Review on Children with Attention Deficit Hyperactivity Disorder-ADHD

This report provides a comprehensive review of Attention Deficit Hyperactivity Disorder (ADHD) in children. It begins by defining ADHD as a neurodevelopmental condition characterized by inattention, hyperactivity, and impulsivity, and explores its presentation, including the three subtypes: predominantly inattentive, predominantly hyperactive-impulsive, and combined type. The report then delves into assessment methods, detailing the use of the Diagnostic and Statistical Manual (DSM-V) and the International Classification of Diseases (ICD-10), behavioral ratings, and continuous performance tests. It compares the assessment of ADHD in adults and children, highlighting the similarities and differences in presentation and diagnostic criteria. The report also discusses the strengths and weaknesses of the DSM-V and other assessment tools, considering cultural sensitivity and ethical considerations. Finally, it offers recommendations for future research, emphasizing the need for further investigation into the causes, diagnosis, and treatment of ADHD in children.

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Review on
Children with Attention Deficit Hyperactivity Disorder-ADHD
University
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Date

Attention Deficit Hyperactive Disorder 2
Table of Contents
Attention deficit hyperactivity disorder.....................................................................................3
Presentation................................................................................................................................4
Assessments...............................................................................................................................5
Diagnostic and Statistical Manual-DSM-V............................................................................5
International Classification of Diseases –ICD 10..................................................................5
Behavioral ratings..................................................................................................................5
Continuous performance tests................................................................................................6
Comparative assessment of adults and children....................................................................6
Strengths and weakness..............................................................................................................7
DSM-V....................................................................................................................................7
Behavioral ratings..................................................................................................................8
Continuous performance tests................................................................................................9
International Classification of diseases-11............................................................................9
Cultural sensitivity of the assessment practices.........................................................................9
Ethics of assessment procedures..............................................................................................10
Recommendations....................................................................................................................11
Future research focus...............................................................................................................12
References................................................................................................................................13

Attention Deficit Hyperactive Disorder 3
Children with Attention Deficit Hyperactivity Disorder-ADHD
Attention deficit hyperactivity disorder
Attention deficit hyperactivity disorder is a mental condition occurring in neural
development. It is influenced by challenges regarding paying attention, excessive activity,
and exercise regardless of the consequences which are not appropriate for the age bracket
(Lenzi Cortese, Harris & Masi, 2018). Often persons with ADHD display challenges in
regulating emotions. Symptoms often appear before the age of 12 years and cause problems
in settings such as schools and recreational activities (Dulcan & Lake, 2011). Among
children, attention in schools is often affected leading to poor school performance. Further, it
is associated with substance abuse and mental disorders (Erskine et al., 2016). Despite the
increasing amount of studies and evidence gathered about this disease, the exact cause is not
known, however, it is estimated that a larger proportion of these occurrences (75%) are due to
genetic factors (Demontis, 2019). Environmental risks such as exposure to nicotine affect
about 5%-7% of the children diagnosed using the DSM-IV criteria (APA, 2013) and about
1%-2% diagnosed using ICD-10 criteria (Harrison, Cowen, Burns & Fazel, 2017). Further
studies have shown that about 30%-50% of the children diagnosed often display symptoms
transcending to adulthood while 2%-5% of this display symptom of the ADHD (Ginsberg et
al., 2014).
It is estimated that ADHD affects about 8-20% of children, and observed among men
more compared to females (Ornoy, Rivkin & Barlev, 2018). ADHD is characterized by
executive functioning, control of impulse and inattention impulsivity, Children having this
condition often display inappropriate levels of developmental activities which leads to
challenges towards daily function activities(Barkley, 2014). Children affected are unable to
sit while paying attention and often struggle on any given tasks and inappropriate talking.

