ADHD: A Comprehensive Overview PDF

[Attention-deficit hyperactivity disorder.] Attention-deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that affects individuals across their lifespan (Poulton, 2021). It is characterised by patterns of inattention, hyperactivity, and impulsivity, which can negatively impact a...

[Attention-deficit hyperactivity disorder.] Attention-deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that affects individuals across their lifespan (Poulton, 2021). It is characterised by patterns of inattention, hyperactivity, and impulsivity, which can negatively impact a child's academic performance, social interactions, and overall well-being (Faraone, 2021). Various theories explain the underlying causes and mechanisms of ADHD, including the biological, environmental, and psychosocial perspectives (Amnie, 2022). Understanding the theories surrounding ADHD is essential for educators to effectively support children in the classroom and inform their approaches to teaching and intervention strategies (Ward, Kovshoff and Kreppner, 2021). According to Pan and Yeh (2017), for children with ADHD, effects can last throughout their lives, it has been linked to underachievement in school, poor mental health, and a lower quality of life as an adult. Driga and Drigas (2019) argue, the exact cause of ADHD is not fully understood, although Altable (2023) suggest, it is influenced by a combination of genetic, neurobiological, and environmental factors. Studies have shown that there is a hereditary component of ADHD, with a likelihood of having ADHD if a close family member has the disorder (Kranz and Grimm, 2023). Mehta et al., (2019) further states, neurobiologically, ADHD has been associated with differences in brain structure and function, particularly in areas in attention, impulse control, and executive functions. According to Yusuf Ali et al., (2022), environmental factors, such as prenatal substance exposure, low birth weight, and early childhood trauma, have also been implicated in the development of ADHD. Similarly, Oudin et al., (2019) states, maternal smoking, exposure to environmental toxins, and certain prenatal and perinatal complications may also contribute to an increased risk of ADHD. The understanding of ADHD has undergone changes over time, with historical perspectives on the condition experiencing various shifts (Wolraich et al., 2019). In the early twentieth century, Still and Lond (1902), described a condition, that according to their research, stemmed from a lack of moral integrity, and made observations that the condition showed itself in recurring patterns of behaviours, which included being agitated, distracted, and overexcited. More recently, Romeo (2021) suggested, historically, ADHD-like symptoms were often attributed to moral deficiencies or poor self-control, thus, children were deemed to be morally defective, or insane, and had most certainly suffered a brain injury. The term was changed to be more behaviourally descriptive, as it became clear that brain injury was not the primary cause of ADHD (Mills, 2022). In 1968, the Diagnostic and Statistical handbook of Mental illnesses (DSM) was updated to reflect the alteration, and the new name for the illness was Hyperkinetic Reaction of Childhood Disorder (Prakash et al., 2021). However, following another review in 1987, the DSM revised the terminology and replaced it with Attention-Deficit Disorder (ADD) and ADHD, the term ADD referred to children with inattentive symptoms without hyperactivity, and ADHD referred to the type with hyperactivity (Sklepnikova and Slezackova, 2023). ADHD was often misunderstood or misdiagnosed, as there was a lack of awareness and specialised services, however, since the 1990's, there has been an increased recognition of ADHD as a legitimate neurodevelopmental disorder (Evans, 2021). Over time, further changes were made to the diagnostic criteria, and three types of ADHD were introduced, predominantly inattentive, predominantly hyperactive-impulsive, and a combined type (de la Peña et al., 2020). However, in the current edition of the DSM, these types were eliminated, and ADHD is now classified as a single disorder with different presentations of symptoms (Posner, Polanczyk and Sonuga-Barke, 2020). Sedgwick-Müller et al., (2022) states the DSM and the International Classification of Diseases version 11 (ICD-11), are the two commonly used handbooks for diagnosing mental illnesses and contain the diagnostic criteria for ADHD. According to the National Institute for Health and Care Excellence (NICE) (2019), in order to establish a diagnosis of ADHD, it is necessary for individuals to show symptoms of hyperactivity/impulsivity and/or inattention that align with the diagnostic criteria outlined in