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Sandra Magdaleno

Introduction to Special Education 203

Research Paper: ADHD

Thur December 01, 2022

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Children have the attention span of a worm. Many say that attention span is correlated

with age, so an eight-year-old has an attention span of eight minutes. The saying isn’t entirely

wrong; people develop better attention as they age, but imagine a disorder that develops at a

young age and causes extreme inattention, hyperactivity, and impulsivity. It creates such a

hardship for a child with this disorder that the description affects their personal, school, social,

and healthy life. There is a name for a disorder that is just that called attention-deficit

hyperactivity disorder (ADHD).

The term for this disorder hasn't been around for much long, but the disease itself has

been described as far back as Hippocrates's time. The mention of ADHD before its name was

always described along the lines of “the disease of inattention,” “simple hyperexcitability, ”

unstable nervous system,” “mentally unstable,” etc. It was also thought to be a disease only

children obtained. A name was finally given in 1968, “hyperkinetic reaction of childhood.” and

was thought to have gone away going into adulthood. Understanding of the disease was more

known and was finally given a name, Attention Deficit Disorder (ADD). It was later changed to

be more specific and refined to include hyperactivity and is now known as ADHD. Now that

there is a better understanding of the disease, there are still a lot of questions, ideas, and conflicts

surrounding ADHD as it continues to be studied.

The idea that ADHD was once considered a childhood disorder can be due to the fact

that a diagnosis of ADHD happens at a young age. “Symptoms and neuro-psychological

impairments associated with ADHD are evident in preschool children.” (Tarver), and symptoms

must be evident before age 12 as early onset symptoms appear very young. Many early

symptoms include failing to pay attention to a given task or activity, not listening when spoken to

directly, excessive talking, and fidgeting with hands and feet. According to the Diagnostic and
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Statistical Manual (DSM), “patients must have experienced a minimum of six symptoms of

inattention or six symptoms of hyperactivity/impulsivity.” (Traver) Depending on the person,

they can be categorized as the predominantly inattentive type, predominantly

hyperactive/impulsive type, or the combined type. Although it is prominent at a young age,

symptoms may decline and become a minor setback, but some are less fortunate, and

impairments can continue to affect those in their adulthood.

ADHD symptoms cause many functional impairments. Neurologically ADHD causes

deficits “in Executive functions (EF), delay aversion, and temporal processing deficits.”(Traver)

Having a decrease in EF causes bad memory, coordination, planning, and difficulty handling

daily tasks. Parents of children with ADHD have observed their children displaying lower levels

of emotional control and usually having higher levels of anger and frustration. Therefore, those

with ADHD have a hard time regulating emotions. Since they have higher levels of negative

emotions socially, they tend to be more aggressive, intrusive, and withdrawn. As a result, they

tend to make fewer friendships and are socially impaired. Lower test scores on standardized tests

and poor grades are associated with ADHD. In general, children with ADHD perform lower

academically and usually require support in school.

So far, it is known that ADHD happens at an early stage of life, but why it happens

exactly is still unknown. Biological and environmental factors are being researched to prove

which one of both play a key role in heightening the risk for ADHD. Biologically, “ADHD is

considered one of the most heritable psychiatric conditions” (Tarver), but it's a complicated topic

because, genetically, no risk factors have been identified. Yet, multiple genetic risk variants

likely play a part in ADHD. Magnetic resonance imaging (MRI) has identified that the brain

structure in children brians with ADHD has numerous morphological abnormalities. Because of
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this find, ADHD is “likely to be the result of complex structural abnormalities involving a

number of brain regions and connecting circuitry.” (Tarver) Pre-natal smoking, prematurity, and

severe neglect at an early age can all be considered risk factors for symptoms of ADHD. Even

diets have been reported to have heightened symptoms of ADHD; artificial food coloring has

been observed to increase hyperactivity in children.

