-Select a current issue in the field of lifespan development.
-Prepare an analysis of the issue. Include a description of the issue and its connection to significant concepts, distinctive features, and critical periods in lifespan development.
-Examine any controversies associated with the issue and summarize how the issue has enhanced or hindered the study of lifespan development.
-Format according to APA standards
-Have a minimum of three scholarly sources-APA formatted.
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ADHD and Lifespan development - The British Journal of Psychiatry (2004) 184: 468-469
© 2004 The Royal College of Psychiatrists.
1. Developmentally inappropriate degrees of hyperactivity, inattention and impulsivity are common symptoms in childhood. If of early onset (before 7 years), present in different settings and to a degree that causes functional impairment, a diagnosis of attention-deficit hyperactivity disorder (ADHD) or 'hyperkinetic disorder' should be considered. The age criterion is crucial to distinguish ADHD and hyperkinetic disorder from later-onset conditions such as agitated depression, adolescent-onset socialised conduct disorder (probably not linked to ADHD) or hypomania, that might appear superficially similar. Attention-deficit hyperactivity disorder and hyperkinetic disorder are commonly associated with language, learning and social impairments. Indeed, in severe cases hyperactivity could be a marker of a multifaceted developmental disorder. Hence, competent assessment usually requires a thorough history, often using a number of sources.
Attention-deficit hyperactivity disorder appears to represent a 'dysmaturity' of the prefrontal cerebral cortex and subcortical structures such as the basal ganglia. In addition, approximate phenocopies might also emerge from intra-uterine alcohol exposure, brain injury and, possibly, severe pre-school social deprivation. However, it is likely that genetic factors contribute significantly to most cases of ADHD and hyper-kinetic disorder in representative child populations.
IMPORTANCE OF ADHD
Such a biologically oriented view amounts to a major reconceptualization of childhood behavioral disorder and has made a substantial impact on child and adolescent psychiatry. It could be on the brink of doing so for aspects of adult practice, not least because adult services are likely to be already treating individuals who have or have had ADHD (Dalsgaard et al, 2002). Insights from child and adolescent practice are therefore likely to be relevant to general psychiatrists.
Nevertheless, the idea that ADHD is responsible for a large proportion of seriously disruptive childhood behaviour was accepted only slowly by UK clinicians, who had favoured explanations that were more socially oriented. Hence, conduct disorder, characterised by 'a repetitive... pattern of dissocial aggressive or defiant conduct' and regarded as subsequent to various forms of family adversity but without a significant biological predisposition, had tended to prevail.
However, aspects of both conduct disorder and ADHD could characterise the behaviour of the most disturbed children with the poorest prognosis. For this and other reasons ICD-10 included a new category, hyperkinetic conduct disorder (World Health Organization, 1992). It now appears likely that this is not simply two common disorders that occur together but a more severe variant of behavioural disorder with a greater genetic loading than ADHD alone.
A CULTURE-BOUND SYNDROME?
The prevalence of ADHD combined type (i.e. with both inattention and hyperactivity) or hyperkinetic disorder is approximately 1-2% of the primary school population. However, cultural factors appear to influence its prevalence (Leung et al, 1996) and severity (Lynam et al, 2000), a phenomenon familiar to general psychiatrists (Harrison et al, 2001). Indeed, some argue that in recent decades Western culture has tended to evolve to the disadvantage of children as well as other vulnerable groups (Murray et al, 2003). These include, for instance, the loss of extended and even nuclear families, informal social controls, safe play areas and, because of crime or traffic, the general freedom of the outdoors. For older children there is the added risk posed by ubiquitous access to affordable illicit drugs and alcohol.
Therefore, it could be that whereas the prevalence of ADHD as a genetically determined syndrome has not changed, there has been a decline in the capacity of Western culture to cope with and raise these children. The implication for the individual is greater culture-related handicaps and for society, greater comorbid or secondary conduct disorders (Jacobson et al, 2000) with all the social disruption, substance misuse and mortality (through substance misuse, accidents and suicide) that that entails.
An analogous set of secular changes might have also contributed to the increased salience of adult ADHD. Driving presents particular risks for young adults with ADHD. In addition, Western economies require higher ...
The field of lifespan development is highlighted.