What Is Strauss Syndrome?

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Table of Contents

Introduction
Background and History
Epidemiology
Aetiology
Treatment
Challenges
Conclusion
Reference List

Introduction

Strauss syndrome is a condition that has been discussed by many researchers. Different names have been adopted for this condition since its original description. The current term is Attention Deficit Hyperactivity Disorder (ADHD). ADHD was initially referred to as “Strauss Syndrome” after Alfred Strauss who was the researcher who did significant work describing the characteristics of children with specific brain condition (Brown, Reichel, & Quinlan, 2011). In this paper, Strauss Syndrome is used to refer to Attention Deficit Hyperactivity Disorder (ADHD). The paper looks at the history of the condition and the term, the signs and symptoms associated with it, its epidemiology, aetiology, treatment, and the challenges that are associated with it.

Background and History

The evolution of ADHD has taken many decades. It took the works of many researchers to make the available information possible. Strauss Syndrome, or ADHD as it is commonly known, has been the subject of many debates. Different researchers have demonstrated different opinions on the aetiology and manifestation of the condition, with this disparity leading to different classifications and naming. Before the 20^th century, there was limited work on the manifestations of brain injuries and other neurological conditions, including Straus Syndrome.

Some of the first studies observed a prominent difference between the behavioural symptoms of the condition, as exhibited by different children (Brown, Reichel, & Quinlan, 2011). Most of the researchers who studied the condition described it in relation to the need for special education in the affected children. Some physicians in 1923 viewed the condition as “epidemic encephalitis” after several children with encephalitis demonstrated cognitive and behavioural impairments (Schwiebert & Sealander, 1995). The characteristic manifestations of the condition described at the time were impulsivity, quarrelsomeness, insomnia, and irritability. These children were hyperkinetic, moody, talkative, and incorrigible (Schwiebert & Sealander, 1995). These presentations were the first symptoms that corresponded to ADHD.

Hyperactivity has been described in many terms over the last few decades, and hence the main reason for the change in naming of the condition. Some of the terms used to describe it were “over-activity”, “irritability”, and restlessness” (Schwiebert & Sealander, 1995). The condition as also once referred to as the “organic behaviour syndrome”, with the term transiting to “minimum brain damage” (Schwiebert & Sealander, 1995). Proponents of organic brain damage stated that the behaviour of children with the condition resembled that of primates with lesions in the frontal lobe (Schwiebert & Sealander, 1995).

During the 1940s, researches suggested the treatment of the condition in specialised classrooms where children were exposed to minimum stimulation. This treatment has been challenged, with the current evidence showing that more stimulation is necessary for the course of treatment of children with this condition (Brown, Reichel, & Quinlan, 2011). Alfred Strauss contributed significantly to the research on the condition, with his research mainly considering the aspect of distractibility (Brown, Reichel, & Quinlan, 2011). The use of the term “minimal brain damage” to refer to the condition was increasingly replaced by the term “Strauss Syndrome” following the contributions of Alfred Strauss (Schwiebert & Sealander, 1995).

In the 1950s and 1960s, the use of more specific terms was adopted to refer to patients exhibiting the different symptoms. The American Psychiatric Association adopted the term in its Diagnostic Statistical manual (DSM II) in the 1960s. Although researchers thought that the condition was restricted to children, there was increasing evidence that the symptoms would persist into adulthood (Das, Cherbuin, Easteal & Anstey, 2014). The publicity of ADHD was evident in the 1980-90s, with different treatments and therapies being studied at this period. The Diagnostic Statistical Manual by the American Psychiatric Association provides standards for the diagnosis, treatment, and care of patients affected by the condition.

Epidemiology

Boys are more affected by the disorder in relation to their female counterparts, with many theories providing support for this claim. The most affected age group is the children between the ages of three and fourteen with a prevalence of between 3% and 5% in children of school going age (Wolraich, Wibbelsman, Brown, Evans, Gotlieb, Knight, Ross, Shubiner, Wender & Wilens, 2005). Most individuals affected by the disorder also have concurrent problems. The most common of the concurrent conditions is conduct disorder that affects a significant proportion of ADHD patients (Wolraich et al., 2005). Mood disorders are also common, with individuals having anxiety disorders (Wolraich et al., 2005). Another common concurrent disorder is the opposition defiant disorder.

