Attention Deficit Hyperactivity Disorder Essay

Attention Deficit Hyperactivity Disorder Essay

Attention Deficit Hyperactivity Disorder Essay

Attention deficit hyperactivity disorder is one of the most common neurodevelopmental mental health disorders in children in the world. This disorder is characterized by inattention and hyperactivity in varying or similar levels of severity. These presentations suggest alterations in executive functioning and motivation. Hyperactivity and impulsivity seen in these patients are also seen in other mental illnesses suggesting similar mechanisms etiologically and pathophysiological processes. Neurotransmitter imbalances in various sections of the brain have been described in attention deficit hyperactivity disorder (ADHD). Dopamine and norepinephrine are the main neurotransmitters that have been explained in scientific literature to be associated with the pathogenesis of ADHD (Alexander & Farrelly, 2018). Usually, the brain is made up of two hemispheres that contain several brain regions interconnected by neurons. The purpose of this paper is to explain the anatomical basis of ADHD and describe the challenges in the management of this disorder in children.

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Parts of the Brain Affected by ADHD

The exact pathophysiology and pathogenesis of ADHD are not fully understood. However, various scientific hypotheses have been put forward to explain the mechanism of ADHD pathogenesis. Various parts of the brain are affected differently in ADHD. The main regions of the brain affected by ADHD include but are not limited to the prefrontal cortex, cerebellum, and corpus striatum. The frontal cortex is interconnected with other brain areas and is responsible for performing vital brain functions such as executive functioning (Mehta et al., 2019). Biologically, the prefrontal cortex is highly sensitive to altercation in catecholamines and other neurotransmitters levels in the brain. These chemicals regulate the psychological functioning of the brain such as mood, behavior, and arousal. The levels of these chemicals are dependent on the developmental maturation of the brain, especially the prefrontal cortex and other connected areas such as basal ganglia (Mehta et al., 2019). Other factors such as aging or brain degeneration as a result of external stimuli can causes alteration in these chemicals (Alexander & Farrelly, 2018). In some children, the level of the aforementioned neurotransmitters is generally low as a result of genetic predisposition, age (Yasumura et al., 2019), or developmental aberrations. Macroscopically, the size of the prefrontal cortex is reduced in individuals with ADHD. A normally functioning prefrontal cortex participates in behavior inhibition, preservation or working memory, and reward reversal.

The cerebellum and corpus striatum are other brain regions that are impacted by ADHD. These areas participate in executive functions and motor control, especially fine motor activities. The corpus striatum and cerebellum directly interconnect with the prefrontal cortex. The highest levels of dopamine in the brain are produced by the corpus striatum which consists of globus pallidus, caudate nucleus, putamen, and nucleus accumbens (Mortimer et al., 2019; Mehta et al., 2019). This explains why structural and functional abnormalities of these regions cause alterations in attention, mood, and activity (Alexander & Farrelly, 2018). Structural reduction in the size of the nucleus has been reported in some individuals with ADHD. Size reductions of the corpus striatum have also been imported. Abnormalities in other areas of the brain such as the inferior parietal cortex and dorsal anterior cingulate cortex have been reported in the literature. These two areas are responsible for cognition, attention, learning, language, and error detection (Mehta et al., 2019). Therefore, in ADHD, several areas of the brain are affected but abnormalities prefrontal cortex, corpus striatum, cerebellum, inferior parietal cortex, and dorsal anterior cingulate cortex are more common. Understanding of the functions and anatomical relations of these parts of the brain explains the variation in the presentations of ADHD such as predominantly inattentive type and predominantly hyperactive type diagnostic descriptions.

Management Challenges of ADHD in Children

The diagnostic criteria for diagnosing ADHD in children are outlined in the DSM-5. Various comorbid conditions such as anxiety, depression, epilepsy, bipolar disorder, obsessive-compulsive disorders, and intellectual disorders complicate the process of diagnosis and treatment of patients with ADHD (Koyuncu et al., 2022). Pharmacotherapy and psychotherapy have been used in ADHD treatment among children and teens (Drechsler et al., 2020). For severe cases, pharmacotherapy is preferred. However, comorbid conditions such as epilepsy and bipolar disorders make challenging the choice of medication and disease treatment priority. According to Verrotti et al. (2018), adverse events in medication therapy for children and adolescents with epilepsy and ADHD make the treatment of ADHD difficult. Prioritizing the illness to give priory is also a clinical nightmare. These diseases co-occur more frequently than is reported. Bath conditions also have aspects of neurodevelopmental etiology in their pathogeneses.

Treating children and teens with ADHD is also complicated by sociocultural and medication adherence issues. Recognition of the disease as a problem, social stigma among minority populations, and health-seeking behavior among parents also complicities the management of this illness. prescribing medications for children among teens has also met controversies and criticisms because of the lack of sufficient scientific research data about three efficacy and safety.

