Running head: Attention-Deficit Hyperactivity Disorder 1

Attention-Deficit Hyperactivity Disorder in School-Age Children

Childhood Illness/Condition Report

Czarina Muyargas

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Attention-Deficit Hyperactivity Disorder in School-Age Children

Attention-deficit hyperactivity disorder, also referred to ADHD, is one of the most

common childhood disorders that can continue through adolescence and even adulthood. It was

originally known as hyperkinetic impulse disorder, until the American Psychiatric Association

(APA) changed the name of the disorder to attention-deficit disorder (ADD). Two subtypes of

ADD were also created: ADD with hyperactivity and ADD within hyperactivity. In 1994, it was

officially renamed attention-deficit hyperactivity disorder and divided into three subtypes:

predominantly inattentive presentation, predominantly hyperactive-impulsive presentation, and

combined presentation. These subtypes are used today by healthcare professionals when

diagnosing and treating ADHD.

According to the Centers for Disease Control and Prevention (CDC) (2016), ADHD is a

complex mental health disorder that is most commonly diagnosed during childhood. It is a

chronic behavioral disorder that results in an ongoing pattern of inattention and/or hyperactivity-

impulsivity that interferes with functioning or development (National Institute of Mental Health

(NIH), 2016). ADHD has a very strong neurobiological basis and is closely associated with a

specific set of brain functions and its related behaviors. The disorder may affect certain areas of

the brain that are responsible for regulating important functions such as attention, concentration,

memory, motivation and effort, impulsivity, and hyperactivity (ADDA, 2016).

The exact causes and risk factors for ADHD are still unknown, but current scientific

research suggests that genetics play a huge role. Studies have shown that many children

diagnosed with ADHD have a close relative who also has the disorder. In many cases, the

disorder is genetically transmitted and results from a chemical imbalance or deficiency in certain

neurotransmitters (CDC, 2016). Recent studies have also shown that the brain chemical
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dopamine may also be a contributing factor. Dopamine is responsible for carrying signals

between nerves in the brain and is associated with movement, sleep, mood, attention, and

learning (CDC, 2016). In addition to genetics, scientists are studying other possible causes and

risk factors of ADHD including, brain injury at birth, exposure to environmental toxins during

pregnancy or childhood, maternal drug use, alcohol and tobacco consumption during pregnancy,

premature delivery, and low birth weight (NIH, 2016). According to the National Institute of

Mental Health (2016), ADHD is more common in males than females, and females with ADHD

are more likely to have problems primarily with inattention.

As mentioned above, ADHD is broken down into three subtypes, each with its own

pattern of behaviors: inattentive type, hyperactive-impulsive type, and combined type. The signs

of attention-deficit hyperactivity disorder vary depending on which characteristics are

predominant. Some children with ADHD only have difficulties with one of the behaviors, while

others show a persistent pattern of both inattention and hyperactivity-impulsivity that interferes

with functioning or development. Symptoms of the inattentive type include having trouble

paying attention to details, making caseless mistakes, difficulty staying focused on tasks, trouble

listening, being unable to follow instructions, avoiding tasks that involve effort, being easily

distracted or forgetful, and having the tendency to lose things (CDC, 2016). The CDC (2016)

states that six or more symptoms of inattention must be present in children up to 16 years old,

and five or more symptoms for adolescents 17 years and older.

Symptoms of the hyperactive-impulsive type include fidgeting or squirming, difficulty

remaining seated, excessive running or climbing in inappropriate situations, having trouble

playing quietly, excessive talking, blurting answers before a question has been completed,

difficulty waiting for his or her turn, and often interrupts others. Similar to the inattentive type,
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children up to 16 years old must have six or more symptoms of hyperactivity-impulsivity, and

five or more symptoms for adolescents 17 years and older (CDC, 2016). The combined type is

the most common type of ADHD. Children with this type have a combination of inattentive

symptoms and hyperactive-impulsive symptoms (CDC, 2016).

The signs and symptoms of ADHD can appear as early as the age of three until the age of

six. They can continue through adolescence and even adulthood. Symptoms can sometimes be

mistaken for emotional or disciplinary problems, leading to a delay in diagnosis. In young

children with ADHD, hyperactivity-impulsivity is the most predominant symptom. As they

reach elementary school, the symptom of inattention may become more prominent and cause the

child to struggle academically (NIH, 2016). In adolescence, hyperactivity typically decreases

and may be considered more often as feelings of restlessness, but inattention and impulsivity

may continue to persist (CDC, 2016).

