Hanifa P. Abdulhalem
Final Requirement: Case Study
PSY105-B7
Attention-Deficit/Hyperactivity Disorder
The Case of Zuhair:
Concentration Issues and Restlessness
Presenting Problem
Zuhair, a-ten-year-old boy, has a bad habit of misbehaving at school. Each week,
his school's teachers report three or four incidents of fighting, kicking, and fleeing in the
hallways to his mother.His mother indicated, "When the guidance office reaches me, it
has always been routine for me to report to his school. According to his classmates, he
engages in frequent physical confrontations with his peers and frequently uses foul
language toward them." He has also been unable to complete the task allotted to him
and is frequently sidetracked.
"My son is unable to sit still for any length of time at home, has had multiple falls
when climbing trees, and requires continuous prompting to arrange his toys," his mother
said, adding that despite his gadgets being confiscated, he would not sleep early. "He
plays around the living room and can't sit still in one area even when everyone inside
the house is asleep.
Zuhair was seen fidgeting with his hands, tilting his head in various directions,
swinging his arms, leaping on his feet, and constantly moving around the room during
the session. When he did make eye contact, which was rare, he frowned a lot and had
narrowed eyes.
His repeated disruptions annoy his classmates at school. His teacher stated that
"Whenever he obtains one-on-one attention from a student teacher who happens to be
in his class on a placement, he is able to calm and do the task provided to him." I asked
Zuhair’s mother to list down behaviors that concern her the most. She stated that
“accept others like making noises or climbing as part of my son’s development as long
as it is safe.”
Additional study using Zuhair's school records produced some additional, useful
information. His teachers became dissatisfied with him as soon as he entered primary
school. Zuhair's previous instructors and other subject tutors, particularly mathematics
lecturers, have complained about his inattentiveness, impulsiveness, and inability to
remain seated from kindergarten to the current grade. As a result of his violent
outbursts, his classroom adviser previously decided to provide him with a statement of
special educational need, and he now works well together with the classroom assistant.
His teacher before the pandemic has moved him to the front of the room, where she can
keep a close eye on him, and has assigned him one task at a time. For example,
anytime a document needs to be delivered to the principal's office, his adviser would
delegate the task to him to avoid sitting in class for long periods of time. "His behavior
has stabilized greatly this year due to the presence of an attendant, although it requires
additional improvement," his adviser stated, "but his troubles appear to exacerbate
when he is without his helper."
Background Information
Zuhair is the family's youngest kid, with a 13-year-old brother and a 15-year-old
sister. "I was diagnosed with pregnancy induced hypertension after 15 weeks of
gestation," the boy's mother claimed throughout her pregnancy. An emergency
cesarean section was performed before the due date which is at 36 weeks of pregnancy
due to preeclampsia." The boy's birth weight was quite low at 1.2 kilograms. The mother
also stated that he has been difficult to handle since early childhood, requiring "repeat
instructions over and over."
For up to three years, he was breastfed. Within the first two months following
birth, he made his first eye contact, smiled, and showed signs of symptoms. He started
sitting at six months, crawling at seven months, standing up at eleven months, and
started walking at thirteen months old.
Zuhair's parents began to notice his hyperactivity, impulsivity, and difficulty to
follow directions when he was three years old. The boy was sent to school earlier than
other children his age since he was highly active. He had poor relationships with his
classmates and teachers from the beginning of school, and his grades were consistently
below average. He couldn't complete the jobs because he couldn't follow the steps, and
his performance deteriorated year after year.
