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CHILDHOOD DISORDERS Why do stimulants appear to slow down hyperactive children and adults?

CHILDHOOD DISORDERS Why do stimulants appear to slow down hyperactive children and adults?

Children may suffer from conditions already discussed in this chapter—for example, depression and anxiety disorders. But other disorders are either characteristic of children or are first evident in childhood. The DSM-IV-TR contains a long list of disorders usually first diagnosed in infancy, childhood, or adolescence. Two of these disorders are attention- deficit hyperactivity disorder and autistic disorder.

Attention-deficit hyperactivity disorder (ADHD) was once known simply as hyperactivity. The new name reflects the fact that children with the disorder typically have trouble focusing their attention in the sustained way that other children do. Instead, they are easily distracted, often fidgety and impulsive, and almost constantly in motion. This disorder affects about 5% of all school-age children worldwide (Polanczyk, de Lima, Horta, Biederman, & Rohde, 2007), about 4% of adults in the United States (Kessler et al., 2006), and is much more common in males than females. Research suggests that ADHD is present at birth, but becomes a serious problem only after a child starts school (Monastra, 2008). The class setting demands that children sit quietly, pay attention as instructed, follow directions, and inhibit urges to yell and run around. The child with ADHD simply cannot conform to these demands.

We do not yet know what causes ADHD, but considerable evidence indicates biological factors play an important role (Monastra, 2008; Nigg, 2005). Neuroimaging studies, for example, reveal individuals with ADHD display altered brain functioning when presented with tasks that require shifting attention. The deficiency appears to involve the frontal lobe (see Chapter 2, “The Biological Basis of Behavior”), which normally recruits appropriate regions of the brain to solve a problem. In people with ADHD, however, the frontal lobe sometimes activates brain centers unrelated to solving a problem (Konrad, Neufang, Hanisch, Fink, & Herpertz-Dahlmann, 2006; Mulas et al., 2006; Murias, Swanson, & Srinivasan, 2007).

Family interaction and other social experiences may be more important in preventing the disorder than in causing it (C. Johnston & Ohan, 2005). That is, some exceptionally competent parents and patient, tolerant teachers may be able to teach “difficult” children to conform to the demands of schooling. Although some psychologists train the parents of children with ADHD in these management skills, the most frequent treatment for these children is a type of drug known as a psychostimulant. Psychostimulants do not work by “slowing down”hyperac- tive children; rather, they appear to increase the children’s ability to focus their attention so that they can attend to the task at hand, which decreases their hyperactivity and improves their aca- demic performance (Duesenberg, 2006; Gimpel et al., 2005). Unfortunately, psychostimulants often produce only short-term benefits; and their use and possible overuse in treating ADHD children is controversial (LeFever, Arcona, & Antonuccio, 2003; Marc Lerner & Wigal, 2008).

A very different and profoundly serious disorder that usually becomes evident in the first few years of life is autistic disorder. Autistic children fail to form normal attachments to parents, remaining distant and withdrawn into their own separate worlds. As infants, they may even show distress at being picked up or held. As they grow older, they typically Describe the key features of attention-deficit hyperactivity disorder and autistic spectrum disorder including the difference between autism and Asperger syndrome.

attention-deficit hyperactivity disorder (ADHD) A childhood disorder characterized by inattention, impulsiveness, and hyperactivity.

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