Week 3: ADHD is a highly publicized and controversial topic. Pick two of the que

Question

Week 3:

ADHD is a highly publicized and controversial topic. Pick two of the questions below to discuss in depth, remembering to back up your opinions with scholarly research.

1. How do you differentiate between a normally active child and a child who has ADHD?

2. Who are the useful informants for a doctor diagnosing a child who may have ADHD?

3. What treatment has been useful in treating children with ADHD? 4. What are the long-term effects on the brain of children who have used medication for ADHD? What are the possible long-term benefits and negative impact of those medications?

Explanation / Answer

ADHD is a highly publicized and controversial topic. Pick two of the questions below to discuss in depth, remembering to back up your opinions with scholarly research.

1. How do you differentiate between a normally active child and a child who has ADHD?

Answer – Sometimes due to negligent clinical judgement the energetic kids get labelled as with ADHD and that leads to various problems including – unnecessary provision for medicine and disciplinary actions at school and home that were not required. In a recent New York Times article Keith Connoer, considered as father of ADHD, shared his apprehension about the over-diagnosis of ADHD and inappropriate treatment with excessive medications.

Keith has advised following to differentiate between normally active from ADHD child –

The clinical assessment should be based upon comprehensive information collected from interviews with kid, parent, and teacher and only when the symptoms are severe and persistent for longer duration as clinical judgement of presence of ADHD should be considered.

Keith has also mentioned the part of problem in the loose definitions of ADHD provided in DSM therefore we should be carefull in applying the definiton and criteria provided in DSM but also at the same we need to work with scientific information provided in Diagnostic and Statistical Manual.

DSM –IV criteria for Attention-deficit/hyperactivity disorder (ADHD) is as follows

ADHD is characterized by a persistent age-inappropriate pattern of inattention, hyperactivity-impulsivity, or both.

Subtypes: Predominantly inattentive type, predominantly hyperactive impulsive type, combined type

Inattention means that the child will not be able to sustain his/her attention on performance of tasks for reasonable time as compared to a normal child. Hyperactivity and impulsive behaviour basically mean that child would not be able to control (inhibit) his behaviour in multiple situations. Not all children may have all the deficits present or may have different combination of levels of inattentions, hyperactivity, and impulsivity.

To effectively differentiate a normally active child from one suffering from ADHD we should carefully collect information about the three criteria mentioned above from multiple sources like parents, observation and clinical interview with child, teacher at school. The label of ADHD is only warranted when the symptoms of inattention, hyperactivity and impulsive behaviours are present for past 6 months, and signs are present across different situations (not just limited to one or two specific situations) and most importantly when these symptoms are associated with functional deficits like academic performance is below expectation, difficulty maintaining peer relationships etc.

While diagnosing ADHD a doctor should be not only thourough in understanding the criteria of ADHD but also perform the informaiton colleciton task very thoroughly from all available sources which may include -

a. self report of the child

b. behavioral obervations of child across few situations

c. interview with parents

d. informaiton/interview with teachers

e. informaiton collected from peers and friends

Only when most of information converge towards the diagnostic criteria then a Label of ADHD should be used.

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