Free Term Paper on ADD and Ritalin
ADD and Ritalin
Attention Deficit Disorder (ADD) is a problem that
affects 5% to 10% of all children. ADD affects more children than any other
childhood problems except asthma. It is estimated to be the largest single cause
for first referrals to child guidance clinics throughout the country, making up
as many as 40% of those cases. Many ADD cases are not diagnosed because the
problem most often does not show in the doctors office.
Current estimates
suggest that approximately 50 to 65% of the children with ADD will have symptoms
of the disorder as adolescents and adults. Although ADD has just recently been
discovered and there is still relatively little known about it. In 1902, George
Frederick Still believed the dilemma of the problem child was linked to a
biological defect inherited from an injury at birth and not the result of the
environment. Through 1930-40's stimulant drugs were first used to successfully
treat many behavior problems due in part by Still's hypothesis. In 1960, Stella
Chess researched in the field by writing about the "hyperactive child syndrome."
She took Still's hypothesis further stating that the resulting behavior problems
stem from a biological cause, although it is linked to a genetic inheritance
rather then a birth defect from an injury. Finally, in 1980, the syndrome was
named Attention Deficit Disorder, due in large part to Virginia Douglas's work
to find accurate ways to diagnose it (Hallowell 2).
This is currently how it
exists today, with the addition of a new category Attention Deficit
Hyperactivity Disorder and there sub types. Most scientists now believe that an
abnormality in brain chemistry could be to blame for the symptoms of Attention
Deficit Disorder. The frontal lobes of the brain are believed to be responsible
for the regulation of behavior and attention. They receive information from the
lower brain, which regulates arousal and screens incoming messages from within
and outside of the body. The limbic system, which is a group of related nervous
system structures, located in the midbrain and linked to emotions and feelings
then sends the messages to the frontal lobes. Finally, the frontal lobes are
suspected to be the site of working memory, the place where information about
the immediate environment is considered for memory storage, planning, and
future-directed behavior.
Scientist believe the activity in the frontal
lobes is depressed in people with ADD. Studies also show, a decrease in the
ability of the Attention Deficit Disorder brain to use glucose, the body's main
source of energy, leading to slower and less efficient activity.
Neurotransmitters provide the connection between one nerve cell and another. It
is also now suspected that people with Attention Deficit Disorder have a
chemical imbalance of a class of neurotransmitter called catecholamine.
Dopamine, helps to form a pathway between the motor center of the midbrain and
the frontal lobes, as well as a pathway between the limbic system and the
frontal lobes. Without enough dopamine and related catecholamine, such as
serotonin and norepinephrine, the frontal lobes are under stimulated and thus
unable to perform their complex functions efficiently.
Attention Deficit
Disorder is primarily considered a genetic disorder. Which is why it is labeled
an axis two in the DSM-IV. Studies show that 20-30% of all hyperactive children
have at least one parent with ADD. However, not all cases of ADD are genetically
linked. Some studies show that smoking, drinking alcohol, and using drugs during
pregnancy, influenced a small percentage of ADD cases. Exposure to toxins, such
as lead, may also alter the brain chemistry and function. Both of these issues
are cause for concern for the at-risk population.
ADD generally affects
males more often than females, in a 3:1 ratio. Because this disorder effects the
brain detection of this condition is difficult. The accepted test, although
today there has been an increase in research into ADD and subsequently now other
tests. The test requires a nine-month observation of the person, as well as
EEGs, MRIs, or a PET scan. During the nine months, the person has to show a
certain number of the classic traits associated with the disorder. The EEG is
used to record the amount of electrical activity that is happening in the brain.
An MRI is an x-ray that shows the brain's anatomy however it is not a routine
assessment. More recently, the way to diagnose ADD is the use of a PET scan,
which measures the amount of activity in the brain.
There are two general
categories for those diagnosed with Attention Deficit Disorder. One is ADHD
(Attention Deficit Hyperactivity Disorder); this is the more prevalent of the
two. A person with ADHD will show certain characteristics. Characteristics like,
fidgeting, squirming, difficulty remaining seated, easily distracted, difficulty
awaiting turn, interrupting, difficulty following directions, sustaining
attention, shifting from one uncompleted task to another, not listening,
following multiple directions, and frequently engaging in dangerous actions. The
general diagnosis of ADD, as opposed to ADHD, has some, but not all of the above
characteristics.
There are people who have been diagnosed with ADD whose
characteristics are not hyperactive but the complete opposite, they are under
active. This goes against the general notion that only kids who are hyperactive
have ADD. These children often daydream and are never mentally present anywhere.
