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Attention Deficit Hyperactivity Disorder and Ritalin

Info: 4128 words (17 pages) Essay
Published: 8th Feb 2020 in Young People

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General Information:

Children tend to become enraged and defiant due to impairment of physical, behavioral, and cognitive functioning. Huang-Pollock Weigard (2018) asserts that “it is linked to a range of severe social and academic impairments” (Loe & Feldman, 2007; Wehmeier, Schacht, & Barkley, 2010) as well. These impairments can become a conflict because it impedes the ability an individual interacts throughout their daily life. Ritalin is a psychoactive drug that helps control attention deficit disorder (ADD), narcolepsy, and attention deficit hyperactivity disorder (ADHD), by sending chemicals that “calms down” the brain.

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 ADHD is highly known to be the dynamic during childhood stages; furthermore, if not correctly handled, it could carry over to adulthood. Without proper treatment, children will continue to develop negative symptoms that will progress throughout an individual’s lifespan.  Hechtman Ingram (1999) expresses “deficits in adaptive functioning, i.e., socialization, communication, and daily life are probable contributors to the poor long-term prognosis” [Stein et al., 1995] continuing within adulthood. During the stages of childhood to adolescents’ children tend to “cry out” for attention manifesting risk-taking, antisocial behaviors, and drugs. For instance, a child can become a bully, overly aggressive, or always fighting; if felt unease and embarrassed.  Kashani Ahamdi (2014) explains “DSM-IV symptoms in preschool-aged children found that parents rated 8% of boys and 4% of girls as meeting the prerequisite number of behavioral symptoms of ADHD” (Gadow & Nolan, 2002).

ADHD umbrella consists of three categories, i.e., inattentive, impulsive-hyperactive, and combination. These disorders hold several symptoms by which children 12 years old and under displays more symptoms before their teenager. Children tend to get frustrated and discouraged quickly due to impairment academically, occupationally, and socially. Individuals experiencing many traits at once is exceptionally unsatisfying because of the interference of proper executive and cognitive functioning. For instance, struggling with ADHD, several executive functioning becomes affected. Individuals have difficulty remembering details, organizing, and paying attention; and the cognitive operation generally applied to learn and focus. I have seen several children with ADHD, and typically the symptoms are inattentive in many forms, i.e. the inability to keep one’s attention focused on a task, anxiety, organizing tasks, and dodging things that take effort. Children with ADHD also have behavior issues without regards of penalties, i.e., problems with hyperactivity, i.e., being fidgeting, excessive talking, restlessness, and impulsivity, i.e., difficulty waiting for one’s turn, having patience, interrupting others, and aggression with people and animals. For instance, something as simple as rocking back and forth and throwing objects a people.

Epidemiology of ADHD affects 3–5% of school-age children with a 4:1 (male: female) ratio (Handen et al. 1994), and its fluctuations occur based on environmental and behavioral changes (Buckley, 2008); which means the rate is higher in boys than in girls. Problematic issues arise once an individual feeling frustrated, very tempered, and destructive. Children tend to be filled with aggression, lashing out, becoming defiant and violent. Children begin to “act out” by displaying certain conduct disorders (CD), for instance, lying, aggression, destructive behavior, i.e., vandalism, destruction of property, smoking, self-destruct.  ADHD indisposition has a high-risk level for adolescents and adults developing substance abuse; which could lead to other problems, i.e., suicide. 

The time, course, and process of ADHD grow before age and maturity level is slower than others. There is this saying that girl matures faster than boys.  Hillary Barkley (2008) explained, “usual ratio of boys to girls accepted as 4:1 and as children aged their hyperactive symptoms usually improve”.  What Barkley means is that boys are more active with ADHD than girls are, which gives females a higher maturity level. Childhood stage occasionally focuses on the combination disorder.  Displays of these symptoms affecting one’s daily activities, Hechtman Ingram (1999) leaves us with” excessive exercise, poor sustained concentration, disorganization, and poor social skills” [Whalen and Henker, 1985], resulting into poor relationships, i.e., socially and academically. As these symptoms progress, individuals begin to lose confidence within themselves. Hechtman Ingram (1999) tell us, “the social and academic difficulties experienced by the child frequently lead to poor self-esteem” [Weiss et al., 1985].

