17.2.1: Brain-Related Disorders

Learning Objectives

1. Identify the core symptoms, diagnostic criteria, and presentations of Attention-Deficit/Hyperactivity Disorder (ADHD).
2. Explain known risk factors and treatments for ADHD.
3. Define Specific Learning Disorder (SLD).
4. Describe neurological and behavioral characteristics associated with dyslexia.
5. Summarize effective intervention strategies and classroom supports for children with ADHD and SLD.

Attention Deficit/Hyperactivity Disorder (ADHD)

The exact causes of ADHD are unknown; however, research has demonstrated that factors that many people associate with the development of ADHD do not cause the disorder including, minor head injuries, damage to the brain from complications during birth, food allergies, excess sugar intake, too much television, poor schools, or poor parenting. Research has identified several significant risk factors that affect neurodevelopment and behavioral expression. Events such as maternal alcohol and tobacco use that affect the development of the fetal brain can increase the risk for ADHD. Injuries to the brain from environmental toxins, such as iron deficiency, have also been implicated.

Symptoms

People with ADHD show a persistent pattern of inattention and/or hyperactivity–impulsivity that interferes with functioning or development:

1. Inattention: Six or more symptoms of inattention for children up to age 16, or five or more for adolescents 17 and older and adults; symptoms of inattention have been present for at least 6 months, and they are inappropriate for developmental level.

• Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.
• Often has trouble holding attention on tasks or play activities.
• Often does not seem to listen when spoken to directly.
• Often fails to follow through on instructions and fails to complete schoolwork, chores, or workplace duties (e.g., loses focus and gets sidetracked).
• Often has trouble organizing tasks and activities.
• Often avoids, dislikes, or is reluctant to undertake tasks that require mental effort over a prolonged period (such as schoolwork or homework).
• Often loses things necessary for tasks and activities (e.g., school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
• Is often easily distracted
• Is often forgetful in daily activities.

Figure \(\PageIndex{1}\): This child is exhibiting inattention. Image by Ben Paarmann is licensed under CC BY 2.0.

2. Hyperactivity and Impulsivity: Six or more symptoms of hyperactivity-impulsivity for children up to age 16, or five or more for adolescents 17 and older and adults; symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for the person’s developmental level.

• Often fidgets with or taps hands or feet, or squirms in seat.
• Often leaves seat in situations when remaining seated is expected.
• Often runs about or climbs in situations where it is not appropriate (adolescents or adults may feel restless).
• Often unable to play or take part in leisure activities quietly.
• Is often “on the go”, acting as if “driven by a motor”.
• Often talks excessively.
• Often blurts out an answer before a question has been completed.
• Often has trouble waiting his/her turn.
• Often interrupts or intrudes on others (e.g., butts into conversations or games)

Figure \(\PageIndex{2}\): This child is exhibiting hyperactivity and impulsivity. Image by Marc Lewis is licensed under CC BY-SA 2.0.

In addition, the following conditions must be met:

• Several inattentive or hyperactive-impulsive symptoms were present before age 12 years.
• Several symptoms are present in two or more settings (such as at home, school, or work; with friends or relatives; in other activities).
• There is clear evidence that the symptoms interfere with or reduce the quality of social, school, or work functioning.
• The symptoms are not better explained by another mental disorder (such as a mood disorder, anxiety disorder, dissociative disorder, or a personality disorder). The symptoms do not happen only during schizophrenia or another psychotic disorder.

Presentation

Based on the types of symptoms, three kinds (presentations) of ADHD can occur:

• Combined Presentation: if enough symptoms of both criteria, inattention and hyperactivity-impulsivity, were present for the past 6 months
• Predominantly Inattentive Presentation: if enough symptoms of inattention, but not hyperactivity-impulsivity, were present for the past six months
• Predominantly Hyperactive-Impulsive Presentation: if enough symptoms of hyperactivity-impulsivity, but not inattention, were present for the past six months.

Because symptoms can change over time, the presentation may also change accordingly.⁵⁴ The diagnosis of ADHD can be made reliably using well-tested diagnostic interview methods. However, as of yet, there is no independent, valid test for ADHD.