They constantly drift off into their own world during classes or conversations.
This type is more prevalent in females with ADD then in males. The underlining
issues with these children are the inability to focus, they are too easily
distracted. This form of ADD is the hardest to diagnose since it seems that
these people simply need to "apply themselves more" or "get their act together."
Attention Deficit Disorder not only affects those afflicted in the classroom
but at home as well. The rest of the families’ daily routine may become a
distraction to those afflicted with ADD. Sometimes a television or radio that is
turned on in another room may become a distraction. What the ADD person needs is
a sound screen. A sound screen is some form of constant noise that plays in the
background, commonly a television or a radio. At first it may seem like a
distraction, but in reality, if the TV or music forms a kind of "white noise"
with an even level of intensity, which actually covers up discrepant noises that
can be a distraction. "The hum of a ceiling fan or motor can do wonders to
soothe and focus you" (Weiss.7).
Getting a family household to function
smoothly is challenging for any family, with or without the presence of ADD.
Adults and children suffering from Attention Deficit Disorder have trouble
establishing and maintaining physical order, coordinating schedules and
activities, and accepting and meeting responsibilities. Parents with children
suffering with ADD have to learn how to deal with the obstacles that they will
have while raising their child. Since ADD is genetically passed through to
children the tendency is to have more then just the child with ADD but the
parents too. Not only does the child have a problem with rules and schedules but
also so does the parent.
Adults dealing with ADD often have chronic
employment problems, impulsive spending, and erratic bookkeeping and bill
paying. Raising healthy, well-adjusted children requires patience, sound
judgment, good humor, and, discipline which is difficult for a parent with ADD
to do. The presence of ADD often hinders the development of intimate
relationships for a variety of reasons. Although many adults with ADD enjoy
successful, satisfying marriages, the disorder almost always adds a certain
amount of extra tension and pressure to the union. The non-ADD spouse bears an
additional burden of responsibility for keeping the household running smoothly
and meeting the needs of the children, the spouse with ADD, and, if he or she
has time, his or her own priorities.
Raising a child who has ADD can be an
exhausting and, at times, frustrating experience. Parents play a key role in
managing the disability. They usually need specialized training in behavior
management and benefit greatly from parent support groups. Parents often find
that approaches to raising that work well with children who do not have ADD, do
not work as well with children who have ADD. Parents often feel helpless,
frustrated and exhausted. Especially if the child's condition is unknown at the
time. It could seem to the parent that the child is just bad. Too often, family
members become angry and withdraw from each other. If untreated, the situation
only worsens. Parent training can be one of the most important and effective
interventions for a child with ADD. Effective training will teach parents how to
apply strategies to manage their child's behavior and improve their relationship
with their child. Without consistent structure and clearly defined expectations
and limits, children with ADD can become quite confused about the behaviors that
are expected of them.
Making and keeping friends is a difficult task for
children with ADD. A variety of behavioral excesses and deficits common to these
children get in the way of friendships. They may talk too much, dominate
activities, intrude in others' games, or quit a game before it’s done. They may
be unable to pay attention to what another child is saying, not respond when
someone else tries to initiate and activity, or exhibit inappropriate behavior.
There is no cure for Attention Deficit Disorder. "Along with increasing
awareness of the problem, a better understanding of its causes and treatment has
developed” ( Wender 3). There is medication for ADD that will only alleviate the
symptoms. The medication will not permanently restore the chemical imbalance.
Approximately 70% of adults with ADD find that their symptoms significantly
improve after they take medication prescribed by their doctors. The patient is
able to concentrate on difficult and time-consuming tasks, stop impulsive
behavior, and time the restless twitches that have been experienced in the past.
