This sample ADHD Research Paper is published for educational and informational purposes only. Like other free research paper examples it is not a custom research paper. If you need help with writing your assignment, please use research paper writing services and buy a research paper on any topic.
- History of ADHD Research
- Theoretical Causes of ADHD
- ADHD Symptoms
- ADHD Diagnosis
- ADHD Treatment
Attention deficit-hyperactivity disorder (ADHD) is a neurobehavioral syndrome. Characterized by inattention and impulsiveness sometimes coupled with hyperactivity. Many people use the term attention deficit disorder (ADD) either interchangeably with ADHD or to refer to those patients who do not exhibit hyperactivity. The most recent edition of the American Psychiatric Association’s (APA)Diagnostic and Statistical Manual of Mental Disorders divides ADHD into three categories: predominantly inattentive type, predominantly hyperactive-impulsive type, and combined type. Statistics show that about 3 to 5 percent of the U.S. population has ADHD, which is the most common form of behavior disorder found in children and teenagers. Men are diagnosed with ADHD much more frequently than women, but some researchers argue that, because of underidentification in females, that ratio should be smaller. This disorder is also more likely to be diagnosed in children, but the adult ADHD population is growing. The disorder is usually permanent and affects both its sufferers and those around them at home, school, work, and in social situations, often leading to serious problems in these areas.
History of ADHD Research
Early research into what the APA would later classify as ADHD began in the early 1800s in the fields of medicine and learning disabilities. Doctors historically labeled children who had problems concentrating as brain injured, brain damaged, hyperactive, or hyperkinetic. In the early twentieth century, British pediatrician George Frederic Still was among the first to document observations of children exhibiting ADHD symptoms, and he credited the behavior to genetics or injury at birth. In the 1940s, psychologist Heinz Werner and psychiatrist Alfred Strauss treated children with severe disabilities at the Wayne City Training School in Michigan. They grouped these children into two categories: endogenous, meaning those who suffered from hereditary mental retardation, and exogenous, meaning those who suffered from brain injury. Children with the exogenous category of deficits, assessed as suffering from minimal brain injury, provided a theoretical basis for the field of learning disabilities. In later years, researchers described these types of deficits with other terms, such as minimal cerebral dysfunction and minimal brain dysfunction.
These terms were in use until the 1960s and 1970s when the APA’s Diagnostic and Statistical Manual of Mental Disorders—Second Edition(DSM-II) elaborated on the definitions of a wide range of mental illnesses and disorders, including “hyperkinetic reaction of childhood.” At this time, school programs for learning disabled students were rapidly expanded, the federal government passed legislation to aid those with disabilities, and organizations focused on a variety of learning disabilities began to provide information and support. The 1960s and 1970s also saw an increase in psychiatric drug intervention, and the use of stimulants to treat ADHD symptoms became widespread. The debate over environmental and biological factors in ADHD also grew.
The terms ADD and ADHD are fairly recent. The APA’s DSM-III first defined attention deficit disorder with or without hyperactivity in 1980, and DSM-IV, published in 1987, relabeled it “attention deficit-hyperactivity disorder.” In 1994, the APA divided ADHD into the three previously mentioned categories (predominantly inattentive type, predominantly hyperactive-impulsive type, and combined type). The name changes over the years reflect increasing knowledge of the disorder. Research has also resulted in an increased recognition of ADHD in adults, increased focus on managing symptoms rather than finding a cure, and increased emphasis on collaboration and combined therapies to treat the disorder. The debate over the causes of ADHD continues, although environmental causes are increasingly falling out of favor.
