Attention Deficit Hyperactivity Disorder in New Zealand: A Critical Analysis
Behavioural problems are an important issue within the educational sector that draw attention from both the public and academic sphere. Attention deficit hyperactivity disorder (ADHD) is a major concern for teachers as those affected can display behaviours that are distracting, aggressive, and unsocial. This essay will examine ADHD in relation to a New Zealand context. First, an outline of ADHD will be given that includes its prevalence, etiology, and presenting behaviours. Predominant diagnostic methods will be explained alongside typical treatment methodologies. A discussion will then follow on the political and cultural influences that dictate ideological trends of thinking on ADHD. It is concluded that while individual choice determines the type of analysis and treatment used by teachers and medical professionals on a micro level, subsequent political and cultural conditions dictate the overall accepted knowledge surrounding ADHD on a macro level.
ADHD is the most commonly diagnosed disorder in childhood (Reid, 2012). It is a chronic condition that typically starts to show signs during preschool years and can abate in adolescents, though it can also persist throughout adulthood. Its symptoms vary, however it is characterised by inattention and hyperactivity. An internationally recognised definition would state that neurological and genetic factors attribute towards the disorder, with environmental factors precipitating it (Merck Manual, 2013). Both the New Zealand Ministry of Health (2001) and the Ministry of Education (2013) are in concordance with this statement. ADHD is a disorder that is given a large amount of attention in New Zealand and Worldwide because of its prevalence and disrupting effects. It is largely associated with educational problems in children and this is where a large amount of attention goes towards the disorder (Reid & Johnson, 2012). Academically, a great amount of effort is spent trying to understand the mechanisms behind the disorder, the problem behaviours associated with it, and valid treatment approaches to help those afflicted.
The prevalence of ADHD internationally is estimated to be between 1.4 to 13.3% (Ministry of Health, 2001), with a metaregression analysis by Polanczyk, de Lima, Horta, Biederman and Rohde (2007) revealing a Worldwide average of 5.29%. In New Zealand, the Ministry of Health quote Anderson, Williams, McGee & Silva’s (1987) study, which puts prevalence at 6.7% (Ministry of Health, 2001). The reason for such large discrepancies being noted in the prevalence of ADHD are associated with a number of different problems: Diagnostic criteria has varied over the past several decades, different diagnostic methods have been used, and sampling and methodological issues connected to the two previous problems exist (Barkley, 2006). The significance of this, alongside the possibility of misdiagnosis, yield prevalence results that are only perhaps indicative of the actual rates of ADHD.
While there is no definitive cause regarding the etiology of ADHD, there are multiple factors that have been proven to account for, and predispose one, towards the disorder (Purdie, Hattie & Carroll, 2002). These include hereditary components, neurobiological imbalances and environmental factors such as parental upbringing, behavioural conditioning and stress. Various nutritional decencies have also been proposed to be causative factors in ADHD, including low iron, zinc, iodine, and omega-3, though more evidence is needed to assert the validity of these claims (Millichap, 2008). Furthermore, “an association with seasonal mediated viral infections” has also been noted by Millichap (2008, p. 360), alongside other bacterial and viral infections, such as HIV, Enterovirus, Lyme disease, and Streptococcal infections. It is concluded that the etiology of ADHD is multifactorial, with genetic causes playing a primary part and various environmental factors having a secondary role.
The presenting behaviours of ADHD can effectively be categorised into two affected areas: Academic learning at school and social interaction. Academic underachievement is commonplace for children with ADHD, who significantly score less on standardised tests for maths, reading and spelling (Reid, 2012). Following the teacher’s instruction, maintaining new information, staying focused, reading comprehension, and writing composition all become challenging for the ADHD student. Furthermore, complex tasks that require multiple steps are often too much. Students with ADHD are shown to have three types of executive cognitive function impairments: Planning strategic approaches to educational tasks, goal setting, and perseverance to stay on task (Meltzer, 2007). These difficulties often manifest in disruptive behaviour and an inability to function at normal academic levels.
Socially, whilst not a defining feature of ADHD, children with the disorder often display peer rejection, social isolation, and conflicts with adults (Jewell, Jordan, Hupp & Everett, 2009). In addition, sociometric studies have shown that children with ADHD are less likely to be accepted by their peers as close friends, or be included in group activities (Goldstein & Brooks, 2007). This social ineptitude, in conjunction with a cognitive awareness of their own social difficulties, can lead children with ADHD to also have self-esteem issues. The adaption of their behaviour to meet the desires of social interaction among their peers is one of the most difficult aspects of ADHD, with impulsive behavioural patterns and aggression being cited as frequent problems. Childhood ADHD has also found to correlate with an increased risk-factor for adolescents who are unable to find effective social coping strategies later in life (Young, Chadwick, Heptinstall, Taylor & Sonuga-Barke, 2005).
Diagnosis of ADHD is based on a compilation of medical, educational, developmental, and psychological evaluations (The Merck Manual, 2013). According to diagnostic criteria of the DSM-IV-TR, there are three distinctive types of ADHD: Predominantly inattentive, predominantly hyperactive-impulsive, and combined (DSM-IV-TR, 2010). In relation to these types, there are nine signs and symptoms of inattention, six of hyperactivity, and three of impulsivity. Examples of inattention include not paying attention to detail, becoming easily distracted and often losing things. Examples of hyperactivity include often fidgeting with hands or feet, often leaving one’s classroom seat, and having a problem playing quietly. Examples of impulsivity include showing difficulty in waiting turn, interrupting or intruding on others, and answering before questions are complete. To be diagnosed as either inattentive, hyperactive-impulsive, or combined, the child must demonstrate at least six signs and symptoms from either category, which occur in at least two differing environmental settings; for instance home and school.