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ADHD

ADHD

ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD)

What is ADHD?

ADHD is one of the most common neuropsychiatric disorders of childhood which may continue till adulthood in some cases. As the name suggests, children with ADHD may have trouble paying attention, controlling impulsive behaviors (may act without thinking about what the result will be), or being overly active.

Prevalence:

The prevalence of ADHD is found to be from approximately 7% to 12% in primary school children with more prevalence in boys (2-3 boys: 1 girl)

Signs and symptoms:

A child with ADHD might have either symptoms of inattention, hyperactivity/impulsivity, or both. 

Inattention:

  • Daydreams a lot
  • Forgets or loses things a lot
  • Often does not seem to listen when spoken to directly
  • Make careless mistakes 
  • Fails to finish tasks like schoolwork, homework, etc
  • Often gets distracted by surrounding

 

Hyperactivity/Impulsivity :

  • Often fidgets with or taps hands or feet, or squirms in seat.
  • not able to sit in one place for a long 
  • Often talks excessively.
  • Runs around or climbs at places inappropriately
  • Have a hard time resisting temptation
  • Cannot wait for a turn
  • have difficulty getting along with others

These symptoms to some extent may be present in children in normal course as well, but the diagnosis of ADHD can be made only if:

  1. The symptoms are present for more than 6 months
  2. There are severe symptoms of either or both domains before 12 years of age
  3. The symptoms occur in at least two settings eg. School, home, social situations, etc

 

Causes of ADHD

  • The cause(s) and risk factors for ADHD are unknown, but current research shows that genetics plays an important role. 
  • Factors like complications during pregnancy or delivery have been found to be associated with ADHD but the exact causative relation is not known.
  • Research shows that some areas of the brain related to attention concentration are deficient in neural transmission involving mainly dopamine, norepinephrine, etc
  • Research does not support the popularly held views that ADHD is caused by eating too much sugar, watching too much television, parenting, or social and environmental factors such as poverty or family chaos, but these factors may worsen the ADHD symptoms.

 

Effects of ADHD:

On Family:

ADHD in a child has a detrimental effect on the family, looking to the amount of time and energy spent by the family to deal with the child, facing repeated complaints from the school, parents of other children, etc.

Marriages are often stressed to breaking point because of disagreements about how to handle the child and exhaustion.  

The normal siblings of these children are often victimized by their demanding and bullying behavior.

On the child:

On the other hand, the child is likely to have academic underachievement, conflicts, and adjustment problems with peers, and may be more prone to physical accidents due to risk-taking behaviors.

Such children are more at risk for developing secondary emotional problems like poor self-esteem, low self-confidence, feelings of rejection, and loneliness.

It may lead to psychological disorders like depression, anxiety, somatization, drug abuse, etc.

Prognosis:

Many of the constitutional hyperactive children slowly grow over it and by adolescence, activity level reaches normal. 

Some children continue with partial remission of symptoms. 

Some of these children do not recover completely and continue to have symptoms in adolescence and even as adults.

Treatment

In most cases, ADHD is best treated with a combination of behavior therapy and medication. 

Medications help to alleviate and control problematic behaviors of the disorder, they help in increasing attention and regulating hyperactivity and impulsivity

The goals of behavior therapy are to learn or strengthen positive behaviors and eliminate unwanted or problematic behaviors. Behavior therapy for ADHD can include

  • Parent training in behavior management
  • Behavior therapy with children
  • Behavioral interventions in the classroom
  • Educational planning

“Do’s” for parents:

  • Create a structure for the day’s routine activities
  • Break tasks into manageable pieces
  • Simplify and organize your child’s life
  • Limit distractions
  • Encourage exercise and healthy food habits
  • Encourage enough sleep
  • Calm yourself, be positive

“Don’ts” for parents:

  • Don’t sweat the small stuff
  • Don’t get overwhelmed and lash out
  • Don’t be negative
  • Don’t blame the child for ADHD
  • Don’t say “You are purposefully doing that”, “you are good for nothing, or any such derogatory statement.”
  • P.S.  A child being able to sit for hours in front of the TV, computer, or on mobile does not rule out the diagnosis of ADHD