Chinese, Mandarin

Spanish

English

Hindi

Arabic

Portuguese

Bengali

Russian

Japanese

Punjabi

German

Javanese

Malay

Telugu

Vietnamese

Korean

French

Marathi

Tamil

Urdu

Turkish

Italian

Chinese, Yue / Cantonese

Thai

Gujarati

Chinese, Jin

Chinese, Min Nan

Persian, Dari

Persian, Western

Polish

Pashto

Kannada

Chinese, Xiang

Malayalam

Sundanese

Hausa

Odia

Burmese

Chinese, Hakka

Ukrainian

Bihari, Bhojpuri

Tagalog

Yoruba

Bihari, Maithili

Uzbek

Sindhi

Amharic

Fula

Romanian

Oromo

Igbo

Azerbaijani

Chinese, Gan

Dutch

Kurdish, Central

Kurdish, Northern

Kurdish, Southern

Malagasy

Lahnda, Saraiki

Nepali

Sinhalese

Chittagonian

Zhuang

Khmer

Turkmen

Assamese

Madurese

Somali

Marwari

Bihari, Magahi

Haryanvi

Hungarian

Chhattisgarhi

Greek, Modern

Chewa

Dakhini

Akan, Twi

Akan, Fante

Kazakh

Chinese, Min Bei

Sylheti

Zulu

Czech

Kinyarwanda

Marwari, Dhundhari

Haitian Creole

Chinese, Min Dong

Ilocano

Quechua

Kirundi

Swedish

Hmong

Shona

Uyghur

Hiligaynon

Mossi

Xhosa

Belarusian

Balochi

Psychology

<OpenstaxParagraph>
	Diego is always active, from the time he wakes up in the morning until the time he goes to bed at night. His mother reports that he came out the womb kicking and screaming, and he has not stopped moving since. He has a sweet disposition, but always seems to be in trouble with his teachers, parents, and after-school program counselors. He seems to accidentally break things; he lost his jacket three times last winter, and he never seems to sit still. His teachers believe he is a smart child, but he never finishes anything he starts and is so impulsive that he does not seem to learn much in school.
</OpenstaxParagraph>
<OpenstaxParagraph>
	Diego likely has <OpenstaxTerm>attention deficit/hyperactivity disorder (ADHD)</OpenstaxTerm>. The symptoms of this disorder were first described by Hans Hoffman in the 1920s. While taking care of his son while his wife was in the hospital giving birth to a second child, Hoffman noticed that the boy had trouble concentrating on his homework, had a short attention span, and had to repeatedly go over easy homework to learn the material (Jellinek &amp; Herzog, 1999). Later, it was discovered that many hyperactive children—those who are fidgety, restless, socially disruptive, and have trouble with impulse control—also display short attention spans, problems with concentration, and distractibility. By the 1970s, it had become clear that many children who display attention problems often also exhibit signs of hyperactivity. In recognition of such findings, the DSM-III (published in 1980) included a new disorder: attention deficit disorder with and without hyperactivity, now known as attention deficit/hyperactivity disorder (ADHD). 
</OpenstaxParagraph>
<OpenstaxParagraph>
	A child with ADHD shows a constant pattern of inattention and/or hyperactive and impulsive behavior that interferes with normal functioning (APA, 2013). Some of the signs of inattention include great difficulty with and avoidance of tasks that require sustained attention (such as conversations or reading), failure to follow instructions (often resulting in failure to complete school work and other duties), disorganization (difficulty keeping things in order, poor time management, sloppy and messy work), lack of attention to detail, becoming easily distracted, and forgetfulness. Hyperactivity is characterized by excessive movement, and includes fidgeting or squirming, leaving one’s seat in situations when remaining seated is expected, having trouble sitting still (e.g., in a restaurant), running about and climbing on things, blurting out responses before another person’s question or statement has been completed, difficulty waiting one’s turn for something, and interrupting and intruding on others. Frequently, the hyperactive child comes across as noisy and boisterous. The child’s behavior is hasty, impulsive, and seems to occur without much forethought; these characteristics may explain why adolescents and young adults diagnosed with ADHD receive more traffic tickets and have more automobile accidents than do others (Thompson, Molina, Pelham, &amp; Gnagy, 2007). 
</OpenstaxParagraph>
<OpenstaxParagraph>
	ADHD occurs in about 8% of children (Danielson et al, 2016), and studies estimate that for about 60% of these people, ADHD continues into adulthood (Sibley et al 2016). On the average, boys are 3 times more likely to have ADHD than are girls; however, such findings might reflect the greater propensity of boys to engage in aggressive and antisocial behavior and thus incur a greater likelihood of being referred to psychological clinics (Barkley, 2006). Children with ADHD face severe academic and social challenges. Compared to their non-ADHD counterparts, children with ADHD have lower grades and standardized test scores and higher rates of expulsion, grade retention, and dropping out (Loe &amp; Feldman, 2007). they also are less well-liked and more often rejected by their peers (Hoza et al., 2005). 