Theoretical Causes of ADHD
Medical experts are unsure of what causes ADHD, but they offer a variety of theories. Many early researchers considered environmental factors as the primary causes of the disorder. Dr. Benjamin Finegold was an early proponent of environmental causation, but most current researchers give such theories little weight. Suggested environmental causes included birth-related brain injuries, birth complications, low birth weight, premature birth, and maternal seizures or use of illegal drugs, alcohol, or tobacco during pregnancy. Environmental causes linked to the home included poor parenting and physical, sexual, or emotional abuse in childhood. Ineffective teachers who command little respect and joining the “wrong” crowd in school were environmental factors in the education system. Researchers have also studied toxins such as lead and pesticides, food allergies, excessive use of refined sugar or food additives, poor nutrition, and excessive television viewing coupled with a lack of sunlight and exercise. Many researchers discount the importance of these environmental factors, as they have not been consistently linked to ADHD, but studies continue in this area.
Most current theories on the causes of ADHD focus on problems within the areas of the brain that inhibit or control impulsive, disruptive behavior. New brain-imaging techniques have revealed that these areas are less active in people who suffer from the disorder. The catecholamine theory focuses on neurotransmitters, chemicals that relay messages of pain, memory, and other neural activity. Dopamine, norepinephrine, and serotonin belong to a group of neurotransmitters called catecholamines that are involved in depression, pain, anxiety, sleep, attention, and alertness. Studies supporting this theory have revealed that people with behavioral abnormalities such as ADHD have lower levels of the products of catecholamine breakdown. Studies supporting the theory of frontal lobe failure show that ADHD patients have a widespread disorder in that part of the brain. Research has also revealed diminished glucose metabolism in the areas of the brain that control behavior, making these areas less active. Another theory points to an improperly functioning reticular activity system (RAS), a neural system in the brain involved in maintaining alertness. And, while experts do not know how genetic factors influence the disorder, research shows that the parents of many children with ADHD also suffer from the disorder.
A third category of voices have joined the debate over the causes of ADHD, represented by those theorists and social observers who believe ADHD is not a genuine medical disorder at all. In the 1975 book The Myth of the Hyperactive Child, Peter Schrag and Diane Divoky provide a gloomy representation of the effects of medications on those children who may or may not have suffered from ADHD. In the 1980s, the Church of Scientology launched a campaign against the stimulant Ritalin, a widely used drug in the treatment of ADHD, suing school boards, doctors, principals, teachers, and the APA to publicize their view. Education expert Alfie Kohn, in 1989, wrote an article in the Atlantic Monthly in which he called ADHD “a highly debatable and pseudo medical concept,” proclaiming it was the “the yuppie disease of the 90s.” In October 1995, educator and psychologist Thomas Armstrong wrote in Education Week that the disorder was partly a conspiracy among the scientific, medical, and educational communities and partly an attempt by society to absolve itself of responsibility for troubled children by blaming a medical condition. Others regard the disorder as a myth created by greedy drug companies and doctors eager to increase profits or by incompetent teachers to avoid the blame for children’s academic failures. Still others view ADHD as a normal part of the spectrum of human behaviors that simply no longer serve a purpose in modern society.
ADHD symptoms fall into three main categories: inattention, impulsiveness, and hyperactivity. The most common symptom, inattention, is characterized by difficulty listening to or focusing on the task at hand, forgetfulness, disorganization, neglect of detail, careless mistakes, and the inability to complete tasks that are boring, repetitive, or challenging. Impulsiveness is characterized by the inability to think before acting, the tendency to call out and interrupt others, and difficulty waiting. Hyperactivity is characterized by constant motion, trouble staying seated, squirming and fidgeting, incessant talking, and the inability to remain quiet when appropriate.
The majority of people with ADHD are not hyperactive in the popular sense of being unable to sit still. In social settings, ADHD patients often avoid eye contact, appear uninterested in others, and fail to exchange social greetings. They struggle to maintain healthy relationships and are often unable to hold jobs for a significant length of time. The disorder is not the same in every patient. The severity of symptoms also varies from person to person, from mild to acute and severe. Doctors look for the consistent manifestation of the majority of these symptoms when diagnosing ADHD.
