Attention Deficit Hyperactivity Disorder: Diagnosis and Treatment

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Table of Contents

Abstract
Introduction
Literature review
Methodology
Reference List

Abstract

It has been widely reported by the parents of the ADHD children that the latter experience a poor sense of time in their behaviors. Therefore this study paper seeks to find out the sense of time in children with attention deficit hyperactivity disorder (ADHD). the study that was carried out found out that many children are affected by attention deficit hyperactivity disorder in their sense of time and therefore this matter should never be taken for granted.

It is advisable that parents should spend most of their time with their children in order to establish if they are free from this disorder. It is also important that children who suffer from ADHD should be taken to a psychiatrist in order to manage this disorder.

Introduction

Undoubtedly, attention-deficit hyperactivity disorder (ADHD) is the most common disorder found in children and adolescent and it is believed that it affects 5-10% of the children all over the world (Willcut, Doyle, Nigg, Faraone & Pennington 2005). This disorder is characterized by hyperactivity pervasive, impulsivity and lack of proper attention. ADHD is a complicated disorder since it is caused by several factors and also the disorder exhibits many clinical conditions.

According to the DSM-IV-R (American Psychiatric Association, 2000), it elaborates that there are three sub types of ADHD namely predominantly inattentive, predominantly hyperactive-impulsive and combined inattentive and hyperactive-impulsive.

However, it has been established by various authors (Amador-Campos, Forns-Santacana, Guardia-Olmos & Pero-Cebollero, 2006; Baldwin, Flake, Meaux, Chelonis, J.J., Edwards, M.C., Field, C.R. et al. 2004) that there are other individual differences which cause ADHD other than the symptoms mentioned above.

Literature review

It is known that ADHD is mainly diagnosed in school going children even though it emerges in the years before the children go to school. However other studies based on community sample have revealed that the problem in behavior which is experienced in early life will likely to be linked to future difficulties in behavior.

On the contrary few studies have highlighted the frequency with which children under the age of five years meet the criteria for ADHD (Barkley, 1990; Barkley 1997; Barkley, Koplowitz, Anderson & McMurray, 1997). Generally, the studies mentioned above found out that approximately half of the young preschool children and almost three quarter of the older preschool children had behavior problem associated to ADHD with the range of age being assessed lying between 2-10 years (Harvey, Youngworth, Thaka &Errazariz, 2009).

In Barkley’s (1997) unifying theory, he examines that impairment to sense of time is one of the major difficulties presented to children with ADHD. He goes further by postulating that the primary deficiency in response led to secondary deficiencies. According to his theory, a working memory deficit leads to lack of proper attention and hinders the development of sense of time in ADHD children.

The children are influenced by the recent activities while they tend to forget the activities which happened long ago. Levine & Spivack (1959) reported that in a group of restless and emotionally disturbed boys there is conception of time constriction and longer estimation of time. Also Capul (1966) noted that children below the age of nine presented problem in estimation of time.

Many researches support the theory of time perception deficit in ADHD children; (Baldwin et al., 2004; Barkley, Koplowitz, Anderson & Mcmurray, 1997; Andreou, Agapitou & Karapetsas, 2005; West et al., 2000 among others). The above named studies show that children with ADHD have difficulty in estimating time and they also have a discrepancy in tasks related to time reproduction.

These children will tend to overestimate short time interval while underestimating long time intervals. Furthermore, it has been established that children with ADHD combined type varied greatly in their time reproduction errors compared to children with inattentive ADHD type (Barkley, 1990).

Experimentally, children with ADHD have an ability to judge time interval appropriately while they fail to do so during their daily activities since they lack attention (Zakay, 2005).

Piaget (1946) illustrated that time was not intuitive but it only resulted from the constructed thoughts. He defined time as “coordination of movements of different speeds” (p.269). Therefore time can never be studied alone from other factors such as causality and space. Examples are time invariance which is the ability to determine time through sequences and simultaneity, time metric operation which is the ability to measure time.

