Introduction

Attention Deficit Hyperactivity Disorder or commonly known as ADHD is a

developmental disorder that affects many aspects of people’s lives. Children with ADHD
may be hyperactive, and unable to control their impulses causing them to have a hard
time at school. They experience failure in school because they’re likely to misbehave and
tend to be disorganized and forgetful. Inattention is also a problem where these children
are unable to focus and concentrate or inability to finish a task on time. As a result, it is
not only lower grades but also having a hard time further learning in school and at home.

Attention Deficit Hyperactivity Disorder (ADHD) is usually considered a

neurobehavioral development disorder. It affects about 3% to 5% of children with
symptoms starting before seven years of age. ADHD occurs twice in boys and commonly
in girls. As part of growing up, it is common for a child to misbehave but when those
misbehaviours becomes too often and excessive, that is when such actions shouldn’t be
ignored. Since little children are prone to this disorder, it makes the situation hard for the
educators as well.

Prevalence estimates of attention deficit hyperactivity disorder (ADHD) vary according to

the diagnostic criteria used and the population sampled. DSM-IV prevalence estimates
among school children in the US are 3% to 5%, but other estimates vary from 1.7% to
16.0%. No objective test exists to confirm the diagnosis of ADHD, which remains a clinical
diagnosis. Other conditions frequently co-exist with ADHD.
 In recent years, educators, parents, policy makers and the
press have expressed their concern about a group of students that is
reported having difficulties in paying attention. These children are
disorganized and always distracted. A great potion of these students
have difficulty meeting the expectation when it comes to school
activities and their educational performance is negatively influenced.
They have called out this condition as Attention Deficit Hyperactive
Disorder.

Based on the extensive research done by Russel Barkley, PhD,

he found out that ADHD is more common in boys than in girls. He said
that 40% of children diagnosed with ADHD have a parent with ADHD
which give an assumption that ADHD may be hereditary. He also
discovered that children with ADHD develop slower than children
without which shows that teachers really have to apply teaching
strategies for these children to help them develop faster.

A Philippine medical television show, “Salamat Doc”, the topic

on ADHD was discussed. An article about the episode “KSP or Kulang Sa
Pansin” was posted online by Yam dela Cruz. According to the article,
Dr. Jocelyn Eusebio, a developmental pediatrician and child
development consultant, ADHD is described as a ‘neuro-developmental
disorder’. Neuro-developmental disorders are group of disorders in
which the development of the of the cenral nervous system is
disturbed. This can include developmental brain disfunction. It means,
ADHD is possibly genetic or inborn. According to the ADHD Society of
the Philippines, 80% of adolescents have symptoms of ADHD. Among
children having ADHD, 40% -50% have learning disabilities. Also, 25% of
children with ADHD often fight with other kids and according to Dr.
Eusebio, children having ADHD manifest inappropriate behaviour
like blurting out answer and difficulty staying at one place because of
their impulsivity .

In 2009 study conducted at U.S Department of Energy’s

Brookhaven National Laboratory, it was found out that people with
ADHD have lower than normal levels of some protein. They discovered
that lacking proteins, people having ADHD are harder to motivate and
drive to do something. That is one of the reasons why the reward
system ( praise, hug, stickers or things that interest a child for the
purpose of increasing desired behaviours) should be evaluated to check
on its effectiveness on children with ADHD

There are two basic principles of behaviour management

theraphy, the first one is encuraging and rewarding good behaviour or
positive reinforcement. They can also be taught that actions have
consequences by establishing rules and clear outcomes for following or
disobeying these rules. These principles must be followed in every area,
that means at home, in the classroom, and in the social arena.

In an article published by Carol Flinch entitled, “Do ADHD Positive

Behavior Management and Reward System Work?” she mentioned that
children act better when when boundaries are set for them and one of
the ways to do this is to create a reward system as a part of their daily
life to assist them to learn how to adjust and control their behavior
appropriately. She said that acknowledging children when they act
appropriately and discourage them when they do something improper
can help them exhibit more desirable behaviors.