During the session, I discovered that Zuhair has an appetite for eggs and eats
them 1-2 times every day. Ice-cold popsicles were also on his mind. He'd go through the
ice popsicles one by one, and if his mother provided him a limitless supply, he'd eat
them all day. It was tough to get him to sleep at night since he would be wide awake
and want to play until at least 1 in the morning, thus exhausting his mother. He would
kick off his blankets and tear off all of his clothes when he is about to sleep as he
despises the feeling of being sweaty. He likes to walk around the home in barefoot since
he prefers the cold tile. He did not perspire excessively during his initial visit. He couldn't
sleep without a nightlight since he was terrified of the dark. He was afraid that there
were ghosts underneath his bed and that he could see their silhouette on the wall in the
dark. He wanted to be outside in the fresh air. Zuhair's mother thought to herself that her
other children had normal personalities, and she had no idea what was wrong with
Zuhair. His parents opted to have him evaluated at the local hospital. Zuhair was
accepted into the hospital's early childhood intervention program. He made some
improvement, but it was hampered by their financial difficulties: "we couldn't care for his
needs at the time because my husband and I were both unemployed, and we had to
rely on my parents for aid."
Zuhair also had an issue with his eyesight. Both his mother and father wear
corrective lenses in their family. His mother has myopia (nearsightedness), whereas his
father has hyperopia (farsightedness). At the age of four, they noticed Zuhair was
having trouble seeing things that were far away. They took him to an optical clinic,
where he and her mother were both diagnosed with myopia. The doctor suggested that
he should wear corrective spectacles from then on, which he initially disliked. It could
also be the reason he gets bored fast at school because he can't read what's written on
the blackboard well. His father displayed indications of inattention and
hyperactivity-impulsivity, according to his family history. "Zuhair's father was claimed to
have been a 'lively' child, then a 'brilliant underachiever' who periodically got on the
wrong side of the law," according to his mother.
Assessment and Evaluation
I conducted an unstructured diagnostic interview, an assessment of his school
and hospital records, and earlier reports were used in order to evaluate Zuhair. In this
case, I worked closely with Zuhair's tutor at home to learn how he performs during class
hours. I also decided to question Zuhair's mother further. I kept questioning Zuhair in
order to get a more accurate diagnosis. I learned a lot more about Zuhair from these
sources.
Prior to the pandemic, which occurred two years ago, I interviewed Zuhair about
his school experiences. "The children pick on me because I wear glasses and talk
loudly; they pick on me because I can't answer the teacher's questions, so I beat them
as a response, and they don't pick on me after that”. I also asked him about how he acts
in class, in which he replied "I am a good boy in class. But if someone picks on me, I
fight back no matter what happens. Recently, when my mother and I shopped for dinner,
I observed a tall child mocking me, so I removed my shirt and struck him in the face with
it. To demonstrate my fury, I yelled at him and used foul language. When other children
pick on me, I simply do not have the patience,” he said. I also spoke with his prior
teachers via online calls, who said they have had similar instances. Zuhair was
frequently involved in fights at school, particularly at recess and in the schoolyard. Even
if it appeared that the children were not targeting him, he would hit them. I went back to
the issue of his attention problems in class. "Well, everything about school is sort of
hard for me sometimes," he explained, "I don't like it much, because it's hard to
understand what the teachers say." I then inquired about his favorite and least favorite
subjects. "To be honest, I dislike all of them, but mathematics the most. I truly do not get
how numbers operate."
Oftentimes, Zuhair was walking around the room in which I conducted the
interview, looking at the objects on display and attempting to rearrange them. I
questioned Zuhair if he frequently misplaced anything. "Happens frequently. I am prone
to forgetting where I placed my money, and I cannot help but accuse my siblings of
stealing, even when I am not certain."
After that, I spoke briefly with Zuhair's mother. With his mother, I questioned her
regarding his behavioral issues. "Well, I'm called into school all the time because his
teachers are fed up with his attitude," Zuhair's mother stated. "Well, Zuhair has always
been a bother on my side, and as you know, his behavior has recently deteriorated
significantly. According to her home tutor, his grades have dropped, and my husband
and I are concerned that his behavior is becoming too extreme. We're scared that once
the face-to-face class starts, he'll be kicked out since he's been so disruptive. He rarely
finishes his homework and frequently arrives to class unprepared. He's always losing or
forgetting stuff." I also inquired about his tutor's performance, "He's very inattentive
during our session. He rarely pays attention to what I'm saying and will occasionally try
to divert our conversation away from our lesson. Her tutor also claimed that "he can't sit
still in his place; he wanders around the room while our class is in session."