The relationship between the condition with family and genetic factors has also been the subject of many studies, with most of such studies finding a direct association (Brown, Reichel, & Quinlan, 2011). The conclusion is that there is a greater risk of developing this condition if a first-degree relative is affected (Brown, Reichel, & Quinlan, 2011). Other associations to that have been made in the occurrence of Strauss Syndrome include prenatal insult, including exposure to drugs such as alcohol and lead poisoning (Brown, Reichel, & Quinlan, 2011). There has been a suggestion that certain food additives and sugar cause the condition. However, research has failed to show an association between them and the condition.

Aetiology

The reason for the many changes in the naming of the condition is mainly due to the scanty evidence on the aetiology of the condition. Many theoretical perspectives have been proposed and grouped into sociological, environmental, and physiological schools of thought (Wolraich et al., 2005). The exact aetiology of the condition is still elusive, with many explanations existing in the aetiology of this disorder. The studies into the aetiology resulted in three types of ADHD, namely attention deficit disorder without hyperactivity, with hyperactivity, and with aggression and aggressiveness (Wolraich et al., 2005).

Although many individual theories are dedicated to the study of the origin of the condition, most researchers are of the opinion that ADHD has no single cause (Wolraich et al., 2005). The most commonly associated cause of the condition is brain damage, with many studies being focused on the same cause. Researchers state that in most of the patients exhibiting the symptoms of the condition, inherent or acquired brain pathology leads to the manifestations (Wolraich et al., 2005). The second commonly cited origin of the condition is the prenatal cause. Researchers state that the prenatal nutrition and care in mothers was inadequate. They also state that mothers who indulge in drug abuse while pregnant are likely to get children with the condition, with the commonest culprit being alcohol (Brown, Reichel, & Quinlan, 2011).

Some of the other theories on the epidemiology of ADHD (Strauss Syndrome) include the malnutrition of children and pregnant women. Malnutrition leads to brain damage (Brown, Reichel, & Quinlan, 2011). Some researchers have also suggested that living in an abusive home can predispose a child to the disorder (Brown, Reichel, & Quinlan, 2011). Other researchers have opposed most of these theories. The theories that are consistent with the origin of the condition include the genetic theory and the association between the conditions with other physical or psychiatric illness (Wolraich et al., 2005).

According to most articles, the condition results from the slow development of neurobiological self-regulatory mechanisms in the brain, with the prefrontal cortex being the main involved area. Studies that use Magnetic Resonance Imaging (MRI) show significant differences in the prefrontal cortex of individuals with the disorder and those without it (Wolraich et al., 2005). In most of the MRI tests that showed small right Globus Pallidus and Caudate Nucleus in the corresponding cortical-striatal-thalamic-cortical brain circuitry, the individuals had a reduced response to inhibition (Brown, Reichel, & Quinlan, 2011).

The infancy stage in human beings is associated with increased production of neurotransmitters that aid the individuals in their exploration f the world around them. The Neurotransmitter that is specifically associated with the over-activity during this period is dopamine. For patients with the Strauss Syndrome, this neurotransmitter remains high even after the stage of development (Wolraich et al., 2005). Studies into the aetiology of the condition have led to the definition of the main features of pure ADHD as being hyperactivity, impulsivity, poor memory, mood disorder, inattentiveness, and low tolerance to frustration (Wolraich et al., 2005). Aside from the many studies on the relationship between dopamine and the condition, Norepinephrine is another chemical that is closely associated with the occurrence of ADHD.

The condition has also been described as being related to learning disorders, with some of the characteristics being common to the two conditions. Wolraich et al. (2005) assert that the manifestation of Strauss Syndrome/ADHD is only after the affected individual is in the presence of other individuals, with the symptoms not being present when they are alone and doing their own personal activities. Therefore, the condition has been described as being influenced by the establishment of rules, with the affected children being unable to relate to the common set rules of engagement. The correlation between the condition and other conditions prompts the belief that the aetiology is diverse and multi-factorial. There are ongoing researches in the aetiology of this condition. Many researchers are aggressively studying it.