Six or more of the following symptoms of inattention have been

present for at least six months to a point that is distruptive and
appropriate for developmental level:

Inattention: The individual does not give attention to details or

make careless mistake in schoolwork or other activities. He or she have
a short span of keeping attention on tasks or play activities. He or she
does not seem to listen when spoken to directly. An individual with a
symptom of inattention does not follow instruction and fails to finish
school work or other duties.

Hyperactivity: The hyperactive individual fidgets hands or feet or

squirms in seat. He or she is constantly restless such as; gets up from
seat when remaining in seat is expected and runs about or climbs when
and when it is not appropriate. A person with hyperactive symptom has
trouble playing or enjoying leisure activities quietly. He or she is often
“on the go” and talk excessively.
 Impulsivity: It is a lack of restrain. Often the individual with a
symptom of impulsivity blurts out answers before question have been
finished. He has trouble in waiting turn and interrupts or intrudes on
others. Some symptoms that cause impairment were present before
age 7 and some impairment of symptoms is present in two or more.
There must be clear evidence of impairment in social, school, or work
functioning. What should we do if the doctor makes an ADHD diagnosis
for your child or on adult family members, it is important to adhere to
prescribed treatment. Your doctor may recommend ADHD medications.
Your doctor may also recommend behavioral theraphy. Many children
and adult with ADHD suffer needlessly. That’s because they don’t seek
professional care. Once ADHD is diagnosed medications and behavioral
theraphy can provide effective relief from the symptoms of ADHD.

Attention Deficit Hyperactive Disorder (ADHD) has a very

strong biological contributions to its occurrence while precise causes
has not yet been identified. There is little question that
hereditary/genetics makes the largest contribiution to the expresseion
of the disorder of the population. The heritability of ADHD averages
approximately 80%, meaning the genetic factors account for 80% of the
differences among individuals in this set of behavioral traits. For
comparison, consider that this figure rivals tests for the role of genetics
in human height. Several genes, associated with the disorder have been
identified and undoubtedly more will be shown that ADHD represents
a set of complex behavioral traits and so a single gene is unlikely to
account for the disorder. In instances, where heredity does not seen as
a factor, difficulties during pregnancy, prenatal exposure to alcohol and
smoke, prematurity of delivery and significantly low birth weight
excessively high body lead levels, natal injury to the prefrontal regions
of the brain have all been found to contribute to the risk for the disorder
in varying degrees.

Research has not supported popularly held views that

ADHD crises from excessive sugar intakes, food additives, excessive
viewing of television, or poor child management by parents. Some drug
used to treat seizure disorders in children may increase symptoms of
ADHD in those children as side effects of these drugs but these effects
are reversible. There is a little compelling evidence at this time that
Attention Deficit Hyperactivity Disorder (ADHD) can arise purely from
social factors or child – rearing methods. As mentioned above, most
substantiated causes appear to fall in the realm of neurobiology and
genetics. This is not to say that environmental factors may not influence
the severity of the disorder and especially the degree of impairment
and suffering the person may experience, but that such factors do not
seem to give rise to the condition by themselves.

Over the last decades, scientists have come up with

possible theories about what causes ADHD. Some of the theories have
led to dead ends, some to exciting new avenues of investigation.
 The cognitive characteristic of a student with ADHD are
thought to be directly related to the unusual features of their brains.
Interestingly, part of the brain that are different in individuals with
ADHD are the one known to regulate attention. Barkeley considered
this fact as well as all the research describing the behavior of individuals
with ADHD. Using the set of information, he proposed the primary
deficit in individuals with ADHD is not really attention, it is behavior
inhibition and self control problems related to these neurobiological
factors. That is, it is not that the student with Attention Deficit
Hyperactivity Disorder can not pay attention, it is that they can not
regulate where their attention is directed or how often it switches to
other areas. A more technical explination of the disorder is to say that
these individuals fail to develop executive funtions.

