Society's View of Adhd/Add

Society’s View of ADHD
Wandalyn Holbert
Saint Leo University

Introduction A few years ago my husband and I were visiting my sister and her family for the weekend. We had a big weekend outdoors planned. My husband was somewhat reluctant to join us for the outing, due to my niece’s hyperactive behavior. At the time the girls were about 7 and 11 respectively, they were both a bottle of energy and never seemed to be able to sit still for more than 5 minutes at a time. On the first morning of our visit, the girls were up, yelling and screaming incessantly, they were also running through the house before the sun came up that first morning. My husband is an avid reader of science fiction and he was up reading one of his many books that morning. The girls were crawling all over his head, jumping over the couch where we were sleeping. Suddenly the clouds burst open and rain started to fall, a severe thunderstorm had sprung forth. My husband stated I will be right back; he went outside and sat in the car to read his book and to get away from the girls and their hyperactivity. I had always believed that the girls had some form of ADD. Yet my sister and brother-in-law were reluctant to accept this possible diagnosis. In this paper I will explore ADHD and ADD and its possible effects on children as they mature into teenagers and finally into adulthood. I will attempt to expound on my views of ADHD/ADD and throughout we will discuss society’s view of this mental disorder.
The changing face of ADHD The increasing prevalence of ADHD over the past thirty years has prompted considerable research into its etiology, and there have been several revisions of the classification of the disorder in subsequent issues of the American Psychiatric Association’s Diagnostic and Statistical Manual for Mental Disorders over that period (American Psychiatric Association, 1980, 1987, 1994). Despite an extensive body of research from various disciplines, there is little cross disciplinary dialogue in the literature that has elucidated the relationships between nutritional and metabolic anomalies, brain morphology, neurochemistry, neurophysiology and behavioral manifestations of the disorder. For decades children have been misdiagnosed with Attention Deficit Disorder (ADD)when in fact they have the more severe form of Attention Deficit, these children have Attention Deficit Hyperactivity Disorder (ADHD). The American Psychiatric Association (1994) defines ADHD as encompassing such behavioral symptoms as inattention, impulsiveness and hyperactivity that interferes with the individual’s family and peer relationship as well as their ability to perform well academically. It is generally accepted that ADHD occurs in 5 – 10% of children (American Psychiatric Association, 1994; Barkley, 1997b; Schneider & Tan, 1997). It has been generally acknowledged that some children were diagnosed with Attention Deficit without hyperactivity. The first case of ADD was reflected in the DSM-III (American Psychiatric Association, 1980). The DSM-III differentiated between Attention Deficit with hyperactivity and Attention Deficit without hyperactivity thus the diagnosis of ADD.
Children with ADD versus children with ADHD Children with ADD without hyperactivity were described as withdrawn, passive, anxious and lethargic (Whalen & Henker, 1998) and seemed to have difficulties with short-term memory, processing speed and focused attention. My nieces on the other hand were not in this ADD category, they were always hyperactive and were never withdrawn, passive nor lethargic. However, once they were diagnosed as ADHD and started their regiment of therapy and medication they were often lethargic and withdrawn. These days however, the children are normal functioning teenagers. Evidence suggests that they are still functioning ADHD patients, and will probably have this disorder throughout adulthood. ADHD children are sometimes known for cheating, stealing, and low self-esteem. My oldest niece has been known for stealing in the past. There was once a period when she was about 8 years old that every day in class she would steal either the other kids lunch money or part of their lunches. She would not spend the money, nor would she eat their food, she would just hoard the food and money in her closet at home. My sister was very upset over this as was my niece’s teacher, they could never figure out for certain who was taking the money or the food, but they had a general idea that it was her. After subsequent visits with her therapist and talks with her teacher and Principal, her behavior stopped. Part of the problem they believed stemmed from her parents subsequent divorce and her feeling the loss of her father’s attention. There is such a disparity in these children’s behavior. The oldest one suffers from low self-esteem whereas the youngest has an extremely high self-esteem. They do however, complement each other immensely, what one lacks the other one makes up for.
Does ADHD lessen during the teenage years? Many researchers suggest that ADHD abates during the teenage years of patients; they state that hyperactivity sort of calms during the teenage years (Weiss, 1990; Weiss & Hechtman, 1993). I find this to also be true of my nieces behavior, currently the girls are both straight A students, however the oldest one somewhat lacks the social skills to maintain friendships. Whereas the youngest one has a host of friends, the youngest girl often bully’s her sister and her friends, most of the kids cannot resist doing what the youngest one tells them to do.

