1. Attention Deficit Hyperactivity Disorder
Dr. Mazher
Andre Aina
SPED 730

2. The distinctive characteristicsof childrenandadolescentswithattentiondeficithyperactivity
disorder(ADHD) are excessive motoractivity,inattention,andimpulsiveness.The conceptof ADHD is
relativelynewbut,the symptomsof inattention,hyperactivity,andimpulsivityhave previouslybeen
describedbyseveral authorsduringthe last200 years.Thispaper will systematicallydetail the historyof
the discoveryof ADHD,howchildrenmayinheritordevelopADHD,methodsof treatment,cognitive
impairments,ADHDinrelationtofamilyfunctioning,disproportionsinADHDdiagnosisandthe impact
on social maintenance throughexplorationof scientificallybasedstudies.
The firstexample of adisorderthatappearsto be similartoADHD wasgivenbySir Alexander
Crichtonin1798. KnowinglyorunknowinglyCrichtonoriginatedthe observable characteristicsforwhat
we nowknowas attentiondeficithyperactivitydisorder,he explainsthat“Whenborn witha personit
becomesevidentata veryearlyperiodof life andhasa verybad effect,inasmuchasitrendershim
incapable of attendingwithconstancytoanyone objectof education.”Several othernotable pioneer
contributingtoADHD researchare mentionedsuchasGermanphysiciansFranzKramerand Hans
Pollnowwhose earlydescriptionsactinaccordance withthe secondmainsymptomof ADHD,
inattention.The DSM-IV-TRportrayschildrenwithADHDasbeingeasilydistractedresultingindifficulty
sustainingattentionintasks.In1994, was it foundthatchildrenwithADDwithouthyperactivitydiffered
fromchildrenwithADDwithhyperactivity.Itwasalsofinallyacknowledgedinthe 1990s that ADHD was
not entirelyajuveniledisorder,whichdisappearedwithage aswaspreviouslythought,butratheran
enduring, persistentdisorderremainingintoadulthoodinmanycases.Thisarticle bringstolightthe fact
that ADHD isa fairlynewlyunderstoodcognitive disorder.ResearchinADHDisfar from thorough;there
are manyquestionstobe answeredandrocksto be over-turned.

3. As of late researchintothe etiologyof ADHDhas beenonthe upswing.A narrative review
focusesonthe originsof ADHD thru literature inthe last15 years. AninheritedcontributiontoADHD
has beenuniversallyidentified.ADHDlike otherpsychiatricanddevelopmental disorderstendstorunin
families.But,highheritabilityestimatesdonotrule outthe influence of environmental risks.The most
importantenvironmentalriskfactorsforpsychopathology,includingADHDandits secondaryadverse
consequences,are likelytobe affectedbygeneticallyinfluencedparental andchilddispositions;for
example,prenatalexposure tomaternal cigarettesmokingorpeerrejectionserveasexamplesof gene-
environmental correlation)Therefore,the connectionof environmental riskswithADHDmightemerge
completelyorpartlythroughinheritedconfoundsandgeneticrisksmightoperate onpresent
phenotypesthroughenvironmental means.Manydifferentenvironmentalfactorshave beenreportedly
associatedwith ADHD,butit has beendifficulttoidentifywhichare causal.
Thoughthere are manytheoriesandexplanationsforthe occurrence of ADHD,there seemtobe
onlytwomethodsof treatment.The twomethodsof treatmentobserve tobe effectiveare medication
therapyand behavioral therapy.
A studyobservedthe long-termeffectsof the twotreatmentsmedicationtherapyand
behavioral therapyforADHD.Theyuseda groupof 579 childrenwithADHDcombinedtype,ages7-9.9
yearsold,ingrades1 through4. Students were assignedto14 monthsof medicationmanagementwith
monthlycheck-ins,intensive behavioral treatment,the twotreatmentscombined;forstandard
communitycare throughcommunityproviders.Behavioral treatmentsincludedparenttraining,child-
focusedtreatment,andaschool-basedinterventionorganizedandintegratedwiththe school year.Six
majoroutcome domainswere identified.Withindomains,the measuresloadinghighestfromeach
informantwere selected:(1) ADHD(2) oppositional/aggressivesymptoms(3) social skills;(4)
internalizingsymptoms(anxietyanddepression)(5) parent-child(6) academicachievement.Resultsof
thisstudydemonstratedthe advantage of medicationmanagementoverbehavioral treatmentfor

