National Health and Morbidity Survey 1996 indicated that 4.3 percent of children in Malaysia suffered disability focus and hyperactivity or ADHD (Zuhayati Yazid, 2010). According to Kauffman and Landrum (2009), 3 to 5 percent of the school’s student population is comprised of students with ADHD. Meanwhile, O’regan (2007) estimated 1 to 3 students from 30 students in the class have ADHD. Statistics show that boys are more likely to show symptoms of ADHD than girls. Meanwhile, Konti et al (2010), explained that the study epidemiological around the world are consistently showing that the ratio of ADHD symptoms between men and women are the 2:1. The study by Martel et al (2011) also found that ADHD is more experienced at a young age, male students than female students and individuals from low-income families. Review by Konti et al (2010), found significant differences between the types of ADHD and gender. The study showed that ADHD-I (ADHD-less concentration) more experienced with girls.
Classification of ADHD
ADHD is a complex disability of neurobiological reliable due to dysfunctional neurotransmitters (Litner, 2003). Individuals who suffer from ADHD are diagnosed as individuals who showed significant problems in concentrating, impulsive and extraordinarily active (Barkley, 1998). United States Psychiatric Association (APA), explains that individuals who suffer from ADHD as those who show signs of a lack of concentration, impulsive and hyperactive permanent and continuous in a certain period (Mash & Wolfe, 2002). Meanwhile, the hyperactivity is defined as the movement and activities of extreme and expressive (Turkington & Harris, 2003). They found it hard to stop doing something when directed or requested to be discontinued and have difficulty in sitting still for a period of time.
ADHD stands for disorder or disability problems of concentration and hyperactivity. Overall, the characteristics of the behavior of a lack of concentration and hyperactivity problems are as follows:
- Seems unable to sit still
- Always feels restless and fidgety in their chair (eg, in the chair);
- Usually playing with hands or feet, twist around;
- Getting the nearest objects that can be played out or put in the mouth;
- Wander in the classroom as well as difficult to sit for long periods;
- Always talking.
b) Impulsive means as to likely be intuitive and less self-control.
- Suddenly speaking in a wrong timing;
- Have difficulty waiting for things they want or waiting their turns;
- Often interrupts conversations or others’ activities;
- Talking nonstop;
- Act without thinking the cause and effect;
- Blurt out with dangerous physical activities and act without regard for consequences.
- Has difficulty in concentrating and may bounce from one activity to the next
- Has problem focusing and sustaining attention
- Would easily get bored with something that unrelated to them and may have better attention to enjoyed activities.
- Has difficulty in concentrating and learn new things
- Difficulty in completing assignments
- Often loss their personal things (like a pencil) that is needed to complete the tasks.
- Daydreaming and easily get confused
- Difficulty in processing information accurately and quickly
- Difficult to follow rules and regulation
ETIOLOGY OF ADHD
To this day, scientists and physicians have sought to gain a better understanding of how the brain performs a task and its effect on learning and concentration (Reif, 2007). According to Nigg (2006), there is no single reason that causes ADHD. ADHD is a complex disability and related chronic brain, behavior and cognitive development due to various factors. Among the causes of ADHD are:
a) Genetic factors
The studies in the west shows that there is strong correlation with aspects of inheritance or breed inside the characteristics of ADHD. Typically, ADHD in child is inherited chronically and growing since childhood and its continuous throughout life. (Litner, 2003; Newark & Stieglitz, 2010). According to Reif (2007), children with ADHD often have parents, siblings, grandparents or other family members who have a history or similar behavior during their childhood. Meanwhile, Kauffman and Landrum (2009), also explained that the symptoms of ADHD is more prevalent among children who have a biological relationship with those individuals having this disabilities. Review by Paloyelis et al (2010) showed the relationship between genetic factors with disabilities focus (ADHD) is moderate:
b) Risk of complications during pregnancy and birth
Most studies cannot prove accurately that the condition during pregnancy and birth complications during delivery can cause the birth of ADHD children. Scientific studies also have not been able to demonstrate a significant association between drugs factor during pregnancy with symptoms of ADHD. However, the study by Motlagh et.al (2010), found that mothers who smoked more than ten cigarettes a day are at risk of having children with ADHD. Meanwhile, there are studies showing that children born to young mothers are at risk of having children in ADHD higher than the aged mother (Barkley, 1998). In addition, the birth of underweight infants is also a factor occurrence of ADHD. According to Nigg (2006), the birth of underweight infants which is less than 2500 grams contribute to a problem of baby development, including symptoms of ADHD.
c) Neurobiological/Biological Factors
ADHD is caused by biological conditions in the brain (Taylor, 2010). Most doctors explain ADHD as inefficiency of the nervous system in the brain areas that control impulses (stimuli) and help filter sensory input and focus (Reif, 2007). As for today, researchers studying the biological reason through sophisticated anatomical and psychological test involving blood flow to the brain, neurotransmitters and others (eg electrical potentials in the brain tissue of magnetic resonance imaging) (Kauffman & Landrum, 2009). Till today, there is no strong evidence showed the neurological problems is the basic in the occurrence of ADHD, although many researchers assumed the causes or biological factors are a major cause of most cases in ADHD (Nigg, 2006).
d) Diet, Allergic & Lead
According to Coleman and Webber (2002), toxins and food allergies are the environmental agents that cause a person to suffer from ADHD. However, the effect of sugar consumption, food addiction and fluorescent lights cause hyperactivity occurred only at a low percentage. In addition, various foodstuffs (such as coloring, sugar and preservatives), toxins from the environment (eg, lead poisoning) and the allergen is believed to be the cause of the hyperactivity and other disabilities (Kauffman & Landrum, 2009). However, the study by Pelsser et al (2010), the respondents showed signs of ADHD decreased by 50 percent after being given nutritional intervention which is the dietary intake of food that does not cause allergy (hypoallergenic), such as rice, chicken and turkey , vegetables and fruits.
e) The influences of family profile
Family aspects or parenting factors also can effect the occurrence of ADHD. Problematic family system also capable to foster up ADHD. According to Coleman and Webber (2002), family is a factor that influence in children to have ADHD symptoms. While the study by Loe et al (2008) found that ADHD is associated with demographic and socioeconomic factors. ADHD children also come from individuals who have parents with low academic achievement and family situations where parents are often not at home.