Suspicion of ADHD is the most common reason for parents, schools, or doctors referring a child to a psychologist or psychiatrist. The process of diagnosing the disorder in children usually begins in the school because the symptoms show more readily in an academic setting. A psychologist, psychiatrist, or other expert familiar with the disorder should make the diagnosis of ADHD. Before any diagnosis is made, the child or adult must undergo a medical examination to rule out physical problems. Once other conditions are eliminated, the medical expert can evaluate the individual using the APA criteria. Characterized as a medical syndrome rather than a disease, ADHD cannot be accurately diagnosed with a single medical or behavioral test. Doctors must use behavioral checklists and patient histories in their evaluation, which makes diagnosis difficult because all children display most or all of these symptoms at some point in their childhood. The diagnosis requires that a person display symptoms consistent, excessive, and disruptive to at least two areas of their lives. These symptoms should appear before the age of seven and continue for at least six months. A child with ADHD is usually diagnosed between the ages of six and twelve years.
Diagnosis is often difficult because ADHD symptoms are similar to those of other disorders. In fact, ADHD patients often suffer from one or more other disorders, a condition known as comorbidity. Symptoms similar to those of ADHD can occur in depression, thought disorder, anxiety, bipolar disorder, hypo- and hyperthyroidism, drug side effects, rare genetic disorders, narcolepsy, sleep apnea, seizure disorders, allergies and upper respiratory illness, hearing or vision problems, and mental retardation. In addition, ADHD patients frequently suffer from academic performance problems and inconsistencies, learning disabilities, speech and language disorders, emotional reactivity, conduct problems, developmental and medical problems, and social skills deficits. Diagnosis is also difficult when schools, parents, and doctors look for symptoms that are not always present in the disorder. Doctors often misdiagnose girls who do not display symptoms of hyperactivity, for example, but not all ADHD patients are hyperactive. Still other patients are misdiagnosed because they are able to pay attention to television or other activities of interest, often to the point of focusing on nothing else. Many ADHD patients have difficulty sustaining attention only when it is demanded of them.
Diagnosis in adults carries unique challenges. In their book ADHD in Adulthood: A Guide to Current Theory, Diagnosis, and Treatment (1999), Margaret Weiss, Lily Hechtman, and Gabrielle Weiss present several categories of diagnostic problem areas in adults, including patients who meet the criteria but cannot provide a confident childhood history; patients who have experienced childhood and adult ADHD, but whose symptoms have been intermixed with disturbed emotional and behavioral functioning; patients whose symptoms meet the criteria but are also symptoms of other diagnoses; and patients whose symptoms meet the criteria but are either mild or present only in specific situations. The authors also outline the challenges an accurate diagnosis of adult ADHD presents: the difficulty of obtaining a history of childhood behaviors that the patient may not have been aware of; dependence on information from others; dependence on functional impairment, which is not easily visible; and the frequent presence of other psychiatric problems in adults with ADHD. Once a person receives a clear diagnosis of ADHD, treatment can begin.
ADHD has no cure, but patients can control the disorder through medication and counseling. Medical remediation for children who have attention deficits and hyperactivity began in the 1930s when researchers discovered that children with these disorders benefited from the amphetamine Benzedrine. The use of medications to treat ADHD, however, did not become popular until the 1960s when researchers found that stimulants such as Dexedrine and Ritalin helped children with similar problems and had fewer adverse effects than Benzedrine. It may sound counterintuitive to prescribe stimulants for a hyperactive child, but these medications have proven to be very effective. Stimulant drugs increase the secretion of neurotransmitters and work on those parts of the brain that control attention (learning) and impulses (behavior). These areas are underaroused in ADHD patients, leading to counterproductive behaviors attempting to induce arousal. Research showed that treatment with stimulants resulted in increased alertness, decreased activity levels, and decreased impulsivity in the majority of children diagnosed with ADHD.
