Overview level of development (American Psychiatric Association,

April 20, 2019 International Studies

Overview
ADHD is a neurobehavioral disorder interferes with a person’s ability to stay on a task and to exercise age-appropriate inhibition (cognitive alone or both cognitive and behavioral). (NIH Medline Plus, 2014) The essential of attention-deficit-hyperactivity disorder (ADHD) is a persistent pattern of inattention, hyperactivity-impulsivity, or both that is more frequent and severe than is typically observed individuals at a comparable level of development (American Psychiatric Association, 1994, P. 78)
ADHD is usually diagnosed in childhood, although the condition can continue into the adult years (NIH Medline Plus, 2014). Basing on the parent-report data regarding U.S children aged 4-17 ever diagnosed with ADHD, the prevalence increased by about 40% between 2003 (7.8%) and 2011 (11.0%). As well, the males had a consistently higher prevalence of ADHD than females from 2003 to 2011 (CDC, 2018). There are three types of ADHD: 1) a predominantly inattentive subtype, 2) a predominantly hyperactive-impulsive subtype, and 2) a combined subtype. (CDC, 2017) The diagnose criteria for ADHD listed in the DSM-VI includes the symptoms of inattentive and hyperactivity-impulsivity listed below (Nielsen, 2008).
Inattentive
Six or more symptoms of inattention for children up to age 16, symptoms of inattention have been present for at least 6 months, and they are inappropriate for developmental level: Hyperactivity and Impulsivity
Six or more symptoms of hyperactivity-impulsivity for children up to age 16, symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for the person’s developmental level:
• Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities
• Often has trouble holding attention on tasks or play activities
• Often does not seem to listen when spoken to directly.
• Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked).
• Often has trouble organizing tasks and activities.
• Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).
• Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
• Is often easily distracted
• Is often forgetful in daily activities. • Often fidgets with or taps hands or feet, or squirms in seat.
• Often leaves the seat in situations when remaining seated is expected.
• Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless).
• Often unable to play or take part in leisure activities quietly.
• Is often “on the go” acting as if “driven by a motor”.
• Often talks excessively.
• Often blurts out an answer before a question has been completed.
• Often has trouble waiting his/her turn.
• Often interrupts or intrudes on others (e.g., butts into conversations or games)

The five causes of ADHD are genes, environmental factors, brain injuries and sugar. Scientists are not sure what causes ADHD, although many studies indicated that genes play a large role. There is also a possibility that ADHD results from a combination of factors which have listed above. The finding of several international studies of twins proved that ADHD often inherits from generations in families. Potential environmental factors can be smoking and alcohol use during pregnancy. In addition, preschoolers who are exposed to high levels of lead have a higher risk of developing ADHD as well. A small percentage of children with ADHD have been through traumatic brain injuries. (NIH Medline Plus, 2014)
No single test can diagnose a child as having ADHD. ADHD symptoms usually appear early in life, often between the ages of 3 to 6. Since symptoms vary from person to person, the disorder can be hard to diagnose. Family members may first notice that their child loses interest in things sooner than other children, or seems constantly “unfocused” or “out of control.” In many cases, teachers can be the first person notice the symptoms, when a child has trouble following rules, or frequently “spaces out” in the classroom or on the playground. (NIH Medline Plus, 2014)
When a child is diagnosed, parents will need to know what are the options for them to choose to help their children release the symptom. Unfortunately, ADHD has no cure at the present. However, fortunately, there are effective treatments for both children and adults with ADHD, including behavior therapy, medication and school intervention (CDC, 2017). According to American Academy of Pediatrics (AAP) (2011), young children age between 4-6 with ADHD, behavior therapy is recommended as the first line of treatment, before medication is tried. Medications, such as methylphenidate (Ritalin) or dextroamphetamine (Dexedrine), are stimulants that decrease impulsivity and hyperactivity and increase attention. The U.S. Food and Drug Administration has approved the generic versions of Strattera (atomoxetine) to treat ADHD in pediatric and adult individuals (CDC, 2017). With treatment, most people with ADHD can be successful in school and lead productive lives. Researchers are developing more effective treatments and interventions and using new tools such as brain imaging, to better understand ADHD and to find more effective ways to treat and prevent it. (NIH, 2018)

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Sensory processing problems in children with ADHD are more common than children without ADHD (Cheung, Siu, 2009) and the patterns of sensory modulation in the ADHD are significantly different from typical children (Yochman, Ornoy, Parush, 2006). Children with ADHD can experience the same feelings and emotions as their peers. However, emotions are more intense with ADHD and impact everyday living. They can be very intense and demand without realizing it, such as they are hard to be patient and take turns which can lead to his/her quickly losing friends. In studies comparing individuals with ADHD and controls, ADHD preschoolers have been shown to experience problems with memory, reasoning, academic skills, conceptual development, general cognitive ability (DuPaul et al. 2001), and acquiring basic pre-reading and mathematics skills (Mariani & Barkley 1997). Lahey and colleagues (1998) found impaired mathematics abilities, but intact reading skills, in their sample of 4- to 6-year-old children.