Among children, ADHD frequently occurs along with other learning, behavior, or mood problems such as learning disabilities, oppositional defiant disorder, anxiety disorders, and depression.

Treatment

A variety of medications and behavioral interventions are used to treat ADHD. The most widely used medications are methylphenidate (Ritalin), D-amphetamine, and other amphetamines. These drugs are stimulants that affect the level of the neurotransmitter dopamine at the synapse. Nine out of 10 children improve while taking one of these drugs.

Figure \(\PageIndex{3}\): Brain scans of brains with and without ADHD. Image by the National Institutes of Health is in the public domain.

In addition to the well-established treatments described above, some parents and therapists have tried a variety of nutritional interventions to treat ADHD. A few studies have found that some children benefit from such treatments. Nevertheless, no well-established nutritional interventions have consistently been shown to be effective for treating ADHD.⁵⁶

Specific Learning Disorder

Specific learning disorder (SLD) is a broader category that includes not only dyslexia but also difficulties in other academic areas, such as mathematics (dyscalculia) and written expression (dysgraphia). The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), defines SLD as a neurodevelopmental disorder that affects a child's ability to perform academically in one or more areas, despite having the opportunity to learn and adequate intelligence. SLD can be diagnosed when academic difficulties significantly interfere with daily functioning, such as causing frustration, poor academic performance, or social difficulties.

The core feature of specific learning disorder is a discrepancy between a child's actual academic performance and what would be expected based on their age, schooling, and intelligence. For example, a child with SLD may be able to solve math problems conceptually but struggle with performing calculations or understanding mathematical symbols.

Dyslexia

Dyslexia is one of the most common learning disabilities in children, specifically characterized by difficulties with accurate or fluent word recognition and poor spelling and decoding abilities. These difficulties occur despite adequate intelligence and exposure to appropriate teaching methods. Children with dyslexia often struggle with reading comprehension, which can significantly impact their academic progress, as reading skills are foundational to learning in most subjects.

In middle childhood, the signs of dyslexia become more pronounced as children are expected to read fluently and understand increasingly complex text. Children with dyslexia may struggle with decoding words and tend to avoid reading tasks. They might also experience difficulty with spelling, writing, and sometimes even with understanding spoken language.

Figure \(\PageIndex{4}\): A 7-year-old boy with visual dyslexia wears corrective bifocal glasses while reading. Image by Charlesjsharp is licensed CC BY 2.5.

Dyslexia is believed to have a neurological basis, and studies suggest that it is related to differences in the way the brain processes written and spoken language (Shaywitz, 2003). Specifically, individuals with dyslexia often show reduced activity in the left hemisphere of the brain, particularly in areas involved in language processing, such as the left temporoparietal region, which is responsible for decoding and processing words. It is essential to note that dyslexia is not directly linked to intelligence; many children with dyslexia possess average or above-average intelligence.

Interventions and Support

Effective interventions for children with dyslexia or specific learning disorder are available, and early identification is key. Specialized teaching methods, such as structured literacy programs, can help children with dyslexia improve their reading and spelling skills. These methods focus on phonemic awareness, phonics, fluency, vocabulary, and reading comprehension. Multisensory instruction, which involves visual, auditory, and kinesthetic learning, is often effective in reinforcing learning (Birsh, 2011).

In addition to direct instruction, children with SLD may benefit from accommodations, such as extended test-taking time, the use of assistive technology (e.g., text-to-speech software), and alternative ways of demonstrating knowledge (e.g., oral reports instead of written assignments). Classroom modifications and individualized education plans (IEPs) are commonly used to ensure that children with learning disorders receive the support they need to succeed academically.

References, Contributors and Attributions

54. Symptoms and Diagnosis of ADHD by the CDC is in the public domain

56. Disease Prevention and Healthy Lifestyles by Judy Baker, Ph.D. is licensed under CC BY-SA

Shaywitz, S. E. (2003). Overcoming dyslexia: A new and complete science-based program for reading problems at any level. Alfred A. Knopf.