</OpenstaxParagraph>
<OpenstaxParagraph>
	A recent study found that nearly 81% of those whose ADHD persisted into adulthood had experienced at least one other comorbid disorder, compared to 47% of those whose ADHD did not persist (Barbaresi et al., 2013).
</OpenstaxParagraph>
<OpenstaxH3>Life Problems from ADHD</OpenstaxH3>
<OpenstaxParagraph>
	Children with ADHD face considerably worse long-term outcomes than do those children who do not have ADHD. Adults diagnosed with ADHD in childhood, but not treated for ADHD, have been reported to have poor outcomes in a wide range of areas of life, including social function, education, criminality, alcohol use, substance use, and occupational outcomes (Arnold et al, 2015). In one investigation, 135 adults who had been identified as having ADHD symptoms in the 1970s were contacted decades later and interviewed (Klein et al., 2012). Compared to a control sample of 136 participants who had never been diagnosed with ADHD, those who were diagnosed as children: 
</OpenstaxParagraph>
<OpenstaxUl>
	<OpenstaxLi>
		had worse educational attainment (more likely to have dropped out of high school and less likely to have earned a bachelor’s degree);
	</OpenstaxLi>
	<OpenstaxLi>
		had lower socioeconomic status;
	</OpenstaxLi>
	<OpenstaxLi>
		held less prestigious occupational positions;
	</OpenstaxLi>
	<OpenstaxLi>
		were more likely to be unemployed;
	</OpenstaxLi>
	<OpenstaxLi>
		made considerably less in salary;
	</OpenstaxLi>
	<OpenstaxLi>
		scored worse on a measure of occupational functioning (indicating, for example, lower job satisfaction, poorer work relationships, and more firings);
	</OpenstaxLi>
	<OpenstaxLi>
		scored worse on a measure of social functioning (indicating, for example, fewer friendships and less involvement in social activities);
	</OpenstaxLi>
	<OpenstaxLi>
		were more likely to be divorced; and
	</OpenstaxLi>
	<OpenstaxLi>
		were more likely to have non-alcohol-related substance abuse problems. (Klein et al., 2012)
	</OpenstaxLi>
</OpenstaxUl>
<OpenstaxParagraph>
	Longitudinal studies also show that children diagnosed with ADHD are at higher risk for substance abuse problems. One study reported that childhood ADHD predicted later drinking problems, daily smoking, and use of marijuana and other illicit drugs (Molina &amp; Pelham, 2003). The risk of substance abuse problems appears to be even greater for those with ADHD who also exhibit antisocial tendencies (Marshal &amp; Molina, 2006).
</OpenstaxParagraph>
<OpenstaxParagraph>
	Diagnosis, treatment, and general awareness of ADHD has certainly improved in the decades since the people in the above studies were diagnosed. Studies that include more recent outcomes show positive effects of treatment as opposed to non-treatment (Harpin, 2013; Arnold 2015). In most cases, the same studies indicate that more research and work needs to be undertaken to understand the most effect treatments and their impacts.
</OpenstaxParagraph>
<OpenstaxH3>Causes of ADHD</OpenstaxH3>
<OpenstaxParagraph>
	Family and twin studies indicate that genetics play a significant role in the development of ADHD. Burt (2009), in a review of 26 studies, reported that the median rate of concordance for identical twins was .66 (one study reported a rate of .90), whereas the median concordance rate for fraternal twins was .20. This study also found that the median concordance rate for unrelated (adoptive) siblings was .09; although this number is small, it is greater than 0, thus suggesting that the environment may have at least some influence. Another review of studies concluded that the heritability of inattention and hyperactivity were 71% and 73%, respectively (Nikolas &amp; Burt, 2010). 
</OpenstaxParagraph>
<OpenstaxParagraph>
	The specific genes involved in ADHD are thought to include at least two that are important in the regulation of the neurotransmitter dopamine (Gizer, Ficks, &amp; Waldman, 2009), suggesting that dopamine may be important in ADHD. Indeed, medications used in the treatment of ADHD, such as methylphenidate (Ritalin) and amphetamine with dextroamphetamine (Adderall), have stimulant qualities and elevate dopamine activity. People with ADHD show less dopamine activity in key regions of the brain, especially those associated with motivation and reward (Volkow et al., 2009), which provides support to the theory that dopamine deficits may be a vital factor in the development this disorder (Swanson et al., 2007). 
</OpenstaxParagraph>
<OpenstaxParagraph>
