The Developmental approach to Disruptive Behaviour
The developmental approach to psychopathology uses a range of other branches of psychology to establish what and if there are any abnormal problems with children as they grow. These problems will generally affect the day to day life of the child and developmental psychopathology aims to provide answers for why they occur and how or if they can be prevented or cured. This approach also looks at whether the condition will affect the child's development in a way that could make them abnormal later on in adult life. There are many different areas of study in developmental psychopathology domains which are; Motor control and function, Intellect, communication and social-emotional. As well as these four different domains it also has to be taken into account that there will be individual differences between each child, their temperament could have a big affect on how they behave. There have been many different models developed in order to record developmental stages, Empson and Nabuzoku outline four such models; The stage 'discontinuous' model, the linear 'continuous' model, the continuity model and the interaction model . There is also the traditional chronological age and cognitive development model. The problem with this method is that it relies on the age of the child. A child and an adolescent clearly have different behaviours however this is not always established on chronological models. There are various different things that have to be considered when diagnosing a child with abnormal behaviour or developmental problems. There is the risk that the child may be encountering past or current problems which are the cause of the issue, the risk is that these problems may continue to cause issues for the child or they may only be temporary. By diagnosing a child it implies that there is a stability to the child's behaviour and environment which is not always the case (Harris 1979, p45). The environment in which the child lives is a vital part of how the diagnosis and treatment are established. A child's behaviour is far more susceptible to changes in the environment than the behaviour of an adult (Gibbs, 1982). The environmental factors also cover the fact that the child may be a scapegoat for other problems within the environment especially those of the parents. This means that it essential to consider by who and when the referral was made.
Disruptive behaviour is any behaviour which is considered to be disruptive to day to day life and affects the development and learning of the child. There are various disorders which are included in this category of Developmental Psychopathology some examples are, Oppositional Defiant and Conduct disorder as well as Attention Deficit Hyperactivity Disorder (ADHD). This report will focus on ADHD, looking at the symptoms of ADHD, how it is diagnosed, risk factors and what affect having ADHD can have on sufferers in life, both at home and socially
ADHD is a disorder that has become more well known to the public in the last few decades, it is now a commonly referred to disorder and is the subject of many debates between both professionals and the lay-person. Almost everybody that you speak to has an opinion of what ADHD is, what causes it and in some cases whether it even exists. ADHD was first reported in 1902 by Sir George Frederick Still, (as cited in Hyperactivity and attention disorders of childhood, Sandberg 2002) he was describing symptoms that he had observed in young children which he deemed abnormal. He mentioned such things as a short attention span, aggression, defiance and a resistance to discipline; the disorder was named 'Morbid Deficit of Moral Control.' There have been many changes in the naming of the disorder, the two most significant were in the 1960's when Dr. Samuel Clements renamed the disorder to 'Minimal Brain Dysfunction' (Clements & Peters, 1962). And then in the early 1980's when the current name of Attention Deficit Disorder with or without the Hyperactivity was created. Since then ADD or ADHD has been recognised by the DSM and become a commonly diagnosed Disorder. In the DSM IV there are two criteria that are met depending on the amount of symptoms. Either criteria A or B. Within these criteria there are three categories to the diagnosis of ADHD, a child must meet 6 or more of the symptoms over a period of six or months in two or more separate environments in order to be classified as having ADHD. The three categories are Inattention, Hyperactivity and Impulsivity. Small selections of the symptoms given in the criterion are listed below;
Often does not give close attention to details or makes careless mistakes in schoolwork, work or other activities.
Often does not follow instructions and fails to finish schoolwork, chores, or duties in the work place (not due to oppositional behaviour or failure to understand instructions.
Is often easily distracted.
Often fidgets with hands or feet or squirms in seat.
Often has trouble playing or enjoying leisure activities quietly.
Often talks excessively.
Often has trouble waiting ones turn.
Often interrupts or intrudes on others (e.g., butts into conversations or games)
There must be clear evidence of significant impairment in social, school, or work functioning.
(DSM IV, American Psychiatric Association, 2000)
From these criteria there are three different types of ADHD that have been identified, which type is diagnosed depends on which symptoms are present. The first of these types is ADHD combined type which is when both criteria A and B are met for the past six months. The second type is called ADHD Predominantly Inattentive type which occurs when criterion A is met but not criterion B. The third and final type is ADHD Predominantly Hyperactive-Impulsivity type, when criterion B but not A is met over the last six months.