Evolving Definitions of ADHD

The clinical criteria for ADHD have evolved over the last 25 years.
Studies from the 1980s and 1990s often used different inclusion and
exclusion criteria than were used in more recent studies. Some studies
carefully differentiate between children with what we now label as
ADHD-Combined subtype (ADHD-C) and attention deficit disorder or
ADHD-predominantly Inattentive subtype (ADHD-I). We will address
briefly the outcomes of the subtypes specifically. Many children with
ADHD have comorbid conditions, including anxiety, depression,
disruptive behavior disorders, tics, and learning problems. The
contributions of these co-occurring problems to the functional
outcomes of ADHD have not been well established. Therefore, in this
review, we will consider the academic and educational outcomes of
ADHD without subdividing the population on the basis of coexisting
neurobehavioral problems in affected children.

What are the Academic and Educational Characteristics of Children with

ADHD?

Children with ADHD show significant academic underachievement,

poor academic performance, and educational problems.3–8 In terms of
impairment of body functions, children with ADHD show significant
decreases in estimated full-scale IQ compared with controls but score
on average within the normal range.9 In terms of activity limitations,
children with ADHD score significantly lower on reading and arithmetic
achievement tests than controls.9 In terms of restrictions in social
participation, children with ADHD show increases in repeated grades,
use of remedial academic services, and placement in special education
classes compared with controls.9 Children with ADHD are more likely to
be expelled, suspended, or repeat a grade compared with controls.10

Children with ADHD are 4 to 5 times more likely to use special

educational services than children without ADHD.10,11 Additionally,
children with ADHD use more ancillary services, including tutoring,
remedial pull-out classes, after-school programs, and special
accommodations.

The literature reports conflicting data about whether the academic and
educational characteristics of ADHD-I are substantially different from
the characteristics of ADHD-C.12,13 Some studies have not found
different outcomes in terms of academic attainment, use of special
services, and rates of high school graduation.14 However, a large survey
of elementary school students found children with ADHD-I were more
likely to be rated as below average or failing in school compared with
the children with ADHD-C and ADHD–predominantly hyperactive-
impulsive subtype.15 A subset of children with ADHD-I are described as
having a sluggish cognitive tempo, leading to the assumption that there
is a higher prevalence of learning disorders in the ADHD-I than the
ADHD-C populations. One study supporting this claim found more
children with ADHD-I than children with ADHD-C in classrooms for
children with learning disabilities.16 Comparative long-term outcome
studies of the subtypes in terms of academic and educational outcomes
have not been conducted.17
What are the Academic Characteristics of Children with Symptoms of
ADHD but without Formal Diagnoses?

Studies of outcome in children diagnosed with ADHD suffer from a

potentially serious logical problem: circularity.32 The clinical definition
of ADHD in the DSM-IV requires the presence of functional impairment,
typically defined in terms of behavior and performance at home and
school. School problems are almost always present to make the
diagnosis and therefore are more likely to be present at follow-up.
Another problem in the use of clinic-referred samples is the selection
bias in who gets referred to diagnostic clinics. One research strategy to
complement the longitudinal studies of clinic-referred samples and
avoid these problems is to evaluate children from community-based
samples who demonstrate symptoms of ADHD but who have not
necessarily been formally diagnosed with ADHD. In general, these
studies find that children with symptoms of ADHD and without formal
diagnoses also have adverse outcomes.

An early community-based study that charted the natural history of

ADHD33 followed subjects who were diagnosed and treated during
childhood and children with symptoms and/or behavior indications
who were never diagnosed or treated. Both groups were far more likely
to attend special education schools and far less likely to graduate from
high school or go to college than the asymptomatic controls. The
magnitude of the difference was greater for the children with formal
diagnosis than for those with pervasive symptoms.

Another community-based study on the relationship between

symptoms of ADHD, scores on academic standardized tests, and grade
retention found a linear relationship between the number of behavioral
symptoms and academic achievement, even among children whose
scores were generally below the clinical threshold for the diagnosis of
ADHD.34 Similar findings have been found in studies from Britain35 and
New Zealand.36 Taken together, these findings suggest that the
symptoms and associated features of ADHD are associated with adverse
outcomes.