	Brain imaging studies have shown that children with ADHD exhibit abnormalities in their frontal lobes, an area in which dopamine is in abundance. Compared to children without ADHD, those with ADHD appear to have smaller frontal lobe volume, and they show less frontal lobe activation when performing mental tasks. Recall that one of the functions of the frontal lobes is to inhibit our behavior. Thus, abnormalities in this region may go a long way toward explaining the hyperactive, uncontrolled behavior of ADHD. 
</OpenstaxParagraph>
<OpenstaxParagraph>
	By the 1970s, many had become aware of the connection between nutritional factors and childhood behavior. At the time, much of the public believed that hyperactivity was caused by sugar and food additives, such as artificial coloring and flavoring. Undoubtedly, part of the appeal of this hypothesis was that it provided a simple explanation of (and treatment for) behavioral problems in children. A statistical review of 16 studies, however, concluded that sugar consumption has no effect at all on the behavioral and cognitive performance of children (Wolraich, Wilson, &amp; White, 1995). Additionally, although food additives have been shown to increase hyperactivity in non-ADHD children, the effect is rather small (McCann et al., 2007). Numerous studies, however, have shown a significant relationship between exposure to nicotine in cigarette smoke during the prenatal period and ADHD (Linnet et al., 2003). Maternal smoking during pregnancy is associated with the development of more severe symptoms of the disorder (Thakur et al., 2013). 
</OpenstaxParagraph>
<OpenstaxParagraph>
	Is ADHD caused by poor parenting? No. Remember, the genetics studies discussed above suggested that the family environment does not seem to play much of a role in the development of this disorder; if it did, we would expect the concordance rates to be higher for fraternal twins and adoptive siblings than has been demonstrated. All things considered, the evidence seems to point to the conclusion that ADHD is triggered more by genetic and neurological factors and less by social or environmental ones. 
</OpenstaxParagraph>
<OpenstaxNote>
	<OpenstaxNoteTitle> Dig Deeper </OpenstaxNoteTitle> <OpenstaxH3> Why Is the Prevalence Rate of ADHD Increasing? </OpenstaxH3>
	<OpenstaxParagraph>
		Many people believe that the rates of ADHD have increased in recent years, and there is evidence to support this contention. In a recent study, investigators found that the parent-reported prevalence of ADHD among children (4–17 years old) in the United States increased by 22% during a 4-year period, from 7.8% in 2003 to 9.5% in 2007 (CDC, 2010). Over time this increase in parent-reported ADHD was observed in all sociodemographic groups and was reflected by substantial increases in 12 states (Indiana, North Carolina, and Colorado were the top three). The increases were greatest for older teens (ages 15–17), multiracial and Hispanic children, and children with a primary language other than English. Another investigation found that from 1998–2000 through 2007–2009 the parent-reported prevalence of ADHD increased among U.S. children between the ages of 5–17 years old, from 6.9% to 9.0% (Akinbami, Liu, Pastor, &amp; Reuben, 2011). 
	</OpenstaxParagraph>
	<OpenstaxParagraph>
		A major weakness of both studies was that children were not actually given a formal diagnosis. Instead, parents were simply asked whether or not a doctor or other health-care provider had ever told them their child had ADHD; the reported prevalence rates thus may have been affected by the accuracy of parental memory. Nevertheless, the findings from these studies raise important questions concerning what appears to be a demonstrable rise in the prevalence of ADHD. Although the reasons underlying this apparent increase in the rates of ADHD over time are poorly understood and, at best, speculative, several explanations are viable: 
	</OpenstaxParagraph>
	<OpenstaxUl>
		<OpenstaxLi>
			ADHD may be over-diagnosed by doctors who are too quick to medicate children as a behavior treatment.
		</OpenstaxLi>
		<OpenstaxLi>
			There is greater awareness of ADHD now than in the past. Nearly everyone has heard of ADHD, and most parents and teachers are aware of its key symptoms. Thus, parents may be quick to take their children to a doctor if they believe their child possesses these symptoms, or teachers may be more likely now than in the past to notice the symptoms and refer the child for evaluation.
		</OpenstaxLi>
		<OpenstaxLi>
			The use of computers, video games, iPhones, and other electronic devices has become pervasive among children in the early 21st century, and these devices could potentially shorten children’s attentions spans. Thus, what might seem like inattention to some parents and teachers could simply reflect exposure to too much technology.
		</OpenstaxLi>
		<OpenstaxLi>
			ADHD diagnostic criteria have changed over time.
		</OpenstaxLi>
	</OpenstaxUl>
</OpenstaxNote>