Attention Deficit Hyperactive Disorder 4
These behaviors portray significant challenges especially in academic settings due to limited
focus and attention hence leading to poor performance.
Presentation
Hyperactivity, inattention, disruptive behavior and impulsive engagements are common
in ADHD. Academic challenges are often prevalent and also difficult in establishing
relationships. This makes it difficult for carers to draw a line on diagnostic procedures.
According to the 5th Diagnostic and Statistical Manual of Mental disorders- DSM-V
symptoms presented need to be 6 or more presenting a greater degree compared to others of
the same age and cause inherent and observable problems in at least two settings. Further, the
criteria need to be met before age twelve to receive a diagnosis of ADHD. ADHD is divided
into three domains; predominate inattentively (ADHD-P1 OR I), predominantly hyper-
reactive (ADHD-PH OR HI) and the combined type (ADHD-C).
Inattentive characteristics entail likely demonstrating activities such as inability to pay
close attention, difficulty in maintaining tasks, none attentive appearance, frequent
carelessness, easy distraction, forgetting tasks and challenges in following instructions. In the
predominantly hyperactive-impulsive state; the person is often on the constant on the go,
inability to be seated, persistent fidgeting, excessive talking, and difficulty in playing and
reluctant to take a turn. In a combined ADHD, the characteristics are often a combination of
the above two types.
Among children in schools, learning-based activities such as reading are affected. With
the challenges regarding ADHD, reading is often a difficult task for children. Further, they
often present with challenges and defects with regards to reading comprehension abilities
(Fienup et al., 2015).

Attention Deficit Hyperactive Disorder 5
Assessments
Diagnostic and Statistical Manual-DSM-V
In managing psychiatric disorders, formal diagnosis needs to be made based on set
criteria. In America, the application of the American Psychiatric Association –DSM manual
is applied to assess ADHD. This tool applies to the three categories of ADHD. The
predominantly inattentive ADHD, have symptoms occasioning forgetfulness, distraction,
disorganization, poor concentration, daydreaming and task completion difficulties. In
predominantly hyperactive-impulsive type has a presentation of excessive fidgetiness,
hyperactivity, waiting for difficulty, immature behavior, and destructive behavior. In
Combined type ADHD; it signifies the various observations above (APA, 2013). For a
diagnosis to be made, a presentation of at least six out of the outlined symptoms has to be
made. Further, the symptoms need to be inappropriate for the age bracket of the children and
clear behavior observation on social, work or school associated issues (Steinau, 2013).
International Classification of Diseases –ICD 10
International Statistical Classification of diseases and associated health problems,
which are analogous to the DSM-5. In this assessment tool, conduct behavior is a definitive
term encompassing attention disturbance and disruptive activity levels.
Behavioral ratings
Behavioral ratings are some of the key underlying aspects under the DSM-V defining
characteristics for ADHD. Parental ratings with clinical are the most valuable resource for
providing children behavior at home. There are various concerns with regards to this tool,
many parents might have the condition due to its genetic inference thus afflicted the reported

Attention Deficit Hyperactive Disorder 6
method. Parental symptomatology can have an impact on the ratings which overall; affect and
impact the ratings posing a threat to validity (Lewandowski & Lovett, 2014).
The application of teacher ratings coupled with parental ratings of behavior has been
employed. However fundamental findings have been observed in this tool. Parental rating of
school behavior was more correlated to home behavior more than teacher behavioral ratings.
Many parents infer the behavior of their children at home characteristics to that in schools
(Mahone, 2011).
Continuous performance tests
Objective assessments of assessing ADHD behaviors have been employed. Continuous
performance tests have been employed and used in assessing inattentive and hyperactive
behaviors. This test entails individuals to observe a stimulus sequence in the screen while
offering response on target stimuli and withholding responses to nontarget stimuli. This test
has adequate psychometric properties and findings of abnormal behavior, its utilization is
quite low occasioned with its inherent low predictive value. Children diagnosed with ADHD
using these tests have been shown to have nonelevated values making it a limited tool for
ADHD diagnosis and assessment (Sims & Lonigan, 2012).
Comparative assessment of adults and children
Among adults, ADHD is diagnosed using the same criteria. Further signs must have
been displayed at an early age between ages 6 and 12. Interrogative aspects of their behavior
during childhood is part of the assessment, further family history is considered. The core
underlying symptoms of ADHD among children and adults are often similar, the differential
observance is seen among adults than the children. These can entail an increased physical

