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The Elusive Disorder

In 1997, CNN published an article that told the story of a nine-year-old boy named Eric Courington (Rowland, 1997). Eric was having trouble paying attention in school, which raised the concern of his parents. When a teacher mentioned that Eric might have ADHD (Attention Deficit/Hyperactivity Disorder), the boy’s parents immediately took him to a pediatrician who prescribed amphetamines or “stimulants” (Rowland, 1997). Although Eric was struggling with inattentiveness, his grades were mostly A’s and B’s (Rowland, 1997). This fact led Eric’s parents to seek a second opinion. Eric’s mother brought the boy to Dr. Hodgens and pediatrician Dr. Ditza Zachor. Both doctors examined Eric and the reasons why he was given Ritalin (a strong drug used to treat ADHD) (Rowland, 1997). After a series of neurological, education, and behavioral tests the doctors found that Eric had been misdiagnosed (Rowland, 1997). Dr. Hodgens concluded that Eric did not have ADHD, but was simply inattentive in school because of his personal learning style. Eric’s condition cleared considerably after the doctors eliminated his prescription use and urged Eric’s teachers to better assist him in school. Unfortunately, Eric is not the only child to be wrongly diagnosed with ADHD. Although ADHD is a very real and serious disorder, determining whether a person has it can be a tricky process. Investigating the origins of ADHD will reveal why this disorder has surfaced in recent years, why it is so difficult to diagnose, and the importance of differentiating between ADHD symptoms and normal, childish behavior.

To explain why it has taken doctors such a long time to identify ADHD, one must look at the disorder’s past. Evidence of ADHD symptoms can be found as early as 1902 when George Still M.D. lectured on the “lack of moral control among children without notable physical impairments” (Rowland, Lesesne, &Abramowitz, 2002). The elusive ADHD disorder has been given many names throughout history, such as: minimal brain damage syndrome, minimal brain dysfunction, hyperkinetic reaction of childhood, and attention deficit disorder (Rowland, Lesesne, & Abramowitz, 2002). Early efforts to connect ADHD with brain dysfunction were the result of the encephalitis epidemic of 1917–1918 (Rowland, Lesesne, & Abramowitz, 2002). Those who survived experienced a lingering effect of hyperactivity after the illness. At first, many hoped that this hyperactive trait would unify the vague idea of an attention-deficit/hyperactivity disorder. Time has proved this hope to be false. Many years of research have failed to reveal one specific cause or “core deficit” of ADHD (Rowland, Lesesne, & Abramowitz, 2002). What has been discovered is that ADHD is a complex disorder containing a heterogeneous mix of symptoms. These symptoms resemble normal childish behavior such as laziness, inattention, and social awkwardness but in a more excessive, exaggerated form. From 1987-1994, the Diagnostic and Statistical Manual for Mental Disorders (DSM-III-R and DSM-IV) was able to separate ADHD’s many symptoms into three general subtypes: primarily inattentive, primarily hyperactive and impulsive, and a combined category for those who are both inattentive and impulsive/hyperactive (Rowland, Lesesne, & Abramowitz, 2002). In addition to “organizing ADHD” epidemiologists also realized that ADHD symptoms may be indications of other, underlying disorders (Laver-Bradbury, 2011). In her article, Detection, assessment, and diagnosis of ADHD, Cathy Laver-Bradbury states that people with ADHD may also battle co-morbid mental health issues such as: depression, anxiety, tic disorders, and social communication difficulties (2011). Therefore, doctors not only struggle with separating ADHD symptoms from normal behavior, but they also must determine whether they are dealing with an ADHD disorder at all! Complications such as these have kept ADHD a medical mystery for many years.

