03.Attention Deficit Hyperactivity Disorder (ADHD)

03.1.What is Attention Deficit Hyperactivity Disorder (ADHD)?

Attention deficit / hyperactivity disorder (ADHD) is a brain disorder. Itis characterized by an ongoing pattern of inattention and/or impulsivity andhyperactivity-impulsivity that interferes with functioning or development.

03.2.Types of ADHD

Inattentive

Hyperactive-impulsivity

03.3.Signs and Symptoms of ADHD

Inattention and hyperactivity / impulsivity are the key behaviors of ADHD.Some people with ADHD have problems with only one of the behaviors, whileothers have both inattention and hyperactivity-impulsivity. Most children havethe combined type of ADHD.

 In preschool, the most common ADHD symptom is hyperactivity.

 It is normal to have some inattention, unfocused motor activity andimpulsivity, but for people with ADHD, these behaviors:

Are more severe

Occur more often

Interfere with or reduce the quality of how they functions socially, atschool, or in a job

Inattention means a person wanders off task, lacks persistence, hasdifficulty sustaining focus and is disorganized; and these problems are not dueto defiance or lack of comprehension.

 Signs & Symptoms of Inattention

Overlook or miss details, make careless mistakes in schoolwork, at work,or during other activities

Difficulty listening when spoken to directly

Difficulty attending to details

Be easily distracted by unrelated thoughts or stimuli

Have problems sustaining attention in tasks or play, includingconversations, lectures, or lengthy reading

Not follow through on instructions and fail to finish schoolwork, chores,or duties in the workplace or start tasks but quickly lose focus and get easilysidetracked

Have problems organizing tasks and activities, such as what to do insequence, keeping materials and belongings in order, having messy work and poortime management, and failing to meet deadlines

Avoid or dislike tasks that require sustained mental effort, such asschoolwork or homework

Lose things necessary for tasks or activities, such as school supplies,pencils, books, tools, wallets, keys, paperwork, eyeglasses, and cell phones

Be forgetful in daily activities, such as chores, errands, returningcalls, and keeping appointments

Impulsivity means a person makes hasty actions that occur in the momentwithout first thinking about them and that may have high potential for harm; ora desire for immediate rewards or inability to delay gratification. Animpulsive person may be socially intrusive and excessively interrupt others ormake important decisions without considering the long-term consequences.

 Hyperactivity means a person seems to move about constantly, includingsituations in which it is not appropriate when it is not appropriate,excessively fidgets, taps, or talks. In adults, it may be extreme restlessnessor wearing others out with their activity.

 03.4.Signs &Symptoms of Hyperactive-Impulsivity

Fidget and squirm in their seats

Leave their seats in situations when staying seated is expected, such asin the classroom

Run or dash around or climb in situations where it is inappropriate or, inteens and adults, often feel restless

Be unable to play or engage in hobbies quietly

Be constantly in motion or “on the go,” or act as if “driven by a motor”

Talk nonstop

Blurt out an answer before a question has been completed, finish otherpeople’s sentences, or speak without waiting for a turn in conversation

Have trouble waiting his or her turn

Interrupt or intrude on others, for example in conversations, games, oractivities

The symptoms of ADHD may resemble other medical conditions or behaviorproblems. Always consult your child's physician or mental health professionalfor a diagnosis.

03.5.Causes of ADHD

The exact cause of ADHD is still unknown. Research shows a combination ofgenes and environmental factors likely plays a role in the development of thecondition. Imaging studies suggest that the brains of children with ADHD aredifferent from those of children without ADHD.

03.6.Incidence of ADHD

ADHD is the most commonly diagnosed behavior disorder of childhood.Estimates suggest that between 3 percent and 9 percent of all children haveADHD. It is more common in boys than in girls. Many parents of children withADHD experienced symptoms of ADHD when they were younger. ADHD is sometimesfound in brothers and sisters within the same family.

03.7.Diagnosis ofADHD

A pediatrician, child psychiatrist, psychologist or a qualified mentalhealth professional usually identifies ADHD in children.

