top of page
Search

Student Inattention: Why is the student distracted or disruptive - and what can be done about it?

  • Chantra
  • Jan 7, 2022
  • 4 min read

Over the past decade, there has been an exponential leap in the diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) in the US. According to the National Survey of Children’s Health, 9.4% of children ages 2-17 were diagnosed with ADHD in 2016. This is an estimated 6.4 million children, which is a staggering 53% increase in diagnosis over the past ten years. Of those children diagnosed, 2/3 of them receive medication.1 Though the increase in diagnosis of ADHD is world-wide, the number of children diagnosed in the US is markedly higher than those in the rest of the world, especially in Europe. Why is there this leap in ADHD diagnosis in the US? Is the definition of ADHD the same world-wide? Or, is the idea of ADHD so ingrained within our cultural environment that we are more readily accepting of the diagnosis and its convenient remedy through medication?



Historically, difficulty with sustaining attention was recorded as early as the 18th century. Sir Alexander Crichton wrote in 1798 about a “mental restlessness” witnessed in children and a limited “capacity to attend to any one object.”2 He attributed this difficulty to a boredom, however. In 1902, Sir George Still lectured about a 6-year old boy who was “unable to keep his attention” and determined to be “backward in school attainments” even though he appeared “as bright and intelligent as any child could be.” Still attributed this to a “marked moral defect.” 3


Even the names used to describe this phenomenon reflect – and generate - misunderstanding. The diagnosis was first called Minimal Brain Damage. “Damage” later became “Dysfunction” and finally “Disorder.” In 1968, it was called Hyperkinetic Reaction of Childhood, describing primarily the motor symptoms of this disorder. It later became known as the more familiar Attention Deficit Disorder (ADD) with or without Hyperactivity in 1980. It was not until 1987 that it became known as ADHD. Today it is one of the three types of ADHD: Predominantly Inattentive, Predominantly Hyperactive-Impulsive or Combined Type.4


Most health care providers accept ADHD as a genuine disorder when it is properly diagnosed. But what is ADHD neuro-biologically? We are familiar with the symptoms. What does research say about how a properly diagnosed ADHD brain functions? Studies are on-going, but here are three insights that are particularly interesting, especially for educators.

Study #1

We’ve heard for several decades that there is a chemical imbalance within the ADHD brain and that medication is necessary to re-establish that balance. The two major chemicals implicated are norepinephrine and dopamine. Norepinephrine mobilizes the brain and body for action. It increases our alertness, enhances the formation and retrieval of memory, and focuses our attention. Dopamine helps control the brain’s reward and pleasure center. Within the ADHD brain, the pathways of these neurotransmitters are impaired. Those pathways primarily go through the areas of the brain designed to facilitate organization (and other executive function), emotion, and movement. 5

Study #2

A 2007 study done by National Institute of Mental Health in conjunction with McGill University in Canada suggests that ADHD is associated with frontal lobe and temporal lobe immaturity. The study claims that “circuitry in the frontal and temporal areas that integrate information from sensory areas with higher order functions showed the greatest maturational delay in youth with ADHD.”6 Furthermore, the motor cortex matured faster than normal. These findings account for the impulsivity commonly seen with those diagnosed with ADHD.

Study #3

A study published in The Lancet in April 2017 (led by Dr. Martine Hoogman in collaboration the international ENIGMA ADHD Working Group) revealed that there is a difference in brain volume in an ADHD brain. Those with ADHD “had smaller volumes in five areas regardless of whether or not participants had taken medication.”7 These five areas are responsible for: formation of memory (including spatial memory), emotion and motivation, procedural learning, and movement and control.


These studies show that ADHD is a genuine disorder that is more than a chemical imbalance. What, then, accounts for its exponential increase in diagnosis over the past ten years in the US? I suggest to two factors: the diagnosis process and the cultural environment.

While the criteria for the diagnosis as determined by the DSM-5 in the US and the ICD-10 world-wide are analogous, the way in which this disorder is diagnosed is different. The diagnosis for ADHD must be made carefully by a licensed specialist to rule out other disorders that present with similar symptoms. That is not always the case in the US. It is acceptable for general practitioners to make this diagnosis in children. Furthermore, while US specialists look to the brain for the underlying cause of the ADHD, physicians in Europe look first to the environment, and treat the symptoms accordingly.


Medication for ADHD is a common remedy in the US. We live in a cultural environment that in some ways has conditioned us to seek easy answers. Just look at the weight loss industry. One must exercise caution when considering introducing chemicals as a form of remedy. Of the three studies shared in this blog, only one centered on chemical imbalance within the brain. The other two did not relate directly to chemistry. They related, instead, to physical maturation process, thickness of folds, and differences in brain volume. We have seen a drastic increase in ADHD diagnosis in children, and along with that, an increase in prescription of medication. We must make sure that the diagnosis is accurate. We must resist the temptation of immediate gratification that can be brought about with a pill.


The symptoms of ADHD can be broad and overlap with other diagnoses. Inattention could be due to disturbed sleep patterns, lack of exercise and imbalanced diet. It could also be due to excessive electronic screen time, bi-polar disorder or hyperthyroidism. Finally, inattention could be due to a language processing difficulty, such as central auditory processing disorder. While a properly integrated, multi-sensory education may be the most time consuming, it is also the most sustaining form of remedy. We must not seek easy answers to complex situations.


Reference:







6 https://www.nimh.nih.gov/news/science-news/2007/brain-matures-a-few-years-late-in-adhd-but-follows-normal-pattern.shtml


Comments

©2020 by Chantra

bottom of page