What is ADHD?
Attention deficit hyperactivity disorder is a dysfunction of the central nervous system.
Why is ADHD dangerous?
Due to attention deficit and/or hyperactivity, a school-aged child with normal or high intelligence has difficulty reading and writing, poor school performance, makes many mistakes when completing tasks and doesn’t listen to adults’ advice. The child is a source of constant anxiety for people around (parents, teachers, peers) as he/she butts into conversations and activity of others, and excessively reacts to external irritants (the reaction is inappropriate). It is difficult for these children to adapt to their environment, they want to be leaders but can’t be ones. Because of their impatience and impulsivity, they often conflict with peers and teachers making a bad educational situation even worse. A child with attention deficit can’t see the consequences of his/her behavior and overrides authority which may result in antisocial conduct. Asocial behavior is very often observed in teenagers when a risk of persistent behavioral disturbances and aggressiveness is increased in children with attention deficit hyperactivity disorder.
What are the types of ADHD?
There are 3 types of attention deficit/hyperactivity disorder by the predominating clinical symptoms:
- ADHD, Combined Presentation;
- ADHD, Predominantly Inattentive Presentation;
- ADHD, Predominantly Hyperactive-Impulsive Presentation.
According to different authors, the rate of attention deficit/hyperactivity disorder in school-aged children ranges from 2.2 to 18 %. There is at least one child with this disease almost in every class Boys are 2 times more likely to receive an ADHD diagnosis than girls. They typically suffer from predominantly hyperactive-impulsive presentation or combined presentation.
The prognosis is rather favorable as the majority of children get rid of the symptoms in adolescence if proper treatment is given. However, in 30–70 % of cases clinical manifestations of attention deficit/hyperactivity disorder (excessive impulsivity, hot temper, distraction, restlessness, impatience, unpredictable, fast and frequent changes of mood) can be observed in adults as well.
In order for a diagnosis of inattentive presentation to be made, at least 6 symptoms described below must be presented. The child suffers from inattentive presentation if he/she:
- is inattentive to details or makes mistakes in work;
- has difficulty sustaining attention in tasks or play activities;
- does not seem to listen when spoken to directly;
- does not follow through on instructions;
- has difficulty organizing tasks and activities (home task);
- has difficulty engaging in tasks that require sustained mental effort;
- is often easily distracted by extraneous stimuli;
To diagnose hyperactivity, at least 5 of the symptoms mentioned below need to be present.
A child suffers from hyperactive-impulsive presentation if he/she:
- fidgets with hands or feet;
- runs about or climbs excessively in situations in which it is inappropriate;
- has difficulty playing leisure activities quietly;
A child is
impulsive if he/she:
- blurts out answers before questions have been completed;
- has difficulty awaiting turn;
- butts into conversations or games.
Other
mandatory characteristics of ADHD are as follows:
- duration: symptoms must have persisted consistently for at least 6 months;
- consistency and existence in all spheres of life: adaptation disturbances must exist in at least two separate settings (for example, at school and at home);
- intensity: significant difficulty studying, poor social functioning and professional activity;
- other mental disorders are excluded: symptoms can’t be associated with the course of another disease only.
What is the cause of ADHD?
Neurobiological factors such as genetic mechanisms and perinatal damage to the central nervous system (damage to the brain and spinal cord during pregnancy, labor and early postpartum period) are responsible for ADHD. They determine changes on the part of the nervous system functioning and disturbed higher mental functions and behavior that correspond to ADHD. In many cases, negative social and psychological factors (interfamilial, most of all) produce an additional effect on children with ADHD. They can’t cause ADHD but always add to the symptoms and adaptation difficulties in a child.
Concomitant ADHD disturbances (the so-called comorbid disorders)
Additional difficulties associated with interfamilial, school and social adaptation in children with ADHD can be due to concomitant disturbances developed in at least 70 % of patients against ADHD as a basic disorder. ADHD-associated comorbid disturbances are presented by the following groups: oppositional defiant behavior, anxiety disorders, mood disorders, speech disturbances, learning disability, improper coordination, awkwardness, and facial spasms. Other ADHD-associated comorbid disturbances can include sleep disorders and urinary incontinence while sleeping.
What is the treatment of ADHD?
The greatest effect in treatment of ADHD is achieved when different psychological methods (applied both to the child and the parents) are combined with drug therapy.However, it is a neurologist who must decide on a set of necessary therapeutic activities.
