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Gene x Environment

There is a huge disagreement about the role of genetics versus environment. The only consensus among scientists about this is that neither one is the sole cause and that both will play a role. Some sources list heritability in ranges from about 60%-90%. This heritability has been tested, with studies involving twins, adoption and families that the disorder is common in. The familial environment, which is partially affected by genes, is a major factor in the development of ADHD. The twin studies are ideal to test this. With the ability to have both genetic and environmental factors tested in the same conditions allows for better results.

Misdiagnosis

Many studies have implied a higher rate of diagnosis for boys as compared to girls. Some of this might be due in part to the normal behavior of a male child as compared to a female child. There are times when the male child can be diagnosed simply to ease in the control of the often more rambunctious nature of younger males. A key point in the diagnosis of ADHD is that the definition of too hyper or not attentive enough is predicated on what a society decides is normal. As this definition has changed, the amount of people diagnosed with ADHD has jumped dramatically.

Academic Advantage

Diagnosis rates are also up because college students are looking for advantages in classes. This misdiagnosis isn’t always the fault of the doctor or parent. Sometimes the patient will feign symptoms or exaggerate the symptoms to get the advantages or the medication that is typically prescribed with a diagnosis. With a diagnosis in ADHD students get advantages like more time for tests or financial advantages. According to the DSM these symptoms must be present before age seven. Many times when an older child is examined they rely on self answer checklists that aren’t always answered truthfully. Also the symptoms must be impairing the subject as compared to the average person rather than to possibly higher standards of other abilities for the individual.

Lack of Standards

The standards for diagnosing vary between doctors. A major source for error in diagnosis is the standard that symptoms must have been present before age seven. It causes problems for people with ADHD that were missed before that age. After that age assumptions of past behavior will have to be made for a diagnosis to be made. Some doctors will just assume that they were while others will decide since the patient did not come in before age 7 that they were not. The vagueness of the diagnostic symptoms gives a lot of variety in what is actually diagnosed as ADHD.

Historical Factors

According to the CDC a review of patients records has shown a dramatic increase in both the diagnosis of ADHD and use of medications for ADHD since the 1970’s. The 1970’s and 1980’s showed a marked increase in the diagnosis of learning disabilities but there was no significant changes between 1997 at 2006. Part of it is that the doctors have made it a priority to avoid missing the diagnosis, but it has been used to handle some personality types. This can best be described as an environmental factor in ADHD. By that what is meant is that the ADHD is only present because of the environment created by the level of normal decided upon by the society.

Socioeconomic Factors

The rate are also factored by the availability of health care to actually diagnose the ADHD. As a result poorer children are more likely to be missed for diagnosis. Many times a less affluent child is also more likely to be written off as a troublemaker for their hyperactive behavior rather than viewing it as a symptom to be treated. In richer families a child that causes problems is more likely to have a parent say that their child isn’t a troublemaker and just has problems, as a result diagnosis levels are much higher. Also causing higher diagnosis rates, and this is the primary cause, among richer families is the greatly increased access to proper medical care and doctors.

Resulting Problems

When diagnosed with ADHD the patient is typically given a prescription for medication. There are a variety of options but they all have similar side effects. Typically the medication is a form of stimulant. The stimulant medication disrupts both the normal sleep cycle and appetite of the patient taking it. The result in many cases is stunted growth. Normally it is overcome, the medication only causes a delay, but there are times that at least some height is lost. Also when on the medication patients will sometimes feel a bit jittery.

Non diagnosis

Despite an increase in the amount of cases of ADHD since it was first accepted as a problem, there are many people that suffer from ADHD and are never diagnosed. As discussed in the socioeconomic section this is increased in poorer populations. There are those that prescribe to the theory that there is no over diagnosing and that is better to treat than not to treat. Though many disagree with this due to side effects of treatment as discussed in the problems section. Others would like to argue that the people taking advantage of the accommodations is a reason to crack down on standards and limit who can use them. The other side is that some feel like it is worth giving the advantages to a few people that don’t have ADHD in order to help those who have been accurately diagnosed with ADHD more accurately.

Citations

1. Auerbach JG, A.-P. N., Berger A, et al. (2010). "Dopamine risk and paternal ADHD symptomatology associated with ADHD symptoms in four and a half-year-old boys " GENES BRAIN AND BEHAVIOR 9(5): 449-458.

2. Cole J, B. H., Martin NC, et al. (2009). "Genetic Overlap Between Measures of Hyperactivity/Inattention and Mood in Children and Adolescents " JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY 48(11): 1094-1101. 3. Dibbets P, E. E., Hurks PPM, et al. (2010). "Differential Brain Activation Patterns in Adult Attention-Deficit Hyperactivity Disorder (ADHD) Associated With Task Switching " NEUROPSYCHOLOGY 24(4): 413-423.

4. Harrison AG, R. Y. (2010). "ADHD documentation for students requesting accommodations at the postsecondary level Update on standards and diagnostic concerns " CANADIAN FAMILY PHYSICIAN 56(8): 761-765. 5. Lasky-Su J, W. S., Mick E, et al. (2010). "On Genome-wide Association Studies for Family-Based Designs: An Integrative Analysis Approach Combining Ascertained Family Samples with Unselected Controls " AMERICAN JOURNAL OF HUMAN GENETICS 86(4): 573-580.

6. Pastor, P. D., Patricia N., and Reuben, M.A., Cynthia A. (2008). "Diagnosed Attention Deficit Hyperactivity Disorder and Learning Disability: United States, 2004–2006." CDC: Vital and Health Statistics 10(237): 1-22. 7. Pires VA, P. F., Pandolfo P, et al. (2009). "Adenosine receptor antagonists improve short-term object-recognition ability of spontaneously hypertensive rats: a rodent model of attention-deficit hyperactivity disorder " BEHAVIOURAL PHARMACOLOGY 20(2): 134-145. 8. Willcutt EG, P. B., Duncan L, et al. (2010). "Understanding the Complex Etiologies of Developmental Disorders: Behavioral and Molecular Genetic Approaches " JOURNAL OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS 31(7): 533-544.