Some ADD patient's psychological
and behavioral problems are not solved by medication alone, and are required
more therapy or training. Adult patients have the burden of the past that often
hinders their progress. The patient then needs help with the relief of
disappointment, frustration, and nagging sense of self-doubt that often weighs
upon the ADD patient. Some ADD patients suffer from low-grade depression or
anxiety, others with dependence on alcohol or drugs, and most with low
self-esteem and feelings of helplessness. There are two types of drugs that work
to balance the neurotransmitter and have been found to be most effective in
treating ADD, stimulants and antidepressants. Stimulants work by increasing the
amount of dopamine either produced in the brain or used by the frontal lobes of
the brain. Antidepressants also stimulate brain activity in the frontal lobes,
but they affect the production and use of other chemicals, usually
norepinephrine and serotonin. All the drugs used to treat ADD have the same
goal, to provide the brain with the raw materials it needs to concentrate over a
sustained period of time, control impulses, and regulate motor activity. The
drug or combination of drugs that work best for the patient depends on the
individual’s brain chemistry and constellation of symptoms. The process of
finding the right drug can be tricky for each individual. The psychologists are
not able to accurately predict how any one individual will respond to various
doses or types of Attention Deficit Disorder medication. However, the drug of
choice for Attention Deficit Disorder is Ritalin. Ritalin (Methylphenidate) is a
mild CNS stimulant. In medicine, Ritalin’s primary use is treatment of Attention
Deficit /Hyperactive Disorder (ADHD). The reason why this drug works so well is
not completely understood, but Ritalin presumably activates the arousal system
of the brain stem and the cortex to produce its stimulant effect. According to
the Drug Enforcement Agency (DEA), prescriptions for Ritalin have increased more
than 600% in the past five years. Ritalin (Methylphenidate) is manufactured by
CIBA-Geigy Corporation. It is supplied in 5 mg., 10 mg., and 20 mg. tablets, and
in a sustained release form, Ritalin SR, in 20 mg. tablets. It is readily
water-soluble and is intended for oral use. It is a Schedule II Controlled
Substance under both the Federal and Vermont Controlled Substance Acts (Bailey
5). As stated before, ADHD is a condition most likely based in an inefficiency
and inadequacy of Dopamine and Norepinephrine hormone availability, typically
occurring when a person with ADHD tries to concentrate. Ritalin improves the
efficiency of the hormones Dopamine and Norepinephrine, increasing the resources
for memory, focus, concentration and attention (Clark 6). Ritalin exhibits
pharmacological activity similar to that of amphetamines. Ritalin’s exact
mechanism of action in the CNS is not fully understood, but the primary sites of
activity appear to be in the cerebral cortex and the subcortical structures
including the thalamus. Ritalin blocks the re-uptake mechanism present in
dopaminergic neurons. As a result, sympathomimetic activity in the central
nervous system and in the peripheral nervous system increases. Ritalin-induced
CNS stimulation produces a decreased sense of fatigue, an increase in motor
activity and mental alertness, mild euphoria, and brighter spirits. In the PNS,
the actions of Ritalin are minimal at therapeutic doses (Clark 2). Ritalin is
the quickest of all oral ADHD stimulant medications in onset of action: it
starts to achieve benefit in 20 - 30 minutes after administration, and is most
effective during the upward ‘slope' and peak serum levels. Ritalin’s effect is
brief: Most people experience 2-3 hours of benefit, but after 3 hours, benefits
drop off rapidly. Some individuals, especially children, may obtain 4 or even 5
hours of positive effect (Clark 1). Attention Deficit Disorder is very prevalent
throughout this country and the world. There is no cure. Those afflicted with
the disorder must learn to compensate for it and live regardless of its affects.
There are drugs and therapy available for those with this disorder to help them
maintain their life. It is very frustrating to live with ADD or ADHD and even
harder to live with it and not know it. Since ADD's detection is difficult,
often the symptoms are likened to some other cause in an effort to explain the
behaviors. This has lead to many misdiagnoses. However, new studies on ADD and
ADHD are in the works and with the Human Genome Project's completion in 2003
there is hope more light will be shed on this disorder.
Bibliography
Bibliography Baliey, W.J. Attention Deficit Disorder. 9 May 1997. Online
Internet. 10 November 2000. http://www.execpc.com/~calliope/ Clark, C.G.
Children Who Can’t Pay Attention. 5 October 1998. Online Internet. 10 November
2000. http://www.aacap.org/publications/factsfam/noattent.htm Hallahan, Daniel
& Kuaffman, James. Exceptional Child. 1999. Online Internet. 10 November
2000. http://borntoexplore.org/ Hallowell, Edward M. & Ratley, John J.
Driven to Distraction. 13 April 1997. Online Internet. 10 November 2000.
http://www.livingwithadd.com/ Wender, Pual H. M.D. The Hyperactive Child,
Adolescent, and Adult. 15 November 1998. Online Interent. 10 November 2000.
http://www.attn-deficit-disorder.com/ Weiss, Lynn M.D. Attention Deficit
Disorder in Adults. 4 January 1999. Online Interent. 10 November 2000.
http://www.mentalhealth.com/dis/p20-ch01.html