Medical Treatments

Psychopharmacological treatments, particularly with stimulant

medications, reduce the core symptoms of ADHD37 at the level of body
functions. In addition, psychopharmacological treatments have been
shown to improve children's abilities to handle general tasks and
demands; for example, medication has been shown to improve
academic productivity as indicated by improvements in the quality of
note-taking, scores on quizzes and worksheets, the amount of written-
language output, and homework completion.38 However, stimulants
are not associated with normalization of skills in the domain of learning
and applying knowledge.39 For example, stimulant medications have
not generally been associated with improvements in reading
abilities.40,41 In longitudinal studies, subjects demonstrated poor
outcomes compared with controls whether or not they received
medication.24,,25,27,42–44 One caution in interpreting these findings
is that it cannot be determined if outcomes would have been even
worse without treatment because studies often lacked a true
nontreatment group with ADHD. Another problem was attrition;
subjects lost to follow-up may include those with worse outcomes. A
third caution is that most children receive medication for only 2 to 3
years,45 and it remains unclear whether steady treatment over many
years would be associated with improved outcomes.
There are existing behavior problems that children with ADHD manifest
in school and at home. In school they ate aggressive, impulsive and
hyperactive. At home, they are aggressive and hyperactive. Teachers
and parents used some approaches in modifying behaviors of children
with ADHD. Only the parents used punishment as an approach. Some
approaches lead to positive effect, others have negative effect.

About this condition

Definition

Attention deficit hyperactivity disorder (ADHD) is "a persistent pattern

of inattention and hyperactivity and impulsivity that is more frequent
and severe than is typically observed in people at a comparable level of
development" (APA, DSM-IV). Inattention, hyperactivity, and
impulsivity are commonly known as the core symptoms of ADHD.
Formal diagnostic criteria state that symptoms must be present for at
least 6 months, observed before the age of 7 years, and "clinically
important impairment in social, academic, or occupational functioning"
must be evident in more than one setting. The symptoms must not be
better explained by another disorder, such as an anxiety disorder, mood
disorder, psychosis, or autistic disorder. In clinical practice, symptoms
are generally, but not always, observed before 7 years of age. The ICD-
10 uses the term "hyperkinetic disorder" for a more restricted
diagnosis. It differs from the DSM-IV classification in that: all three
problems of attention, hyperactivity, and impulsiveness must be
present; more stringent criteria for "pervasiveness" across situations
must be met; and the presence of another disorder is an exclusion
criterion. However, in clinical practice, the co-existence of anxiety and
mood and autistic spectrum disorders is generally recognised. Formal
diagnostic criteria are most applicable to boys aged 6 to 12 years, and
most research data relate to this group. Pre-school children,
adolescents, and females may present with less typical features but
similar levels of impairment. The evidence presented in this review
largely relates to children and adolescents aged 3 to 18 years. There is
no distinct boundary between the upper ranges of childhood,
adolescence, and adulthood in terms of symptomatology and response
to treatment. The research relating to adults is growing. For pre-school
children there is still a paucity of evidence of efficacy and safety of
medical treatments and role of behavioural interventions.

Incidence/ Prevalence

Prevalence estimates of ADHD vary according to the diagnostic criteria

used and the population sampled. DSM-IV prevalence estimates among
school children in the US are 3% to 5%, but other estimates vary from
1.7% to 16.0%. In common with all mental health disorders, no
objective test exists to confirm the diagnosis of ADHD, which remains a
diagnosis based on clinical assessment of the nature of the behavioural
disorder and functional impairment of cognitive processes. ADHD
generally co-exists with other developmental and mental health
disorders. Oppositional defiant disorder is present in 35% (95% CI 27%
to 44%) of children with ADHD, conduct disorder in 26% (95% CI 13% to
41%), anxiety disorder in 26% (95% CI 18% to 35%), and depressive
disorder in 18% (95% CI 11% to 27%). Of the developmental disorders,
developmental coordination disorder has been found in just under 50%
of children with ADHD, specific learning disabilities in around 40%, tics
in 33%, and Asperger's syndrome in 7%.

