May/June,
1996
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May/June,
1996
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Looking at Attention Deficit Disorder (Part 2)
Attention Deficit Disorder, with or without hyperactivity (AD/HD) affects
approximately three to five percent of children in the United States, with
boys outnumbering girls by at least a three to one margin. The percentage
of children appearing the the monthly MARE photolisting book who have been
diagnosed with the disorder, or who are "receiving medication to help
modify behavior" is even higher.
The March/April issue of Recruitment News identified three types of AD/HD
(predominantly inattentive, predominantly hyperactive-impulsive, and combine
type) and described different methods of assessing AD/HD in children. (For
additional copies of this article, phone the MARE office.) In the second
part of this two-part series, we examine the causes and developmental aspects
of AD/HD.
Causes of AD/HD
Heredity
AD/HD does not have one clear and identifiable cause. Many factors can play
a role in its development. Most researchers believe that heredity is the most
prevalent cause of AD/HD. It is common for an AD/HD child to have a close
relative who also displayed hyperactivity or attention deficit as a child.
Family history of AD/HD symptoms may predispose a child to the disorder, but
it is only one of many factors in the diagnosis. AD/HD symptoms vary among
children so the disorder may manifest itself differently, even in members
of the same family. Environmental, discipline, and school factors can also
affect how specific symptoms arise in a child. Intervention should begin early
if a child is thought to have a hereditary disposition to AD/HD. A proactive
approach which provides a structured, nurturing environment before problems
occur can only help these children.
Researchers think that AD/HD is a brain-based neurological disorder that is
genetically transmitted. The attention system of AD/HD children functions
differently. In non-AD/HD children, this attention system adjusts the child's
degree of activity, impulsiveness, and concentration to the appropriate levels
for a given situation. AD/HD children cannot always appropriately adjust this
attention system for their environment.
While many researchers agree that AD/HD involves a dysfunction of the brain,
it is not as clear whether the dysfunction is a cause or symptom of the disorder.
Brain damage was once thought to be the main cause of AD/HD, however, it only
accounts for approximately five percent of the cases. Some causes of brain
dysfunction may be: health problems in infancy, poor health of the pregnant
mother, use of alcohol and nicotine by the pregnant mother, young age of the
mother, and long labor.
Though brain damage is not a major cause of AD/HD, dysfunction of the attention
center in the frontal lobe of the brain may account for the development of
AD/HD symptoms. The dysfunction in the attention system may be caused by a
deficit in the level of certain neurotransmitters. This theory is supported
by the fact that many AD/HD children respond positively to psycho stimulant
medications which increase levels of dopamine and norepinephrine. This suggests
that these children have a shortage of the chemical neurotransmitters that
help the attention system function properly.
Sometimes AD/HD symptoms develop as a result of unrelated medical illnesses
that affect the brain functioning of the child. AD/HD has been linked to ear
infections, anemia, and seizure disorder.
Even though AD/HD can be traced to physical and chemical dysfunction of the
brain, one should not consider this the only cause and simply try to fix the
problem with medication. Although medication can improve the functioning of
the brain systems associated with AD/HD, it may not be appropriate for every
child. Environment, behavioral modification programs, and therapeutic intervention
are also important in addressing the disorder.
Environment
Environmental factors may also influence the development of AD/HD symptoms.
These theories generally have much anecdotal support; however, except for
lead exposure, most research does not support environmental causes. Lead exposure
has been repeatedly linked in studies to the development of AD/HD symptoms
and a host of other developmental impairments.
Diet
Another popular theory about hyperactivity is that it is caused by refined
sugar or food additives. However, research findings have been inconclusive
about whether this creates a response in AD/HD children that is different
from other children.
If parents suspect that a child has a sensitivity to food additives they can
try to eliminate them from the child's diet by carefully reading labels to
avoid them. Avoiding highly processed foods and incorporating more natural
foods into the family's diet would be beneficial. It is important to make
dietary changes a family project, reducing the risk that a child would feel
as if he or she was being punished or singled out.
Developmental Aspects
Infants
Behavioral traits can change as children develop, making it difficult to draw definitive conclusions from infants who display a difficult demeanor. However, infants with the following characteristics are more likely to develop AD/HD or other problems:
Preschool
It is likewise difficult to make an AD/HD diagnosis for preschoolers since they are normally very active and impulsive as they explore the world around them. In general, preschoolers diagnosed as AD/HD:
AD/HD preschoolers also tend to have problems with language and language
development. These language difficulties can cause the AD/HD preschooler to
be more physical and tactile. AD/HD preschoolers may have problems interacting
with their peers and may be more aggressive.