the DSM or ICD-11. Jerome and Jerome (2020) suggest, symptoms of ADHD must be frequent, and occur in at least two important settings, and have persisted for at least six months. Cabral, Liu, and Soares (2020) indicate, several symptoms of ADHD must have been present before the age of twelve, and negatively impact their social or academic functioning. When diagnosing ADHD, it is essential for a healthcare professional to conduct a comprehensive evaluation, gathering information from various sources, such as, parents, teachers, and the child themselves (Kruger, 2023). Furthermore, the evaluation may include interviews, questionnaires, behavioural assessments, and a thorough medical and psychiatric history review (Waltereit et al., 2019). However, behaviour has the potential to change over time or manifest differently in different situations (Young et al., 2020). Therefore, Kazda et al., (2021) suggest, this makes medical diagnosis less reliable, because doctors have to decide for themselves if the child\'s actions seriously affect their ability to function enough to warrant a diagnosis. Firouzabadi et al., (2021) identifies, symptoms of inattention can include failure to pay attention or making careless mistakes, difficulty listening, difficulty organising tasks, or being easily distracted. Barkley's (1997) executive functioning theory suggests, individuals with ADHD may have differences in the development and functioning of the prefrontal cortex, contributing to difficulties in completing tasks, impulse control, and following instructions. Barkley's theory further emphasises the role of executive functioning deficits in ADHD, and highlights their impact on daily functioning, academic performance, social interactions, and overall quality of life, suggesting ADHD is a disorder of self-regulation due to lack of these executive functions (Barkley, 2012). To support children with ADHD, Barkley's theory further suggests, interventions should target support through behavioural, or cognitive interventions (Akiflow, 2023). For example, establishing a routine, using visual reminders, taking breaks, and breaking down tasks into smaller manageable steps to make it more approachable (Levrini, 2023). Furthermore, setting clear goals and objectives to maintain focus and minimise distractions as much as possible, use noise cancelling headphones, if necessary, as creating a distraction free environment could enhance concentration. Piaget's (1971) cognitive theory aligns with Barkley\'s theory, since it emphasises the significance of a structured environment that facilitates children\'s learning and growth. In contrast, Sweller's (1988) Cognitive-Emotional Load Theory identifies, individuals with ADHD struggle to successfully regulate their emotions, because they lack the cognitive resources necessary to handle both cognitive and emotional tasks. Therefore, emotional dysregulation may manifest as impulsivity or a lack of ability to control emotional reactions (Lavigne-Cerván et al., 2022). According to Greenway, Robinson, and King (2023), symptoms of hyperactivity may include, fidgeting, difficulty engaging in activities quietly, interrupting, or blurting out answers in class. As a result, a combination of the emotional dysregulation, impulsivity, and the difficulty of controlling emotional reactions, can create challenges in all aspects of a child's life who has ADHD, including school and relationships. According to O'Connor and McNicholas (2020), children diagnosed with ADHD have an increased chance of being excluded from school, compared to their non-ADHD peers. Consequently, Arnez and Condry (2021) state, the social consequences associated with being excluded, can be associated with antisocial and criminal activities, further outlining how a significant proportion of individuals who have been imprisoned had experienced exclusion from school.  While it would be inaccurate to say that ADHD is equivalent to antisocial behaviour, school exclusion has been highlighted as a risk factor for antisocial behaviour, and this has been acknowledged by the government in the current Severe Violence Strategy report (Home Office, 2018). Therefore, Cecil and Nigg (2022) would argue, early intervention and diagnosis of ADHD, play a critical role in addressing the challenges associated with the disorder. Children with ADHD often struggle with attention, impulse control, and concentration, leading to academic failure (Ewe, 2019). Research indicates that early intervention allows for implementation of appropriate strategies to support the child's learning needs (NSPCC, 2023). Thus, highlighting the importance of the educator in supporting children with ADHD, and providing a supportive and inclusive learning environment (Welsh Government, 2019). For that