A child with ADHD needs an easier mode of education: a minimum amount of children in a class (no more than 12), lesser lesson duration (up to 30 minutes), sitting at the forefront (looking at a teacher improves attention concentration). Targeted and long-term development of socially encouraged behavior is important from the point of view of social adaptation as behavior of some children can contravene the agreed standards. Psychotherapeutic working with parents is essential so that they wouldn’t consider the child’s behavior as disorderly and be more attentive and patient.
Drug therapy is developed based on individual indications when it’s impossible to overcome cognitive work disturbances and behavioral issues in a child or adolescent with ADHD using psychotherapeutic methods of management.
Russian specialists use nootropics, peptide agents that launch internal compensational processes and can restore normal functioning of a child producing a positive effect on cognitive functions (attention, memory, speech). Besides, these agents produce a beneficial effect on metabolic processes in the nervous system and promote maturation of inhibitory and regulatory systems of the brain.
Agents that enhance synaptic transmission with noradrenalin participating in different brain structures are used when ADHD is combined with destructive behavior, anxiety disorders, and facial spasms.
ADHD-associated sleep- and behavior-related disorders require additional treatment with opiates and anti-anxiety medications.
Another direction of ADHD therapy consists in the control of negative factors of nutrition and environment leading to the entry of neurotoxic substances in a child’s body (lead, pesticides, food colorants, preservatives). Among micronutrients with approved clinical effect used in ADHD, magnesium preparations are of note.
Thus, treatment of ADHD must be early (immediately after the diagnosis), complex, continuous and long-term.
O. V. Bykova
Doctor of Med. Sc., Principal Researcher of the Centre for Applied Research in Pediatric Psychoneurology
of Moscow Health Department
You can find out whether your child has attention and behavioral disorders by answering the questions from the table below. If the suggested behavioral feature is observed for over 6 months, answer ‘yes’.
1 | Often fails to give close attention to details or makes mistakes in schoolwork | yes | no |
2 | Often has difficulty sustaining attention in tasks or play activities yes no | yes | no |
3 | Often does not seem to listen when spoken to directly | yes | no |
4 | Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace | yes | no |
5 | Often has difficulty organizing tasks and activities | yes | no |
6 | Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework) | yes | no |
7 | Often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools) | yes | no |
8 | Is often easily distracted by extraneous stimuli | yes | no |
9 | Is often forgetful in daily activities | yes | no |
10 | Often fidgets with hands or feet or squirms in seat | yes | no |
11 | Often leaves seat in classroom or in other situations in which remaining seated is expected | yes | no |
12 | Often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness) | yes | no |
13 | Often has difficulty playing or engaging in leisure activities quietly | yes | no |
14 | Is often “on the go” or often acts as if “driven by a motor” | yes | no |
15 | Often talks excessively | yes | no |
16 | Often blurts out answers before questions have been completed | yes | no |
17 | Often has difficulty awaiting turn | yes | no |
18 | Often interrupts or intrudes on others (e.g., butts into conversations) | yes | no |
In order for a diagnosis of ADHD to be made, you need at least six positive answers to points 1–9 and at least six positive answers to points 10–18. If you have enough positive answers, consult a specialist immediately. He will select an optimum treatment regimen for your child.
Remember that any treatment of a child should be accompanied by parental aid and support.
Parents of children with ADHD need to follow certain principles:
- Develop positive relationships. Praise the child when he/she deserves it.
- Avoid prohibitory words such as ‘no’ and ‘you mustn’t ‘and flat bans.
- Give one task at a time or only one task for a specified period of time so that the child could complete it. Control how the task is done.
- Combine verbal instructions and visual stimulation.
- Encourage a child for any activity requiring concentration (reading, playing with blocks, painting).
- Strictly adhere to daily regimen. Eat, make homework and sleep at the same time daily.
- Avoid being in public places, limit on your guests at home.
- Do not let your child overwork him/herself as this will result in decreased self-control and accrual of hyperactivity.
- Limit your child’s TV/computer time.
- The child must get enough sleep.
- Daily physical activity such as races, sports activities, swimming, long-distance hiking.
O. V. Bykova
Doctor of Med. Sc., Principal Researcher of the Centre for Applied Research in Pediatric Psychoneurology
of Moscow Health Department
