M4. Lesson 4.6: ADHD and Related Behavior Disorders

Question 1

In what age are children with ADHD more particularly diagnosed?

Answer 1

Attention-Deficit/Hyperactivity Disorder (ADHD) is a psychiatric disorder that is most often diagnosed in school-aged children.

Question 2

What is the percentage of people with ADHD?

Answer 2

At least 50% of children with ADHD will continue to have symptoms in adolescence and adulthood. Approximately 4% of adults experience at least some symptoms of ADHD.

Question 3

What is the childhood and ADHD childhood stage?

Answer 3

Childhood and ADHD Childhood is a stage of life characterized by rapid and profound development.

Question 4

What do children develop from birth?

Answer 4

Starting at birth, children develop the skills necessary to function in the world around them at a rate that is faster than any other time in life. This is no small accomplishment!

Question 5

What have children mastered by the end of their first decade of life?

Answer 5

By the end of their first decade of life, most children have mastered the complex cognitive operations required to comply with rules, such as stopping themselves from acting impulsively, paying attention to parents and teachers in the face of distraction, and sitting still despite boredom.

Question 6

What is an important developmental task for children?

Answer 6

Indeed, acquiring self-control is an important developmental task for children, because they are expected to comply with directions from adults, stay on task at school, and play appropriately with peers.

Question 7

What is a unique challenge for children with ADHD?

Answer 7

For children with Attention-Deficit/Hyperactivity Disorder (ADHD), however, exercising self-control is a unique challenge.

Question 8

What are children with ADHD often labeled as?

Answer 8

Children with ADHD, oftentimes despite their best intentions, struggle to comply with adults’ instructions, and they are often labeled as “problem children” and “rule breakers.”

Question 9

What were children with ADHD viewed as historically and how are they viewed now?

Answer 9

Historically, people viewed these children as willfully noncompliant due to moral or motivational defect (Still, 1902). However, scientists now know that the noncompliance observed in children with ADHD can be explained by a number of factors, including neurological dysfunction.

Question 10

What is a clinician’s first goal when a family refers their child to a mental health professional?

Answer 10

When a family is referred to a mental health professional for help dealing with their child’s problematic behaviors, the clinician’s first goal is to identify the nature and cause of the child’s problems.

Question 11

What is the most important step in the intervention process?

Answer 11

Accurately diagnosing children’s behavior problems is an important step in the intervention process, because a child’s diagnosis can guide clinical decision making.

Question 12

Where do childhood behavior problems often arise from?

Answer 12

Childhood behavior problems often arise from different causes, require different methods for treating, and have different developmental courses.

Question 13

What will arriving at a diagnosis allow clinicians to do?

Answer 13

Arriving at a diagnosis will allow the clinician to make inferences about how each child will respond to different treatments and provide predictive information to the family about how the disorder will affect the child as he or she develops.

Question 14

What do adults feel about diagnosing children and why do they think it is controversial?

Answer 14

Despite the utility of the current diagnostic system, the practice of diagnosing children’s behavior problems is controversial. Many adults feel strongly that labeling children as “disordered” is stigmatizing and harmful to children’s self-concept. Others have criticized the use of the diagnostic system because they believe it pathologizes normal behavior in children.

Question 15

What has one study found about children’s attitudes when they play with a child with ADHD?

Answer 15

One study found that children have more negative attitudes toward a play partner if they are led to believe that their partner has ADHD, regardless of whether or not their partner actually has the disorder.

Question 16

What kind of role does the diagnostic system play in children’s lives

Answer 16

Despite these criticisms, the diagnostic system has played a central role in research and treatment of child behavior disorders, and it is unlikely to change substantially in the near future.

Question 17

What are the two clusters of ADHD?

Answer 17

The core symptoms of ADHD are organized into two clusters, including clusters of hyperactivity/impulsivity and inattention.

Question 18

What is the hyperactive symptom cluster?

Answer 18

The hyperactive symptom cluster describes children who are perpetually in motion even during times when they are expected to be still, such as during class or in the car.

