ADHD In Children
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Question: a. Recognize the relevant information needed to formulate a diagnosis.
b. Make differential diagnoses as needed.
c. Understands the course of a disorder and the affect a child's disorder has on the family, school.
Answer: Introduction: As opined by Polanczyk, et. al. (2014) ADHD (Attention Deficit Hyperactivity Disorder) is a neurological disorder developed in children, primarily affecting the executive functions such as problems with controlling impulse, trouble in attention and over-activity. These characteristics and symptoms that are displayed in the child are highly unfortunate for their age (DuPaul, and Stoner, 2014). These indicators strain the child's ability to pay attention as well as restrain their movement. The child diagnosed with ADHD may have trouble in following direction, completing assignment and task at school or at home and may also have trouble sitting still. The focus of this paper was to present a case study of a child suffering from ADHD. This paper will highlight the history of illness and symptoms of the child. It will also recognize the relevant information needed to formulate a diagnosis as well as understand the affect of a child's disorder on the family, education and the society.
Course of disorder: The child selected for this paper is a nine year old boy who is diagnosed with ADHD and was exhibiting its primary characteristics at a very young age. He is an intelligent young boy and is caring in nature. The boy has a potential to shine academically as he has a family background of academic excellence. He has a lot of friends with whom he loves spending time and also participates in various school activities such as swimming and running
Presenting problems and reason for treatment: He had experienced a lot of difficulty in school since kindergarten and was positioned in a kindergarten where he was checked by the regional psychoanalyst as he was undergoing significant complexities with his motor abilities and lack of attentiveness. The boy is very active as he also loves participating in social events and often goes to birthday parties and play dates. It is worth mentioning that the child was unable to remember his home address or contact number. He also had a problem with registering is surname and only recognized a small number of pre-primer words. The child fits in well with peers of his own age, but it is noted by his parents that he is easily mislead and influenced by others.
As discussed earlier the child is stated to be intelligent but was often seen throwing tantrums at the teachers and parents. It was reported that it would upset him if he did not receive any recognition or was ignored for a long time. He used to behave socially immature and would act out indicating an attention- seeking behavior. The child has had quite a few occurrences of hitting, howling outbursts, and improper conduct. Behavioral apprehensions with hostility, dishonest arguments, and disorderly actions were noted in his pre-school program at an age of four.
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Symptoms: The patient describes his symptoms and expressed his difficulty with concentrating and sitting still in class for a particular time period. He identifies his hyper focus behavior in some significant activities of importance and also recognizes difficulty in sustaining attention in class room or school activities. He parents and teacher have also indicated the child to be restless and stated that he needs reminders to aid him to keep on track. His parents described him as a child who is constantly running around and has issues in listening and following instruction. His parents see him always facing problems at night. It is noticed that he had problems falling asleep and is sometimes found awake in the middle of the night without any reason. After he awake it is very difficult for him to go back to sleep again. Due to this he is getting crankier as lack of sleep is making him less attentive and irritated.
He was also facing difficulties in following the routine at home and is describe as emotionally reactive as well as his confrontational behavior is creating problems at home and at the school. The child was often seen to interrupt others students in the classroom and blurt own answers loudly.
Family history: The selected child was an elder son of his parent and had a younger sister who was five years old. The parents especially the mother of the child had great concern for his son and his future. She was very anxious and went out her way to help her son in every way possible. The parents were well educated and there extended family has a history of mental illness. His parents at a very young age identified his symptoms and were smart enough to understand his mental condition. They were very supportive regarding the issue of their son and as he was their single child, they fully dedicated themselves to do anything that would make his life a little better.
Formulation of Diagnosis: According to Ziereis, and Jansen, (2015) ADHD is a complicated condition most of the time it is difficult to diagnose this disease based on the symptoms. As claimed by the doctors there are not specific and single test to diagnose the disease especially in children and teens (Asherson, 2012). The doctor identifies this disease after having a lengthy discussion with the child, teacher and the parents.