 Adolescents not only tend to display similar symptoms; Ingram (1999) asserts that “they begin showing secondary issues, i.e., depression, conduct problems, antisocial behavior, substance use, social problems, low self-esteem, and emotional problems” [Fischer et al., 1993; Slomkowski et al., 1995]. Adolescent tend to have lower rates of high school completion, alcohol illicit substance abuse, even an increase in nicotine use. As the disorder becomes resistance towards reaching adulthood, it could be challenging to identify ADHD in adults. Adults with a childhood history of ADHD tend to higher rates in substance abuse, injuries/accidents, even relationship issues, and employment difficulties.  According to research study by Hechtman and Weiss (1983), “the adult outcome of the patients with ADHD may be grouped into three clusters: whose functioning in many spheres is fairly normal, all symptoms are continually displayed, but not severely displaying psychiatric or antisocial pathology, and who’s significantly disturbed which requires psychiatric hospitalization and/or jail” (Ingram, 1999).

 Besides, Ingram (1999) explains “research indicates that 50% to 65% of adult patients with ADHD still demonstrate deficits, such as impaired social relationships, depression, low self-concept, antisocial behavior, drug use, and education and occupational disadvantages” [Barkley, 1990a; Weiss and Hechtman,1993]. Individual’s struggling with “hyperactivity” tends to produce psychiatric disorders, including conduct problems, mood disorders, anxiety, antisocial personality disorder, and suicidal behavior. For instance, children dealing with bullying and fluctuating in mood, begin to start cutting themselves or attempting to commit suicide.

Theory:

Children and adults struggling with ADHD, Prasad (2013) believe” display slower, less accurate, and more variable performance on a wide array of cognitive tasks” (Castellanos et al., 2005; Epstein et al., 2011; Willcutt et al., 2005). However, the direct theory of ADHD has not quite established; although, it predominantly concerns genetics/hereditary factors, neurobiological conditions, i.e., frontal lobe lesions, anterior and medial to the pre-central motor cortex, and environmental influences, i.e., smoking and fetal exposure to alcohol. A large longitudinal study of children aged 3–12-year estimated heritability for attention problems at 75% at all ages (Boomsma, 2010). ADHD affects the monoamine neurotransmitters that are in the autonomic nervous system (ANS), i.e., norepinephrine, and dopamine (Advokat, 2014); and serotonin, which plays its role in the central nervous system (CNS); Bari (2013) describes “noradrenergic projections from the locus coeruleus (LC) and dopaminergic neurons arising from the ventral tegmental area converge in the medial PFC” (mPFC; Berger et al. 1974; Lindvall and Bjorklund 1974; Thierry et al. 1973).

Dopamine (DA) levels decrease in the brain, and it is likely that one will have issues with the ability to problem-solving, reasoning, and decision making. Norepinephrine (NE) role is maintaining mental activity, regulating mood and quick-tempered, and improving memory storage and recollection during stressful periods; low levels enhances the flight and fight notion. Lastly, serotonin (5-HT) is considered to regulate emotions and control; therefore, low levels of serotonin one may experience feelings of sadness for no reason, which easily can misinterpret as feelings of hopelessness or worthless. Without treatment, problematic issues will continuously occur with social interactions, hyperactivity, and cognitive functioning. Too much of it and a person blood pressure will increase; resulting in a stroke.