Methodology

The participants were 50 children with various ADHD symptoms (40 were boys while the rest were girls of age 6 to 13 years). This diagnosis was carried out by experienced child psychiatrists and the results were that 43 of the children suffered from combined hyperactive-impulsive and inattentive types while the remaining seven suffered from predominant inattentive type.

It was also revealed that 20 children suffered from other conditions; 4 dyslexia, 6 learning disorder, 3 anxiety disorder and 7 mood disorder. 42 of the children were continuing with their medication at the time of the study even though they discontinued with medication 24 hours prior to the study (Quartier, Zimmerman & Nashat 2010).

There was a control group consisting of 50 children selected from schools. There was no significant difference between the two groups since they had similar characteristics concerning their age and their socioeconomic status. However, there was a large effect size in socioeconomic status which designates that more children with ADHD comes from lower socioeconomic class while the reverse is true for those that come from the upper socioeconomic class (Andreou, Agapitou & Karapetsas, 2005).

The children who had ADHD were selected from an association of patients who had ADHD and also from hospitals that offer mental services. The study was carried out after obtaining the consent from both parties i.e. their parents, children who had ADHD and the control group. The children who participated in this study were rewarded with gifts while their parents received the results of the study after two months of the study.

The time concept questionnaire (TCQ) was used to evaluate the knowledge of time in children with ADHD. This questionnaire consisted of 50 questions to be answered by the children from both the control group and the group that had ADHD. The questions were about time sequence and the orientation in time.

There was a control grid which helped in rating the responses of the children towards the prompt of the question. For example, 1 for “right” and 0 for “wrong”. Then, the time that was taken to fill the questionnaire form completely was recorded in order to determine the level of attention between the two groups that were involved (Harvey, Youngworth, Thaka & Errazariz 2009).

Parents of these children were also asked to fill “Its About Time” questionnaire (IATQ) which intended to gauge the time perception. There were thirty items on the questionnaire which had to be responded according to a scale that ranged from “hardly” to “almost often”.

A coefficient of .82 was estimated for the samples that were analyzed in the study. The scores that were obtained indicated the relationship with time oriental behavior i.e. lower scores showed that there was a problem in time oriental behavior and vice versa (Harvey, Youngworth, Thaka & Errazariz 2009).

The results that were obtained after conducting interview on questionnaire were recorded in the table as follows.

ADHD group

N=50

Control group

N=50

Effect size

TCQ

IATQ

Total score

Delay respect

Anticipation

Referring to past or future

52.10(5.02)

40.02(12.80)

-.65(.93)

-.80(.54)

-.36(.89)

53.47(3.82)

75.34(24.82)

.24(.78)

.084(.74)

.009(1.534)

d = .52

d = 1.98

d = 1.34

d = 1. 15

d = .32

The results showed that children with ADHD did not necessarily differ from children without ADHD in their abilities to remember a series of events at a given time. However if this is compared with the Piagetian time conservation task which has a medium effect size of 0.55, it reveals that there is a slight possibility of vulnerability of event order in children with ADHD (Piaget, 1946).

The results obtained from TCQ showed an important difference in the two groups of study. Generally the results indicate that children with ADHD had a difficult time in evaluating time concepts and they seemed to be impaired in orientation of time.

Parents of the children with ADHD frequently reported that their children were disorganized about time conservation and this is especially true according to our findings. This is so because the mean difference between the two groups for IATQ total score was at effect size of 1.98 representing a percentage of 98% of the ADHD group.

Also it is worth to note that ADHD group were less prone to delay respect (large ES d =1.34), they are likely to think before acting (large ES d = 1.15) and more likely to be impulsive than the control group i.e. children without ADHD (Quartier, Zimmerman & Nashat 2010).

This study had an aim of investigating organization of behavior as compared to time management as well as time knowledge and time invariance in children with ADHD.

According to the study, the results failed to establish that there was a deficit on time conservation in children with ADHD since there was no difference in time interval between the two groups. However analysis on the effect size reveals that children with ADHD performed poorly in tasks involving time as compared to the children without ADHD (Quartier, Zimmerman & Nashat 2010).

In conclusion, the study that was carried out found out that many children are affected by attention deficit hyperactivity disorder in their sense of time and therefore this matter should never be taken for granted. It is advisable that parents should spend most of their time with their children in order to establish if they are free from this disorder.

