Biological Issues Related to Emotional/Behavioral Disorders (continued)

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Copps relates the history of Attention Deficit Hyperactivity Disorder as beginning in 1845, when Henrich Hoffman described "fidgety Phil," the boy who never sat still, as being naughty, rude, and wile (cunning). In 1902, George Still indicated that such children had a "deficit in moral control." However, he described a biologic deficit in "inhibitory volition" because these children often had competent parents who would not typically have had such "morally defective" children.

Following an outbreak of encephalitis in the 1 940s, there were reports of children becoming disruptive, inattentive, and hyperactive as a result of being afflicted with this neurologic disease. These children were referred to as "brain damaged" or "behavior disordered"; children who did not have a physically detectable neurologic deficit were said to have "minimal brain damage." Despite intensive study of children who demonstrated these behaviors, direct evidence could not be found for minimal brain damage. Because no evidence of damage was detected, and also because the term itself was considered distasteful, the name of this condition was changed to "minimal brain dysfunction."

As the symptoms of Attention Deficit Hyperactivity Disorder became increasingly accepted as a dysfunction, rather than a damage, and as a result of a resurgence of a belief in the idea that nurture, rather than nature, determined a child's behavior, poor parenting emerged as a probable cause of this disorder. The response to medication, however, increasingly cast doubt on ineffective parenting and supported a biological cause.

With increased technology, it became possible to measure the functioning of the brain and levels of neurotransmitters, which are chemicals in the brain that affect the efficiency with which the brain functions. It became apparent that individuals with Attention Deficit Hyperactivity Disorder show a deficiency or imbalance in the chemical elements catecholamine, dopamine, and norepinephrine. Although it is not yet clear whether there is a decrease in production or excessive absorption of these neurotransmitters, a significant body of evidence indicates that inefficient transmission of neurological impulses affects the entire attention system of the brain, including attention, inhibition, and motor planning. Viewing Attention Deficit Hyperactivity Disorder in this way, children with this disorder have a deficiency in executive control, which governs the inhibition and monitoring of behavior. These students then neurologically have difficulty selecting and maintaining goals, anticipating, planning, completing tasks, and adapting plans.

Similar evolutionary paths are apparent in our understanding of pervasive developmental disorders, including autism, which was once thought to be a consequence of inadequate parenting, but is now thought, by some, to be a complex neurological disorder; Tourette's disorder; borderline personality disorder; and obsessive compulsive disorder. These disorders, with the exception of autism, will be discussed in more detail in another section of this chapter.