Unfortunately, there Is no single test that can determine if a child has ADHD. A

diagnosis is made on the basis of observable behavioral symptoms in multiple settings. It

requires a comprehensive evaluation by a healthcare professional, such as a pediatrician,

psychologist, or psychiatrist. For a child to receive an accurate diagnosis of ADHD, the

symptoms of inattention and/or hyperactivity-impulsivity must be long-lasting, impair the childs

functioning, and cause the child to not develop normally for his or her age (NIH, 2016). The

diagnosis involves collecting information from a variety of sources, including teachers at school,

caregivers, and parents (NIH, 2016). Health professionals will also ensure that any ADHD

symptoms are not due to another medical or mental condition by screening a childs medical

history. In addition, guidelines from the American Psychiatric Associations Diagnostic and

Statistical Manual (DSM) are also used to help diagnose ADHD (CDC, 2016). This diagnostic
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standard helps guarantee that children are properly diagnosed and treated for the disorder. Using

the same standard throughout all communities can also aid in determining how many children

have ADHD.

According to the CDC (2016), recent surveys have indicated that approximately 11% of

children ages 4-17 have been diagnosed with ADHD as of 2011. This makes up for about 6.4

million children in the United States. Prevalence of ADHD varied substantially by state, from a

low of 5.6% in Nevada to a high of 18.7% in Kentucky (CDC, 2016). Additionally, the CDC

(2016) reports that recent data has shown 8.8% of children ages 4-17 currently suffer from

ADHD. The incidence of ADHD also varied by state, with Midwestern states having the overall

highest rates. Cases and diagnoses of ADHD have been increasing dramatically in the past few

years. The number of children with an ADHD diagnosis increased from 7.8% in 2003 to 9.5% in

2007 and again 11% in 2011 (CDC, 2016). This resulted in an average increase of

approximately 5% per year from 2003 to 2011. Noticeable trends include significant increases in

the percentage of school-aged children who received an ADHD diagnosis by a health

professional and in the percentage of children 4-17 years old taking medication treatment for

ADHD (CDC, 2016).

While there is no cure for ADHD, available treatments can aid in successfully managing

the disorder and reducing symptoms. Standard treatments include medications, behavior therapy,

education, and training (NIH, 2016). The CDC (2016) argues that for children 6 years of age and

older, the best treatment is a combination of medication and behavior therapy. For children

under 6 years of age with ADHD, behavior therapy is recommended as the primary treatment,

before medication is tried. Overall, recommendations for treatment of children with ADHD vary

depending on the childs age.

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Research has shown that behavior therapy is an essential part of treatment for children

with ADHD. Behavior therapy is a type of psychotherapy treatment that aims to reduce the

disruptive behaviors that children with the disorder often display. The therapist works with the

child to learn new behaviors to replace his or her current behaviors that are triggering problems.

They may also help the child learn how to express their feelings without creating difficulties for

themselves or others. Parent training in behavior therapy has also proven to be highly effective

(CDC, 2016). Parents will learn new skills or strengthen their current skills to educate their child

and manage their behavior. Parent training in behavior therapy has been shown to decrease

childrens negative or problem behaviors. Additionally, medication can help children with

ADHD in their everyday life, as well as manage ADHD symptoms. Several different types of

medications are approved and available to treat the disorder in children including, stimulants and

nonstimulants (CDC, 2016). Stimulants are the most popular and widely used ADHD

medications because they appear to boost and balance levels of neurotransmitters. According to

CDC (2016), 70 to 80 percent of children diagnosed with ADHD have improved signs and

symptoms when they take this type of medication. The right dose varies from child to child, so it

may take some time to find the correct dosage.

Though is no way to prevent ADHD, there are a number of measures that can be taken to

reduce the chances of a child being diagnosed with ADHD. Studies have shown that

complications during pregnancy are linked to ADHD (CDC, 2016). Good prenatal care can

increase the chances of your child not having ADHD. Avoiding anything that could harm fetal

development while pregnant are key to potentially reducing your childs risk of attention-deficit

hyperactivity disorder. Another preventative measure is protecting your child from exposure to

pollutants and toxins while pregnant or during early childhood, specifically tobacco smoke and
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lead. Lastly, although still scientifically unproven as a prevention method for ADHD, limiting

your childs exposure to TV and video games during the first five years of life may also decrease

risks.

Attention-deficit hyperactivity disorder is a serious public health problem that affects a

very large number of children in several communities. Federal level efforts to prevent and treat

ADHD include using data from national surveys to understand the number of children with the

disorder, other conditions they might experience, and the kind of treatment they might receive.

Three primary national surveys are the National Survey of Childrens Health, National Health

Interview Survey, and National Survey on Children with Special Health Care Needs (CDC,

2016). Federal supported clinical trials are also conducted and aim to look at new ways to

prevent, detect, or treat ADHD. The goal of clinical trials is to determine if a new test or

treatment works effectively and efficiently. Additionally, there are two federal laws under which

children diagnosed with ADHD can receive special help in school. The first law, Section 504 of

the Rehabilitation Act of 1973, prohibits programs that receive federal funds from discriminating

against children with disabilities and, under specific circumstances, requires school districts to

make accommodations for students diagnosed with ADHD (PBS, 2016). The other federal law,

Individuals with Disabilities Education Act, mandates that qualified students receive access to

special education and/or related services which are designed to meet each childs specific

educational needs (PBS, 2016). Since learning is considered an important life activity, children

who have been diagnosed with ADHD and have demonstrated difficulty focusing in school

become eligible for special educational services required by both laws.

