Attention-deficit/hyperactivity disorder (AD/HD or ADHD) is a disorder that affects neurobehavioral functioning and development (Banerjee et al.,2007; Zwi et al., 2000). In children, ADHD is the most prevalent diagnosed cognitive and behavior disorder among school children (Banerjee et al.,2007). ADHD consists of recur- ring problems with impulse control and inattention and can involve symptoms of hyperactivity (Biederman and Faraone, 2005; American Psychiatric Association, 2000).
Various epidemiological neuropsychological, neuroimaging, genetic, and treat- ment investigations reveal that ADHD is a legitimate medical condition (Banerjee et al.,2007). The disorder has been recognized as part of society for a long time.
Crichton (1798,2001) discussed the phenomenon of mental restless. In 1937, using stimulants to treat the condition was first discussed (Patrick et al.,2009).
Over time, the term for the disorder has changed. The condition has been described as learning/behavioral disabilities, hyperactivity, minimal brain damage, minimal brain dysfunction, or hyperkinetic reaction of childhood. The diagnosis, attention-deficit disorder (ADD) with or without hyperactivity, was introduced in the DSM-III. In the DSM-IV, the diagnosis was changed to ADHD.
Experts disagree about whether the symptoms and impairments of ADHD are expressed differently in various cultures (Caldararo, 2002, 2003). However, the condition is viewed in divergent ways depending on different factors. ADHD is viewed in certain ways depending on how experts relate to the topic. Specialists may use terms from the DSM-IV to describe the disorder. Some experts view the condition in regard to biological factors or character flaws (Danforth and Yogawin, 2001).
Some critics, including Fred Baughman and Peter Braggin, see ADHD as a fraud perpetrated by the psychiatric profession and pharmaceutical industry. They view the condition as a fraud perpetrated on families who try to make sense of their children’s perplexing behaviors. Russell Barkley and Xavier Catellanos assert that the condition is a true psychiatric disorder. Castellanos, however, has pointed out that the phenomenon is poorly understood (Castellanos,2000).
One of the problems associated with the disorder is that the recognition of ADHD as a problem has led to the development of ineffective school policies that may result in over diagnosing of the condition among some school children (Kidd,2000).
99 M.L. Goldstein, S. Morewitz, Chronic Disorders in Children and Adolescents,
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Regardless of treatment, children diagnosed with ADHD often have comor- bid conditions and suffer substantial social, educational, and family problems and reduced health-related quality of life (HRQL) (Molina et al.,2009; Loe and Feldman,2007; Breslau et al.,2009; Peters and Jackson,2009; Klassen et al.,2004).
Based on a cross-sectional survey of 165 children who were referred to an ADHD Clinic in British Columbia, Canada, Klassen et al. (2004) showed that children with ADHD had more parent-reported problems in behavioral and emotional functioning, emotional well-being, and self-esteem.
In Klassen et al. (2004)’s investigation, 131 children were diagnosed with ADHD. Of these, 68.7% had a comorbid psychiatric disorder. Twenty of these ADHD children had two comorbid conditions, five had three comorbid conditions, and one had four comorbid problems. Fifty-one ADHD children were diagnosed with a comorbid learning disorder (LD), 45 had either oppositional defiant disorder (ODD) or conduct disorder (CD), and 27 suffered from another type of comorbid problem. ADHD children with comorbid disorders tend to have lower psychosocial- related HRQL than those without comorbid conditions. ADHD children with two or more comorbid conditions had worse psychosocial health across a variety of psychosocial HRQL areas than ADHD children with none or one comorbid disorder.
Based on a sample of 105 Korean children, Byun et al. (2006) showed that 80 children had at least one comorbid problem such as ODD, anxiety disorders, and affective disorders.
ADHD children have an increased likelihood of having low grades, low stan- dardized reading and mathematics scores, and increased grade retention (Loe and Feldman, 2007; Galera et al., 2009). Based on a sample of 1,264 individuals, aged 12–25 years of age, from the longitudinal GAZEL Youth study, Galera et al.
(2009) revealed that childhood and adolescent hyperactivity-inattention symptoms increased the likelihood of grade retention, failure to graduate from secondary school, earning a lower level diploma, and worse academic achievement.
ADHD children are likely to have greater use of school services, higher rates of detention and expulsion, and low rates of graduation from high school and postsec- ondary schools (Loe and Feldman,2007). The high rates of expulsion and school dropout explain why almost 50% of all students with ADHD never complete high school. Another report found that less than 5% of persons in the USA with the disorder graduate from college (Cimera2002).
Both the problematic behaviors of the ADHD children and the educational practices of their teachers may affect the affected students’ academic performance.
Using an ethnically diverse cohort of 693 children assessed at age 6 and 17, Breslau et al. (2009) discovered that teacher evaluations of student attention problems predicted subsequent achievement in mathematics and reading.
Child and family characteristics may influence the academic achievement and level of behavioral adjustment of children with the disorder. In a longitudinal investigation of 115 ADHD children and a 59 controls from elementary through secondary school, Latimer et al. (2003) discovered that positive emotional and behavioral status during middle school mediated their negative academic and behavioral functioning during high school. The researchers also demonstrated that
5 Attention-Deficit Hyperactivity Disorder 101 family conditions during middle school influenced the behavior of both ADHD and non-ADHD children in high school. Moreover, the students’ previous academic achievement predicted their subsequent performance levels.
