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Attention Deficit Hyperactivity Disorder

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The most common reason that children are referred to child-guidance clinics is for attention deficit hyperactivity disorder (ADHD). ADHD is a behavioral disorder with a strong hereditary component, which likely results from neurological dysfunction. According to the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Text Revision (DSM-IV-TR), there are three diagnostic categories of ADHD: (1) ADHD, Predominantly Inattentive Type; (2) ADHD, Predominantly Hyperactive-Impulsive Type; and (3) ADHD, Combined Type. ADHD often occurs simultaneously with other behavioral and learning problems, such as learning disabilities, emotional or behavioral disabilities, or Tourette's syndrome.

A 1998 study by Russell A. Barkley stated that ADHD is a deficit in behavior inhibition, which sets the stage for problems in regulating behavior. Students with ADHD may experience problems in working memory (remembering things while performing other cognitive operations), delayed inner speech (self-talk that allows people to solve problems), problems controlling emotions and arousal, and difficulty analyzing problems and communicating solutions to others. Hence, students with ADHD may find it difficult to stay focused on tasks such as schoolwork–tasks that require sustained attention and concentration, yet are not intrinsically interesting. In addition, the majority of individuals with ADHD experience significant problems in peer relations and demonstrate a higher incidence of substance abuse than that of the general population.

Although professionals did not recognize ADHD as a diagnostic category until the 1980s, evidence of the disorder dates from the beginning of the twentieth century. The physician George F. Still is credited with being one of the first authors to bring those with "defective moral control" to the attention of the medical profession in 1902. In the 1930s and 1940s Heinz Werner and Alfred Strauss were able to identify children who were hyperactive and distractible–children who exhibited the Strauss syndrome. Later, in the middle of the twentieth century, the term minimal brain injury was used to refer to children of normal intelligence who were inattentive, impulsive, and/or hyperactive. This term fell out of favor and was replaced by hyperactive child syndrome. Professionals eventually rejected this term, as inattention, not hyperactivity, was recognized as the major behavior problem associated with the disorder.

Students with ADHD are eligible for special education services under the category "other health impaired (OHI)." This category has dramatically increased in size; however, the number of students served in this category remains well below the estimated prevalence rate of 3 to 5 percent of the school-age population. From discrepancies such as this, researchers have estimated that fewer than half of all students with ADHD are receiving special education services.

As Barkley noted in his 1998 study, the effective diagnosis of ADHD requires a medical exam, a clinical interview, and teacher and parent rating scales. During the medical exam the physician must rule out other possible causes of the behavior problem, and through the clinical interview, the clinician obtains information from both parents and child about the child's physical and psychological characteristics. Finally, parents, teachers, and in some cases children themselves, complete behavioral rating scales, such as the Connors scales and the ADHD Rating Scale–IV in order to quantify observed behavior patterns.

Frequently students with ADHD are treated with psychostimulants, such as methylphenidate (Ritalin), which stimulate areas of the brain responsible for inhibition. Despite some negative publicity in the media, most authorities in the area of ADHD are in favor of Ritalin's use. In addition to medication, students with ADHD also benefit from carefully designed educational programming. In the early 1960s William Cruickshank was one of the first to establish an educational program for students who would meet what has become the criteria for ADHD. This program, proposing a degree of classroom structure rarely seen in the early twenty-first century, advocated: (1) a reduction of stimuli irrelevant to learning and enhancement of material important for learning and (2) a structured program with a strong emphasis on teacher direction. In addition to educational programs that emphasize and provide structure, a 1997 study by Robert H. Horner and Edward G. Carr indicated that students with ADHD benefited from instructional approaches examining the consequences, antecedents, and setting events that maintain inappropriate behaviors. Other researchers' findings indicated that they also profited from behavior management systems in which the student with ADHD learns to monitor his or her own behavior. These strategies, although effective, are not generally powerful enough to completely remedy the symptoms of children with ADHD. The majority of children diagnosed with ADHD continue to demonstrate symptoms in adulthood.

BIBLIOGRAPHY

AMERICAN PSYCHIATRIC ASSOCIATION. 1994. Diagnostic and Statistical Manual of Mental Disorders, Text Revision, 4th edition. Washington, DC: American Psychiatric Association.

BARKLEY, RUSSELL. A. 1998. Attention-Deficit Hyperactive Disorder: A Handbook for Diagnosis and Treatment. New York: Guilford Press.

CONNORS, C. KEITH. 1989. Connors Teacher Rating Scale-28. Tonawanda, NY: Multi-Health Systems.

DUPAUL, GEORGE J.; POWER, THOMAS J.; ANASTOPOLOUS, ARTHUR D.; and REID, ROBERT. 1998. ADHD Rating Scale–IV: Checklists, Norms, and Clinical Interpretations. New York: Guilford Press.

HALLAHAN, DANIEL P., and COTTONE, E. A. 1997. "Attention Deficit Hyperactivity Disorder." In Advances in Learning and Behavioral Disabilities, Vol. 11, ed. Thomas E. Scruggs and Margo A. Mastropieri. Greenwich, CT: JAI Press.

HORNER, ROBERT H., and CARR, EDWARD G. 1997. "Behavioral Support for Students with Severe Disabilities: Functional Assessment and Comprehensive Intervention." Journal of Special Education 31:1–11.

SHAPIRO, EDWARD S.; DUPAUL, GEORGE J.; and BRADLEY-KLUG, KATHY L. 1998. "Self-Management as a Strategy to Improve the Classroom Behavior of Adolescents with ADHD." Journal of Learning Disabilities 31:545–555.

DEVERY R. MOCK

DANIEL P. HALLAHAN

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