Attention Deficit-Hyperactivity Disorder

Attention deficit-hyperactivity disorder (ADHD) is a neurobehavioral disorder that affects 3-5 percent of all American children. It interferes with a person's ability to stay on a task and to exercise age-appropriate inhibition (cognitive alone or both cognitive and behavioral). Some of the warning signs of ADHD include failure to listen to instructions, inability to organize oneself and school work, fidgeting with hands and feet, talking too much, leaving projects, chores and homework unfinished, and having trouble paying attention to and responding to details. There are several types of ADHD: a predominantly inattentive subtype, a predominantly hyperactive-impulsive subtype, and a combined subtype. ADHD is usually diagnosed in childhood, although the condition can continue into the adult years.

Symptoms

Attention-deficit/hyperactivity disorder (ADHD) has been called attention-deficit disorder (ADD) in the past. But ADHD is now the preferred term because it describes both of the primary features of this condition: inattention and hyperactive-impulsive behavior. In some children, signs of ADHD are noticeable as early as 2 or 3 years of age.

Signs and symptoms of ADHD may include:

·         Difficulty paying attention

·         Frequently daydreaming

·         Difficulty following through on instructions and apparently not listening

·         Frequently has problems organizing tasks or activities

·         Frequently forgetful and loses needed items, such as books, pencils or toys

·         Frequently fails to finish schoolwork, chores or other tasks

·         Easily distracted

·         Frequently fidgets or squirms

·         Difficulty remaining seated and seemly in constant motion

·         Excessively talkative

·         Frequently interrupts or intrudes on others' conversations or games

·         Frequently has trouble waiting for his or her turn

ADHD occurs more often in males than in females, and behaviors can be different in boys and girls. For example, boys may be more hyperactive and girls may tend to be quietly inattentive.

Normal behavior vs. ADHD

Most healthy children are inattentive, hyperactive or impulsive at one time or another. It's normal for preschoolers to have short attention spans and be unable to stick with one activity for long. Even in older children and teenagers, attention span often depends on the level of interest.

The same is true of hyperactivity. Young children are naturally energetic — they often wear their parents out long before they're tired. In addition, some children just naturally have a higher activity level than others do. Children should never be classified as having ADHD just because they're different from their friends or siblings.

Children who have problems in school but get along well at home or with friends are likely struggling with something other than ADHD. The same is true of children who are hyperactive or inattentive at home, but whose schoolwork and friendships remain unaffected.

Causes

While the exact cause of ADHD is not clear, research efforts continue.

Multiple factors have been implicated in the development of ADHD. It can run in families, and studies indicate that genes may play a role. Certain environmental factors also may increase risk, as can problems with the central nervous system at key moments in development.

Risk factors

Risk factors for ADHD may include:

·         Blood relatives (such as a parent or sibling) with ADHD or another mental health disorder

·         Exposure to environmental toxins — such as lead, found mainly in paint and pipes in older buildings

·         Maternal drug use, alcohol use or smoking during pregnancy

·         Maternal exposure to environmental poisons — such as polychlorinated biphenyls (PCBs) — during pregnancy

·         Premature birth

Although sugar is a popular suspect in causing hyperactivity, there's no reliable proof of this. Many things in childhood can lead to difficulty sustaining attention, but that is not the same as ADHD.

Complications

ADHD can make life difficult for children. Children with ADHD:

·         Often struggle in the classroom, which can lead to academic failure and judgment by other children and adults

·         Tend to have more accidents and injuries of all kinds than children who don't have the disorder

·         Have poor self-esteem

·         Are more likely to have trouble interacting with and being accepted by peers and adults

·         Are at increased risk of alcohol and drug abuse and other delinquent behavior

Coexisting conditions

ADHD doesn't cause other psychological or developmental problems. However, children with ADHD are more likely than are other children to also have conditions such as:

·         Learning disabilities, including problems with understanding and communicating

·         Anxiety disorders, which may cause overwhelming worry, nervousness and worsening of ADHD symptoms until the anxiety is treated and under control

·         Depression, which frequently occurs in children with ADHD

·         Bipolar disorder, which includes depression as well as manic behavior

·         Oppositional defiant disorder (ODD), generally defined as a pattern of negative, defiant and hostile behavior toward authority figures

·         Conduct disorder, marked by antisocial behavior such as stealing, fighting, destroying property, and harming people or animals

·         Tourette syndrome, a neurological disorder characterized by repetitive muscle or vocal tics

Tests and diagnosis

In general, a child shouldn't receive a diagnosis of ADHD unless the core symptoms of ADHD start early in life and create significant problems at home and at school on an ongoing basis.

