Influence of relative age on diagnosis and treatment of attention-deficit hyperactivity disorder in Taiwanese children. The Journal of Pediatrics, 172, 162–167. doi:10.1016/j.jpeds.2016.02.012
Elder, T. E. (2010). The importance of relative standards in ADHD diagnoses: Evidence based on exact birth dates. Journal Of Health Economics, 29(5), 641-656. doi:10.1016/j.jhealeco.2010.06.003
Evans, W. N., Morrill, M. S., & Parente, S. T. (2010). Measuring inappropriate medical diagnosis and treatment in survey data: The case of ADHD among school-age children. Journal Of Health Economics, 29(5), 657-673. doi:10.1016/j.jhealeco.2010.07.005
Karlstad, Ø., Furu, K., Stoltenberg, C., Håberg, S. E., & Bakken, I. J. (2017). ADHD treatment and diagnosis in relation to children’s birth month: Nationwide cohort study from Norway. Scandinavian Journal Of Public Health, 45(4), 343-349. doi:10.1177/1403494817708080
Morrow, R. L., Garland, E. J., Wright, J. M., Maclure, M., Taylor, S., & Dormuth, C. R. (2012). Influence of relative age on diagnosis and treatment of attention-deficit/hyperactivity disorder in children. CMAJ: Canadian Medical Association Journal, 184(7), 755-761. doi:10.1503/cmaj.111619