It's still a mystery as to how ADHD is developed, and to make it much more complex,

ADHD is known to be comorbid with a list of other psychotic conditions and functional

impairments, making it much more complex. Sometimes when one is clinically assessed, many

more impairments may be apparent that do not correlate with ADHD. Disruptive behavior

disorders like oppositional defiant disorder (ODD) and conduct disorder (CD) are highly

comorbid with ADHD. Mood and anxiety disorders, tic disorders, and substance misuse are all

common diseases that are also associated with ADHD. All of these diseases add more stress and

difficulties. Children with ADHD and behavioral disorders can be more resistant to treatment.

Tic disorders with ADHD can make treatment more complicated. Certain medications for ADHD

can contradict symptoms of a tic disorder and exacerbate those symptoms. Comorbidities with

ADHD need to be considered, as they over-complicate the symptoms, treatment, and deficits.

Unfortunately, there is no cure for ADHD, but many treatments are available that help

lower symptoms, impairment, and poor functioning in those with ADHD. There are two general

types of treatments, pharmacological and non-pharmacological. Pharmacological treatments tend

to be the primary source of treatment for those with ADHD. 90% of children are likely to receive

medication. Almost all medications made for ADHD are made to increase dopamine and/or

noradrenaline. The most common type of medication offered is psychostimulants.

Methylphenidate (MPH) and amphetamines (AMP) are the two most common medications
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provided to those with ADHD. They are seen and have been studied as the most effective

intervention and are usually recommended to those with moderate to severe cases.

Psychostimulants work well for short-term effectiveness, as it has immediate on and offset

action.

Although psychostimulants are the most effective, a third of people who suffer from

ADHD do not respond well to stimulants. Some people may not tolerate the treatment well,

adverse effects may cause concern, lack of response to the medication, or specific comorbidities

may suggest other medical treatment options. The second line of medication is less effective than

stimulates, non-stimulates. Atomoxetine (ATX), guanfacine (GFC), and clonidine (CLO) are all

common non-stimulate medication treatments. ATX is the most important and the most effective

of the three. It showed a more significant decrease in ADHD symptoms without worsening

symptoms of comorbid disorders, which at times also helps reduce those symptoms. CLO and

GFC both have shown a moderate decrease in ADHD symptoms and have shown some adverse

effects. Both are also seen as add-on treatments to psychostimulants rather than stand-alone

treatments.

If there is a second line of treatment available to people with ADHD, there has to be a

third and a fourth as well. Bupropion is an antidepressant that has been studied to treat children,

adolescents, and adults with ADHD. The effect of bupropion was small to moderate and was

similar/lower than that of ATX. It isn't the most recommended suggestion for treating ADHD for

its lack of evidence/studies to support the effectiveness of antidepressants. Still, more studies are

being conducted to produce more information on the efficacy of different types of medication for

ADHD. Modafinil is another emerging medical treatment that is being studied and has been
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shown to also have moderate effects on decreasing ADHD symptoms. Yet, it continues to be

studied due to its terrible adverse effects of insomnia, decreased appetite, and skin reactions.

Drugs being developed at the moment continue to focus on targeting increased levels of

dopamine and norepinephrine. More work is being done to increase drug medication's half-life.

Unfortunately, no significant revolution should be expected for new resources for drugs for

ADHD.

Although stimulates are the most effective pharmacological treatment, all

pharmacological treatments are more effective at treating ADHD than nonpharmacological

treatments. Evidence on all types of nonpharmacological treatments is complex and scarce, and

many studies are contradictory. More studies are needed to either refute or prove the overall

function of someone with ADHD being treated with nonpharmacological treatments. That being

said, it is still used and recommended for those with ADHD. Behavioral and psychosocial

treatments are the most common alternative to medication. It is highly suggested as the first line

of treatment, even over medication, to younger children under six and those with minor to

moderate ADHD. It is also an add-on treatment plus medication standard for those with severe

ADHD.

There are many other nonpharmacological treatments, like cognitive training, which aims

to improve attention, inhibitory control, and working memory in people with ADHD. The

training is done through programs on a device similar to video games. Neurofeedback is another

treatment for ADHD “to improve self-control over brain activity patterns, which is most often

monitored through simultaneously collected electroencephalogram (EEG) data” (Caye). ADHD

patients would work on a task or a game while measuring EEG activity. It is said that those with

ADHD show distinct patterns of EEG activity. Both types of treatment do not have enough
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evidence to support their effectiveness. As of now, there is no reduction of symptoms or increase

in functional outcomes using these treatments, but these continue to be studied.

