Essay-Diagnosing ADHD

The DSM-IV, which is the Diagnostic Statistical Manual of Mental Disorders (version four), sets up specific guidelines for what constitutes a case of Attention Deficit Hyperactivity Disorder (ADHD). It measures inattention, hyperactivity, and impulsivity. There are several criteria for what constitutes the above symptoms and a subject must meet six of the criteria for inattention, and/ or six for hyperactivity-impulsivity. If six criteria are met in one or both subject areas an ADHD diagnosis can be reached with the addition of some considerations (DSM-IV).

While the criteria presented must be met, there are also conditions which must also be met which are in place to try and prevent misdiagnosis. Since ADHD was traditionally a children’s disorder (though today it has also been recognized in adults) one consideration is that the child must have had some symptoms before seven years of age. Some symptoms must also impair function in two or more different settings and in a clinically observable way to constitute a case of ADHD. The seemingly obvious consideration is that the abnormal behavior cannot be explained better by another developmental or mental disorder (DSM-IV).

Tandon et. Al. conducted a study to measure the effectiveness of the DSM-IV in children. They found that the criteria appeared to be satisfactory for children over four years of age, but that the ADHD guidelines may need to be revised for children under the age of four. This conclusion was arrived at by comparing scores from a test administered by the study leaders between children diagnosed with ADHD and children who were not diagnosed. It showed that those diagnosed with ADHD according to the DSM-IV criteria did indeed to worse on the test (Tandon, 2009). This study seems to fuel the debate as to whether or not the criteria are effective.

Despite the apparently clear-cut criteria for diagnosing ADHD and the conditions which need to be necessarily met, there still appears to be enough doubt in proper diagnosing that a relentless debate continues on whether or not ADHD is over-diagnosed (Compton, 2006). In order to avoid making generalizations on the other side of the argument, Manuel Mota-Castillo lays out some ways in which ADHD mis- and over-diagnosis happens in his experience as a medical director at juvenile detention centers and residential treatment centers.

Often, failure to obtain a complete and thorough family history results in missed symptoms. Some disorders like schizophrenia and bipolar disorder can display symptoms similar to those of ADHD; but doctors rely heavily on family history to determine a diagnosis. Some disorders do display hereditary characteristics. Another common problem is that in-take and evaluating psychiatrists all too often do not communicate enough, or at all, with the clinicians who are regularly seeing the patients in question (Mota-Castillo, 2007). In this case, those all too important details which are indeed known get forgotten and generalizations are made in their place.

One of the most common issues with diagnosing ADHD is the fact that many symptoms present in ADHD are also present in many other psychological disorders (Wagner, 2005). Many professionals are quick to diagnose ADHD as a common disorder instead of fully investigating behavior (Compton, 2006). Mota-Castillo cites hyperactivity, oppositional behavior, and defiance as examples of symptoms which are often present in ADHD as well as many others (Mota-Castillo, 2007). This idea is one of the reasons why so many parents are beginning to refuse diagnosis and/ or treatment. Since there is a possibility of generalization, many do not wish to risk labeling their child or possibly altering their behavior with drugs when it is not needed.

From a slightly less observable and recordable angle, some have argued that the confidence and comfort level of those doing the diagnosing is also a factor. Through this information advanced practice registered nurses have been studied and it has been found that most nurses who are involved in the diagnosing process tend to follow the standards of diagnosing more closely than most. This study was based on a non-experimentally self-administered survey (Vlam, 2006). It is somewhat alarming that such subjective criteria have been used as justification and explanation for something which requires incredible attention to detail.

In the general teaching field the implication is that a teacher should not hint at disorders to parents (Nadeem, 2009). While there are few issues with explaining a child’s disruptive behavior to the parents, it is not the place of a general education teacher to suggest to a parent to have their child reviewed by a psychologist or doctor for ADHD or any other developmental disability (Skinner, 2009). There are ways in which a parent could needlessly upset a parent or even the student with such ideas.

If a parent feels that this may be necessary, they may ask the teacher for recommendations, but otherwise there should be no involvement. There are ways in which a teacher could upset a parent or even the student. In class it is important for a teacher to take objective notes of children’s behavior, especially if they believe that there is an anomaly and that they need to communicate this to the parents. That is what should be presented at a conference, not a medical diagnosis which a teacher is not qualified to make. A teacher can even recommend a child to special education if the parents seek the route (Skinner, 2009).

On the flip side of the coin, there is still the possibility of children not being diagnosed when in fact they should be. In this case it is up to the teacher to advocate for the child, and if that does not work for any reason, to be able to foster growth as best as possible. A teacher is expected to be able to do their job regardless of the children who make up the classroom, and even if miracles cannot be worked, there is no excuse for not trying to adjust for the needs of any child.

