Attention Deficit Disorder

.. clude the symptoms and causes of ADD, and the criteria for it’s diagnosis. The criteria for the diagnosis of Attention Deficit Disorder can be found in the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition), nicknamed DSM-IV. The DSM-IV was developed in coordination with the tenth edition of the World Health Organization’s International Classification of Diseases, and groups some 230 psychological disorders and conditions into 17 categories of mental disorders. It is ..the current authoritative scheme for classifying psychological disorders..

(Myers 458a) In fact, most North American health insurance companies require a DSM-IV diagnosis before they will pay for therapy. The DSM-IV lists diagnoses for practically every conceivable complaint. Some critics find fault with the manual claiming it brings ..almost any kind of behavior within the compass of psychiatry. (Eysenck & Freedman & Wakefield 184) However, for the DSM-IV categories to be valid, they must first be reliable. The guidelines for the DSM-IV work by asking clinicians a series of objective questions about observable behavior. In one study, 16 psychologists used the structured-interview procedure to diagnose 75 psychiatric patients as suffering from (1) depression, (2) generalized anxiety, or (3) some other disorder. Without knowing the first psychologist’s diagnosis, another psychologist viewed a videotape of each interview and offered a second opinion.

For 83 percent of the patients, the two opinions agreed. (Myers 458b) As evident, the DSM-IV is a reliable source, and the fact that Attention Deficit Disorder is recognized by the American Psychiatric Association in the DSM-IV aids in establishing it’s validity as a disorder. Another factor which aids in establishing ADD as a valid disorder is the fact that it is treatable through prescription medication and behavior therapy. There are two modalities of treatment that specifically target symptoms of ADD. One uses medication and the other is a non-medical treatment with psychosocial interventions. The combination of these treatments is called multimodality treatment. Psychostimulants are the most widely used medications for the management of ADD symptoms.

At least 70% to 80% of children and adults with ADD respond positively to psychostimulant medications, which have been used to treat the cognitive and behavioral symptoms of ADD for more than 50 years. (Laws [on-line]) Stimulant drugs, such as Ritalin, Dexedrine, and Aderall when used with medical supervision, are usually considered quite safe. Although they can be addictive to teenagers and adults if misused, these medication are not addictive in children. They seldom make children high or jittery. Nor do they sedate the child. Rather, the stimulants help children control their hyperactivity, inattention, and other behaviors. Different doctors use the medications in slightly different ways. Ritalin and Dexedrine come in short-term tablets that last about 3 hours, as well as longer-term preparations that last through the school day. The short-term dose is often more practical for children who need medication only during the school day or for special situations, like attending church or a prom, or studying for an important exam.

As useful as these drugs are, Ritalin and the other stimulants have sparked a great deal of controversy. Most doctors feel the potential side effects should be carefully weighed against the benefits before prescribing the drugs. While on these medications, some children may lose weight, have less appetite, and temporarily grow more slowly. Others may have problems falling asleep. Other doctors say if they carefully watch the child’s height, weight, and overall development, the benefits of medication far outweigh the potential side effects. Side effects that do occur can often be handled by reducing the dosage.

However, doctors recommend that patients be taken off a medication now and then to see if it is still necessary. They recommend temporarily stopping the drug during school breaks and vacations, when focused attention and calm behavior are usually not as crucial; this precaution is referred to as a drug holiday. Drug therapy is a highly effective means of treating disorders, including ADD. They are ..by far the most widely used biomedical treatments. (Myers 507b) When introduced in the 1950’s, drug therapy greatly reduced the need for psychosurgery or hospitalization.

Thanks to drug therapy..the resident population of state and county mental hospitals in the United States today is but 20 percent of what it was 40 years ago. (Myers 508a) For those not comfortable with drug therapy there are other means of treating ADD, such as behavior therapy. This is especially effective for children. For example, children with ADD need structure and routine. They should be helped to make schedules and break assignments down into small tasks to be performed one at a time.

It may be necessary to ask them repeatedly what they have just done, how they might have acted differently, and why others react as they do. Especially when young, these children often respond well to strict application of clear and consistent rules. In school, they may be helped by close monitoring, quiet study areas, short study periods broken by activity (including permission to leave the classroom occasionally), and brief directions often repeated. They can be taught how to use flashcards, outlines, and underlining. Timed tests should be avoided as much as possible.

Other children in the classroom may show more tolerance if the problem is explained to them in terms they can understand. When combined, drug and behavior therapies can be highly effective when treating Attention Deficit Disorder. Like many disorders, ADD is disruptive and if left untreated inhibits the proper functioning in society and of one’s daily activities. Family conflict is one of the most troublesome consequences of ADD. Especially when the symptoms have not yet been recognized and the diagnosis made, parents blame themselves, one another, and the child.

As they become angrier and impose more punishment, the child becomes more defiant and alienated, and the parents still less willing to accept his excuses or believe his promises. The home of an ADD child is frequently stressful and filled with conflict. The problems in the home vary based on the severity of symptoms, the make-up of the family and the personalities of family members. Take Johnny, for instance. A routine chore like getting dressed can become a battle as the parent first gently prompts Johnny to get dressed and stop playing with his toys, then nags and often, out of frustration, begins to yell.

This scenario occurs almost every morning despite any repeated attempts by the parent to improve things. A family dinner with an ADD child, rather than being a pleasant family gathering, becomes a dreaded hour. The child is bouncing around and knocks his plate on the floor. He constantly interrupts conversations and may erupt in a temper tantrum over a remark by a sibling. Daily life with an undiagnosed ADD child can cause a parent to question their parenting skills and ability to nurture a child. It can also stress the relationship between husband and wife especially if there is a disagreement about discipline methods or perception of the child’s behavior.

Siblings’ rivalry is magnified. If a child is extremely disruptive, the family may become isolated and certain members may withdraw from the family unit. School may also become of a place of chaos for an undiagnosed ADD child. ADD children often appear to be lazy or under-achievers. Their work is often incomplete, sloppy or lost.

The paper may be done but directions were not followed. The child is often unprepared for class — he cannot find his pencil or worksheet or textbook. He may stare at the paper because they do not know how to start the assignment, and his performance is inconsistent. Yet the ADD child is not dumb — in fact many have above average intelligence. Unbeknownst to most, Albert Einstein, Walt Disney, Winston Churchill, Henry Ford, and John F. Kennedy were all diagnosed with ADD.

Children are not the only ones who may suffer if left undiagnosed; adults also struggle with this problem. Most adults with ADD were not diagnosed until they were adults. Throughout their lives, they have suffered a great deal of pain. Many have had to develop coping mechanisms to help them survive. Over time, the constant pressure brought on by their new ways to cope with problems can bring about stress. As a result, some adults become overwhelmed, depressed, anxious, and lose confidence.

As is evident, Attention Deficit Disorder clearly meets all the criteria for the definition of a disorder including the fact that it is recognized by the Diagnostic and Statistical Manual (Fourth Edition), it is treatable through prescription medication and behavioral therapy and if left untreated inhibits one from functioning in society properly. At this time there is no cure for ADD, but much more is now known about effectively coping with and managing this persistent and troubling developmental disorder. Hopefully, the day is not far off when genetic testing for ADD may become available and more specialized medications may be designed to counter the specific genetic deficits of those who suffer from it. Psychology.

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