Progress of the Disorder from Childhood to Adulthood

Research state that many ADHD children have difficulties with their academic performance at school. More than 20% to 30% of children do not achieve the results that would be expected of children of their age and general intelligence (Frick & Lahey, 1991). As many as 40% to 60% of children diagnosed with ADHD have repeated a grade at school by adolescence (Brown & Borden, 1986). Many are performing below grade level or have borderline academic performance. Children with ADHD typically have impaired concentration and attention. This results in poor self-organization, poor self-regulation, and difficulty with time management, which in turn lead to the poor academic performance that is frequently observed (Searight, Nahlik, & Campbell, 1995).
Children with Attention Deficit without hyperactivity It was generally acknowledged that it was possible for children to have attention deficit difficulties without hyperactivity symptoms. This condition was first reflected in the third edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-III) (American Psychiatric Association, 1980), where the disorder was labeled “Attention Deficit Disorder” (ADD). The DSM-III diagnostic criteria differentiated between two classifications: ADD with hyperactivity and ADD without hyperactivity. Children diagnosed as having ADD without hyperactivity were described as withdrawn, passive, anxious and lethargic (Whalen & Henker, 1998) and seemed to have difficulties with short-term memory, processing speed and focused attention. On the other hand, children with hyperactivity seemed to have difficulties with sustained attention and behavioral disinhibition (Barkley, 1990). It was not until 1987 that the disorder was relabeled “Attention Deficit/Hyperactivity Disorder” in the DSM-IIIR, the revised third edition of the DSM-III (American Psychiatric Association, 1987). This diagnostic system is still currently used in the DSM-IV, the fourth edition of the DSM, which combines attention deficits with hyperactivity into a single classification that includes the combined symptoms of inattention, impulsivity and hyperactivity (American Psychiatric Association, 1994).
Will ADD/ADHD Children behavior continue into Adulthood? (Butcher 2013) tells us that many children with ADHD retain symptoms well into early adulthood. Several colleagues Kessler and Adler (2006) have reported a prevalence of 4.4 percent of ADHD behavior in adult patients. Some researchers even state that adolescent boys go on to have psychological problems such as overly aggressive behavior or substance abuse in their late teens and early adulthood (Barkley et al., 2004). Several colleagues did an 11 year study of girls with ADHD and found that girls with ADHD were at high risk for antisocial, addictive, mood, and anxiety disorders as adults. This study also found that college students with ADHD have exhibited more on the job difficulties than their peers that do not have ADHD (Shifrin et al., 2010).
Progress of ADHD from childhood to Adulthood Many children with ADHD have difficulties with their academic performance at school. As many as 23% to 30% of ADHD children do not achieve the results that would be expected of children of their age and general intelligence (Frick & Lahey, 1991). Between 40% and 60% of children diagnosed with ADHD have repeated a grade at school during adolescence (Brown & Borden, 1986).
ADD/ADHD Alternatives Over the past decade, researcher Kuhn have applied unique paradigms to fields outside of science including business (Barker, 1993), religion (Berthrong, 1994), psychology (Fuller, Walsh, & McGinley, 1997), and education (Foster, 1986). Kuhn has surmised that children diagnosed with ADHD Kuhn’s approach to the study of children, in particular, to those children who have special difficulty paying attention, concentrating, or sitting still. Over the past 20 years, a paradigm has emerged in the United States and Canada to try to explain how and why these kinds of behavior occur in certain children. The paradigm suggests that such children have something called attention- deficit-hyperactivity disorder (ADHD) or attention-deficit disorder (ADD), disorders that are said to be biological in origin, affecting from 3 to 5 percent of all children in North America. In this book, I challenge this paradigm (hereafter referred to as the ADD/ADHD paradigm) and suggest that it represents a limited and artificial way of viewing children who have difficulties with attention and behavior. Professor Kuhn proposed that the ADD/ADHD paradigm does not adequately explain various anomalies found in the educational literature concerning children with attention and behavior difficulties. In this book, Kuhn explores other perspectives that shed light on the behavior of these children. These perspectives include historical, sociocultural, cognitive, educational, developmental, and psycho affective domains. I do not advocate any one of these particular perspectives, but seek instead to work toward a new paradigm that incorporates aspects of each of these points of view (including the biological) within a holistic framework that addresses the needs of the whole child.