Question 19

What is the impulsive symptom cluster?

Answer 19

The impulsive symptom cluster describes difficulty in delaying response and acting without considering the repercussions of behavior.

Question 20

Are the hyperactive and impulsive symptoms closely related?

Answer 20

Yes. Hyperactive and impulsive symptoms are closely related, and boys are more likely than girls to experience symptoms from this cluster.

Question 21

What are inattentive symptoms?

Answer 21

Inattentive symptoms describe difficulty with organization and task follow-through, as well as a tendency to be distracted by external stimuli.

Question 22

Children with ADHD can have very different symptom presentations. True or False.

Answer 22

True. Two children diagnosed with ADHD can have very different symptom presentations. In fact, children can be diagnosed with different subtypes of the disorder (i.e., Combined Type, Predominantly Inattentive Type, or Predominantly Hyperactive-Impulsive Type) according to the number of symptoms they have in each cluster.

Question 23

What do social critics say about children with ADHD?

Answer 23

Many laypeople and social critics argue that ADHD is not a “real” disorder. These individuals claim that children with ADHD are only “disordered” because parents and school officials have trouble managing their behavior. These criticisms raise an interesting question about what constitutes a psychiatric disorder in children: How do scientists distinguish between clinically significant ADHD symptoms and normal instances of childhood impulsivity, hyperactivity, and inattention? After all, many 4-year-old boys are hyperactive and cannot focus on a task for very long.

Question 24

What are the criteria to distinguish normal and disordered behavior in terms of ADHD?

Answer 24

To address this issue, several criteria are used to distinguish between normal and disordered behavior:

1. The symptoms must significantly impair the child’s functioning in important life domains (e.g., school, home).
2. The symptoms must be inappropriate for the child’s developmental level.

Question 25

What is the explanation behind ADHD’s first criterion?

Answer 25

The first criterion states that children with ADHD should show impairment in major functional domains. This is certainly true for children with ADHD. These children have lower academic achievement compared with their peers. They are more likely to repeat a grade or be suspended and less likely to graduate from high school (Loe & Feldman, 2007). Children with ADHD are often unpopular among their peers, and many of these children are actively disliked and socially rejected (Landau, Milich, & Diener, 1998). Children with ADHD are likely to experience comorbid psychological problems such as learning disorders, depression, anxiety, and oppositional defiant disorder. As they grow up, adolescents and adults with ADHD are at risk to abuse alcohol and other drugs (Molina & Pelham, 2003) and experience other adverse outcomes (see Focus Topic 1). In sum, there is sufficient evidence to conclude that children diagnosed with ADHD are significantly impaired by their symptoms.

Question 26

What is the explanation behind ADHD’s second criterion?

Answer 26

It is also important to determine that a child’s symptoms are not caused by normal patterns of development. Many of the behaviors that are diagnostic of ADHD in some children would be considered developmentally appropriate for a younger child. This is true for many psychological and psychiatric disorders in childhood. For example, bedwetting is quite common in 3-year-old children; at this age, most children have not gained control over nighttime urination. For this reason, a 3-year-old child who wets the bed would not be diagnosed with enuresis (i.e., the clinical term for chronic bedwetting), because his or her behavior is developmentally appropriate. Bedwetting in an 8-year-old child, however, is developmentally inappropriate.

At this age, children are expected to remain dry overnight, and failure to master this skill would prevent children from sleeping over at friends’ houses or attending overnight camps.

Question 27

What are the reasons that some children develop ADHD?

Answer 27

The reasons that some children develop ADHD are complex, and it is generally recognized that a single cause is insufficient to explain why an individual child does or does not have the disorder. Researchers have attempted to identify risk factors that predispose a child to develop ADHD. These risk factors range in scope from genetic (e.g., specific gene polymorphisms) to familial (e.g., poor parenting) to cultural (e.g., low socioeconomic status).

Question 28

What are the main factors that experts believe ADHD cases to be?