Aetiology/ Risk factors

The underlying causes of ADHD are not known. There is some evidence
that there is a genetic component: twin studies suggest an average
heritability of 76%. However, a high heritability does not exclude the
important role of environment acting through gene–environment
interactions. The uneven distribution of ADHD in the population, which
mirrors that of other mental health and behavioural disorders, also
suggests that psychosocial factors are involved. Boys are at a greater
risk of developing ADHD compared with girls, with a ratio of about 4:1.
Although the link between ADHD and dietary and nutritional factors
(such as artificial food colours) is yet to be satisfactorily researched,
studies suggest a correlation between artificial food colours and
symptoms of hyperactivity in some young children.
Prognosis

More than 70% of hyperactive children may continue to meet criteria

for ADHD in adolescence, and up to 65% of adolescents may continue
to meet criteria for ADHD in adulthood. Changes in diagnostic criteria
cause difficulty with interpretation of the few outcome studies that
exist. ADHD is also a risk factor for psychiatric diagnosis, persistent
hyperactivity, violence, and antisocial behaviours. Follow-up studies of
children with ADHD into adulthood indicate an increased risk of
antisocial, depressive, and anxiety disorders, and of antisocial
personality disorder.

Aims of intervention

To reduce inattention, hyperactivity, and impulsivity; and to improve

psychosocial and educational functioning in affected children and
adolescents, with minimal adverse effects of treatment.

Outcomes

Symptom severity: measures of children's behaviour, such as Conners'

Teacher's Rating Scales; ADHD Rating Scale-IV SNAP, CLAM, SKAMP.
School performance, such as School Situations Questionnaire; self-
rated symptoms. Adverse effects.

Methods

Clinical Evidence search and appraisal August 2009. The following

databases were used to identify studies for this systematic review:
Medline 1966 to August 2009, Embase 1980 to August 2009, and The
Cochrane Database of Systematic Reviews 2009, Issue 2 (1966 to date
of issue). An additional search within The Cochrane Library was carried
out for the Database of Abstracts of Reviews of Effects (DARE) and
Health Technology Assessment (HTA). We also searched for retractions
of studies included in the review. Abstracts of the studies retrieved from
the initial search were assessed by an information specialist. Selected
studies were then sent to the contributor for additional assessment,
using predetermined criteria to identify relevant studies. Study design
criteria for inclusion in this review were: published systematic reviews
of RCTs and RCTs in any language, at least single blinded, and containing
more than 20 individuals of whom more than 80% were followed up.
There was no minimum length of follow-up required to include studies.
We excluded all studies described as "open", "open label", or not
blinded unless blinding was impossible. We have searched for RCTs
comparing each listed intervention versus placebo, no treatment, or
each other, and have included all studies of sufficient quality. In the first
question on the effects of pharmacological treatments, we searched for
the effects of listed pharmacological treatments alone. However, we
also searched for three combinations of drugs, namely,
methylphenidate plus clonidine, dexamfetamine sulphate plus
clonidine, and atomoxetine plus methylphenidate, and reported any
studies that we found. Where we have included a systematic review,
we have only reported comparisons for which the identified review
found RCTs. We included systematic reviews of RCTs and RCTs where
harms of an included intervention were studied applying the same
study design criteria for inclusion as we did for benefits. In addition we
also did a specific harms search and searched for
prospective/retrospective cohort studies reporting on atomoxetine and
growth. In addition we use a regular surveillance protocol to capture
harms alerts from organisations such as the US FDA and the UK MHRA,
which are added to the reviews as required. To aid readability of the
numerical data in our reviews, we round many percentages to the
nearest whole number. Readers should be aware of this when relating
percentages to summary statistics such as relative risks (RRs) and odds
ratios (ORs). We have performed a GRADE evaluation of the quality of
evidence for interventions included in this review (see table ). The
categorisation of the quality of the evidence (into high, moderate, low,
or very low) reflects the quality of evidence available for our chosen
outcomes in our defined populations of interest. These categorisations
are not necessarily a reflection of the overall methodological quality of
any individual study, because the Clinical Evidence population and
outcome of choice may represent only a small subset of the total
outcomes reported, and population included, in any individual trial.