I went over Zuhair's medical history again. He was diagnosed with both
nearsightedness and astigmatism. His eyes still require the use of corrective lenses to
this day. This problem might have hampered his growth. "When he was younger, his
class adviser thought a visit to the GP might be a good idea, so he was referred to me
for an assessment," his mother added. "After a careful assessment, which included
collecting information from school, questionnaires, and Zuhair's observations, a
diagnosis of ADHD was made." That was predictable, given his father's history of
ADHD. It's possible he inherited it from him. My husband and I, however, decided that
we did not want any medication after discussing the treatment options." Because the
family does not want to try a pharmaceutical, a psychological intervention is offered
instead, but drug treatment has more benefits and is superior to other treatments for
children with severe ADHD.
With all of that evidence, I was confident enough to establish a diagnosis for Zuhair. My
preliminary diagnosis are as follows:
Attention-Deficit/Hyperactivity Disorder,
Predominantly Hyperactive-Impulsive Type.
Theoretical Etiologies
Similar to other prevalent medical and mental illnesses (e.g., asthma,
schizophrenia), ADHD is influenced by numerous genes, non-inherited variables, and
their interaction. There is no definitive etiology of ADHD, and being exposed to a
contributing factor does not always mean that you will develop the illness. This indicates
that any particular health risk will only be found in a subset of instances and so will be
present in people who are not affected. Risk factors that lead to the onset of ADHD may
not invariably be similar to the ones that affect its course and results.
There is significant evidence from a variety of study types that ADHD has a
substantial genetic component. Consistently, family studies have indicated greater
likelihood of ADHD (twofold to eightfold heightened risk) in the parents and siblings of
afflicted patients as compared to relatives without the disorder. Twin studies have
revealed that monozygotic twin pairs have considerably greater heritability estimates for
ADHD than dizygotic twin pairs. Adoption studies have also found elevated ADHD rates
in the birth parents of ADHD adoptees opposed to both the foster parents of the
subjects and the parents of controls without ADHD (e.g., Sprich et al.). The average
estimate of heritability is around 79%. But nonetheless, heritability is not 100%, which
suggests that other factors outside inheritance also play a role.
ADHD seems to share a hereditary vulnerability with a number of other
neurodevelopmental and mental impairment, including autism spectrum disorders
(ASDs), developmental motor control,problems, reading skills, intelligence, behavioral
and mood issues. As was the case with Zuhair, he comes from a family where ADHD
runs in the blood; in fact, his own father has been diagnosed with the condition. Based
on these data, it appears that the same genetic and familial factors can lead to the
development of a variety of clinical presentations.
There are several potential causes of ADHD besides inherited traits. As there are
several environmental risk factors related with ADHD, determining which of them are
causal is difficult. This is because many reported relationships could be caused by
symptoms/disorders in the kid or parent; reverse causality, for example, peer rejection,
familial adversity, low socioeconomic position, or head injury, or by unmeasured
confounders, which could include inherited variables. Studies of time trends have shown
that the rate of ADHD in the population has not gone up over time, even though the
number of people who know they have ADHD has increased dramatically. In
cross-national investigations, there has been no conclusive evidence that particular
nations have fewer ADHD rates. On the other hand, data on behavioral issues among
children show an increase in the last half-century, and that these increases differ
geographically. These data show that ADHD is more likely to be associated with many
environmental dangers, each of which has a minor influence, with the cumulative
burden of these risks being comparable across time and nations. There may be genetic
impacts (gene–environment interaction) that alter some of these outcomes.