Answer 28

Most experts believe that genetic and neurophysiological factors cause the majority of ADHD cases. Indeed, ADHD is primarily a genetic disorder—twin studies find that whether or not a child develops ADHD is due in large part (75%) to genetic variations (Faraone et al., 2005). Further, children with a family history of ADHD are more likely to develop ADHD themselves (Faraone & Biederman, 1994). Specific genes that have been associated with ADHD are linked to neurotransmitters such as dopamine and serotonin. In addition, neuroimagining studies have found that children with ADHD show reduced brain volume in some regions of the brain, such as the prefrontal cortex, the corpus callosum, the anterior cingulate cortex, the basal ganglia, and the cerebellum (Seidman, Valera, & Makris, 2005). Among their other functions, these regions of the brain are implicated in organization, impulse control, and motor activity, so the reduced volume of these structures in children with ADHD may cause some of their symptoms.

Question 29

Aside from genetics, what other risk factors are researchers considering?

Answer 29

Although genetics appear to be a main cause of ADHD, recent studies have shown that environmental risk factors may cause a minority of ADHD cases. Many of these environmental risk factors increase the risk for ADHD by disrupting early development and compromising the integrity of the central nervous system. Environmental influences such as low birth weight, malnutrition, and maternal alcohol and nicotine use during pregnancy can increase the likelihood that a child will develop ADHD (Mick, Biederman, Faraone, Sayer, & Kleinman, 2002). Additionally, recent studies have shown that exposure to environmental toxins, such as lead and pesticides, early in a child’s life may also increase risk of developing ADHD (Nigg, 2006).

Question 30

What are the controversial explanations for the development of ADHD?

Answer 30

Controversial explanations for the development of ADHD have risen and fallen in popularity since the 1960s. Some of these ideas arise from cultural folklore, others can be traced to “specialists” trying to market an easy fix for ADHD based on their proposed cause. Some other ideas contain a kernel of truth but have been falsely cast as causing the majority of ADHD cases.

Question 31

What is one of the main criticisms proposed to be a major cause of ADHD?

Answer 31

Some critics have proposed that poor parenting is a major cause of ADHD. This explanation is popular because it is intuitively appealing—one can imagine how a child who is not being disciplined at home may be noncompliant in other settings. Although it is true that parents of children with ADHD use discipline less consistently, and a lack of structure and discipline in the home can exacerbate symptoms in children with ADHD (Campbell, 2002), it is unlikely that poor parenting alone causes ADHD in the first place. To the contrary, research suggests that the noncompliance and impulsivity on the child’s part can cause caregivers to use discipline less effectively.

Question 32

What have research studies explained about poor parenting and ADHD?

Answer 32

In a classic series of studies, Cunningham and Barkley (1979) showed that mothers of children with ADHD were less attentive to their children and imposed more structure to their playtime relative to mothers of typically developing children. However, these researchers also showed that when the children were given stimulant medication, their compliance increased and their mothers’ parenting behavior improved to the point where it was comparable to that of the mothers of children without ADHD (Barkley & Cunningham, 1979). This research suggests that instead of poor parenting causing children to develop ADHD, it is the stressful effects of managing an impulsive child that causes parenting problems in their caregivers. One can imagine how raising a child with ADHD could be stressful for parents. In fact, one study showed that a brief interaction with an impulsive and noncompliant child caused parents to increase their alcohol consumption—presumably these parents were drinking to cope with the stress of dealing with the impulsive child (Pelham et al., 1997). It is, therefore, important to consider the reciprocal effects of noncompliant children on parenting behavior, rather than assuming that parenting ability has a unidirectional effect on child behavior.

Question 33

What are other causes of ADHD assumed aside from “poor parenting”?