Treatment

The treatment of psychiatric conditions is the main reason why they are studied. Many modalities have been employed in the diagnosis and management of Strauss Syndrome /ADHD, with some being more successful in relation to others. Many organisations and medical bodies describe the diagnosis of the condition. One of them is the American Psychiatric Association that provides some of the mandatory manifestations at diagnosis. The main features required in the diagnosis are inattentiveness, hyperactivity impulsivity, and ease in distraction (Wolraich et al., 2005).

The treatment of the condition takes many shapes with the use of medication and other therapies. The use of central nervous system stimulants have been studied in the treatment of the condition as the most important treatment modality (Brown, Reichel, & Quinlan, 2011). Some of the most commonly used drugs in the category of CNS stimulants include the pemoline (Cylert), dextroamphetamine (Dexedrine), and methylphenidate (Ritalin) (Black, 1992).

These medications have different efficacies, with the most commonly used of them being Ritalin (Brown, Reichel, & Quinlan, 2011). The results of treatment with the medications are positive. Many patients who receive these drugs register improvements (Wolraich et al., 2005). However, some of the patients are reported to have worsening of their symptoms with the treatment using stimulants.

The response to the medication is observed with a reduction in hyperactivity. The children are able to concentrate and pay attention in class (Brown, Reichel, & Quinlan, 2011). The activity that reduces includes the task-irrelevant ones and non-productive movements.

Students have improvements in compliance with rules and authority. The use of medications in the treatment of the condition subjects the patients to the different side effects that are characteristic to the medications. Some patients are reported to have increased irritability, pain symptoms such as headache, stomach pain, and the onset of vocal and motor tics (Wolraich et al., 2005). The treatment of Strauss Syndrome/ADHD may be unsuccessful in some of the patients, with the patients having a rebound of the symptoms (Brown, Reichel, & Quinlan, 2011).

In cases where rebound occurs after treatment, patients usually have conduct deteriorations in the afternoons after the administration of the medications (Brown, Reichel, & Quinlan, 2011). According to Brown, Reichel, and Quinlan, (2011), some of the distressing side effects of the medication used in the treatment of the condition include suppression of increments in height and weight. However, most of the side effects of the medications used in the treatment are not fatal. Growth inhibition associated with them is reversible upon withdrawal of the medications (Wolraich et al., 2005).

Apart from the use of stimulants in the treatment of the condition, antidepressants constitute some of the other types of medications. These are widely used in individuals who exhibit significant side effects after using the conventional treatment drugs such as Ritalin (Brown, Reichel, & Quinlan, 2011). Examples of antidepressants that are commonly used include Coniine, which is the first line in treatment after side effects to Ritalin and the Monoamine Oxidise inhibitors (Gomez, & Cole, 1991).

Many other treatment modalities for Straus Syndrome are available apart from the medication-based treatment. The therapies are aimed at making the affected children more adaptive to their natural environment while improving their performance in the classroom. These therapies are also crucial in the development of social skills and/or improvement in their academic skills (Wolraich et al., 2005). These patients are also managed through special education where they are put through special programmes to improve their skills. Other interventions that are commonly used in combination with the use of medication include the use of the token economy, home-based contingencies, and the use of contingent attention (Brown, Reichel, & Quinlan, 2011).

Group contingencies are other forms of intervention, with patients being trained that the consequences in a group are the result of individual actions (Schwiebert & Sealander, 1995). Patients learn how to control their behaviour and emotions. Another intervention according to Schwiebert and Sealander (1995) is the peer-mediated intervention, which involves the management of the patient using the input of peers in their environment. Schwiebert and Sealander (1995) also assert that the most commonly used interventional technique in therapy aside from the use of medication is contingent attention, which involves the use of positive and negative feedback to influence the behaviour of the patients.

In most of the psychiatric conditions, the management of Strauss Syndrome requires a multimodal approach (Schwiebert & Sealander, 1995). Therefore, it is common for health experts to use a combination of medication and other therapies as described above. A significant proportion of patients have recurrence of the symptoms after successful treatment, with another ratio experiencing a relapse. However, the biggest proportion exhibits improvement in the manifestation of this condition. There are many challenges in the diagnosis and management of the condition, as discussed in the next section.