It is also important that children who suffer from ADHD should be taken to a psychiatrist in order to manage this disorder. If the children with ADHD are looked after properly, the level of the disorder will go down. However it is a challenge to various stakeholders to educate people about the menace of ADHD.

Reference List

Amador-Campos, J.A., Forns-Santacana, M., Guardia-Olmos,J., & Pero-Cebollero, M. (2006). DSM-IV attention deficit hyperactivity disorder symptoms: agreement between informants in prevalence and factor structure at different ages. Journal of the Psychopathology and Behavioral Assessment, 28, 23-32.

American Psychiatric Association. (2000). Diagnostic and statiscal manual of mental disorders DSM-IV-TR (4^th ed., text revision). Washington, DC: Author.

Andreou, G., Agapitou, P., & Karapetsas, A. (2005). Verbal skills in children with ADHD. European Journal of Special Needs Education, 20, 231-238.

Baldwin, R.L., Flake, R.A., Meaux, J.B., Chelonis, J.J., Edwards, M.C., Field, C.R. et al. (2004). Effect of methylphenidate on time perception in children with attention deficit/ hyperactivity disorder. Experimental and Clinical Pharmacology,12, 57-64.

Barkley, R.A (1997). Behavioral inhibition, sustained attention, and executive functions: constructing a unifying theory of ADHD. Psychological Bulletin, 121, 65-94.

Barkley, R.A. (1990). Attention-deficit hyperactivity disorder: a handbook for diagnosis and treatment. New York: Guilford.

Barkley, R.A., Koplowitz, S., Anderson, T & McMurray, M.B. (1997). Sense of time in children with ADHD: Effects of duration, distraction and stimulant medication. Journal of International Neuropsychological Society, 3, 359-369.

Bauermeister, J.J., Barkley, R.A., Martinez, J.V., Cumba, E., Ramirez, R.R., Reina, G. et al. (2005). Time estimation and performance on reproduction tasks in subtype of children with ADHD journal of clinical child and adolescent psychology ,34, 151-162.

Capul, M. (1966). Étude des difficultés temporelles chez des enfants inadaptés [A study of temporal difficulties in maladjusted children]. Revue de Neuropsychiatrie Infantile et d’Hygiène Mentale de l’Enfance, 14, 19–39.

Harvey E.A., Youngworth S.D., Thaka D.A & Errazariz P.A. (2009). Predicting Attention – Deficit/Hyperactivity Disorder and Oppositional Defiant Disorder from preschool diagnostic assessments. Journal of consulting and clinical psychology, 77, 349- 354.

Levine, M., & Spivack, G. (1959). Incentive, time conception, and self-control in a group of emotionally disturbed boys. Journal of Clinical Psychology, 8, 110–113.

Mullins, C., Bellgrove, M.A., Gill, M., & Robertson, I.H. (2005). Variability in time reproduction: Difference in ADHD combined and inattentive subtypes. Journal of American Academy of Child and Adolescent Psychiatry, 44, 169–176.

Piaget, J. (1946). Le developpement de la notion de temps chez l’enfant. [The child conception of time]. Paris: PUF.

Quartier V., Zimmerman G. & Nashat S. (2010). Sense of time in children with Attention- Deficit/ Hyperactivity Disorder (ADHD). Swiss Journal of Psychology, 69(1), 7-14.

West, J., Douglas, G., Houghton, S., Lawrence, V., Whiting, K.,&Glasgow, K. (2000).

Time perception in boys with attention-deficit/hyperactivity disorder according to time duration, distraction, and mode of presentation. Child Neuropsychology, 6, 241–250.

Willcutt, E.G., Doyle, A.E., Nigg, J.T., Faraone, S.V., & Pennington, B.F. (2005). Validity of the executive function theory of attention-deficit/hyperactivity disorder: A meta-analytic review. Biological Psychiatry, 57, 1336–1346.

Zakay, D. (2005). Attention et jugement temporel. [Attention and duration judgment.] Psychologie Française, 50, 65–79.

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