The most common medication prescribed for ADHD is the stimulant methylphenidate, commonly known as Ritalin. Other medications prescribed for ADHD patients include amphetamines such as Adderall and Dexedrine, antidepressants such as desipramine and bupropion, and high blood pressure medications such as clonidine. Doctors also sometimes use the category of antidepressants known as selective serotonin reuptake inhibitors (SSRIs) to treat ADHD. The side effects of these medications include headaches, loss of appetite, mood changes, and sleep and weight management problems, the two most common being loss of appetite and insomnia. Most side effects are easily controlled by adjusting the dosage or timing of the medication. Some patients may be unable to take medications such as Ritalin because of a family or personal history of drug abuse or coronary disease and hypertension. Those starting medication often experience difficulties as they adjust to an entirely new set of behaviors. Negative behavior is usually just a temporary reaction to treatment. Researchers and doctors consider stimulants to be safe drugs.
Medical experts recommend coupling medication with counseling or other forms of treatment. Counseling for children has been well researched and techniques include emotional therapy, psychotherapy, stress management therapy, behavior modification, and support groups. Emotional therapy helps the patient overcome the feelings of frustration, underachievement, loss of confidence, insecurity, inferiority, depression, or anxiety that often result from living with the disorder. The best academic setting for the ADHD student is a small, structured classroom with a low student-to-teacher ratio and very few distractions, but this is difficult to achieve in either public or private schools. A child with ADHD becomes a problem not only at school, but at home as well. Family members need to work together to monitor the child’s medications and, most of all, to support the child while working to control the disorder. Using behavior modification, parents can also create a system to reward ADHD children for good behavior. Family therapy, parent education, and support groups can help with the family’s adjustments to living with an ADHD child.
The adult ADHD patient has similar therapy options, although there is less research on their effectiveness in adults. Group therapy is very important in dispelling the sense of being different and alone. Hearing that others have the same problems and listening to others’ ordeals have a positive impact. Groups also offer strategies for coping with work, family, or other difficulties. One-on-one cognitive-behavorial therapy helps a patient cope with specific issues such as self-esteem, organization, and social interaction and teaches the patient how to use internal dialogue to master and direct behaviors efficiently. Another emerging therapy for adult ADHD is biofeedback, which uses electrodes on the scalp and ears to help patients influence their brain wave patterns. The patient learns to control physiologic processes through repeated trials. Another new therapy, auditory integration therapy, improves an inefficient central nervous system and increases sensory awareness by feeding the patient various repeated sound frequencies.
Other therapists focus on helping ADHD patients live and function with their disorder. In his book Healing ADD (1998), Thom Hartman offers a three-step approach to healing the disorder. First, patients must redefine themselves in relation to the rest of society and reinvent their lives to work with the disorder’s symptoms rather than view themselves as victims. Second, patients must learn specific skills that will help them cope with the disorder. For example, they must find the motivation to plan ahead by learning to think differently about time. Finally, patients must relive their memories of pain or discomfort from the disorder, using these memories as learning experiences. The use of ADHD coaches for adults is also becoming more prevalent. Coaches help the patient with life strategies and offer moral support. A number of organizations are also dedicated to providing information on ADHD and other related disorders. These include the ADD Information Network, the ADD Association, Children and Adults with ADD, the National Institutes of Mental Health, the National Alliance on Mental Health, the National Information Center for Children and Youth with Disabilities, the Learning Disabilities Association of America, and the National Center for Learning Disabilities.
Less popular, more controversial therapies are also available to ADHD patients. Diet therapy is an option, although research has failed as yet to support its effectiveness. Doctors recommend that patients maintain a well-balanced diet that incorporates all the food groups and is low in fat and cholesterol. The Finegold diet recommends the removal of all food additives to rule out food allergies as the cause of ADHD symptoms. Other ADHD patients have turned to homeopathy and alternative medicine, choosing to take certain megavitamins and mineral supplements such as gingko, ginseng, and ephedra.