Case Study
Robby is a 4-years-old boy come from mixed-race family, living with his mother, maternal grandmother, step-maternal grandfather and newborn younger brother. Robby’s maternal grandmother is a white lady who married maternal grandfather who was black. They gave birth to Robby’s mother. Later Robby’s grandmother divorced and then married Robby’s step-grandfather. Robby’s mother gave birth to Robby when she was a teenager girl. Robby’s father is black American who never showed up in the school. Robby’s grandma and step-grandpa are workers in a hospital who are the breadwinner for this family. Robby’s grandma is the decision-maker of the family taking care of all family issues as well as Robby’s. Robby’s mother is still in college finishing her study and recently gave birth to a baby boy who is a mix. Robby’s mother rarely present in school events or parent conference. It is Robby’s step-grandpa drop him off and pick him up every day and it is grandma meeting with the school regarding Robby’s performance and development instead of mom.
Despite the fact that Robby’s mom is an adolescent mother, she was diagnosed had server ADHD when she was a child. Medication was used for a long period of time to relieve her symptoms. When the teacher tried to have a conversation with mom Robby’s impulsive behaviors. Mom didn’t respond. Grandma finally came to school and meet the teachers. She explained that mom doesn’t want to accept that Robby is same as herself. Grandma agreed on teacher’s observation and concerns because Robby did the same at home. She also expressed her helplessness to control or help Robby control his behavior. The family has no knowledge of early intervention service and referral process before the teacher bring it up. Teacher initiates the referral but took several months for mom to agree on signing the referral letter.
From the observation of classroom teacher, Robby is not able to sit still for 4 minutes. He is always on move or running around in the classroom. He is very easily be distracted and not able to hold his attention or stay on task. He has difficulty in following teacher’s instruction and complete a task. His needs are very intensive and cannot wait for his turn. He became very emotional and impulsive if his needs are not met immediately. He will pretend to cry, really cry, push other or even put fists on his peers. He is very active, and talks a lot and play wild. He often interrupts conversation or activities between teachers and peers. He constantly leaves classroom by himself to wherever interest him.
As the development along the age, his disorder starts to impact on his cognitive and social-emotional development. Cognitively, He shows no interest in problem-solving or similar mental activities. His attention span below average. He is not able to complete a 15-minutes morning meeting or a story-reading. He has difficulty retell a story. He can only name a few simple numbers and letters. When the teacher works in a small group, constantly interrupts teacher’s instruction in the process or distracted and left the task unfinished. Social-emotionally, he presents an interest in playing with his peers, however, he easily gets frustrated or angry by minor annoyances or gentle criticism.
According to Gardner’s multi-intelligence, Robby’s intellectual in music and bodily-kinesthetic is very high. Robby’s fine motor skill and gross motor well developed. His finger is strong enough to hold pencil, canyon, spoons or so. He runs very fast, hoops on one foot, climb up the down, catches a bounced ball. He loves music and very sensitive to rhythm and sound. Therefore, Robby could learn better with music in the background. The teacher could also try to add lyrics, movements to the lesson or speak in rhythm, as well as utilizes tools include musical instruments or music.
Testing accommodations remove obstacles to the test-taking process that are presented by the disability without reducing expectations for learning (SUNY, 2018). According to SUNY, accommodation could be applied in test time span, classroom setting, ways to administer the test, the format of the test, ways to response the test. For instance, Robby has difficulty complete or on task, during a formative assessment, the teacher can extend the time for the task or play a background music help Robby focus on his task.
According to Urie Bronfenbrenner’s -ecological systems theory, multiple environments can affect child’s development. The family has a child with ADHD is face extreme pressure from the disability itself. Many people misinterpret ADHD as bad parenting. The children cannot help to control his impulsive. Most of the time, the parent is helpless too. When the child creates trouble, parents need to take the responsibility and criticize from the surround. Negative feedback from the world also could negatively impact the family’s attitude toward their child. Moreover, the relationships in school also could influence by the disorder. Teachers as the primary care provider in the school setting can be stressful. Safety is always the priority in the classroom. However, a child with ADHD would bring many potential risks to the setting and children in the setting, such as Robby could easily drive by his intensive needs and misinterprets what other says and put his hand on his peers. This could also result in the child has trouble building friendship with his peers. One strategy that we can use to help the child, we could role-play the social scene with the child. Teacher and his peers can model how to communicate with others, express his needs and feeling in a moderate way. By switching the role, have the child experience other people’s feeling and grow empathy and self-esteem.

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