reason, Mohammed Taresh et al. (2020) suggests, educators should be vigilant in identifying potential signs of ADHD and provide a structured and organised classroom to help them thrive. Furthermore, it is important to recognise children with ADHD have varied learning styles and strengths, and educators should alter teaching methods and activities to meet the needs of the child (Frolli et al., 2023). However, a study by Ward, Kovshoff and Kreppner (2021) highlighted, to enhance their understanding of ADHD and effective teaching strategies, educators should pursue ongoing professional development opportunities, as this can help to stay updated on the latest research, interventions, and classroom management techniques. Nevertheless, according to ADHD UK (2017), 63% of teachers state they have not received training, or have the support for children who present with ADHD symptoms, yet, Ward, Kovshoff and Kreppner (2021) argue, teachers play a significant role in identifying and addressing ADHD-related issues, and are often seen as a reliable source for recognising when a child may be experiencing difficulties associated with ADHD. Children with ADHD often struggle with social interaction, following social cues, maintaining friendships, and managing emotions (Kouvava et al., 2021). Leavell et al., (2019) suggests, social skills training, behavioural interventions, and counselling to address these difficulties would be beneficial, consequently, helping children develop healthier social relationships and improve their well-being. Untreated ADHD can lead to the development of other mental health disorders, such as anxiety and depression, and they may be more prone to risky behaviours (Young and Cocallis, 2021). These comorbid conditions can further exacerbate the challenges faced by individuals with ADHD, leading to a higher risk of symptoms and difficulties functioning daily, therefore, highlighting the importance of early intervention (Young et al., 2020). Likewise, ADHD Aware (2023) states, ADHD is known to coexist with other mental health conditions, such as, anxiety, depression, and post-traumatic stress disorder. Faraone and Larsson (2019) suggest, ADHD is shown to run in families and genetic factors may contribute to the development of ADHD. Kian, Samieefar and Rezaei (2022) argue, environmental factors such as, maternal substance abuse, low birth weight, or maternal smoking, can interact with genetic factors and increase the risk of developing ADHD. Uddin et al., (2020) further suggests, exposure to Adverse Childhood Experiences (ACE), such as abuse, socioeconomic stress, and family dysfunction could increase the risk of a child developing ADHD. Thus, ACE's can have a significant effect on the development of the brain that involves attention, impulse control, and emotional regulation, which are all symptoms of ADHD (Lugo‐Candelas et al., 2020). According to Ogundele (2018), children are more likely to have ADHD, in addition to other issues, if they have experienced ACE's. The medical model is a key component of the diagnosis, treatment and understanding of ADHD, it emphasises the role of biological factors, such as genetics and neurochemical imbalances in the diagnosis of ADHD (Aktan and Yarar, 2014). However, Kistler (2022) argues, the social model of ADHD emphasises the social and environment factors that contribute to the symptoms, and it recognises that individuals with ADHD face challenges due to social expectations, educational settings, and socials situations. Alternatively, Nilsson Sjöberg (2019) argue, the diagnosis of ADHD may be viewed as an infringement on a child's self-expression and identity, impacting their ability to learn and understand things. Further arguing, the diagnosis is based on fundamental beliefs that are influenced by society about the appropriate behaviour and traits of children. Armstrong (2005) states, ADHD traits, such as high energy levels, creativity and attention seeking, can be assets in the right context, and emphasises the need for a supportive and inclusive environment. Ten et al., (2020) argues, the use of medication can be effective in managing the symptoms for some children. Furthermore, medication can help children improve their ability to focus, concentrate and control impulsive behaviour, thus, leading to better academic achievement and social interactions (NHS, 2021). Although, medication can be seen as an affective way of treating ADHD, there are many opposing views on the subject. According to Pozzi et al., (2020), there are many side effects from the medication, such as, decreased appetite, trouble sleeping, irritability, and headaches. Nazarova et al., (2022) states, medication is often used as a first-line treatment without exploring alternative interventions. Research