Conclusion

ADHD mainly distracts the prefrontal cortical lobe of the brain. Other areas such as the corpus striatum, dorsal arterial cingulate cortex, and anterior parietal cortex are also affected. Dopamine and norepinephrine imbalances in these regions are responsible for the symptomatic presentation. Treating children and teens with ADHD is complicated by the comorbid conditions such as anxiety and epilepsy that cooccur with ADHD. The choice of medications and the prioritization of the disease are also difficult.

References

Alexander, L., & Farrelly, N. (2018). Attending to adult ADHD: a review of the neurobiology behind adult ADHD. Irish Journal of Psychological Medicine, 35(3), 237–244. https://doi.org/10.1017/ipm.2017.78

Drechsler, R., Brem, S., Brandeis, D., Grünblatt, E., Berger, G., & Walitza, S. (2020). ADHD: Current concepts and treatments in children and adolescents. Neuropediatrics, 51(5), 315–335. https://doi.org/10.1055/s-0040-1701658

Koyuncu, A., Ayan, T., Ince Guliyev, E., Erbilgin, S., & Deveci, E. (2022). ADHD and anxiety disorder comorbidity in children and adults: Diagnostic and therapeutic challenges. Current Psychiatry Reports. https://doi.org/10.1007/s11920-022-01324-5

Mehta, T. R., Monegro, A., Nene, Y., Fayyaz, M., & Bollu, P. C. (2019). Neurobiology of ADHD: A review. Current Developmental Disorders Reports, 6(4), 235–240. https://doi.org/10.1007/s40474-019-00182-w

Mortimer, N., Ganster, T., O’Leary, A., Popp, S., Freudenberg, F., Reif, A., Soler Artigas, M., Ribasés, M., Ramos-Quiroga, J. A., Lesch, K.-P., & Rivero, O. (2019). Dissociation of impulsivity and aggression in mice deficient for the ADHD risk gene Adgrl3: Evidence for dopamine transporter dysregulation. Neuropharmacology, 156(107557), 107557. https://doi.org/10.1016/j.neuropharm.2019.02.039

Verrotti, A., Moavero, R., Panzarino, G., Di Paolantonio, C., Rizzo, R., & Curatolo, P. (2018). The challenge of pharmacotherapy in children and adolescents with epilepsy-ADHD comorbidity. Clinical Drug Investigation, 38(1), 1–8. https://doi.org/10.1007/s40261-017-0585-1

Yasumura, A., Omori, M., Fukuda, A., Takahashi, J., Yasumura, Y., Nakagawa, E., Koike, T., Yamashita, Y., Miyajima, T., Koeda, T., Aihara, M., & Inagaki, M. (2019). Age-related differences in frontal lobe function in children with ADHD. Brain & Development, 41(7), 577–586. https://doi.org/10.1016/j.braindev.2019.03.006

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Module 7 Case Study

1. ADHD “distracts” which lobe of our brains?
2. What is the hardest part about treating children or teens?

Case Study Rubrics

Application of Course Knowledge 1.  List Potential Differential Diagnoses based on DSM 5 Criteria 2.  Include brief rationale to support Dx 3. Select Final Diagnosis from the Differential Dx List. Note: You may have more than one final dx 4. Include Management Plan for chosen diagnosis(es): 1.Pharmacological 2.Psychotherapy   (4 critical elements)
Support from Evidence-Based Practice (EBP) 1.    1. Case Study Answers are supported with a minimal of One (1) appropriate, scholarly source; AND 2.    2. Sources are published within the last 5 years 3. 4.    3. Reference list is provided and in-text citations match. 5. 6.       4. Includes support from textbook(s)     (4 critical elements)

 

REQUIRED TEXTS

1.American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Association Publishing, Inc.

2.American Psychiatric Nurses Association, International Society of Psychiatric-Mental Health Nursing, & American Nurses Association. (2014). Psychiatric-mental health nursing: Scope and standards of practice (2nd ed.). Nursebooks.org.

3.American Psychological Association. (2019). Publication manual of the American Psychological Association (7th ed.). American Psychological Association.

4.Perese, E. (2012). Psychiatric advance practice nursing: A biopsychosocial foundation for practice. F.A. Davis Company.

5.Taylor, D. M., Barnes, T. R. E., & Young, A. H. (2018). The Maudsley prescribing guidelines in psychiatry (13th ed.). John Wiley & Sons, Inc.

OPTIONAL MATERIALS

1.Boyd, M. A. & Lubbert, R. A. (2019). Essentials of psychiatric nursing (2nd ed.). Wolters Kluwer/Lippincott Williams & Wilkins Co. Leahy, L. G., & Kohler, C. G. (2013).

2.Clinical manual of psychopharmacology for nurses. American Psychiatric Association Publishing.

3. Stahl, S. M. (2017). Prescriber’s guide: Stahl’s essential psychopharmacology (6th ed.). Cambridge University Press.