Tissue-specific epigenetic processes can also affect gene function when exposed to
environmental hazards. Animal studies have established, for instance, that bad early
upbringing has an effect on stress reactions through such systems and that these
biological alterations can be passed down to the future generations.
The vast majority of studies, such as meta-analyses, on premature and/or low
birth weight children indicate evidence of a link between ADHD and ADHD
symptoms/attentional issues (relative risk of 2.64 for ADHD in premature children).
Inattention symptoms and the ADHD inattentive subtype appear to be most strongly
linked to extreme prematurity and low birth weight. Preliminary research suggests that
intrauterine growth restriction may be of significant consequence (small for gestational
age). In relation to this, Zuhair's mother indicated that she was having trouble
conceiving. After 15 weeks of pregnancy, she received the diagnosis that she was
suffering from pregnancy-induced hypertension. Then, emergency caesarean section
performed prior to the due date (i.e., in 36 weeks of gestation) for reasons of
preeclampsia. ” Because of this, Zuhair's birth weight was extremely low (i.e., 1.2 kg),
and he has been exceptionally challenging to care for ever since he was a little child.
Prematurity, low birth weight, and other pre- and postnatal hazards are all thought to be
risk factors for ADHD, but no one knows for sure whether or not they are the cause of
ADHD. Research suggests that children who were born prematurely or with low birth
weight may be more susceptible to ADHD than previously thought.
Additionally, it appeared as though Zuhair enjoyed sweets rather frequently. Icy
popsicles are his favorite snack and if his mother offered him a limitless supply, he'd
devour them all day long. Despite popular belief, studies do not support the notion that a
diet high in sugar or excessive television viewing is to blame for the development of
ADHD.
Although genetics has advanced rapidly, further study into environmental
dangers is still needed. There are a plethora of possible causes of ADHD, but no single
test can definitively determine which factors are to blame. The most compelling
evidence relates to the relationship between ADHD/ADHD-like behaviors and very
uncommon extreme adversities, such as extreme preterm, exceedingly low birth weight,
foetal alcohol syndrome, and a pattern of behaviors associated with early institutional
deprivation. There is a lack of understanding of the risk variables that influence ADHD
outcomes. Only one study has found a link between COMT and antisocial behavior in
ADHD, and this suggests that behavioral issues in persons with ADHD may have a
different etiology than behavioral issues in the general population.
The present information, combined collectively, paves the path toward identifying
populations at higher risk, notably those with a family background of ADHD and/or
neurodevelopmental or cognitive issues, as well as those people who have been
exposed to the environmental stressors indicated previously. However, no tests or
biomarkers for ADHD can be found for any of these dangers, not even in the genetic
testing that is available. In the upcoming years, it is anticipated that greater discovery of
ADHD risk factors and mechanisms would boost our knowledge of the as-yet-unknown
etiology of ADHD and act as a catalyst for improved diagnosis and treatment.
Treatment Plan
There is currently no single, definitive treatment for attention deficit hyperactivity
disorder (ADHD), however there are numerous different treatment alternatives. The
treatment approach for each kid with ADHD must be personalized to his or her specific
needs, beginning with behavioral results.
Taking medication isn't the only way to treat attention deficit hyperactivity disorder
(ADHD). There are numerous more effective treatments that can assist children with
ADHD in improving their attentiveness, regulate impulsive behavior, and limit
hyperactivity. A well-balanced treatment plan can help your kid perform better in school,
strengthen their connections with others, and reduce stress and frustration—for them
and for your entire family—by incorporating nutritious food, play and exercise, trying out
new coping techniques, and enhancing social skills.
A child's ability to focus and sit still at school is not the only thing ADHD has an
impact on. It also has an impact on the child's interactions with their family and peers.
Frequently, children with ADHD exhibit behaviors that can be quite bothersome to
others. When a diagnosis is made, behavior therapy can be an effective treatment
option for reducing these behaviors. Behavioural therapy aims to teach patients new,
more desirable behaviors while also working to eradicate problematic ones. Therapy for
ADHD might involve training for parents in behavior management; behavioural therapy
with children; and classroom behavioral interventions that will be highly essential for
Zuhair when he returns to face-to-face classrooms this school year.