ADHD is most likely to be detected and diagnosed in childhood. Usually by school age, before 7 years old, it has been discovered, it is often a teacher, who is more aware of the disorder, who refers the child to a specialist. ADHD can continue into adulthood, with 70-80% likely to show symptoms in adolescence and up to 50-65% in adulthood. It can in some case cause more disruption at this age. Due to the fact that as an adult there are more responsibilities which can be affected by the disorganisation and lack of focus that is caused by ADHD.
There are many different individual factors that can affect how severe ADHD is. Temperament plays a big part in how well a child is able to deal with ADHD. For instance if a child has quite a mild temperament the ADHD may not negatively affect their life as it would if the child had a more aggressive temperament. Even within the range of different temperament the way that ADHD combines with it will vary. Other disruptive behaviour disorders can also have an effect on the severity of ADHD. When combined with other disorders such as CD the impact of having ADHD as well can have a large affect. There are many disorders which ADHD could be combined with; those which are most common are CD and OCD, 34.7-48% co-morbidity and autism. It is also thought that 9-18% of children at school age who suffer from mental retardation meet criteria for ADHD. The intensity of symptoms of ADHD can also vary. To qualify for ADHD you have to meet a minimum of six of the criteria outlined in the DSM IV (DSM American Psychiatric association 2000). There may be some people with ADHD who only meet the minimum requirements yet there may be some who have nearly all of the symptoms listed in the DSM. Those people who suffer from more of the symptoms will be affected by ADHD more than those with fewer symptoms.
Risk and protective factors
Gender is a factor which plays a big role in ADHD; it is far more likely to affect males than females. The exact ratio of how many males to females there are that have ADHD is unclear, estimates range from 4:1 through to 9:1. This uncertainty may be due to cultural differences. Within the last few years the difference in the number of males compared to females has fallen, this may be due to many different factors.
There are many factors relating to the pregnancy, birth and early childhood which can be linked to ADHD. If there are problems with the birth then the child can be affected by many different childhood problems including ADHD. A low birth weight, less than 2500gms has been shown to implicate difficulties in childhood, such as lower IQ levels, motor difficulties and behavioural problems. Sykes 1997 suggests that a 'pure' form of ADHD occurs due to early physiological problems. In early childhood if the child suffers from early childhood illnesses which induce a high fever, or incur a head injury at any point it may lead to learning problems, developmental delays and ADHD. These illnesses are part of paediatricÂ autoimmune neuropsychiatric disorder associated with group AÂ streptococcal infection (PANDAS) (Murphey & Pichichero 2002).
Most of the factors listed above are unavoidable, the mother could do very little to prevent the situations occurring. However something that they could control has also been linked to ADHD. There is very strong evidence that there is a link to ADHD if the mother smokes during the pregnancy. Smoking during pregnancy can cause many different early childhood issues but has been most strongly linked to ADHD (Neuman et al. 2007). Drinking during pregnancy has many ill effects on the unborn baby. The child could suffer from Foetal Alcohol Syndrome, this means that the child will not only be deformed physically but may suffer from developmental issues also. These issues can include developmental delays, physical stigmata, attention and activity problems which can result in them being diagnosed with ADHD.
Recent research has also found that there may be genetic reasons for why ADHD occurs. It was found that there is a genetic link to ADHD when a study was conducted looking at the DNA of children who suffer from ADHD. It was found that a significant amount of those children had large amounts of DNA that was duplicated or missing in comparison to the control group (Thapar et al. 1999). This is evidence that ADHD may be caused by genetics, however it is more likely that there is a relationship between genetic factors and the environment. For example the parenting techniques and teaching environment can have a major effect on how severe the ADHD is. So much so that it can appear far worse in one environment than it does in another environment. In order for the genetic link to be proved there would have to be a detailed examination of the child's immediate family's history of mental illness. Rutter et al. (1999) warns that caution is necessary when examining the claims made by genetics, he reminds us that environments are also a key factor and should not be forgotten.