There's no specific test for ADHD, but making a diagnosis will likely include:

·         Medical exam, to help rule out other possible causes of symptoms

·         Information gathering, such as any current medical issues, personal and family medical history and school records

·         Interviews or questionnaires for family members, your child's teachers or other people who know your child well, such as baby sitters and coaches

·         ADHD rating scales to help collect and evaluate information about your child

Diagnostic criteria for ADHD

To be diagnosed with ADHD, your child must meet the criteria in the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association. For a diagnosis of ADHD, a child must have six or more signs and symptoms from one or both of the two categories below.

Inattention

·         Often fails to give close attention to details or makes careless mistakes in schoolwork and other activities

·         Often has difficulty sustaining attention in tasks or play activities

·         Often doesn't seem to listen when spoken to directly

·         Often doesn't follow through on instructions and fails to finish schoolwork or chores

·         Often has difficulty organizing tasks and activities

·         Often avoids, dislikes or is reluctant to engage in tasks that require sustained mental effort, such as schoolwork or homework

·         Often loses items necessary for tasks or activities (for example, toys, school assignments, pencils, books)

·         Is often easily distracted

·         Is often forgetful in daily activities

Hyperactivity and impulsivity

·         Often fidgets with hands or feet or squirms in seat

·         Often leaves seat in classroom or in other situations when remaining seated is expected

·         Often runs about or climbs excessively in situations when it's inappropriate

·         Often has difficulty playing or engaging in leisure activities quietly

·         Is often "on the go" or often acts as if "driven by a motor"

·         Often talks too much

·         Often blurts out answers before questions have been completed

·         Often has difficulty awaiting turn

·         Often interrupts or intrudes on others' conversations or games

In addition to having at least six signs or symptoms from these two categories, a child with ADHD:

·         Has inattentive or hyperactive-impulsive signs and symptoms that cause impairment

·         Has behaviors that aren't normal for children the same age who don't have ADHD

·         Has symptoms for at least six months

·         Has symptoms that affect school, home life or relationships in more than one setting (such as at home and at school)

A child diagnosed with ADHD is often given a more specific diagnosis (a subtype), such as:

·         Predominantly inattentive type ADHD. A child has at least six signs and symptoms from the inattention list above. This child may sit quietly and appear to get along with others, but he or she is not paying attention.

·         Predominantly hyperactive-impulsive type ADHD. A childhas at least six signs and symptoms from the hyperactivity and impulsivity list above. This may be misjudged as an emotional or disciplinary problem.

·         Combined-type ADHD. A child has six or more signs and symptoms from each of the two lists above.

Other conditions that resemble ADHD

A number of medical conditions or their treatments may cause signs and symptoms similar to those of ADHD, or exist along with ADHD. Examples include:

·         Learning or language problems

·         Mood disorders (such as depression)

·         Anxiety disorders

·         Seizure disorders

·         Vision or hearing problems

·         Tourette syndrome

·         Sleep disorders

·         Thyroid medication

·         Substance abuse

·         Brain injury

Diagnosing ADHD in young children

Although signs of ADHD can sometimes appear in preschoolers or children even younger, diagnosing the disorder in very young children is difficult. That's because developmental problems such as language delays can be mistaken for ADHD. For that reason, children preschool age or younger suspected of having ADHD are more likely to need evaluation by a specialist, such as a psychologist or psychiatrist, speech pathologist, or developmental pediatrician.

Treatment

The usual course of treatment may include medications such as methylphenidate (Ritalin) or dextroamphetamine (Dexedrine), which are stimulants that decrease impulsivity and hyperactivity and increase attention. Most experts agree that treatment for ADHD should address multiple aspects of the individual's functioning and should not be limited to the use of medications alone. Treatment should include structured classroom management, parent education (to address discipline and limit-setting), and tutoring and/or behavioral therapy for the child.

Prognosis

There is no "cure" for ADHD. Children with the disorder seldom outgrow it; however, some may find adaptive ways to accommodate the ADHD as they mature.

Reference link:

·         http://www.mayoclinic.org/diseases-conditions/adhd/basics/tests-diagnosis/con-20023647

·         http://www.ninds.nih.gov/disorders/disorder_index.htm