4. ADHD. Combinedbehavioralinterventionandstimulantmedication—multimodaltreatment,the current
criterionstandardforADHD interventions—yieldednosignificantlygreaterbenefitsthanmedication
managementforcore ADHD symptoms.Thisbringsintoquestionwhetherbehavioral treatmentsare
necessaryif medical treatmentsare alsosimultaneouslybeingimplemented?
One of the core issuesforchildrenandadolescentscopingwithADHDinregardsto academic
achievementstemfromdeficitsinworkingmemoryandexecutive functioning.Researchershave
exploreddeeplyintothe workingsof theseprocessesinchildrenwithADHD.
A studysuggeststhatpeople withADHD,alsoexperience impairmentsinworkingmemoryand
executivefunctioning.A groupconsistedof 81 participants(44 malesand37 females),aged8to 16
years.In all,45 childrenwere diagnosedwithADHD-I(primarilyInattentive),36 withADHD-C(Combine
type).None of the participantshadeverbeenmedicatedwithstimulants.The Control group(n= 50)
consistedof 32 malesand 18 females,withanage range from8 yearsto 17 years.All participants
underwentacomprehensiveneuropsychological testbatteryinadditiontothe learningandmemory
tests.
The main findinginthe presentstudyisthatlearninganddelayedmemoryprocessesare
compromisedinchildrenandadolescentswithcombinedandinattentivesubtypesof ADHD.Acquisition
or encodingisthe mainproblemforthe ADHD group,as thisdeficitcausesdeficitsincritical encoding
stagesinthe learningprocessand,asa result,the participantswere notable torememberitems
because thattheydidnot properlyencode theminthe firstplace.Resultsalsoeludetoa more
persistentimpairmentinlearninganddelayedmemoryinthe ADHD-Igroupcomparedtothe ADHD-C
group.The study indicatesthatemphasismustbe putonthe acquisitionphase andonnotonly

5. observable inattentionbutalsohowpupilswhoare seeminglyattentive organize andencode new
information.
An importantfactorfor childrenwithADHDisthe amountof familyinvolvementinassistingthe
childaddressdifficultiesaswell asthe familieswillingnesstocooperate withthe child'sschool to
promote academicsuccess.
Thisstudyobservesthe elementsof familyinvolvementandfamilySchoolinteractionsfor
childrenwithADHD.The studentsinvolvedinthisstudywere enrolledingrades2 - 6 and metthe
criteriaforADHD, combinedtype orinattentivetype.TwodifferentFamilyengagementprogramswere
introducedtofamilies.The firstbeingFamily - School Success(FSS).Thisbeinganactual real program
addressesbuildingafamily - school partnershipsthroughthe use of behavioral consultationand
promotingfamilyinvolvementineducationsystematichomeworkinterventions.The secondprogram
developedwasusedforthe sole purpose of acontrol for non - specificeffectsof anintervention.
The resultsconfirmedthe value of behavioral interventiondesignedtoimprove child
functioningathome andschool.The resultsexhibitedasignificantimprovementinhome - work
performance anda decline innegative/ineffective parenting.The studyalsodemonstratesthatfamily-
school interventionforchildrenwithADHDcanimprove the qualityof a parent - teacherrelationship.
Sometimespromotingfamilyinvolvementismore difficultthanitseemsdue tothe parents
havingdifficultiesof theirown.Because there'sahighcorrelationwiththe parentsof childrenwith
ADHD alsoto have the disorder;parentswithADHDmay finditdifficulttocope withachildwithADHD
furtherstressingthe situation.
FamilystudiessupportthatachildwithADHD ismore likelytohave a parentwithADHD.A
studydescribesandinvestigatesfamilycharacteristicsinrelationtosupportthe behaviorof achildand