Bibliography:

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders, (4th ed., text revision). Washington, DC: American Psychiatric Association.

Compton, K., Taylor, L., Carlozzi, N., Fortson, B., Bushardt, R L, Askins, D G, & Barkley, R A (Dec 2006). Distinguishing ADHD from juvenile bipolar disorder a guide for primary care PAs: pediatric clinicians should know how to distinguish juvenile-onset bipolar disorder from ADHD, since arriving at the right diagnosis is essential to providing the most effective treatment. JAAPA-Journal of the American Academy of Physicians Assistants, 19, 12. p.41(6). Retrieved July 13, 2009, from General OneFile via Gale:
http://find.galegroup.com/ips/start.do?prodId=IPS

Mota-Castillo, M. (July 1, 2007). The Crisis of Overdiagnosed ADHD in Children.(attention deficit hyperactivity disorder). Psychiatric Times, 24, 8. p.12. Retrieved July 08, 2009, from General OneFile via Gale:
http://find.galegroup.com/ips/start.do?prodId=IPS

Nadeem, E., & Jensen, P S (March 2009). Teacher consultation research in attention deficit hyperactivity disorder: a cause for congratulation or consolation?(COMMENTARY)(Report). School Psychology Review, 38, 1. p.38(7). Retrieved July 13, 2009, from General OneFile via Gale:
http://find.galegroup.com/itx/start.do?prodId=ITOF

Skinner, J N, Veerkamp, M B, Kamps, D M, & Andra, P R (May 2009). Teacher and peer participation in functional analysis and intervention for a first grade student with attention deficit hyperactivity disorder.(Report). Education & Treatment of Children, 32, 2. p.243(24). Retrieved July 13, 2009, from General OneFile via Gale:
http://find.galegroup.com/itx/start.do?prodId=ITOF

Tandon, M., Si, X., Belden, A., & Luby, J. (May 2009). Attention-deficit/hyperactivity disorder in preschool children: an investigation of validation based on visual attention performance.(Report). Journal of Child and Adolescent Psychopharmacology, 19, 2. p.137(10). Retrieved July 08, 2009, from Academic OneFile via Gale:
http://find.galegroup.com/ips/st (Mota-Castillo, 2007)art.do?prodId=IPS

Vlam, S. L. (Jan-Feb 2006). Attention-deficit/hyperactivity disorder: diagnostic assessment methods used by advanced practice registered nurses. Pediatric Nursing, 32, 1. p.18(7). Retrieved July 08, 2009, from General OneFile via Gale:
http://find.galegroup.com/ips/start.do?prodId=IPS

Wagner, K. D. (April 1, 2005). Treating ADHD in Childhood Bipolar Disorder. Psychiatric Times, 22, 4. p.61. Retrieved July 13, 2009, from General OneFile via Gale:
http://find.galegroup.com/itx/start.do?prodId=ITOF

Essay-The Importance of Word Choice in Persuasion

According to Art Silverblatt of the St. Louis Journalism Review, the words which a speaker chooses to use “define a position, person or issue.” He goes on to say that connotations associated with words, even synonyms, influence the way a reader or listener understands the subject matter, and how they respond to it. Silverblatt uses the presidency of George W. Bush and is over-use of the title “Commander in Chief” as a way to illustrate this point (Silverblatt 2007).

Former President Bush’s administration had a belief in a strong executive branch which was heavily backed by then Vice-President Dick Cheney. Based on dictionary definitions and popular ideas behind word usage, Silverblatt concluded the following:

“Thus… he is a commander who exercises authority and control.”

Having established what this title truly means and how it is received by the general population, a specific view of President Bush was built (Silverblatt 2007). The creation of this image for the President of the United States owes its life to word choice.

In relation to purely oral speech, Aristotle explains to us in his Rhetoric that most speech is intended to persuade. He also speaks of word choice and how it is necessary to have the right vocabulary to form his now famous syllogisms. Since there are different connotations to different words of similar meaning, a syllogism can be easily broken apart based on inconsistencies with the speaker’s belief about his meaning and the meaning which the audience picks up (Aristotle). This brings up another crucial point regarding word choice in relation to persuasion. It is important that the words which are chosen are understood by the audience to mean the same thing which they mean to the speaker. It is pointless to use “fancy” words or to use words based on little known meaning or inclination if they fail to connect with the audience. Aristotle continues by explaining that putting the audience in a receptive state of mind is one of the three key components to a good argument. Proper word choice will persuade people to be open to being persuaded (Aristotle). Much of this happens on an almost subconscious level, again, based on the audience’s own personal experiences and ideas related to the chose words.