Advancement in medical research has helped detect and organize the symptoms and implications of ADHD. One of the biggest consequences of the ADHD disorder is that it hinders children/young adults from progressing socially and academically. Since cooperation and scholastic achievement is necessary for success, parents/caregivers are encouraged to notice ADHD symptoms early in a child’s development. This increased awareness of ADHD has been a major factor in the increase of ADHD diagnoses. The CNN article, ADHD may be over diagnosed, states that 6% of the school-age U.S. population is diagnosed with ADHD and nearly 90% of ADHD patients take the stimulating drug Ritalin (Rowland & Salvatore, 1999). However, recent stories reveal that not every person diagnosed with ADHD actually has the disorder. People like young Eric Courington may be dealing with symptoms that resemble ADHD, but are actually the effects of a different issue. How can one know the difference? According to the article, “The Epidemiology of Attention-Deficit/Hyperactivity Disorder (ADHD): a Public Health View,” ADHD symptoms are considered significant “only if they are in excess of what would be expected of a child of the same age and cognitive level (2002).” This article also emphasizes the importance of a child being observed by his/her parents, caregivers, and teachers. To simplify the matter for a child’s caregivers, Cathy Laver-Bradbury outlines nine telltale difficulties of children likely to have ADHD. First, ADHD patients have executive function difficulties. Executive functions respond to the frontal cortex of the brain which is involved with executive tasks like connecting past and present events to make future decisions (Laver-Bradbury, 2011). The second and third difficulties include delay aversion and timing. Delay aversion/timing refers to waiting for the appropriate moment to act or speak (Laver-Bradbury, 2011). Motivational problems are the fifth criterion. ADHD patients often struggle to respond positively to rewards or gifts (Laver-Bradbury, 2011). The sixth criterion is conduct disorder. Children and adolescents with ADHD become disruptive, oppositional, and may cause people to think they are purposely annoying others (Laver-Bradbury, 2011). Learning disabilities and mental health is the seventh and eighth criterion. People with ADHD usually have other learning disabilities like dyslexia, dyscalculia or dysgraphia, and may battle co-morbid mental disorders such as depression or anxiety (Laver-Bradbury, 2011). Finally, it is hard for ADHD patients to maintain healthy social communication and friendships (Laver-Bradbury, 2011). After parents and teachers have confirmed these nine criteria, it is vital that the ADHD candidate visit a clinical specialist who has a thorough knowledge of the Diagnostic and Statistical Manual for Mental Disorders (DSM-III-R and DSM-IV). Comment by Instructor Jim: Articles are put in quotation marks, the name of the journal or book it came from would be italicized

It may not be easy to diagnose ADHD, but the effort is well worth it. A person that is properly diagnosed will be given useful treatments instead of unnecessary ADHD medication. In fact, CNN writer Louis Schiavone reported that in the year 1997 alone over 3.5 million prescriptions were given for ADHD (Schiavone, 1998). People diagnosed with this disorder are put on stimulants that boost the central nervous system (Rowland & Salvatore, 1999). The purpose of these stimulants is to assist the brain’s ability to control reckless behavior and focus on the tasks at hand (Rowland & Salvatore, 1999). Ritalin is used by 90% of ADHD patients and is one of the top two drugs prescribed for the disorder’s symptoms (Rowland & Salvatore, 1999). The debate over whether Ritalin is safe for children has surfaced in recent years due to the drug’s comparison to cocaine. Author Dr. Mary Ann Block explains that Ritalin and cocaine have similar affects on the brain’s receptor functions (Rowland & Salvatore, 1999). Despite these findings, medical experts are confident that ADHD medication is safe to use if applied appropriately and with regards to a patient’s personal needs (Rowland & Salvatore, 1999). This state of affairs makes the process of diagnosing ADHD extremely important. If a child or young adult is misdiagnosed, that person may be in danger of overdosing on a strong drug like Ritalin (Rowland, 1997).

In the final analysis, ADHD diagnosis has increased over the years because of its diverse definitions, subtypes, and symptoms which have often revealed various underlying disorders. ADHD is not the definition of a singular disorder. Rather, it is a collection of heterogeneous symptoms that are categorized by subtypes and individual experience. ADHD has remained an ‘elusive mystery’ for many years but medical experts have finally realized its complex definition and are searching for methods to treat the disorder. Due to controversial drugs such as Ritalin, it is of paramount importance that patients receive an accurate diagnosis of their problematic symptoms. With careful observation and advice, potential ADHD patients will be able to receive the care they deserve to live a successful life.

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