Chapter 7: ADHD and Related Behaviour Disorders in Childhood
Summary and Self-Test: ADHD and Behaviour Disorders in Children
Richard Milich; Walter Roberts; and Jorden A. Cummings
Attention-Deficit/Hyperactivity Disorder (ADHD) is the most prevalent childhood psychiatric disorder in Canada, occurring in 3-5% of elementary school children. At least half of these children will continue to experience symptoms in adolescence and adulthood.
Children with ADHD have difficulty exercising self-control, complying with adults’ instructions, and are often labeled as “problem children.”
The practice of diagnosing children’s behaviour problems, including ADHD, is controversial. Many feel that labeling children as disordered is stigmatizing and harmful to children’s self-concept. Some believe that the diagnostic system pathologizes normal childhood behaviour.
The core symptoms of ADHD are organized into two clusters: hyperactivity/impulsivity and inattention. The hyperactive symptoms describe being perpetually in motion even during times when children are expected to sit still. Impulsivity describes a difficulty in delaying response and acting without considering the repercussions of behaviour. Inattentive symptoms describe difficulty with organization and task follow-through, as well as a tendency to be distracted by external stimuli.
Many laypeople and critics argue that ADHD is not a “real” disorder, claiming that children with ADHD are only considered disordered because parents and school officials have trouble managing their behaviour. Several criteria are used to distinguish between normal and disordered behaviour, including the level of impairment the symptoms cause for the child’s functioning in important life domains, and that the symptoms are inappropriate for the child’s developmental level.
Most experts believe that genetic and neurophysiological factors cause the majority of ADHD cases. ADHD is, indeed, primarily a genetic disorder.
Environmental risk factors may cause a minority of ADHD cases. Many of these environmental risk factors increase the risk by disputing early development and compromising the integrity of the central nervous system. Examples include low birth weight, malnutrition, and maternal smoking during pregnancy.
Controversy has surrounded the causes of ADHD, which several causes being proposed that have no grounded in research. These include poor parenting, as well as sugar and food additives. Neither of these have been shown to contribute to ADHD.
Parents can be trained to use contingency management more effectively. Stimulant medications and parenting management are used to treat ADHD. The Multimodal Treatment Study of ADHD found that stimulant medication was the most effective treatment.
Ideas for future consideration within the study of ADHD include controlling access to stimulant medication, as well as the role of neuroscience and behavioral genetics in understanding ADHD.