Introduction
Attention-deficit/hyperactivity disorder (ADHD) belongs to the number of diagnostic categories recognized in the recent edition of the Diagnostic and Statistical Manual of Mental Disorders. As a disorder causing hyperactivity and reduced self-control, ADHD can be misunderstood as the manifestation of laziness or a weak will. This essay explores the disorder with attention to its causes, symptoms, disease prognosis, treatment/prevention, evaluations, and links to the Bible.
Etiology
Similar to many other disorders, ADHD does not have one clear cause that would be accepted by all scholars and authoritative organizations. As Comer and Comer (2017) report, the majority of clinicians support the idea of ADHD resulting from interacting biological and genetic factors, which makes it similar to other neurodevelopmental disorders. Among the contributing causes are dysfunctional family situations, severe stress, attention circuit dysfunctions, or having a family history of ADHD (Comer & Comer, 2017). Non-genetic environmental factors that are believed to contribute to ADHD also include the alterations of neurogenesis stemming from preterm birth, perinatal oxygen deficiency, malnutrition, and exposure to pesticides during active development (Núñez-Jaramillo et al., 2021). Aside from pesticides, the emergence of ADHD symptoms can be predicted by childhood exposure to heavy metals with neurotoxic effects, such as mercury, manganese, or lead (Núñez-Jaramillo et al., 2021). Another cause is the imbalance between type I and II attention processes, making a child incapable of suppressing automatic type I alerts to concentrate on something on purpose (Comer & Comer, 2017). Based on this, the pathogenesis of ADHD involves combinations of diverse factors.
Symptoms
As the name of the disorder suggests, there are two large groups of symptoms related to hyperactivity and the inability to pay attention. Group one, impulsivity/hyperactivity, comprises obsessive fidgety movements of one’s extremities, the tendency to wander from the seat, and the inability to stay quiet or immobile when necessary (Comer & Comer, 2017; Núñez-Jaramillo et al., 2021). Some warning signs in this cluster of symptoms also point to social malfunctioning. They include the inability to have conversations without interrupting others, wait for one’s turn to do something, and avoid intervening in others’ activities (Comer & Comer, 2017). The second group of ADHD manifestations consists of the signs of inattention that hinder a person’s social functioning. Among such symptoms are frequent errors stemming from little attention to details, difficulty maintaining attention, poor listening abilities, and the tendency to get distracted easily (Comer & Comer, 2017). The avoidance of tasks requiring great mental effort is also present in this disorder.
The symptoms listed above are measured and observed by means of the ADHD symptoms checklist. The disorder is considered a largely clinical diagnosis, and its symptoms are observed by means of collecting and evaluating family, prenatal, and perinatal history, assessing performance at school, and physical examinations (Wolraich et al., 2019). Notably, as per the Dx checklist for ADHD, the presence of symptoms in only one setting is not enough for making a diagnosis (Comer & Comer, 2017). Thus, it is pivotal to confirm the symptoms’ occurrence in diverse settings, including educational institutions, kindergarten, home, and so on.
Prognosis
In ADHD, disease prognosis depends on a plethora of factors, including the presence and adequacy of treatment. ADHD does not have a known cure, but patients receiving a combination of cognitive-behavioral therapy (CBT) and stimulant pharmaceutical treatment with methylphenidate and other FDA-approved solutions show reductions in undesirable symptoms (Comer & Comer, 2017). However, in spite of treatment, the disorder persists into the patient’s adulthood in up to 78% of cases, thus requiring transition to ADHD services for adults (Comer & Comer, 2017; Wolraich et al., 2019). From research, hyperactivity symptoms in ADHD patients often resolve and diminish during puberty, whereas inattentiveness remains strongly pronounced (Wolraich et al., 2019). Untreated ADHD can promote numerous issues in teenage years and adult life, including the likelihood of developing substance use disorders and excessive impulsivity leading to the propensity to crime (Wolraich et al., 2019). Therefore, with the necessary treatment, ADHD patients’ symptoms can be relieved to support their functioning in society.
Treatment
Treatment plans for ADHD patients are based on medication use and behavioral interventions. Stimulant medication therapy with methylphenidate has replaced Benzedrine and dextroamphetamine treatments as a first-line medication and is widely used nowadays, even in children as young as four (Wolraich et al., 2019). Regarding non-pharmaceutical options, effective treatments for symptom reduction include school-based behavior management programs, cognitive-behavioral therapy (CBT) interventions, and token economy programs, in which children receive rewards for behaving appropriately (Comer & Comer, 2017). Other helpful procedures with known effectiveness are combination therapies incorporating the elements of CBT and family interventions to provide child behavior management training for caregivers (Comer & Comer, 2017). These methods are used in different combinations depending on symptoms’ severity.
