Majorek, Tuchelmann and Heusser (2004) presented ADHD as the
interaction among biological systems of the individual, the psychological systems of the individual and the environmental factors that impact on his/her life (see Figure 3). Their reason for taking this integrated approach was their contention that the current research on ADHD does not clearly support one aspect as the “cause.” In their experience, they found that each individual’s temperament determines how the condition manifests itself, and each individual’s environment influences how ADHD presents at any given time. Pughe-Parry (2007) supported the approach that ADHD is most accurately thought of as an interaction among the individual and the environment. For example, they concluded that in some cases environmental factors may contribute directly to the cause of ADHD and that in other cases, environmental factors may aggravate neurological factors, causing a wide range of psychological problems. There are also co-morbid conditions that make it still more difficult to determine how ADHD is manifested in a particular individual’s behaviour.
ADHD
Biological Systems Environmental Factors Psychological Systems Figure 3ADHD as an interaction among biological, psychological and environmental considerations
Biological Systems
Furman (2005) reported that the consensus opinion in the United States is that ADHD is a neurological disorder, despite the fact that there is no scientific evidence to support this conclusion. Gilliam (1994) attributed this assumption to the common use of terminology such as “minimal brain dysfunction” when ADHD was first identified as a disorder. Because people who acquired mild brain
damange in accidents were often left with behavioural problems such as inattention and impulsivity, the link may have been made to brain involvement when inattention and impulsivity were observed in children when no apparent cause was evident. Mash and Wolfe (2005) did report that neurologists described a reduced blood flow to the cerebellum and cerebral cortex for children diagnosed with ADHD compared t(o those without ADHD, but more reserach was
recommended.
Stolzer (2009) provided an alternative rationale for this belief in the medical origins of ADHD in his critique of the extraordinarily high rates of medication adminstered to American children who show signs of ADHD. He noted that the pharmaceutical industry has a huge economic investment in the use of medication for ADHD, estimating that as many as 99% of the American children diagnosed with ADHD may be on daily doses of medication. He contended that commercials and adverstisements promoted the medication of chidlren with ADHD and
encouraged teachers and parents to regard medication as a solution to their behavioural problems.
The possiblity of a genetic origin or at least influence on the occurence of ADHD in some children appears to have some scientific support. Barkley (1998) reviewed the incidence of ADHD in families and found the rate of occurence was as high as 35% in some of the families with members with ADHD. Another
biological consideration is that of gender differences in relation to the incidence of ADHD. The vast majority of children diagnosed with ADHD are boys, which
introduces the possiblity that the disorder may be brain-based (Stolzer, 2009).The gender differences between the male and female brain have been documented, although the origins of those differences is debated. Soffer, Mautone and Power (2008) cited research that found that internalising and withdrawal behaviours were
present more often for girls than boys with ADHD. He recommended that research with larger samples of girls with ADHD is needed to describe more precisely the issues unique to girls that may require special adaptations during assessment and interventions. When conducting reserach on genetic and gender factors, it will be necessary to go beyond investigations into the functions of the biological/physical systems and include the psychologial systems and environmental factors as well.
Psychological Systems
The strong relationship between psychological functions and ADHD is widley supported. Gilliam (1994) noted that problems of self-esteem, mood swings, and low tolerance for frustration and temper tantrums were common among children with ADHD. Barkley (1997) proposed that a primary deficit in the psychological ability to inhibit behaviour was the central mechanism underlying many of the related behavioural control difficulties shown by children with ADHD. He also suggested that children with ADHD would respond well to immediate reinforcement of behaviour, but would not respond well if reinforcement was delayed. Majorek et al. (2004) were convinced that problems in the development of psychological self-regulation skills were central to ADHD.
The ability to control attention is another psychological function that has been identified as a problem area for children with ADHD. The results of selective attention studies on children with ADHD have been mixed. In her review of
cognitive abilities in children with ADHD, Douglas (1988) listed several selective attention tasks on which children with ADHD displayed deficits, and some on which they did not. For example, children with ADHD had difficulty inhibiting responses to irrelevant stimuli and ignoring irrelevant stimuli. However, they performed adequately on tasks requiring recall of spatial locations. Brodeur and Pond (2001) also found that children with ADHD demonstrated performance deficits under some selective attention conditions but not others. Difficulties with selective attention could be one reason why some children with ADHD are accident-prone (Mash & Wolfe, 2002).
Environmental Factors
The academic problems experienced by many children with ADHD have been related to their inability to control their attention and their difficulty working
within specific time frames (Gilliam,1994). This can lead to a school environment that contributes to the behavioural problems of children with ADHD. Stolzer (2009) even suggested that the school environment contributes to children’s attentional control difficulties. He claimed that the premium placed on sedentary learning and compliant/conforming behaviour in the school environment actually penalises active and energetic children to the point where some of them are referred for assessment for ADHD. He even suggested that many children have been carelessly placed on medication to control their assertive behaviours in an effort to create a controlled school environment.
Mash and Wolfe (2002) confirmed that children with ADHD do experience school performance difficulties, reflected in lower marks, failure to advance in grade level and even placements in special education classrooms. Problems with specific learning areas like reading and mathematics have been identified. Speech and language impairments and difficulty in using language have also been
reported. Flick (1998) added that children with ADHD experience numerous interpersonal problems with parents, siblings and teachers, as well as peers.