Treatments for children with ADHD at the state level also plays an important role. They

monitor how health resources are utilized, implemented ADHD treatment policies, and shape
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access to behavioral health services. The CDC (2016) promotes the use of effective treatments

for children with ADHD, and an important part of this effort is providing states with resources

that help improve decision making. Community level prevention and treatment is also important

for children with ADHD. There are a number of community-based, epidemiologic studies that

increase the opportunity to make the most informed recommendations about potential public

health prevention and intervention strategies for children with ADHD. In addition, many

community social services and support groups are available for parents and families to discuss

with others who have similar concerns about their child with ADHD. Support groups often

provide useful information about coping with ADHD. School are also required by law to have a

program to make sure children who have a disability that interferes with learning get the needed

support.

Because ADHD is most common in children and directly affects their ability to learn,

educators must take certain actions in a school setting to accommodate a child with this disorder.

The classroom environment can be a highly challenging place for a child with ADHD. The

school setting requires children to sit still, listen quietly, pay attention, concentrate, and follow

instructions. These are the main things that children with ADHD have difficulty doing. As a

teacher, your role is to evaluate each childs individual needs and strengths. Strategies can then

be developed that will help the student with ADHD focus, stay on task, and succeed in the

classroom.

In addition to implementing a set routine and clear instructions, some adjustments

teachers need to make for a child diagnosed with ADHD are seating the child away from doors

and windows to reduce the amount of distractions, using discreet gestures or words that have

previously been talked about to inform the child they are interrupting, finding creative ways to
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allow the child to move around at appropriate times, breaking down and reinforcing the steps

involved in assignments, and most importantly making learning fun for them (CDC, 2016).

Making learning more interactive and interesting can help a child enjoy learning and even reduce

the symptoms of ADHD alone. As for adaptations of the curriculum, one change that a teacher

must make for a student with ADHD is using more visual aids, for example, charts, pictures, and

outlines for note-taking. Another change may be reducing the number of timed tests, and instead

allowing the student to take the test in the way he or she does best. Other curriculum changes

may include doing as much work as possible on the computer, diving long-term projects into

smaller segments with an assigned completion date for each, and accepting late work (CDC,

2016).

Attention-deficit hyperactivity disorder continues to be one of the most commonly

diagnosed childhood disorders today. ADHD cause problems in a childs ability to function

socially, academically, and at home. The first step to addressing the disorder is learning to

recognize the signs and symptoms. Once you understand the issues a child is struggling with,

you can work together to find creative solutions that will allow them to learn to their fullest

potential. Although there are treatments to improve ADHD symptoms, more information is still

needed about managing the disorder so that children can successfully learn and grow into

adulthood.
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References

Centers for Disease Control and Prevention. (2016, October 5). Prevalence | ADHD | NCBDDD |

CDC. Retrieved from http://www.cdc.gov/ncbddd/adhd/prevalence.html

Centers for Disease Control and Prevention. (2016, October 17). Key Findings: Parent-Report of

Diagnosis|Features|ADHD|NCBDDD|CDC. Retrieved from

http://www.cdc.gov/ncbddd/adhd/features/key-findings-adhd72013.html

Centers for Disease Control and Prevention. (2016, October 5). Data and Statistics | ADHD |

NCBDDD | CDC. Retrieved from http://www.cdc.gov/ncbddd/adhd/data.html

Centers for Disease Control and Prevention. (2016, October 4). Facts | ADHD | NCBDDD |

CDC. Retrieved from https://www.cdc.gov/ncbddd/adhd/facts.html

Centers for Disease Control and Prevention. (2016, October 5). Symptoms and Diagnosis |

ADHD | NCBDDD | CDC. Retrieved from

https://www.cdc.gov/ncbddd/adhd/diagnosis.html

Centers for Disease Control and Prevention. (2016, October 6). Treatment | ADHD | NCBDDD |

CDC. Retrieved from https://www.cdc.gov/ncbddd/adhd/treatment.html

Centers for Disease Control and Prevention. (2016, October 5). Research | ADHD | NCBDDD |

CDC. Retrieved from http://www.cdc.gov/ncbddd/adhd/research.html

National Institute for Mental Health. (2016, March). Attention Deficit Hyperactivity Disorder.

Retrieved from https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-

disorder-adhd/index.shtml

Public Broadcasting Service. (2016). Adhd In Schools - Federal Laws Pertaining To Adhd

Diagnosed Children | PBS - Medicating Kids | FRONTLINE | PBS. Retrieved from

http://www.pbs.org/wgbh/pages/frontline/shows/medicating/schools/feds.html
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