Challenges

The main challenge is in the diagnosis of the condition. Many cases go undiagnosed for several reasons. Most of the researchers who have described the existence of the condition have concluded that it exists with different manifestations. Some of the affected children and adults have mild symptom manifestation. Authorities and learning institutions brand them a nuisance. Hence, these patients are subjected to unnecessary correctional measures, with the consideration that they are not fit to interact with the other normal individuals (Das, Cherbuin, Easteal & Anstey, 2014).

Apart from the learning institutions, families also have difficulties in dealing with the behaviours of children exhibiting the symptoms of the disorder. There is inadequate knowledge on the condition, with the parents equally misunderstanding their children (Wolraich et al., 2005). Most families have ended up abandoning their children and adults who suffer from the condition because of the antisocial behaviours that they exhibit at times. As earlier stated, the condition may occur concurrently with another psychiatric condition, hence posing difficulties in the diagnosis.

The training of some medical personnel may be inadequate in the management of patients who exhibit symptoms of Strauss Syndrome. There are frequent cases of mismanagement. Therefore, there is the need to engage in the training of health practitioners on the management of the condition and the available effective therapies. The observations that lead to the diagnosis of Strauss Syndrome/ADHD are usually present in childhood. Caregivers and teachers mainly observe them (Das, Cherbuin, Easteal & Anstey, 2014). The existence of the symptoms in adulthood makes management difficult, thus leading to the individuals receiving care that is not standard.

The other challenge that the condition is associated with is in the increased accusation of patients through the legal systems of countries with inadequate laws on psychiatric illness (Schwiebert & Sealander, 1995). In some cases, patients with Strauss Syndrome are involved in practices that are illegal in some parts of the world. Some of them face arrest warrants and/or court charges. If there is no opinion on their illness and mental status, they may get a prison term. However, some countries have developed special laws that allow the assessment of individuals before they are charged in court with certain types of crimes.

As originally described, Strauss Syndrome is usually a condition that is associated with the young. Few studies have been done on the effects that adults may experience in the event of recurrence. However, the truth is that a sizeable number of individuals is affected by the condition in their adulthood. Some of them have been wrongly diagnosed of related conditions (Das, Cherbuin, Easteal & Anstey, 2014). Conduct disorders are also common conditions that are wrongly diagnosed in relation to Strauss Syndrome. There is the need for further research on the condition to establish the most effective treatment modalities and the prevalence in adulthood.

Conclusion

This report describes Strauss Syndrome as a condition that is currently defined as Attention Deficit Hyperactivity Disorder. The report establishes that the naming was due to the input of the researcher Alfred Strauss. Along with other researchers, Strauss provided the definition for the condition, with other researchers providing some important treatment modalities. There were changes in the naming of the condition as discussed in the paper. There is the need for more research into the disorder, especially in the aetiology section.

Reference List

Black, S. (1992). Kids Who Can’t Sit Still. The Executive Educator, 14(11), 31-34. Web.

Brown, T., Reichel, P., & Quinlan, D. (2011). Executive function impairments in high IQ children and adolescents with ADHD. Open Journal of Psychiatry, 1(1), 56-65. Web.

Das, D., Cherbuin, N., Easteal, S., & Anstey, J. (2014). Attention Deficit/Hyperactivity Disorder Symptoms and Cognitive Abilities in the Late-Life Cohort of the PATH through Life Study. PLoS ONE, 9(1), 1-13. Web.

Gomez, M., & Cole, L. (1991). Attention-Deficit Hyperactivity Disorder: A Review of Treatment Alternatives. Elementary School Guidance & Counselling, 26(1), 100-113. Web.

Schwiebert, V., & Sealander, K. (1995). Attention-Deficit Hyperactivity Disorder: An Overview for School Counsellors. Elementary School Guidance & Counselling, 29(4), 249-261. Web.

Wolraich, M., Wibbelsman, C., Brown, T., Evans, S., Gotlieb, E., Knight, J., Ross, C., Shubiner, H., Wender E., & Wilens, T. (2005). Attention-Deficit/Hyperactivity Disorder among Adolescents: A Review of the Diagnosis, Treatment, and Clinical Implications. Paediatrics, 115(1), 1734-1746. Web.

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