Research
Many professionals to include parents believe that ADHD and ADD have been over-diagnosed. They do agree however on the basic symptoms of the disorders such as:
• ADD/ADHD is a biological disorder (most probably of genetic origin).

• The primary symptoms of this disorder are hyperactivity, impulsivity, and distractibility. A person can have certain of these symptoms and not others (for example, ADD doesn’t include hyperactivity as a symptom, whereas ADHD does).

• This disorder affects 3–5 percent of all children and adults in the United States (and presumably the world).
• ADD/ADHD can be assessed in many ways, or in a combination of ways: a medical history; observations of the child in a variety of contexts; the use of rating scales to document these observations; performance tasks to assess such traits as vigilance; and psychological tests to assess memory, learning, and related areas of functioning.
• The most effective approaches for treating ADD/ADHD are medications and behavior modification.
• Many children will continue to have ADD/ADHD throughout their lives.
• A child can have ADD or ADHD and also have other disorders, such as learning disabilities and anxiety or mood disorders. Some researchers surmise that these assumptions along with some evidence calls into question the essential credibility of the ADD/ADHD paradigm. PET scans and MRIs of children of ADD and ADHD has shown that researchers could not find any significant global differences between “hyperactive” boys versus “normal” boys. Similarly, attempts to find differences in brain metabolism of “hyperactive” girls also yielded no significant differences (Ernst et al., 1994). As Rapoport (1995) points out, “[because] PET scans can be cumbersome and difficult to do correctly . . . it’s been very hard to replicate findings.” Even if researchers were to find significant differences between the cerebral glucose metabolic rate as measured in the PET scans of so-called “normal” and “ADHD” brains, one cannot be certain that these differences result from inherent neurological problems in the ADHD groups. Recent research suggests that the environment can have a big effect on brain metabolism. Jeffrey M. Schwartz and his colleagues at UCLA School of Medicine have been able to demonstrate systematic changes in cerebral glucose metabolic rates after successful behavior modification treatment of individuals described as having obsessive-compulsive disorder (Schwartz, Stoeseel, Baxter, Martin, & Phelps, 1996). If the environment can create positive changes in cerebral glucose metabolic rates, it may also be able to create negative changes. Kuhn tells us that factors like stress, family discord, and cultural pressures may have a large role to play in the incidence of the kinds of behavior associated with ADD/ADHD among some people. Environmental factors may well interact with brain chemistry to create what looks like an “abnormal brain” but may be instead an intact brain responding to an “abnormal environment.”
MRI Studies MRI studies were done on the corpus callosum (a collection of nerve fibers that connect right and left hemispheres) of 18 boys labeled “hyperactive” or ADHD and 18 boys labeled “normal. They found that in the group identified as “ADHD,” the rostrum and rostral body regions of the corpus callosum were smaller at the 0.05 level of significance. This study, and others like it, are used as indicators that people labeled ADHD have abnormal brains. Yet the study itself stated “no gross abnormalities were found in any subject” from the MRI measurements
(Giedd et al., 1994, p. 666). Moreover, the study found no correlations between brain differences and measures of attention in the people identified as “attention deficit disordered.” The differences found in the “ADHD” group were subtle differences in only two of the seven regions measured—regions that relate to premotor functioning. Most important, even if these neuroanatomical differences do in fact exist (e.g., if future studies are able to replicate these findings) they could well represent just that—differences—and not necessarily disorders. We should avoid pathologizing people so quickly, based on the subtle differences in the bumps on the inside of the brain—or we could fall into a modern-day neurological version of the trap that doctors of the 18th and 19th centuries fell into when they used facial features or bumps on the outside of the head to decide who had criminal tendencies or other unsavory moral characteristics (see Gould, 1981, for a historical perspective). To use a metaphor: If gardeners treated their flowers like psychiatrists do their “ADHD” patients, we might well hear things like “This lily has petal-deficit disorder!” or “My ivy has gone hyperactive!” We should consider the possibility that neurological diversity may be a potentially healthy development.
Genetic Studies There has been several studies to try and link ADD and ADHD with a missing gene. In fact researchers at the University of California-Irvine claimed to have found a link between children with ADHD and a specific gene (the dopamine D4 receptor gene) associated with “novelty seeking” behavior (LaHoste et al., 1996). There was another study that garnered much publicity (“Hyperactive
Behavior in English Schoolchildren,” by Taylor & Sandberg, 1984), researchers at NIMH claimed that some cases of ADHD were due to a thyroid disorder caused by mutations in a thyroid receptor gene (Hauser et al., 1993). A follow-up study among 132 children labeled with ADHD, however, revealed no evidence of clinically significant thyroid dysfunction (Spencer, Biederman, Wilens, & Guite, 1995). Many difficulties are inherent in attempting to build a case for a genetic basis for ADHD. First, how can one reduce the complex feelings, behaviors, and thoughts of a person to a single gene (an “ADHD” gene) or even to a series of such genes?