Drugs can assist children cope with their ADHD symptoms and prevent doing
things which make life hard for them at home, school, and with their peers and family.
Stimulants like Ritalin and Adderall are frequently recommended for ADHD, but they
may not always be the right approach for a child, nor are they the only treatment.
Therefore, I strongly recommended Zuhair's parents to contact the doctor who
previously diagnosed him with ADHD, as they stated, "it's been a long since we've
made an appointment with Zuhair's doctor." A child's developing brain is also at risk
from these potent medications, which raises more questions than it answers. Side
effects such as irritation, lack of appetite and insomnia might also be a concern. In
conclusion, medication is not a cure but rather a tool.
ADHD medicine affects individuals differently. Some children enjoy substantial
improvement, while others get little or no alleviation. Additionally, the adverse effects
vary from child to child, and for some, they outweigh the benefits. Finding the proper
drug and dosage takes time because individuals respond differently. Combining ADHD
medication with other treatments increases its efficacy.
Medication for ADHD must always be checked closely. It is not enough to simply
swallow a tablet and forget about it when it comes to treating ADHD. If your child
experiences any negative side effects, the doctor will have to alter the dosage based on
these observations. Without rigorous monitoring, ADHD medications are less efficient
and more dangerous.
Given Zuhair's parents' previous refusal to give him medications, I reassured
them that, if they decided to put their kid on medication, it does not imply they must
keep him on it indefinitely. It is safe for the parents to discontinue their child's ADHD
medication if things aren't going well, despite the fact that it isn't advisable to frequently
switch medications. However, if they wish for their child to cease taking medicine, they
must inform their child's doctor and cooperate with them to go off the drugs gradually.
In terms of Zuhair's parents, I explained to them how they may have a significant
impact on their child's upbringing. They may help Zuhair with ADHD symptoms by
encouraging him to eat healthy food, engage in exercise activities, and make other wise
decisions and actions. I emphasized to them that exercise is among the simplest and
most effective strategies to alleviate ADHD symptoms. Increases in brain dopamine,
norepinephrine, and serotonin, which are all important for maintaining attention and
concentration, occur almost immediately after engaging in vigorous physical activity.
Exercise and ADHD drugs like Ritalin and Adderall function similarly in this regard.
Contrary to ADHD medications, however, exercise does not necessitate a prescription
and has no adverse effects. These indicate that Zuhair can begin his ADHD treatment
at home.
Prognosis
On the basis of the evaluation, Zuhair's prognosis has been determined to be
"good." He has made significant progress, and his parents are very supportive of his
recovery and willing to cooperate with my proposed treatment regimens. Additionally, it
is to their advantage that they have visited a general practitioner in the past; as a result,
even before the interview, they have some prior knowledge of what to do. Zuhair's
parents had previously changed their parenting ways after Zuhair's doctor encouraged
them to do so. In addition, during this pandemic, Zuhair's home tutor has been
cooperative regarding the strategies she should implement during their class sessions
in order to pique his desire in accomplishing his modular learning responsibilities.
Zuhair's parents begin to motivate him to respond vocally rather than violently
and to channel his energy into hobbies such as athletics or frenetic percussion playing
in an effort to lessen the amount of violence and impulsivity that he displays. The
parents of Zuhair have gotten adept at picking their conflicts with the passage of time.
The atmosphere in their house has improved. However, I am concerned about Zuhair's
use of profanity. His parents have been given the go-ahead to allow him to
communicate verbally for the time being. Even though some kids might not be allowed
to do these things, they are better than being physically mean. Nonetheless, it assisted
him in reducing his outbursts and likelihood of engaging in physical conflict with other
children. Overall, Zuhair appears to have a good probability of recovering from his
health condition.