15.10.1 Attention Deficit/Hyperactivity Disorder

1 Introduction to Psychology

1.1 What Is Psychology?

1.1.1 Why Study Psychology?

1.2 History of Psychology

1.2.1 Wundt and Structuralism

1.2.2 Functionalism

1.2.3 Freud and Psychoanalytic Theory

1.2.4 Wertheimer, Koffka, Köhler, and Gestalt Psychology

1.2.5 Pavlov, Watson, Skinner, and Behaviorism

1.2.6 Maslow, Rogers, and Humanism

1.2.7 The Cognitive Revolution

1.2.8 Multicultural And Cross-Cultural Psychology

1.2.9 Women in Psychology

1.3 Contemporary Psychology

1.3.1 Biopsychology and Evolutionary Psychology

1.3.2 Sensation and Perception

1.3.3 Cognitive Psychology

1.3.4 Developmental Psychology

1.3.5 Personality Psychology

1.3.6 Social Psychology

1.3.7 Industrial-Organizational Psychology

1.3.8 Health Psychology

1.3.9 Sport and Exercise Psychology

1.3.10 Clinical Psychology

1.3.11 Forensic Psychology

1.4 Careers in Psychology

1.4.1 Other Careers in Academic Settings

1.4.2 Career Options Outside of Academic Settings

2 Psychological Research

2.1 Why Is Research Important?

2.1.1 Use of Research Information

2.1.2 NOTABLE RESEARCHERS

2.1.3 The Process of Scientific Research

2.2 Approaches to Research

2.2.1 Clinical or Case Studies

2.2.2 Naturalistic Observation

2.2.3 Surveys

2.2.4 Archival Research

2.2.5 Longitudinal and Cross-Sectional Research

2.3 Analyzing Findings

2.3.1 Correlational Research

2.3.2 Causality: Conducting Experiments and Using the Data

2.3.3 Reliability and Validity

2.4 Ethics

2.4.1 Research Involving Human Participants

2.4.2 Research Involving Animal Subjects

3 Biopsychology

3.1 Human Genetics

3.1.1 Genetic Variation

3.1.2 Gene-Environment Interactions

3.2 Cells of the Nervous System

3.2.1 Neuron Structure

3.2.2 Neuronal Communication

3.2.3 Neurotransmitters and Drugs

3.3 Parts of the Nervous System

3.3.1 Peripheral Nervous System

3.4 The Brain and Spinal Cord

3.4.1 The Spinal Cord

3.4.2 The Two Hemispheres

3.4.3 Forebrain Structures

3.4.4 Midbrain and Hindbrain Structures

3.4.5 Brain Imaging

3.5 The Endocrine System

3.5.1 Major Glands

4 States of Consciousness

4.1 What Is Consciousness?

4.1.1 Biological Rhythms

4.1.2 Problems With Circadian Rhythms

4.2 Sleep and Why We Sleep

4.2.1 What is Sleep?

4.2.2 Why Do We Sleep?

4.3 Stages of Sleep

4.3.1 NREM Stages of Sleep

4.3.2 REM Sleep

4.4 Sleep Problems and Disorders

4.4.1 Insomnia

4.4.2 Parasomnias

4.4.3 Sleep Apnea

4.4.4 Narcolepsy

4.5 Substance Use and Abuse

4.5.1 Substance Use Disorders

4.5.2 Drug Categories

4.6 Other States of Consciousness

4.6.1 Hypnosis

4.6.2 Meditation

5 Sensation and Perception

5.1 Sensation versus Perception

5.1.1 Sensation

5.1.2 Perception

5.2 Waves and Wavelengths

5.2.1 Amplitude and Wavelength

5.2.2 Light Waves

5.2.3 Sound Waves

5.3 Vision

5.3.1 Anatomy of the Visual System

5.3.2 Color and Depth Perception

5.4 Hearing

5.4.1 Anatomy of the Auditory System

5.4.2 Pitch Perception