Prevention
Because of its genetic component, ADHD is not preventable in all cases. However, since there are certain environmental predictors of this disorder, the recommendation to avoid these factors in pregnancy can be made to decrease the likelihood of giving birth to infants that will develop ADHD. Specifically, there are pernicious habits to avoid, including smoking while pregnant and alcohol use (Comer & Comer, 2017). Other steps that can potentially decrease ADHD risks are the prevention of metal and pesticide poisoning in pregnant women and young children (Roberts et al., 2019). Recommendations for expecting and new mothers might include proper hand hygiene, household dust removal, and the use of safe covered outdoor playing areas. Also, the implementation of all safety measures when applying pesticides at home and in the garden is crucial, as well as reading all label directions carefully. Other procedures that do not necessarily prevent ADHD but support children in accepting routines are structured routine interventions and behavioral management techniques that teach parents to use positive reinforcement (Wolraich et al., 2019). Therefore, as a disorder with multiple contributing factors, ADHD is associated with many potentially effective prevention strategies.
Overall Evaluation
Regarding evaluation, ADHD is often positioned as a disorder that is rather difficult to assess. One evaluation-related challenge is young children’s excessive subjectivity when reporting and describing their symptoms, which creates the need for more credible reports from adults, including caregivers and teachers (Comer & Comer, 2017). Specifically, accurate child evaluations are impossible without psychological tests and rating scales that would demonstrate the evidence of dysfunctional behaviors in diverse contexts and communicative situations (Comer & Comer, 2017). At the same time, modern researches raise concerns about the quality of child evaluation endeavors by proving that there is a continuing tendency to overdiagnose ADHD (Comer & Comer, 2017). It might lead to the cases of excessive and unjustified use of stimulants in pediatric populations, with insomnia, headaches, or poor appetite as the key side-effects (Comer & Comer, 2017). Taking that into consideration, clinical evaluation and diagnostic tools for ADHD in underage patients should be implemented carefully to distinguish between the cases that should and should not be managed medically.
Approaching the Disorder from a Biblical Worldview
From the perspectives of Christianity and the Bible, ADHD and impulsivity should not be taken with criticism and vilified or mistakenly associated with a person’s ill intentions. Based on my experience with individuals displaying ADHD patterns, there is some misunderstanding of this disease, including attempts to equate ADHD symptoms with laziness and weak character. However, I am deeply convinced that a devoted Christian would try to mimic God’s non-judgmental and open-minded attitudes instead of mistaking ADHD patients’ appearances and symptoms for their essence. “Man looks at the outward appearance, but the Lord looks at the heart” is the quote that illustrates this perspective properly (Holy Bible, New Living Translation, 1996/2015, 1 Samuel 16:7). It encourages a person to refrain from superficial conclusions and generalizations when communicating with individuals affected by neurological deficiencies. As per Matthew 7:2, “the standard you use in judging is the standard by which you will be judged” (Holy Bible, New Living Translation, 1996/2015). Thus, these pieces of Biblical wisdom warn individuals against judging those with developmental disorders, including ADHD, to experience a false sense of superiority.
Conclusion
To sum up, ADHD is a disorder with a complex etiology, which might create challenges related to evaluation, management, and prevention measures. Treatment success and the chances of recovery in ADHD depend on disease management options’ timeliness and adequacy. Although the Bible does not discuss this neurodevelopmental condition explicitly, the promotion of non-judgmental attitudes to others can be applied to reduce harmful stereotypes about the ADHD population.
References
Comer, R. J., & Comer, J. S. (2017). Abnormal psychology (10th ed.). Worth Publishers.
Holy Bible, New Living Translation. (2015). Tyndale House Publishers. (Original work published 1996).
Núñez-Jaramillo, L., Herrera-SolĂs, A., & Herrera-Morales, W. V. (2021). ADHD: Reviewing the causes and evaluating solutions. Journal of Personalized Medicine, 11(3), 1-25. Web.
Roberts, J. R., Dawley, E. H., & Reigart, J. R. (2019). Children’s low-level pesticide exposure and associations with autism and ADHD: A review. Pediatric Research, 85(2), 234-241. Web.
Wolraich, M. L., Chan, E., Froehlich, T., Lynch, R. L., Bax, A., Redwine, S. T., Ihuembe, D., & Hagan, J. F. (2019). ADHD diagnosis and treatment guidelines: A historical perspective. Pediatrics, 144(4), 1-9. Web.