by Risley et al., (2020) suggests, therapy such as behavioural therapy, parent classes, and educational accommodations can be effective in managing ADHD symptoms. Historically, the legislation which referred to children and young people who required extra help and support due to learning difficulties or disability, was known as Special Educational Needs (SEN) (Gov.UK, 2012). However, the Additional Learning Needs and Educational Tribunal (Wales) Act 2018 (ALNET), was introduced in Wales in 2018, this framework aimed to improve support for learners by implementing a more inclusive and person-centred approach (Welsh Government, 2021). According to Demetriou (2020), SEN was seen by some individuals as focusing on the difficulties and potentially labelling the child in a negative way. Knight and Crick (2021) state, the term Additional Learning Needs (ALN), aimed to focus on the additional support and opportunities that the child requires, focusing on strengths and individual needs. The ALN system centred around identifying and addressing the individual learning needs of children and young people, from birth to twenty-five, and aimed to provide a seamless and coordinated approach to support, involving parents, the child themselves, and professionals working together (Welsh Government, 2021a). A multi-agency approach allows professionals from different fields to provide a holistic strategy for care and support. A study by Jessiman et al. (2022) found, a holistic approach incorporates not only the teaching of health as part of the curriculum, but also the promotion of a healthy environment inside the school, and the involvement of families and the community, as they play a vital role in promoting and maintaining the mental health of children and young people. A report by Ofsted (2021) outlined, consistency across different environments can make a significant difference in managing ADHD symptoms and promoting positive behaviour. By working together, it can help identify and address issues early, for example, practitioners may notice changes in a child's behaviour or academic performance that may not be evident to health professionals (Welsh Government, 2021). Social Care Institute for Excellence (2023) suggests, a multidisciplinary team can combine their expertise and perspectives to develop a comprehensive plan to address all aspects of the child's life. Parsons et al., (2021) agrees, stating a holistic approach recognises each child is unique and requires an individualised plan, which is specific to the child, emphasising a collaboration among professionals, parents, and caregivers involved in the child's life. Learners with ALN are entitled to an Individual Development Plan (IDP), which outlines the child's needs and the support required to achieve their goals (Ware, 2019). IDP's are a personalised plan outlining specific learning goals, objectives, and strategies for a child, they are developed collaboratively between the child, their parents, and the Additional Learning Needs Co-Ordinator (ALNCO) (Welsh Government, 2020). NICE (2021), provides evidence-based guidelines for the management and treatment of various health conditions, including ADHD, and explains how children should be involved in decisions around their healthcare, particularly when it comes to treatment which directly affect them. The recommendations came from the United Nations Convention on the Rights of the Child (UNCRC) (2023), specifically Article twelve, which outlines the right for children to be involved in the decision-making process. Additionally, Article twenty-four of the UNCRC, recognises the right of the child to receive the highest standard of health, which includes access to appropriate healthcare services and treatment (UNCRC, 2023). It is evident that children with ADHD require a comprehensive and multi-faceted approach to support their academic, social, and emotional development. Educators play a vital role in creating an inclusive and supporting learning environment by implementing strategies that address the challenges faced by them. For example, breaking down tasks into smaller steps, provide visual aids, and establishing routines can help children with ADHD remain focused. By understanding theories, having open lines of communication, and multi-agency working are seen as essential in supporting the child's needs across the different settings. Historical perspectives of ADHD have undergone significant shifts over time, from early observations and moral judgements to the recognition of ADHD as a legitimate clinical condition. Controversies and debates surrounding ADHD exist, with discussions on overdiagnosis, medication usage, and the role of social and environmental factors. 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