Attention Deficit Hyperactive Disorder 7
activity which is observed among children, while adults can display increased levels of
restlessness and mental activeness (Kooji et al., 2010).
Statistics have shown that about 2%-5% of adults have ADHD, in children population
25-50% presentation presenting with ADHD progress with the symptoms to adulthood
accounting for the adult occurrence with symptoms while the rests do not show any
characteristics (Kooji et al., 2010). The majority of the adult population does not get medical
management, they present with a disorganized life and present with excess drug abuse usage.
Other aspects entail challenges in managing relationships, jobs, and increased criminal
activities.
Despite this, some of the symptoms displayed by adults often differ from childhood’s
states. Children can engage in climbing and running around, while in adults they exhibit
difficulties in relaxing or increased talking rates in social places. ADHD symptoms since
childhood require an assessment t during adulthood, despite this, a proportion of the adults do
not meet the ADHD criteria might not have been diagnosed during childhood. Late-onset of
ADHD symptoms among children can be considerably adolescent or adult ADHD onset
(Asherson & Agnew‐Blais, 2019).
Strengths and weakness
DSM-V
DSM-v has been utilized as a diagnostic tool for assessing mental disorders for a long
period. This tool offers a set of advantages as well as drawbacks to its usage. The DSM has
been extensively employed in the clinical arena in making diagnosis and assessment. The
underlying advantages entail offering standardization, research guidance and key in
therapeutic guidance. The DSM offers key benefits to both the clinician and patients; it offers

Attention Deficit Hyperactive Disorder 8
standardization of diagnosis and reception of appropriate treatment processes. It facilitates
guidance in research especially in the mental filed (Clarke & Kuhl, 2014). The checklists
offer researches an avenue for reference. It facilitates therapeutic guidance and eliminates
aspects of guesswork. The DSM diagnostic criteria offer a guide map in the care process. The
underlying drawbacks entail oversimplification of human behavior which vast and wide
(Nemeroff et al., 2013). It oversimplifies human-related behavior aspects making it lose
track, further, it is concerned with misdiagnosis and overdiagnosis. The majority of the
people can be labeled as having specific disorders due to aspects of ideal behavior (Bolton,
2013). This has been commonly been observed in ADHD. Further, labeling and
stigmatization are influencing it as a drawback to the tool. Specific disorders labeling offers
an avenue for stigmatization and differentiation of clients (Lingiardi & McWilliams, 2015).
Behavioral ratings
Behavior ratings assessments have been widely employed clinical tools in providing
crucial information regarding child behavior. Despite this applied tools across settings,
drawbacks have been observed. Parental bias ratings have been shown to have an impact on
responses. Due to the genetic avenue of the condition parental symptomatology can pose a
challenge regarding behavioral responses. Further, teacher rating assessing to have been
shown to vary based on assessor level variations (Waterman, McDermott, Fantuzzo &
Gadsden, 2020). The further occurrence of extraneous factors affecting teacher ability can
have an impact on the assessment, leading to over-reporting of teachers (Phillips & Lonigan,
2010).

Attention Deficit Hyperactive Disorder 9
Continuous performance tests
Continuous performance tests tool offers an avenue for circumventing the rating biases
often found in parental and teacher behavioral ratings. This tool offers an avenue for patients
to view the stimulus sequence while responding on a target stimuli and withholding nontarget
stimuli. Due to various versions available, the continuous performance tests vary in their
complexity making it a challenge to be adapted for young children. An example of such a
version is the A-X tool task, which entails working memory component which often exceeds
preschoolers' cognitive ability. In general preschoolers and school-age children often commit
more errors, making these tool tests vulnerable for confounding factors (Sims & Lonigan,
2012).
International Classification of diseases-11
ICD-10 offers an avenue for new health care practitioners as a new stand for clinical
data assessment. Its inherent advantages entail offering an effective transition in the care
practice, it enhances effective patient analysis leading to better care coordination. This test
tool is applicable globally compared to other forms such as DSM-5 which is applied in the
US alone.
Cultural sensitivity of the assessment practices
ADHD assessment patterns and behavioral perspectives of culturally diverse
populations have often been underestimated. The rapid growth of diverse ethnic and minority
populations globally and especially the US outline key disparities in the care process (La
Roche Carrick & Hammerness, 2015). The prevalence rates of ADHD among children are
observed to be declining, however, statistics indicate that among non-Hispanic white, rates
are higher compared to other population groups such as Latino, Hispanic or Asians (Bloom et