More options for nonpharmacological treatments are being tested for ADHD as well.

Coaching programs are created to help those cope with the environmental demands of

prioritizing, time management, and effort sustainment. “The Supporting Teens’ Autonomy Daily

(STAND) program targets adolescents with ADHD and uses motivational interviewing to

enhance adherence” (Caye) is another promising treatment for ADHD and has shown good

outcomes for those with ADHD. Even Mindfulness therapy is being studied as it is associated

with the deficits of ADHD. These are still being studied, and more well-designed experiments

are needed to further advance the understanding of treatments for ADHD of both kinds.

The cost of research couldn’t be identified, but it can be assumed that the cost of research

and studies of treatments to understand ADHD more is costly. Much research is conducted

regularly in different areas of ADHD, and many of them happen to have inconclusive outcomes

that require more time and money. Also, it can be assumed that research is expensive due to the

actual cost of treating a patient with ADHD. Medical cost for ADHD is unmatched compared to

other diseases. It is considered to be higher “due to increased use of hospitalizations, primary

care office vis- its, outpatient mental health visits and the pharmacy fills.”(Matza) To show some

perspective, MPH is the most cost-effective treatment for children with ADHD. “The cost per

QALY gained in the Gilmore and Milne study ranged from $15,509 to $19,281 when considering

the short-and medium-term benefits of MPH.” (Matza) and doesn't consider the cost of added

treatments, issues with comorbidities, work loss, family, etc.

Families with children who have ADHD have a lot to consider when their child is first

diagnosed. The cost of treatment for ADHD can impact a family financially. Many times ADHD
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requires frequent and consistent treatment, which means time needs to be taken out of one's day

for doctor, hospital, or therapy visits. Parents might need to take time off work and students

might have to skip school. ADHD is hard for those who have it, but those who are around

someone with ADHD can be impacted by their odd behavior or inattention. Many times it can

require adjustment to help them out, which requires more patients. Teachers might need to learn

to accommodate lessons and assignments. If ADHD progresses into adulthood, keeping and

forming relationships can be hard. Finding and keeping a job can be ten times more difficult than

it needs to be. Parents are the ones who struggle the most and who will worry the most for their

children with ADHD.

Having done extensive research on ADHD, it has come to my attention that work still

needs to be done to further understand ADHD. So many studies have inconclusive conclusions

that it's hard to identify what actually works to help treat ADHD. On top of that, the cause of

ADHD is still a mystery, and the idea that other diseases can contribute to or be involved with

ADHD makes it much more difficult to really grasp the disease. It's good to know that the

awareness of ADHD is more prevalent and more than ever before. It's being acknowledged for

what it is. The contribution and the work that has been done are still relevant and useful because

although there is no long-term treatment, it's enough to help those with ADHD manage such a

burden disease.
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Works Cited

ADHD: Out of Control Kids (Medical/Parenting Documentary) [Video file]. (2017, September

25). Retrieved December 4, 2022, from

https://www.youtube.com/watch?v=yRYl9Bf0yhs&t=1306s

Caye, A., Swanson, J., Coghill, D., & Rohde, L. (2019). Treatment strategies for ADHD: An

evidence-based guide to select optimal treatment. Molecular Psychiatry, 24(3), 390-408

Matza, L. S., Paramore, C., & Prasad, M. (2005). A review of the economic burden of ADHD.

Cost effectiveness and resource allocation : C/E, 3, 5.

https://doi.org/10.1186/1478-7547-3-5

More fire than water: A short history of ADHD. (2018, October 23). Retrieved November 29,

2022, from https://chadd.org/adhd-weekly/more-fire-than-water-a-short-history-of-adhd/

Tarver, J., Daley, D., & Sayal, K. (2014). Attention-deficit hyperactivity disorder (ADHD): an

updated review of the essential facts. Child: care, health and development, 40(6),

762–774. https://doi.org/10.1111/cch.12139
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