The Theory and Medical Treatment of ADHD

For the past several decades the terms learning disorders, learning dysfunctions, learning disabilities, learning differences, and attention-deficit disorders have made the rounds in the educational, medical, and psychological journals. The concepts have been studied routinely and thoroughly with similar and distinct differences. Some theoreticians and educators include the concepts of dyslexia, hyperactivity, interrupted concentration, anxiety, perceptual dysfunction, and a host of other variables as belonging to the definition of what should be called a learning puzzle rather than a dysfunction. If the perception of a piece is placed before the recognition of the whole, then treatment is item specific and not supportive of the entire structure. In other words, learning, and the process whereby it is completed or interrupted, must be viewed in relation to the whole structure rather than identified by its parts. The learning puzzle can be properly described as an intricate formation of a human's neurological, physiological, psychological, and sociological systems (parts) blended together to produce a healthy functioning individual (whole). The â€Å"act† of learning is accomplished optimally when all parts of the puzzle are functioning without interruption. However, when learning is interrupted through external or internal stimuli the puzzle cannot be completed and negative results occur. The lack of puzzle completion is brought about both environmentally and medically. For example: A lack of educational opportunity, poor self esteem, and even peer pressure (environmental leaning interruption) can help to erode the puzzle structure and produce a dysfunctional situation in the learning process (Jourard, 1959). Similarly, should there exist a malfunction in the body (medical part) disruption in learning can occur as well; thus preventing the puzzle from becoming complete. The focus, therefore, of this paper will be to report on that which causes learning to be disrupted through a medical variable (hyperactivity) and the treatment that can be applied to permit learning to take place on a much more normal basis. The literature is replete with references to Attention-Deficit/Hyperactivity Disorder (AD/HD) and the learning consequences. Generally speaking AD/HD is characterized by developmentally inappropriate impulsivity, attention, and hyperactivity. It is a neurological disorder (DSM-IV-TR, 2000; Breggin, 2000) that has serious consequences including school failure, problems with relationships, conduct disorder, substantive abuse and job failure (Bagwell, 2001; Cepeda, 2000). More specifically AD/HD refers to a family of related chronic neurobiological disorders that interfere with an individual's capacity to regulate activity level (hyperactivity), inhibit behavior (impulsivity), and attend to tasks (inattention) in developmentally appropriate ways. Treatment for the disorder runs the gambit from behavioral therapy (Rabiner, 2003), to herbal remedies (Chan, 2000), to medication (Biederman, 1999). For the most part the drugs used to treat AD/HD are those, which must be prescribed by a physician. Regardless of the drug prescribed the most effective way to treat AD/HD is to use a combination of drugs and therapy. The most common, as well as most familiar, prescriptive medications used for the treatment of AD/HD in children are those stimulants known as methylphenidates (Ritalin, Concerta, Metadate-ER) and amphetamines (Dexedrine, Dexedrine Spansules, Adderall. (Breggin, 1998; Watkins and Brynes, 1999). However, administering these particular drugs to AD/HD children reportedly has some rather severe ramifications such as drug dependency, changing brain chemistry, suppressing appetite, and disrupting the growth hormone. Stimulant medications commonly used to decrease distractibility by increasing focus and concentration, are Ritalin, Dexedrine and Cylert. The general misconception is that this type of medication is used to control hyperactivity. However, the decrease in observable hyperactivity is actually the result of increased ability to concentrate. On the other hand there are even some researchers and practitioners who believe that Ritalin can also lead the way to the use of other narcotics and drugs as the child gets older. Yet there are those who believe that even though the use of Ritalin should be discontinued, they believe the AD/HD child can be placed in a more compliant or submissive state with medications that will permit the child to gain control over the disruptive behavior and learn more (Pelham, Carlson, Sams, Vallano, Dixon, & Hoza, 1993; Runnheim et al. 1996; Barkley, R. A. ,1990). Just because an AD/HD child may have a positive reaction to medication is not indicative that medication is all that is required to produce the desired learning and behavioral results. The medications do not cure the disorder; they only control the symptoms while the medication is in the system. Knowing that medications may help a child pay better attention they do not improve the child's academic skills or increase the child's knowledge. What is most often recommended for lasting improvement is to combine a medical management program with other treatment modalities such as behavioral therapy, emotional support, and parental and educational involvement. The concern today is that everyone is looking for a miracle cure for AD/HD children. Successful treatment of AD/HD requires specifically dealing with several problems in terms of hyperactivity, impulsivity, inattention, and poor motivation. In fact the more the treatment digresses from the aforementioned performance points, the less successful the treatment becomes. Knowing that proper nutrition, exercise and a healthy lifestyle is important for everyone, including ADHD children, there is extremely little scientific evidence that any homeopathic or herbal preparations will lessen or eliminate the symptoms of AD/HD in children. In addition there is little evidence as well treating an AD/HD child with vitamin and mineral supplements, biofeedback, or acupuncture will have any long-lasting affect. The life of an AD/HD child can only change for the better through a combination of careful assessment, proper counseling, family involvement, and appropriate medical treatment.