Attention Deficit Hyperactive Disorder 10
al., 2013). These differences can be attributed to the influence of reporting based on cultural
meanings and biological differences regarding normal and abnormal behaviors (La Roche,
Carrick & Hammerness, 2015).
Further, the rate of minority children with ADHD has low access to cure and treatment
compared to non-Hispanic whites (Marcus & Durkin, 2011). The cultural psychotherapeutic
framework of the minority parents often makes them hesitant to show and explain the
behavioral challenges of the children concerning ADHD. Further, they are reluctant to
believe whether these difficulties can be managed medically. Observation indicates that when
the treatment protocols match that of the family culture, resources and vales, there is an
increase in efficacy and adherence to the treatment process (La Rocher &, La Rocher, 2013).
The current assessment protocols have often failed in entrenching these aspects of culture
into its domain.
Ethics of assessment procedures
In managing ADHD assessments, health care practitioners are bound to their legal duty
on optimal treatment of the child. Normal practice allows for consent seeking from parents
while taking into account the views of the child. Despite concerns of sufficient autonomy,
assessment and treatment need to be based on professional guidance. The process ensures that
it involves autonomy, beneficence, and non-maleficent in the care process delivery (Jonsson
et al., 2016).
Treatment safety practices have at times lead to ethical challenges beneficent, non-
maleficent and respect for autonomy during the initial assessment. Due to the young of the
children, the overwhelming responsibility of autonomy is placed on the parents while
respecting the child’s autonomy, as the treatment is a long duration process. Due to this, there

Attention Deficit Hyperactive Disorder 11
is a need for child appreciation on the treatment process to enhance the balance autonomy as
it is shifting as the child ages (Chan, Fogler & Hammerness, 2016).
More common in ADHD, ethical concerns often tend to arise on beneficence and non-
maleficent. At school levels, teachers may restrict children who have hyperactive-impulsive
before they are medicated due to their behavior in school. This can lead to aspects of
retribution however, in this challenge the needs of the child often is paramount. Balancing the
conflicting principles is geared towards a possible outcome for the child.
Recommendations
Based on the underlying assessments focused on ADHD, culture perspectives inclusion
remains to be a fundamental challenge in enhancing family ability to be open to children's
adverse behaviors. The majority of the minority communities often exhibiting a high
prevalence of ADHD are often reluctant to believe that such behavioral characteristics can be
managed through medication. A classical example in an explanatory model demonstrates that
the restlessness of a child can be a result of bad spirits, leading to seeking consultations to a
priest rather than a psychiatrist (La Roche, Carrick & Hammerness, 2015). Enabling
treatments to match the values, practices and community resources, it increases the overall
efficacy and treatment process.
Thus given this, the need for adoption of the psychotherapeutic model in both
assessment and treatment phases is essential in founding a shared understanding between the
family and the health care practitioner on the problems showcased by the child, goals of
treatment and key interventions to manage the state. In essence, this psychotherapeutic
approach allows for the ADHD approach on the assessment of the child's cultural context and
ethical views of approach towards a shared understanding. Family’s ability to understand
behavior challenges needs to make a basis for the therapeutic process, thus improving the

Attention Deficit Hyperactive Disorder 12
overall assessment process, increasing the treatment process. A classical view is on aspects of
hyperactivity and impulsivity which is a classical symptom of ADHD, can be viewed in
terms of certain cultural contexts (Sue, Gallardo & Neville, 2013), affecting the assessment
process. Thus incorporating the cultural psychotherapeutic model in the assessment of ADHD
among children across the population context is essential especially for the minority and
indigenous populations who exhibit high levels of ADHD.
Future research focus
The need for an exploration of the contextual variables regarding culture concerning
ADHD is of great interest. This can moderate or mediate medication management of ADHD.
The potential of this avenue is to assess on risks and benefits of ADHD for family assistance.
Consideration of the underlying ethical and cultural aspects in the treatment process is
essential in informing diverse influence on clinical practice to have a shared avenue for
behavior-related problems. Thus the need for a comparative assessment of cultural
therapeutic framework assessment tools to other assessment methods in managing ADHD
especially among the indigenous and minority groups is essential as they continue to exhibit
elevated prevalence levels of ADHD.

Attention Deficit Hyperactive Disorder 13
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