Ritalin is the drug which is most commonly prescribed to people diagnosed with ADHD. Doctors are unsure as to how exactly Ritalin works. As it is a stimulant it is thought that it stimulates neurons in parts of the brain which are under-working in order to create a balanced amount of stimulation. Therefore counterbalancing the over stimulation of the other neurons which may be the cause for ADHD in the first place. There are many side effects to taking Ritalin; insomnia, decreases in appetite, headaches, stomach aches and irritability. However, most doctors and parents believe that the benefits outweigh the side effects. There is much debate around the subject of Ritalin. It has been suggested that Ritalin is over-prescribed to children who not only have very little say about if they take it or not but whom perhaps do not even need it. They may be able to manage the disorder in other ways. There are many techniques that can be learnt to aid parents, older children, adolescents and adults in coping with ADHD. These techniques deal with the way that they tackle everyday problems that can interrupt their daily lives, such as how to manage excess energy. Both of these methods can be very effective in ensuring that people with ADHD can lead as normal a life as possible.
The fact that genetic links have been found as a factor of ADHD can have different effects on how the parents of a sufferer feel. It provides evidence against the people that argue that bad parenting alone is the cause of ADHD, therefore relieving some of the guilt that parents may feel. They may have felt that if they had been better parents their child would not have the problems they do. However the genetic link could now provide a different source of guilt for the parents. They may develop an unreasonable guilt that their DNA contributed towards their child being a sufferer. Guilt about genetic contribution, or indeed guilt of any kind may have a detrimental effect on the way that they treat the child and think of themselves. For a mother this guilt can be even worse if she smoked or drank alcohol knowing that she was pregnant.
Parents and other family members can become physically and mentally drained by the behaviour of a family member who suffers from ADHD. The behaviour if a child who has ADHD can be very physically demanding due that the hyperactivity levels associated with ADHD. It can be hard for the parents to keep up and keep control of the child. This can lead to mental exhaustion because it can feel like a battle of wills, giving a more mental draining aspect. As well as battling with the child it can cause tensions between the parents. Discussions about how to deal with problems and planning events such as holidays or days out can become tiring.
Parents will worry about their child making friends or being bullied even without the added pressure of the child being labelled ADHD. With that label the parents may worry that the child will be stigmatised for being different. The behaviour of the child can also be noticeable different from other children. Not only will this cause other parents to ask questions but it may also cause bullying from other children. This can affect other family members and especially parents.
ADHD can have very negative effects on the social life of those people who suffer from ADHD, lack of friends, victimisation, withdrawal and aggression. ADHD affects the behaviours of the sufferer in such a way that social situations can become difficult. In certain social situations it is important to be able to focus and pay attention to fellow peers. The lack of attention and hyperactivity that is associated with ADHD can make this difficult. This means that without understanding friends it can be very difficult to have successful relationships. It can also make people with ADHD more open to bullying. Children can be especially tough when they are presented with something different to themselves. Bullying is hard for anyone to deal with, but when having to deal with the effects of ADHD too it can be quite hard, this can even result in depression. The impulsivity associated with ADHD can lead to bad judgement making, this means that they are more likely to be influenced by peer pressure and make unwise decisions. Within schools there are thought to be 3-5% of all students that have ADHD, this can make it harder for both the teachers and other students. This can cause resentment which results in the child's work and achievement suffering and being lower than their peers.
ADHD is a disorder which causes hyperactivity, impulsivity and inattention. It affects both males and females, although it affects considerably more males. The symptoms can persist through childhood, adolescence and into adulthood. Throughout this time it can cause various disruptions to the day to day life of the sufferer. Bullying, tensions at home, between peers and reduced learning can all become issues which the person with ADHD must learn to deal with. There are different techniques available for the person to learn in order to deal with these issues. Another way which is commonly used to help people cope with ADHD is the drug Ritalin. Despite some people having reservations about the drug it is the most effective way of calming and stabalising the behaviour of people with ADHD. The cause of ADHD is unknown, however there have been many research projects which have found various things which linked to ADHD these include unpreventable pre-natal, birth and childhood problems and illnesses, as well as those which are preventable such as smoking, drinking and drug use. The negative affect that ADHD can have on people's lives extends from just the sufferer, especially onto close family members and parents. Parents can feel undue guilt for being unable to control their child or for inadvertently passing on genes which have contributed towards their child being diagnosed with ADHD.
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