Susan Creal, an entrepreneur turned success coach, gives tips to doctors about patients accepting treatments. In a 2004 article in Clinician Reviews, Creal gives the example of persuading a patient to accept receiving staples in their head after suffering from a severe scalp laceration. She explains that instead of saying “staples,” the doctor would have more success using the words “closure clips.” (Creal 2004). Both expressions mean the exact same thing, but have highly different connotations. Staples evoke feelings of “fear and anxiety” according to Creal; whereas closure clips would sound more comforting (closure) and not as extreme as a staple (a clip does not imply as much force). Relaxing the patient will more than likely result in a more cooperative patient. This is an example of how it is possible to use word choice to assuage a non-receptive audience.

Inevitably, the topic of word choice brings up the use of jargon. Jargon is defined as technical vocabulary by Michael Lindvall, the senior pastor of the Brick Presbyterian Church in New York City. Lindvall postulates five reasons for the use of jargon. These include making the speaker sound like and expert (or “smarty-pants”), making the speaker look like an “insider,” making a possibly long and arduous definition into a small compact word or expression, capturing “the history of an idea,” and for the sake of precision (Lindvall 2008). Jargon is a form of persuasion when not used within the confines of the originating group. When used with the originating group, it becomes more a means of convenience. Because of this, we can eliminate the third use of jargon for our purposes. Jargon requires explanation to out-group people (the audience) anyway, thus defeating the purpose. Using jargon is somewhat akin to using “big words” or “fancy words” to woo the audience into granting the speaker credibility through experience and supposed knowledge. Therefore it would behoove the orator to use the technical term for something, instead of the commonly used term. That makes him or her seem as though they know more than their audience about a subject.

While the above refers to what some may call a sneaky or underhanded way of persuasion, Herschell Gordon Lewis refers to a type of persuasion called “power persuasion” in an article written for Direct Marketing International. This technique consists of using the proper words to convey meaning in a powerful way. Lewis cautions prospective orators and writers that word choice is ever changing because societal connotations rely of course on how society is developing at any given moment. Based on the societal atmosphere, a writer chooses his wording in order to deliver the greatest effect, and this extends of course to orators (Lewis 1992). The following is an example of word choice to deliver the greatest verbal “punch”:

“The dedicated wordsmith recognizes the difference between at once and immediately: At once is more emotional, ergo more imperative; immediately is more intellectual, ergo arm’s-length.”

Lewis also emphasizes the fact that although two or more words may be synonyms, their connotations are quite different, which changes the game, so to speak, in regards to persuasive writing or speech (Lewis 1992).

Besides the words themselves, the grammar also has a great effect on how the audience receives the material and the speaker. There is the obvious syntax which must be taken care of, but even correct grammar can be improved upon. Active versus passive voice and present versus past tense are both important things to consider as well when giving a speech. An active voice presents the speaker as an authority, and as a decision maker. A passive voice presents the speaker as a victim (which could be used as persuasion by reversal or an appeal to pathos). Present tense indicates urgency, whereas past tense indicates a “revision of history” which does not need immediate attention or action (Lewis 1992).

Ultimately word choice is incredibly important when it comes to persuading an audience. It can garner support; it can create a sense of need, a sense of action. On the other hand, it can alienate and turn off the audience. It is a mistake to assume that although words are synonyms that they will be received the same way regardless of which is used. Word choice is an indispensable tool in the hands of government entities, religious institutions, copywriters, advertisers, used car salesmen, and anyone else who try to persuade using written or oral words.




Works Cited

1. Aristotle. Rhetoric. Trans. Roberts, W. Rhys. Adelaide, Australia: eBooks@Adelaide, 2007.

2. Creal, Susan. "Watch your language." Clinician Reviews 14.4 (2004): 78. General OneFile. Web. 29 Oct. 2009. <http://find.galegroup.com/gps/start.do?prodid=ips&usergroupname=nm_a_albtechvi>.

3. Lewis, Herschell Gordon. "Cold-blooded copywriters beat poets." Direct Marketing International 21 (1992): 35. General OneFile. Web. 29 Oct. 2009. <http://find.galegroup.com/gps/start.do?prodid=ips&usergroupname=nm_a_albtechvi>.

4. Lindvall, Michael L. "Choice terms.(Faith MATTERS)(jargon)." The Christian Century 125.8 (2008): 33. General OneFile. Web. 29 Oct. 2009. <http://find.galegroup.com/gps/start.do?prodid=ips&usergroupname=nm_a_albtechvi>.

5. Silverblatt, Art. "I'm the Commander in Chief.(off the record)(George W. Bush)(Brief article)." St. Louis Journalism Review 37.299 (2007): 4. General OneFile. Web. 29 Oct. 2009. <http://find.galegroup.com/gps/start.do?prodid=ips&usergroupname=nm_a_albtechvi>.