Answer 33

Other purported causes of ADHD are dietary. For example, it was long believed that excessive sugar intake can cause children to become hyperactive. This myth is largely disproven (Milich, Wolraich, & Lindgren, 1986). However, other diet-oriented explanations for ADHD, such as sensitivity to certain food additives, have been proposed (Feingold, 1976). These theories have received a bit more support than the sugar hypothesis (Pelsser et al., 2011). In fact, the possibility that certain food additives may cause hyperactivity in children led to a ban on several artificial food colorings in the United Kingdom, although the Food and Drug Administration rejected similar measures in the United States. Even if artificial food dyes do cause hyperactivity in a subgroup of children, research does not support these food additives as a primary cause of ADHD. Further, research support for elimination diets as a treatment for ADHD has been inconsistent at best.

Question 34

What is the summary of causes of children developing ADHD?

Answer 34

In sum, scientists are still working to determine what causes children to develop ADHD, and despite substantial progress over the past four decades, there are still many unanswered questions. In most cases, ADHD is probably caused by a combination of genetic and environmental factors. For example, a child with a genetic predisposition to ADHD may develop the disorder after his or her mother uses tobacco during her pregnancy, whereas a child without the genetic predisposition may not develop the disorder in the same environment. Fortunately, the causes of ADHD are relatively unimportant for the families of children with ADHD who wish to receive treatment, because what caused the disorder for an individual child generally does not influence how it is treated.

Question 35

What is the most common method of treating ADHD?

Answer 35

The most common method of treating ADHD is to prescribe stimulant medications such as Adderall.

Question 36

What can be treated by medications (for children with ADHD)?

Answer 36

These medications treat many of the core symptoms of ADHD—treated children will show improved impulse control, time-on-task, and compliance with adults, and decreased hyperactivity and disruptive behavior.

Question 37

What are the negative side effects of medication for children with ADHD?

Answer 37

However, there are also negative side effects to stimulant medication, such as growth and appetite suppression, increased blood pressure, insomnia, and changes in mood (Barkley, 2006). Although these side effects can be unpleasant for children, they can often be avoided with careful monitoring and dosage adjustments.

Question 38

What are the arguments on stimulant medication for children with ADHD?

Answer 38

Opinions differ on whether stimulants should be used to treat children with ADHD. Proponents argue that stimulants are relatively safe and effective, and that untreated ADHD poses a much greater risk to children (Barkley, 2006). Critics argue that because many stimulant medications are similar to illicit drugs, such as cocaine and methamphetamine, long-term use may cause cardiovascular problems or predispose children to abuse illicit drugs. However, longitudinal studies have shown that people taking these medications are not more likely to experience cardiovascular problems or to abuse drugs (Biederman, Wilens, Mick, Spencer, & Faraone, 1999; Cooper et al., 2011). On the other hand, it is not entirely clear how long-term stimulant treatment can affect the brain, particularly in adults who have been medicated for ADHD since childhood.

Question 39

What have critics proposed about psychostimulant medication for children with ADHD?

Answer 39

Finally, critics of psychostimulant medication have proposed that stimulants are increasingly being used to manage energetic but otherwise healthy children. It is true that the percentage of children prescribed stimulant medication has increased since the 1980s. This increase in use is not unique to stimulant medication, however. Prescription rates have similarly increased for most types of psychiatric medication (Olfson, Marcus, Weissman, & Jensen, 2002). As parents and teachers become more aware of ADHD, one would expect that more children with ADHD will be identified and treated with stimulant medication.

Question 40

Parent children with ADHD is not frustrating nor challenging. True or False.

Answer 40

False. Parenting children with ADHD can be challenging. Parents of these children are understandably frustrated by their children’s misbehavior.

Question 41

What kind of discipline tactics feel ineffective for children with ADHD?

Answer 41

Standard discipline tactics, such as warnings and privilege removal, can feel ineffective for children with ADHD.

Question 42

What do standard discipline tactics for children with ADHD lead to?

Answer 42

This often leads to ineffective parenting, such as yelling at or ridiculing the child with ADHD. This cycle can leave parents feeling hopeless and children with ADHD feeling alienated from their family. Fortunately, parent management training can provide parents with a number of tools to cope with and effectively manage their child’s impulsive and oppositional behavior.