Unfortunately, children with the disorder often have families that are charac- terized by varying degrees of impaired family and marital functioning, difficult parent–child interactions, and parents’ beliefs about lower parenting self-efficacy (Johnston and Mash,2001). Moreover, the presence of ADHD in children is related to increased parental stress and parental mental health problems (Peters and Jackson, 2009).
Based on in-depth interviews of 11 mothers of ADHD children, Peters and Jackson (2009) showed that these mothers experience substantial stress and role demands from parenting a child with this disorder. The mothers suffered from so much stress from these responsibilities that they felt marginalized, stigmatized, and criticized.
Parental coping styles may affect parent–child interactions, including how par- ents discipline their ADHD children (Modesto-Lowe et al., 2008; McKee et al., 2004; Harvey et al., 2003). In a literature review, Modesto-Lowe et al. (2008) demonstrated that ADHD symptoms in children produce high parental stress and dysfunctional parenting. Parents of children with the condition often have mental health problems that affect how they respond to their child’s symptoms. McKee et al.
(2004) discovered that mothers of ADHD children who relied on more dysfunctional coping styles were more likely to be associated with more self-reported weak and over-reactive discipline, more observed coercive parenting, and more observed child misbehavior before parent training. Fathers of ADHD children who used more dys- functional coping patterns were more likely to report using weak discipline before and after parent training.
Impaired parental coping styles and other family difficulties are especially promi- nent when the ADHD child has comorbid CD and ODD (Pfiffner et al.,2005; Kilic and Sener,2005; Satake et al.,2004; Klassen et al.,2004). ADHD is highly comor- bid with CD and ODD, and these comorbidities can negatively alter the response, course, and outcome of treatment (Chronis et al.,2004; Pfiffner et al.,2005).
Investigators have analyzed the nature of family characteristics and functioning in families with ADHD children who have comorbid CD and ODD. In a study of 92 Turkish children, aged 6–11, diagnosed with ADHD and ADHD with comorbid ODD/CD, Kilic and Sener (2005) reported that maternal depression and paternal alcoholic drinking difficulties were prevalent among parents of ADHD children with comorbid ODD and CD. Unhealthy functioning was evident in the families of ADHD children with comorbid ODD and CD. Children with ADHD and comor- bid ODD and CD scored high on the Child Behavior List subscales except for the subscales dealing with social withdrawal and sexual difficulties.
Using a sample of 149 families, Pfiffner et al. (2005) showed that negative and ineffective discipline by mothers was linked to ADHD children with comorbid ODD and CD. Lack of maternal warmth and involvement, negative and ineffective disci- pline by fathers, and fathers with an antisocial personality disorder were related to comorbid CD, but not ODD in ADHD children.
ADHD is a life-long chronic problem (Van Cleave and Leslie, 2008; Van Ameringen et al.,2010). Between 30 and 50% of the children diagnosed with the condition continue to have related problems as adults (Balint et al.,2008; Elia et al., 1999). In the USA, an estimated eight million adults have ADHD.
Based on a sample of 129 patients who were referred to an anxiety disorders clinic, Van Ameringen et al. (2010) found that the rate of adult ADHD was 27.9%.
Most of the sample was female and single. In their study, major depressive disorder, social phobia, generalized anxiety disorder, and impulse control disorders were the most prevalent comorbid conditions among the adult ADHD patients.
Adults with ADHD who are not treated frequently have lifestyles that are chaotic and seem disorganized. As they age, these individuals develop ways of coping with their disabilities (Gentile,2004). Some of these individuals may cope by using non- prescription drugs and alcohol.
Researchers have assessed the possible link between ADHD in childhood and adolescence and suicidal behaviors (Sourander et al.,2009; Galera et al., 2008).
Based on the results of the Finnish 1981 Birth Cohort Study, using a sample of 5,302 individuals who were born in 1981, Sourander et al. (2008) discovered that among males, living in a broken family, psychological, hyperkinetic, conduct, and emotional problems at age 8 years predicted completed or serious suicide attempts.
Among females, no associations were found between study variables at 8 years of age and suicide behaviors.
Similar findings were obtained using a sample of 916 persons, aged 7–18 years, from the longitudinal GAZEL Youth study (Galera et al.,2008). This investiga- tion revealed that among males, hyperactivity-inattention symptoms were associated with an increased risk of both lifetime suicide plans and attempts and 12-month prevalence rates of suicide plans and attempts among adolescents. In contrast, hyperactivity-inattention symptoms did not increase the risk of lifetime suicide plans and attempts among females or adolescent 12-month prevalence rates of suicide plans and attempts.
In terms of functioning in different work environments, adults with ADHD are more likely to function better in less structured work settings that have fewer workplace regulations. They do better in jobs that have substantial autonomy such as self-employment. Persons who have symptoms of hyperactivity have a greater chance of changing jobs frequently because of their recurring need for stimulation and new interests.