The differential diagnosis was made on the child by observing the child's behavior and discussing about the activities of the child at home and at school. After gathering significant information and relating the gather data from related problems running in the family and reflect on all the possible causes. After observing and collecting all the required information different tests were given to examine the child's mental and neurological status. The tests included
• A full body physical exam and neurological assessment that consist of examining the vision, hearing ability, verbal skills and motor skills. As the test given gave negative result more test was granted to understand the hyperactivity in the patient.
• A medical history chart was created where call the social and health history of both the parents and the child was provided.
• A test was created to evaluate the intelligence, personality traits, capacity and his processing skills. This evaluation was done with a contribution from the parents and teachers of the child.
• Neuropsychiatric EEG-Based Assessment Aid (NEBA) System, a scan that measures the brain waves was also done.
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Impact on children: According to Smith (2013) ADHD had a significant impact on the child himself. This issue was creating a negative impact on the child's behavior and self confidence. He felt neglected by his parents and teachers. Different from other children was affecting his mental health and deteriorating his performance at school. He was becoming more aggressive and emotional because of his underachievement in academic arena. The learning problems faced by him were making him act immaturely. The physical and mental health problems faced by him on a regular basis made him exhausted and disruptive. As he was facing a lot of trouble mentally this was impacting and making him more aggressive verbally and physically. He was felt victimized by the whole world as he was granted this special condition. They felt sorrow and exhausted which reflected in their behavior towards their parents and teachers. Their life being complex made them more vulnerable and overwhelmed. The inconsistent environment in their family made him feel less safe and secure in his home setting (Sprenger, 2013). He often felt anxious and wanted to resort to self-injury as he felt underestimated. Less sleep made them more irritated and unsatisfied with his parents and life. The child was effortlessly provoked and had become emotionally impetuous. He feels and recognizes his tendency himself, but is unable to control his behavior. In spite of his best intention to manage his actions, he is felt restrained and incapable to control his destructive attitude.
Impact on family: The parent of the child suffering from ADHD was very supportive but had to go through a lot of developmental, behavioral and educational disturbances. They have to spend more time and energy on the child than the normal parent. Due to their hectic schedule and dealing with the tantrums of the child, the parents are having stress in their marriage and functioning of the family. The chronic illness was creating a stressful atmosphere among the family members and they were often having health problems such as depression, stress related headaches and aggravating behaviors towards each other. The most severe impact that affected the parents was the economic stress and burden (Johnston, and Chronis-Tuscano, 2015). This financial burden was stressing the functioning of the family and also resulted in psychiatric disorder. This was upsetting the child-parent relationship and diminishing the parental monitoring. They were feeling powerless as they could not do anything to make tier child feel better.
Impact in school education: As opined by Weiss, et. al. (2011) the educational troubles faced by the ADHD children include several limitations, impairments and constraints that affect the performance of the children academically. The child discussed in this paper belongs to a family of excellent academic background and is depicted as an intelligent student. Due to ADHD, the child was having problems in sequencing complex movement and it also limits its writing and reading capabilities. The child was having troubles in completing general tasks and maintaining interpersonal relationship. He was having issues in coping up with the teachers and was also facing problems with process the information provided by the teacher.
Conclusion: ADHD being a complicated disease is quite rare but has an extensive affect on the child's present behavior. The child discussed in this paper was from a well academic background and had to deal with a lot of issues in relation with his family, education and school environment. The parents were said to be quite supportive but still had to face challenges such as financial burden and it was affecting their marriage. The child was also depressed because of his disease which made him aggressive and anxious. The conflicting environment in their family made the child less safe and secure in his home surroundings. The child was having dilemma in finishing common tasks and sustaining interpersonal connection. He was also having issues in managing with the teachers and was also facing problems in processing information provided by the teacher. In conclusion the diagnosis of this disease is very difficult and the doctor has to go through the symptoms and observe the child's behavior systematically. Thus it is essential for the parents to identify the initial symptoms and recognize the problems in their child at an early age. This might help the child and the parents as the medication will be provided at an early age reducing the symptoms.
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