In addition to medication and therapies, accommodations at school or in the workplace can help ADHD patients function better in their daily lives. Federal legislation, including the Rehabilitation Act of 1973, the Americans with Disabilities Act, and the Individuals with Disabilities Education Act, classifies ADHD as a disability. The court system, the Department of Education, the Office for Civil Rights, the Congress, the National Institutes for Health, and all major professional medical, psychiatric, psychological, and educational associations classify ADHD as a disability as well. This official recognition entitles those patients with a clinical diagnosis of ADHD to receive accommodations at school and in the workplace. School accommodations include preferential seating, a reduced workload or more time to complete tests and assignments, the use of a note taker to write down the teacher’s instructions for later reference, or individual help with organizational skills, social skills, or academics. Adults may receive similar help in the workplace. Supplemental Security Income is also available for individuals whose disability is so severe it renders them unable to find or keep a job.
ADHD is a biologically based disability with no cure, and a child rarely outgrows it. Most people with ADHD will continue to have problems at school, at work, with their families, and with the authorities. It is a myth, however, that most ADHD children become delinquents. ADHD and conduct disorder are separate disorders with different causes and outcomes. The best method for controlling ADHD symptoms remains a combination of medication, counseling, and adaptive methods to help patients function with the disorder. Researchers have outlined beneficial training programs for both parents and teachers, and many support networks, groups, and organizations are available to help people with ADHD as well as their families. There are also laws that protect the right of children to an excellent educational environment and guarantee workplace accommodations for adults with the disorder. Promising research continues, especially into biochemical causes, the role of the brain and neurotransmitters, and the disorder’s genetic component. The prevalence of the disorder and the continued controversy over its causes and authenticity ensure that ADHD will remain a prominent social issue.
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-Text Revision. Arlington, VA: American Psychiatric Press, 2000.
- Brown, Thomas E. Attention Deficit Disorder: The Unfocused Mind in Children and Adults. New Haven, CT: Yale University Press, 2005.
- Fitzgerald, Michael, Mark Bellgrove, and Michael Gill, eds. Handbook of Attention Deficit Hyperactivity Disorder. Hoboken, NJ: John Wiley, 2007.
- Haber, Julian Stuart. ADHD: The Great Misdiagnosis. Dallas: Taylor Trade Publishing, 2000.
- Hartmann, Thom. Attention Deficit Disorder: A Different Perception. Grass Valley, CA: Underwood Books, 1997.
- Hartmann, Thom. Healing ADD: Simple Exercises that Will Change Your Daily Life. Grass Valley, CA: Underwood Books, 1998.
- Hartmann, Thom. Complete Guide to ADHD: Help for Your Family at Home, School, and Work. Grass Valley, CA: Underwood Books, 2000.
- Ingersoll, Barbara D., and Sam Goldstein. Attention Deficit Disorder and Learning Disabilities: Realities, Myths, and Controversial Treatments. New York: Doubleday, 1993.
- McEwan, Elaine K. A Guide for Parents and Educators: Attention Deficit Disorder: Helpful, Practical Information. Colorado Springs, CO: Waterbrook Press, 1995.
- Oades, Robert D. Attention Deficit/Hyperactivity Disorder (AD/HD) and the Hyperkinetic Syndrome (HKS): Current Ideas and Ways Forward. New York: Nova Science Publishers, 2006.
- Schrag, Peter, and Diane Divoky. The Myth of the Hyperactive Child. New York: Pantheon Books, 1975.
- Sears, William, and Lynda Thompson. The ADD Book: New Understanding, New Approaches to Parenting Your Child. Boston: Little, Brown, 1998.
- Sudderth, David B., and Joseph Kandel. Adult ADD: The Complete Handbook. Roseville, CA: Prima Publishing, 1997.
- Taylor, John F. Helping Your ADD Child. Roseville, CA: Prima Publishing, 2001.
- Weiss, Margaret, Lily Trokenberg Hechtman, and Gabrielle Weiss. ADHD in Adulthood: A Guide to Current Theory, Diagnosis and Treatment. Baltimore: Johns Hopkins University Press, 1999.
- Wender, Paul H. ADHD: Attention-Deficit Hyperactivity Disorder in Children, Adolescents, and Adults. New York: Oxford University Press, 2000.