6. the parent'sperspective onfamilieswithachildwithADHD.A simple,of randomlyselected354mothers
and 194 fatherswas used. Data wascollectedwiththe use of Surveysandquestionnaires.
Resultsconveyedthatparentsandfamilies;where childrenweremedicatedforADHDwere
more satisfiedwithsocial supportandintegrationinsocial networktheyalsorelatedtheirchild's
behavioraslessproblematicandreported,betterfamilyfunctioningthanfamiliesof childrenfor-go
medication.ParentswithADHDthemselveswere the mostvulnerable astheyhada low sense of
coherence andpoorfamilyfunctioningthanparentswithoutADHD.Familieswithchildrenmedicatedfor
ADHD reportedlessbehavioral problemsbetterfamilyfunctioningandmore social supports.
Diagnosisdisproportionsisawell-knownproblemwithinspecial educationinmostcases
minoritiestendtobe identifiedashavinglearningdisabilitiesata higherfrequencythanwhite students.
But for ADHD,in particular,thiseffectseemstobe reversed.
Thisstudyinvestigatesracial disproportionsinADHDdiagnosisduringentryintoelementary
school;kindergarten.6,550childrenwere involvedinthisstudy,(childrenwithandwithoutanADHD)
diagnosisat60 months. The datasetincludesbirthcertificate information,aswell asparent interviews
and directassessmentsof children’scognitive,academic,behavioral,andphysical functioningat9, 24,
48, and 60 monthsof age. The measuresinthisstudyincludedADHDdiagnosisandmedicationuse
socio-economiccharacteristics,birthcharacteristics,vocabularyknowledge,cognitive functioning,family
historyof mental illness,limitedaccesstohealthcare,andnone Englishasprimarylanguage athome.
Withinthispopulation,2.4%of childrenreceivedanADHDdiagnosisbysix months.Resultsconveythat
Black or Hispanicchildrenhave significantlyloweroddsof ADHDdiagnosis. Variablesthatincreasedthe
likelihoodof diagnosisincluded;beingwhite,the child'sbiological fathernotinthe household,and
familyhistoryof mental illness. Resultsalsoindicate thatall those childrenare blackare 80% lesslikely

7. to be diagnosedincomparisontowhite childrenbut,blackchildrenhave asignificantlyhigher
probabilityof displayingADHDsymptoms.
ChildrenwithADHDdon'tonlyhave problems withacademicachievementtheyfinddifficulties
insocial interactionaswell.These childrentendtohave misconceptionsaboutotherssentiments
towardsthemand have a difficultymaintainingpositive relationships.
In thisstudy,the researchersexaminedhow the friendshipsof 87 childrenwithADHDand46
comparisonchildren(76%boysoverall) aged7-13yearschangedovera six monthperiodinOttawa,
Canada.In the firstvisit,childrenwithADHDperceivedlesspositivefeaturesandmore negative
friendshipfeaturesthanotherchildren,andtheywere lesssatisfiedwiththeirfriendshipsoverall.First,
at the 6-monthfollow-up,childrenwithADHDwere more likelythancomparisontonolongerbe friends
withthe childtheyhave broughtinthe firsttime.Theirfriendshipsweremore likelytoendduringthis
interval.Forthose whoreturnedwiththeirfriend,astrikingfindingwasthatthere were clear
differencesinhowchildrenwithADHDandtheirfriendperceivedthe friendship.The friendsof childre n
withADHD reportedlesspositive friendshipqualitythantheyhadsix monthsearlier,andtheir
satisfactionwiththe friendshiphaddeclinedsignificantly. Incontrast,childrenwithADHDreportedno
similardeclineinthe qualityof the friendship.Overtime,the value of relationshipsforchildrenwith
ADHD declined - atleastfromthe perspective of theirfriendswhowere lesssatisfiedwiththe friendship
duringthe secondvisitthantheyhadbeeninitially.ChildrenwithADHDthemselvesdidnotreporta
parallel decline,suggestingthattheydidnotconsistentlypickuponthe dissatisfactionexperiencedby
theirfriend.
There are more than a hundredyearsof researchreportingthe presence of ADHDand
proposinganswersasto the beneficial waystoapproachthe neurobiological disorder.The 21st century
promisesprogressthatwill reconstructthe waypeopleview,diagnose,andtreatADHD.Our

8. understandingof geneticsisgrowingbyleapsandboundsandremarkable advancementsintechnology
will provide more findingsonthe ADHDbrain.Due to thisexplorationwe are now more likelytodiscuss
and researchissuesimportanttoHispanics/Latinos,women,AfricanAmericans,andotherMinority
groups.