Treatment:

Although cognitive behavioral therapy (CBT), and psychological treatment assists individuals with ADHD; drug treatment is required. CBT redirects negative behaviors, implements positive, and gaining self-esteem by using positive and negative reinforcements. Environmental influences contribute to ADHD; therefore, participants involved should include teachers, counselors, and parents. Tillery (2000) states, “successful remediation of ADHD requires a multimodal treatment approach with a combination of the CNS stimulant medication, behavioral interventions, counseling, and educational assistance” (Borden & Brown, 1989; Munoz-Millian & Casteel, 1989; Silver, 1990.) These individuals (as a collective) tend to be the support system; which assists both children and adults in building their life skills and self-confidence while removing as many barriers to independent living as possible. ADHD can improve with intervention treatment, i.e., family therapy. Sprich (2016) emphasizes,” comparing problem-solving and communication training with behavior management training” (Barkley, Edwards, Laneri, Fletcher, & Metevia, 2001). Stimulant medication improvement in task behavior as well as work output; both considered measures of attention (Handen et al. 1990, 1992) (Barkley,2008). One known psychoactive drug that’s effective due to its ability to raise DA levels rapidly; which increases the ability to remain focus and concentrate on a task is methylphenidate hydrochloride.

Methylphenidate hydrochloride is known as Ritalin. Ritalin is a stimulant (Moore, 2014) short-acting methylphenidate (with Ritalin SR being intermediate-acting and Ritalin LA being long-acting) (Edmunds & Mayhew, 2014); usually taken with food. The stimulant medication is thought to potentiate the effects of DA (related to motor processing) and NE (associated with sensory processing) (Tillery, 2000).  The pharmacokinetics consists of oral administration; i.e., tablet form; it reaches the peak plasma around one to three hours, with a half-life of 1.5-2.5 hours. After oral administration, Ritalin excreted in the urine, about 78% to 97% of the dose and 1% to 3% in feces in the form of metabolites within 48 to 96 hours. Ritalin pharmacodynamics is a mild CNS stimulant. Advokat (2014) states,” it blocks the reuptake of norepinephrine and dopamine into the presynaptic neuron and increases the release of these monoamines into the extraneuronal space.  Dosages for children six years old and older consist of 5 mg orally twice a day before lunch and breakfast; in adults, their daily dose consists of 20-30 mg; orally, two to three times a day. (https://www.drugs.com/dosage/ritalin.html).

Common side effects of Ritalin are uneasiness and insomnia, however, typical side effects include decreased appetite, weight loss, headache, abdominal pain, depression, irritability, and what are called “rebound symptoms” (Edmunds & Mayhew, 2014); more or less, (Moore, 2014) explained, “the low effects include dizziness, tachycardia, psychotic symptoms, and tics, and occasional visual disturbances” (Edmunds & Mayhew, 2014). Severe effects of Ritalin causes loss of appetite (which may cause acute malnutrition), tremors and muscle twitching, headaches and fevers, seizers, hallucinations, restlessness, irregular heartbeat and breathing (which can be life-threatening), anxiety, and delusions. Besides, it includes a lower threshold for seizures for some patients; sudden death in children with underlying structural heart and cardiac rhythm disorders; increases in blood pressure; and mania and other psychotic symptoms (Edmunds & Mayhew, 2014). Furthermore, (Moore, 2014) adverse effects of stimulants include cardiovascular symptoms such as hypertension, tachycardia, vasospasm, and dysrhythmia in addition to neurological and psychiatric symptoms (Hernandez & Nelson, 2010). The most severe attempt for anyone is to take prescription stimulants that’s not theirs. Short-term effects involve nervousness and insomnia, loss of appetite, nausea, and vomiting, dizziness, headaches, changes in heart rate and blood pressure causing depression, skin rashes, itching, abdominal pain, weight loss, and digestive problems, psychotic episodes, drug dependence and severe depression upon withdrawal.

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The benefits of oral administration of Ritalin is that it used as a cognitive enhancer; causing less trouble completing schoolwork and homework, less fidgeting or squirming, better control of emotions, less impatience, and impulsiveness, a better relationship with family and friends, and increased in self-esteem. Oral administration is the safest and easiest routes because it is for all ages; young or old, individuals can take their medication without help, low chances of overdose is restricted, and no wastage. Risk of not receiving or quitting Ritalin includes a decrease in appetite, headaches, difficulty falling asleep, irritability, and stomach pain.