Middle Childhood
Late elementary and junior high school are the years when AD/HD children
will most likely exhibit full blown symptoms of AD/HD. Though most AD/HD children
are at least as intelligent as the average child, the additional organization
and concentration demands of this educational level may present problems.
A lack of social skills among AD/HD children becomes particularly evident
during these years, putting these children at risk for social rejection.
Adolescence
The primary symptoms of AD/HD tend to diminish during adolescence. The adolescent
may be able to better control his or her behavioral impulses and experience
higher levels of attention. Unfortunately, secondary symptoms can become increasingly
problematic. AD/HD adolescents who continue to have problems interacting with
others are typically behind socially and academically. As a result, these
adolescents may lack confidence, have low self-esteem and suffer from depression.
Adults
The majority of AD/HD children outgrow their inattentive and hyperactive
tendencies by adulthood and can function acceptably in society. About one
third of AD/HD children carry AD/HD with them into their adult years. These
adults may have trouble keeping jobs and present higher incidence of underachievement
as well as having social, psychiatric, and marital problems.
Education is the first step in the successful intervention and treatment of
AD/HD children. Family members, educators and others who regularly interact
with the AD/HD child need to be educated about the disorder in order to clear
up any misconceptions about the child and the disorder itself. An AD/HD child
is not stupid, lazy, or intentionally trying to make life difficult. Parents
need not be blamed for not being able to control their children. Once the
condition is properly identified, everyone needs to understand that this is
a problem requiring treatment and not a character flaw of the child and parents.
Meet the MCI Superintendent
Many of you have probably heard the news that the position
of the Michigan Children's Institute (MCI) Superintendent has been filled
by Bill Johnson. Mr. Johnson recently spent a day at the MARE office learning
about the tracking system and related issues. While at the MARE office,
we took the opportunity for a quick interview with him.
Mr. Johnson's professional background is in child welfare, having most recently
been involved in the area of foster care and foster care supervision. He
has also worked with the State Court Administrative Office on the Foster
Care Review Board.
The MCI Superintendent has a great responsibility and plays a very important
role in the entire child welfare system. Aside from being the legal guardian
for all wards of the Michigan Children's Institute, the Superintendent is
responsible for signing all consent forms regarding the placement of children.
Mr. Johnson also works to resolve any disputes involving permanency plans
for permanent state wards and acts as an advocate for the children and any
services they may need. Mr. Johnson is also personally concerned with the
number of children who do not have a permanency plan of adoption. His goal
is to make sure these children are receiving the services they need and
to promote a smooth transition out of the child welfare system.
With such a wide range of responsibilities, one might be surprised to learn
that the staff size of the MCI Office numbers just four people. The office
currently consists of Bill Johnson, MCI Consultant Bruce Hoffman, and a
temporary clerical worker. Eventually a permanent clerical staff position
will be filled and another full time Consultant position will be added as
well.
We asked Mr. Johnson if there were any policy or procedure updates to report
at this time. He explained that there seems to have been much confusion
in the past regarding child evaluations and homestudies, and the information
that needs to be included with each. Mr. Johnson plans to work on developing
policy which hopefully will clarify exactly what information needs to be
included.
When asked about his goals for the office, Mr. Johnson says that he would
like to identify any system barriers which may delay permanency for children,
and then focus on removing those barriers. In the future he is planning
to work more closely with the FIA Zone offices and would like to be more
active with them in responding to cases which are "out of compliance"
with MARE time frames. Mr. Johnson would also like to work more closely
with Foster Care services in trying to minimize separation of sibling groups.
He explained that quite often a foster home may not be licensed to care
for a large sibling group so the group is split into separate foster homes,
with the intention that it is only a temporary situation. The reality is
that these separate placements often become permanent placements for these
children. The preference in most situations is to place siblings together
and Mr. Johnson would like to work on ways to avoid sibling group separations
in the first place.
MARE has worked closely with the MCI office in the past and will continue
to do so in the future. The MCI Superintendent will continue to receive
the MARE tracking list and the Kinship list. The MARE office will also regularly
send Mr. Johnson special lists showing those cases which are out of compliance
with MARE time frames and FIA policy.
Bill Johnson appears quite able and committed to serving Michigan's permanent
wards. It is our hope that under his guidance the MCI office will move forward
in serving all waiting children, regardless of their permanency plan.