Summary and Conclusions ADHD is a disorder unlike any other; studies suggest that the disorder disappears when the child gets treatment. Neurologist and Psychiatrist Sydney Walker believes that doctors today do a cursory review of patients, spending no more than 15 minutes diagnosing patients and determines in 15 minutes that the patient has ADHD. Walker believes that there are several factors that can cause Attention Deficit problems. Some of the unanswered questions should be “What is causing your child to hyperactive” or “What is causing your child to have attention problems” (Walker, 2006). Walker suggests that hyperactivity in children can be caused by environmental factors such as lead poisoning; petit mal seizures, early inset diabetes, head injuries, viral or bacterial infections, or other life threatening injuries could cause children to behave badly.

References
Butcher, J.N, Mineka, S, Hooley, J.M. (2013). Attention Deficit/Hyperactivity Disorder. In Butcher, J.N, Mineka, S, Hooley, J.M, Abnormal Psychology (pp. 525 - 530). Boston: Pearson Education Inc.
Walker, S. (2006). Critiques of the ADHD Enterprise. In G. S. Lloyd, Critical New Perspectives of ADHD (pp. 24 - 26). New York: Taylor & Francie e-library.
Bilton, K., & Cooper, P. (1999). ADHD : Research, Practice and Opinion London:Whurr.
Benson, H., & Klipper, M. Z. (1990). The relaxation response. New York: Avon.
Berk, L. E., & Landau, S. (1993). Private speech of learning disabled and normally achieving children in classroom academic and laboratory contexts. Child Development, 64(2), 556–571.
Berk, L. E., & Potts, M. (1991). Development and functional significance of private speech among attention-deficit hyperactivity disordered and normal boys. Journal of Abnormal Child Psychology, 19(3), 357–377.
Berke, R. L. (1992, July 11). Sound bites grow at CBS, then vanish. The New York Times, p. L7.
Berlin, E. (1989, October). Michael’s orchestra. Ladies Home Journal, p. 108.
Berthrong, J. H. (1994). All under Heaven: Transforming paradigms in Confucian-Christian dialogue. New York: SUNY Press.
Biederman, J., Newcorn, J., & Sprich, S. (1991). Comorbidity of attention deficit hyperactivity disorder with conduct, depressive, anxiety, and other disorders. American Journal of Psychiatry, 148(5), 564–577.
Biederman, J., Milberger, S., Faraone, S. V., Kiely, K., Guite, J., Mick, E., Ablon, S., Warburton, R., & Reed, E. (1995). Family-environment risk factors for attention deficit hyperactivity disorder. Archives of General Psychiatry, 52, 464–469.
Blakeslee, S. (1997, September 2). Some biologists ask “Are genes everything?” The New York Times, pp. B1, B13.
Block, G. (1977). Hyperactivity: A cultural perspective. Journal of Learning Disabilities, 10(4), 48–52.
Bonny, H., & Savary, L. M. (1990). Music and your mind. Barrytown, NY: Station Hill Press.
Braswell, L., Bloomquist, M., & Pederson, S. (1991). ADHD: A guide to understanding and helping children with attention deficit hyperactivity disorder in school settings.
Minneapolis: University of Minnesota.
Breggin, P. (1998). Talking back to Ritalin: What doctors aren’t telling you about stimulants for children. Monroe, ME: Common Courage Press.
Brooks, R. B. (1992, Fall/Winter). Fostering self-esteem in children with ADD: The search for islands of competence. CHADDER, 12–15.
Brooks, R. B. (1994). Children at risk: Fostering resilience and hope. American Journal of Orthopsychiatry, 64(4), 545–553.
Budd, L. (1993). Living with the active alert child: Groundbreaking strategies for parents. Seattle, WA: Parenting Press.
Callan, R. J. (1997, December–1998, January). Giving students the (right) time of day. Educational Leadership, 55, 84–87.