Interactions with Ritalin is not the safest route, using other MAO drug, i.e., antidepressant drugs could slow down the chemicals causing a hyperactive crisis. Common side effects could also cause dry mouth, skin reactions, circulation problems in limbs, even nausea and constipation. When a drug affects dopamine in an individual, they may feel like they cannot function without it, which causes the person to become dependent and addicted to the drug. They depend on the entry of DA inhabiting their brain, and without it, they will go through withdrawals, both physically and mentally. Ritalin is a Schedule II drug (Advokat, 2014) which is considered to have high potential in abuse, and if children were given Ritalin without a prescription ethnical implications for high-risk treatment conditions based on how the chemicals modify the brain activity/messages; consequences for usage of unprescribed drugs  charged with possession of a controlled substance.

Conclusion:

From the age of infancy to five years old is the stage of which children absorb the most information by observing, applying, and mimicking. Typical behaviors occur within the first year; however due to prenatal maternal smoking, maternal depression, poor parenting practices, and living under disadvantaged circumstances; behavioral problems, i.e., inattentive and hyperactive does not arise until four years old. Therefore, when thinking of a child’s behavior; one should consider thinking of aversion childhood experiences, their environment, and their health. Sometimes, boredom intolerance is one of the causes of ADD and ADHD behavior.

Children with ADHD do not know how to think before they act. Their minds are always going at such a fast pace that they cannot keep up. These notions tend to become very frustrating for the child, especially when they get into trouble for behaviors that they feel they have no control over. Kids with ADHD are almost always moving, whether getting up and pacing or rocking when sitting. They cannot seem to keep their bodies still for any period. They also tend to talk nonstop or make noises all the time. They are easily distracted as they seem to have to pay attention to every sound around them. However, to minimize behaviors issues, i.e., socially, physically, and academically, cognitive behavior therapy (CBT), group interventions, and medicine, are required.

The purpose of Ritalin is to stimulate the CNS; by combating these symptoms, which allows a child to focus and slow down. Ritalin affects the brain by enhancing DA and 5-HT neurotransmitters. In layman’s terms, Ritalin increases dopamine neurotransmission, which makes people without ADHD hyperactive, but can “calm” individuals with the disorder.

ADHD and attention deficit disorder (ADD) are categorized as a neurological disorder trademarked by hyperactivity, forgetfulness, mood shifts, poor impulse control, and distractibility and is always present from childhood. Consequently,  was believed that when a person develops ADHD, the executive functions of his/her brain are impaired. Executive roles include things like paying attention, ability to concentrate on a task or “stay on task,” self-motivation, problem-solving, organizing and planning. Ritalin entire motive is to improve the child’s performance.

The advantages of these theories are that they fall under the ADHD disorder is that it reflects on one’s problematics, i.e., defiant, impulsive, and hyperactive behaviors. The treatment prescribed assist with returning DA to the brain so that one may gain control of their impulses; by a significant reduction in fidgeting and rocking back and forth, improvement of excellent motor skills, ad better management of moods and emotions.

However, the disadvantages of being treated are that children take the medication only during school days because of this problem some children experience poor sleep, while others may become more irritable, develop tics, or have headaches or upset stomach, feelings of extremely tired or exhausted, as well as experiencing bouts of dizziness.

Children tend to have poor communication, and failure in academic performances tend to fall under other disorders, i.e., depression, anxiety, and ADD. Symptoms generally interfere with academic and behavioral functioning and frequently disrupts family and peers’ relationships. Because of specific issues, parents and school officials tend to look towards medication to handle the ADHD to “calm” them down; but often do not seek out help to deal with the other issues the child is experiencing as a result of the ADHD. On the contrary, this does not always help because multiple problematically effects could occur based on psychoactive drugs working against the aim. Possible area for further research is aversion childhood experiences, i.e., trauma experiences and PTSD within their environment because they contribute to the effects of how neurotransmitters send messages to the brain. 

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