COMPLICATIONS OF ADHD
The results of the clinical studies and the social sciences tend to create an experience of ADHD symptoms for individuals with ADHD. Among the complications are learning disabilities, behavioral problems and psychological problems.
a) Learning disabilities
ADHD is one of the learning disabilities (Mohd Zuri Ghani & Aznan Che Ahmad, 2011). According Litner (2003), the characteristics of ADHD was found to have a significant effect on academic achievement. Academic achievement of students in the ADHD found to be very poor compared to normal students. In addition, ADHD students academic achievement also lower than the supposed achievements (Coleman & Webber, 2002; Saudino & Plomin, 2007). Approximately 80 percent of children with ADHD have difficulties in reading, spelling, and writing (Wolfish, 1988). In addition, a study by Loe et al. al (2008) found that ADHD students with learning disabilities have a cognitive and lower score for vocabulary acceptance compared with other students.
According to Young and Bramham (2007), clinical specialists opinion shows that the characteristics of ADHD and learning disabilities are difficult to distinguish because of ADHD characteristics also a part of learning disabilities. This explains that low in factor of mental intelligence (IQ) and the development of behavior problems resulted in ADHD with learning disabilities was difficult to be diagnosed in children or adults. Studied by Paloyelis et al (2010), found a significant relationship between IQ and ADHD-lack of concentration and hyperactivity and ADHD-impulsitivity. Meanwhile, according to O’regan (2007), 40 percent of students in the ADHD also suffer from specific learning difficulties such as dyslexia, dyspraxia and dyscalculia. Meanwhile, ADHD students also exhibit low performance in intelligence tests than normal students (Wicks-Nelson & Israel, 2006). This achievement also shows that there is a relation between ADHD and learning disabilities. According to Wicks-Nelson and Israel (2006), academic deterioration is particularly pervasive in youth with ADHD. The performance was shown low by the achievement test scores in schools and led to a 30 to 40 percent of ADHD students placed in special education classes.
(b) Behavioral Problems
Characteristics of ADHD was found to have a significant effect on the social problems that have an impact on one’s aspects of life (Litner, 2003). According O’regan (2007), ADHD individuals aged 11 years were found to have disruptive behavior and low socialization skills in the school environment, and by the age of 14 years, ADHD individuals exhibit competitive behavior, criminal behavior, truancy and suffers behavioral disorders. However, not all ADHD individuals will experience the same level of development. Nevertheless, this problem usually will lead that individual to criminal activity, although there are other factors that will influence their behavior towards criminal activity (O’regan, 2007).
In addition, a study by Loe et al (2008) found that behavioral problems of ADHD students will develop according to the time sequence, whereas the non-ADHD students encountered behavior problems is decreasing over time. Meanwhile, a study by Lee et al (2008) showed that only a small portion of the ADHD student in teens age can adapt well towards their emotional, and social behavior simultaneously. However not all ADHD individuals show the same level of disability during teenagers. The study by Loe et al. al (2008) also found that the ADHD group showed a consistent behavior problems. Individuals with ADHD also found to have low driving skills (Barkley, 1998).
(c) Psychological Problems
Psychiatric condition alleged to be associated with ADHD. Children with ADHD have low self-esteem at the age of 7 years (O’regan, 2007). The effects of low levels in self-esteem cause these children require different techniques or methods to be accepted by their peers. According to Litner (2003), two-thirds of the ADHD individuals suffers one or more comorbidities symptoms such as depression, anxiety, Obsessive-Compulsive Disorder, Oppositional Defiant Disorder (ODD), conduct disorder (CD) and bipolar disorder.
Review by Baving et al (2006) found that individuals with ODD show difficulty in the ability to focus. ODD symptoms refers to difficulty in controlling anger, difficult to comply with adult instruction, refused to comply with the rules, annoy other people deliberately, blames others for their own mistakes or misbehavior, irritability, always feeling angry and discouraged, and a vindictive and spiteful. At the age 10 to 12 years they will be exposed to an increased in risk of psychiatric, known as behavioral disorders that often lying, stealing, running away from home and frequently absent from school.
The literature review clearly shows that there are many aspects of the etiology of ADHD symptoms that led to the existence and cause various complications to patients. Among the causes of the existence of ADHD symptoms are genetic factors, risk of complications during pregnancy and birth, neurobiological factors, dietary, allergic and influence of family profile. Whereas, the symptoms of ADHD create complications in terms of learning disabilities, behavioral problems and psychological problems. Therefore, the individual ADHD require special attention and should get medical treatment that includes educational strategies (involving intervention or training),a combination of psychotherapy or treatment. The treatment given is to focus on ways to reduce the symptoms of ADHD and enhance the potential of ADHD individuals in order to reduce the gap with the normal individual in the national development plan.
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