Cameron, J. (1978). Parental treatment, children’s temperament, and the risk of childhood behavioral problems. American Journal of Orthopsychiatry, 48(1), 140–141. Campbell, L., Campbell, B., & Dickinson, D. (1996). Teaching and learning through multiple intelligences. Needham Heights, MA: Allyn & Bacon.
Carlson, E. A., Jacobvitz, D., & Sroufe, L. A. (1995). A developmental investigation of inattentiveness and hyperactivity. Child Development, 66(1), 37–54.
Cartwright, S. A. (1851, May). Report on the diseases and physical peculiarities of the Negro race. The New-Orleans Medical and Surgical Journal, 7, 691–716.
(2006, 05). How Society Views Children with Adhd. StudyMode.com. Retrieved 05, 2006, from http://www.studymode.com/essays/Society-Views-Childrenadhd-87315.html

References: Butcher, J.N, Mineka, S, Hooley, J.M. (2013). Attention Deficit/Hyperactivity Disorder. In Butcher, J.N, Mineka, S, Hooley, J.M, Abnormal Psychology (pp. 525 - 530). Boston: Pearson Education Inc. Walker, S. (2006). Critiques of the ADHD Enterprise. In G. S. Lloyd, Critical New Perspectives of ADHD (pp. 24 - 26). New York: Taylor & Francie e-library. Bilton, K., & Cooper, P. (1999). ADHD : Research, Practice and Opinion London:Whurr. Benson, H., & Klipper, M Berk, L. E., & Landau, S. (1993). Private speech of learning disabled and normally achieving children in classroom academic and laboratory contexts. Child Development, 64(2), 556–571. Berk, L. E., & Potts, M. (1991). Development and functional significance of private speech among attention-deficit hyperactivity disordered and normal boys. Journal of Abnormal Child Psychology, 19(3), 357–377. Berke, R. L. (1992, July 11). Sound bites grow at CBS, then vanish. The New York Times, p. L7. Berlin, E. (1989, October). Michael’s orchestra. Ladies Home Journal, p. 108. Berthrong, J. H. (1994). All under Heaven: Transforming paradigms in Confucian-Christian dialogue. New York: SUNY Press. Biederman, J., Newcorn, J., & Sprich, S. (1991). Comorbidity of attention deficit hyperactivity disorder with conduct, depressive, anxiety, and other disorders Biederman, J., Milberger, S., Faraone, S. V., Kiely, K., Guite, J., Mick, E., Ablon, S., Warburton, R., & Reed, E. (1995). Family-environment risk factors for attention deficit hyperactivity disorder. Archives of General Psychiatry, 52, 464–469. Blakeslee, S. (1997, September 2). Some biologists ask “Are genes everything?” The New York Times, pp. B1, B13. Block, G. (1977). Hyperactivity: A cultural perspective. Journal of Learning Disabilities, 10(4), 48–52. Bonny, H., & Savary, L. M. (1990). Music and your mind. Barrytown, NY: Station Hill Press. Braswell, L., Bloomquist, M., & Pederson, S. (1991). ADHD: A guide to understanding and helping children with attention deficit hyperactivity disorder in school settings. Breggin, P. (1998). Talking back to Ritalin: What doctors aren’t telling you about stimulants for children. Monroe, ME: Common Courage Press. Brooks, R. B. (1992, Fall/Winter). Fostering self-esteem in children with ADD: The search for islands of competence. CHADDER, 12–15. Brooks, R. B. (1994). Children at risk: Fostering resilience and hope. American Journal of Orthopsychiatry, 64(4), 545–553. Budd, L. (1993). Living with the active alert child: Groundbreaking strategies for parents. Seattle, WA: Parenting Press. Callan, R. J. (1997, December–1998, January). Giving students the (right) time of day. Educational Leadership, 55, 84–87. Cameron, J. (1978). Parental treatment, children’s temperament, and the risk of childhood behavioral problems. American Journal of Orthopsychiatry, 48(1), 140–141. Campbell, L., Campbell, B., & Dickinson, D. (1996). Teaching and learning through multiple intelligences Carlson, E. A., Jacobvitz, D., & Sroufe, L. A. (1995). A developmental investigation of inattentiveness and hyperactivity. Child Development, 66(1), 37–54. Cartwright, S. A. (1851, May). Report on the diseases and physical peculiarities of the Negro race. The New-Orleans Medical and Surgical Journal, 7, 691–716. (2006, 05). How Society Views Children with Adhd. StudyMode.com. Retrieved 05, 2006, from http://www.studymode.com/essays/Society-Views-Childrenadhd-87315.html