 There is no definitive test or set of tests for ADHD. Currently, the “goldstandard” for diagnosing ADHD utilizes a combination of a detailed history ofthe child's behavior from parents and teachers, observations of the child'sbehavior, and standardized assessment measures to assess for the presence ofADHD symptoms and impairments at home and school.

 Other tests may be used in some cases to rule out other conditions. Forexample, if there is a concern about a possible learning disability,intellectual and achievement testing may be conducted. Other psychological,neurological, or physical testing may also be used to rule out other conditionsthat may be suspected on the basis of the initial evaluation for ADHD. Consult yourchild's physician for more information.

03.8.Treatment of ADHD

Specific treatment for ADHD will be determined by your child's physicianbased on:

 Your child's age, overall health and medical history

Extent of your child's symptoms and resulting impairments

Your child's tolerance for specific medications, procedures, or therapies

Expectations for the course of the condition

Your opinion or preference

Treatment for children with ADHD includes parental support and educationin behavioral training, appropriate school placement and medication (typicallypsychostimulants).

Treatment may include:

 Pharmacological Treatment

Psychostimulants (also known as stimulants) are the most commonly usedADHD medicines. Although these drugs are called stimulants, they actually havea calming effect in people with ADHD. These medications are used for theirability to increase the level of chemicals in the brain that help the child tobetter maintain attention and exhibit greater self-control. They have beenshown to provide the greatest improvement in the core symptoms of ADHD(inattention, impulsivity and hyperactivity). Treatment with a psychostimulantis highly effective in 75 percent to 90 percent of children with ADHD.

 Psychostimulants have been used to treat childhood behavior disorderssince the 1930s. They have been widely studied. Stimulants take effect in thebody quickly, work for one to four hours (in their short-acting forms; extendedrelease formulations usually last two to three times as long), and then leavethe body quickly.

 Doses of stimulant medications need to be timed to match the demands ofthe child's schedule – for example, to help the child pay attention for alonger period of time and improve classroom performance at school, as well asto help with homework and other after-school activities which requireage-appropriate attentional functioning and/or self-control. Current researchsuggests that the majority of children with ADHD who respond to medicationbenefit most from taking it daily, given its positive impact not just at schoolbut also in behavior at home and other social settings.

 There are several different ADHD medicines that may be used alone or incombination. Your healthcare provider will decide which medicine is right basedon your child’s symptoms and needs. Always follow your healthcare provider'sinstructions on how to take ADHD medicine. Some ADHD medicines have sideeffects. If your child has side effects, contact your healthcare provider rightaway. Most side effects of stimulant use are mild, decrease with regular useand respond to dose changes.

 Antidepressant or other psychotropic medications may also be administeredfor children and adolescents with ADHD (often but not always in combinationwith a psychostimulant or other medication) to help improve attention whiledecreasing aggression, anxiety and/or depression.

03.9.Psychosocial Treatments

Parenting children with ADHD may be difficult and can present challengesthat create stress within the family. Classes in behavior management skillsdesigned to address the special challenges associated with parenting a childwith ADHD can help to both improve the child's functioning at home as well ashelp reduce stress for all family members.

 Training in behavior management skills for parents usually occurs in agroup setting which encourages parent-to-parent support. Behavior managementskills may include:

 Use of “timeout”

Point systems

Contingent attention (responding to child with positive attention whendesired behaviors occur; withholding attention when undesired behaviors occur)

Teachers may also be taught behavior management skills to use in theclassroom setting. Training for teachers usually includes use of daily behaviorreports that communicate in-school behaviors to parents.

 Behavior management techniques tend to improve targeted behaviors (such ascompleting school work or keeping the child's hands to himself/herself), butare not usually helpful in reducing the child's broader difficulties withinattention, hyperactivity, or impulsivity.

 03.9.Preventive Action

Preventive measures to reduce the incidence of ADHD in children are notknown at this time.

 However, early detection and intervention can reduce the severity ofsymptoms, decrease the interference of behavioral symptoms on schoolfunctioning, enhance the child's normal growth and developmental process andimprove the quality of life for children or adolescents with ADHD.