Study: Brain differences found in children with ADHD

Melissa Jenco, News Content Editor

As many as five brain regions may not be fully developed in children

with attention-deficit/hyperactivity disorder (ADHD), according to a
new imaging study.

“The results from our study confirm that people with ADHD have
differences in their brain structure and therefore suggest that ADHD is
a disorder of the brain,” lead author Martine Hoogman, Ph.D., said in a
news release. “We hope that this will help to reduce stigma that ADHD
is ‘just a label’ for difficult children or caused by poor parenting.”

Worldwide, about 5.3% of children have ADHD, and symptoms persist

into adulthood for about two-thirds, according to the study “Subcortical
brain volume differences in participants with attention deficit
hyperactivity disorder in children and adults: a cross-sectional mega-
analysis”
With funding from the National Institutes of Health, researchers from
the international ENIGMA ADHD Working Group embarked on what
they said is the largest study performed on brain differences in people
with and without ADHD. They analyzed MRI data from 1,713 people
with ADHD and 1,529 controls ranging in age from 4 to 63 years.

The team found those with ADHD had smaller brain volumes in the
accumbens, amygdala, caudate, hippocampus and putamen regions.
Intracranial volume also was lower. They dubbed ADHD a “disorder or
brain maturation delay” and said structural differences were greatest
for children. In adults, there were no significant differences between
those with ADHD and the control group.

The research confirms previous findings on the caudate and putamen

and shows the impact is bilateral, the study said. The findings on the
accumbens, amygdala and hippocampus were new. The large impact
seen in the amygdala, which regulates emotions, may change the way
ADHD is viewed.
“These differences are very small — in the range of a few percent — so
the unprecedented size of our study was crucial to help identify these,”
Dr. Hoogman said. “Similar differences in brain volume are also seen in
other psychiatric disorders, especially major depressive disorder.”

However, neither a comorbid psychiatric disorder nor psychostimulant

medications appeared to cause the brain differences of people in the
study with ADHD, authors wrote.

In a related commentary, Claudia Lugo-Candelas, Ph.D., and Jonathan

E. Posner, M.D., praised the group’s collaboration on such a large study.

“This study represents an important contribution to the field by

providing robust evidence to support the notion of ADHD as a brain
disorder with substantial effects on the volumes of subcortical nuclei,”
they wrote. “Future meta-analyses and mega-analyses will need to
investigate medication effects as well as the developmental course of
volumetric differences in this disorder.”
ACKNOWLEDGEMENT

This research was supported/partially supported by the studies of

Prestigious Universities around United Kingdom .We thank our
colleagues from Cambridge University who provided insight and
expertise that greatly assisted the research, although they may not
agree with all of the interpretations/conclusions of this paper.

We thank our Adviser Sir Allan S. Cruz for assistance with research
methods like methods in title page definitions and spacing , and we
thank for comments that greatly improved the manuscript.

We would also like to show our gratitude to the Department of Mental

Health of Manchester Hospital for sharing their pearls of wisdom with
us during the course of this research.

We acknowledged the schools whom we profound the settings of the

study which provided immersing information of our research regarding
the ADHD in children.
INFANT JESUS LEARNING ACADEMY OF RODRIGUEZ RIZAL

PHASE 7 BLOCK 2 LOT 2 EASTWOOD GREENVIEW SUBD

SAN ISIDRO RODRIGUEZ RIZAL TEL NO. 666-3252

In Partial Fullfillment of the

Requirements for the subject English

Academic Year 2018-2019

A research paper in English

Understanding

Attention Deficit Hyperactivity Disorder

Within 6-8 years old

PRESENTED BY: GROUP 6

ALLIAH JANAH E. BONGHANOY

ALYSTER CARL R. JORTA

RUPERT JOHN V. LEE

SUBMITTED TO:

SIR ALLAN S.CRUZ