Understanding attention deficit disorder: a neuroscience prospective.

Abstract

Today’s ready access to electronic devices and the internet often substitute for social interaction. Such situation, if it starts in early childhood, in certain vulnerable individuals, who crave immediate rewards, can decrease the ability to maintain prolonged attention (1) and tolerate delayed gratification, thus reinforcing future addictive behaviors (2). Once established, these behaviors, such as attention deficit hyperactivity disorder (ADHD), may persist into adulthood. ADHD is one of the most common reasons for referring children to mental health facilities. Generally, parents seek professional help for their children after the school suggests that their child has difficulties. These difficulties may be related to academic performance, behavior, or both. Research data support the idea that children with attention deficit disorder often come from families with attention deficit in one or both parents (3). Very recent data indicate a significant genetic predisposition for this disorder. Seventy percent of children who have this disorder will have the disorder as teenagers, and about 40%-60% will still have the disorder as adults, and although genetic studies have not isolated a gene for ADHD, there may be several genes contributing to the vulnerability for developing this disorder. For example, twin studies have shown a significant heritability for ADHD (4) as high as 76%. In addition, the parents and siblings of children with ADHD have an ADHD diagnostic probability 4-5 times higher than the general population, and boys are more vulnerable than girls (5). Based on these data, it might appear that ADHD is easily diagnosed and, thus, simple to treat, but we still must question the methods and criteria used for diagnosing ADHD. Currently, clinical interviews and collateral histories from parents and teachers drive the standards. Only occasionally do we use objective assessments, such as continuous performance tasks and neuropsychological assessments, to evaluate whether or not a child can sustain attention, and whether their deficits lie in either or both auditory and visual domains. Various factors may play a role in sustaining attention. These may include: motivation, concurrent anxiety, lack of sleep, low blood glucose, medication, and family collaboration (6). Clinicians consider and evaluate three major symptom groups for diagnosing ADHD: inattention, hyperactivity, and impulsivity. Each category describes particular symptoms; for example, inattention may involve an inability to finish tasks, organize, and sustain efforts as well as forgetfulness and distractibility. Hyperactivity is defined as being fidgety, inability to sit still, and motoric hyperactivity – excessive running, climbing, and moving. Impulsivity involves excessive talking, answering without thinking, inability to wait one’s turn, interrupting, and so on. Both the DSM IV and the ICD 10 provide guidelines for the frequency and duration of the symptoms in these diagnostic categories, and both generally agree on the necessary number of symptoms before someone receives the diagnosis of ADHD. Nevertheless, it should be noted that these symptoms may be defined and scored by individuals that are untrained in this process. Therefore, we need to question the reliability and validity of such unidimensional data.