Attention deficit disorder (ADD) or attention deficit hyperactive disorder (ADHD) is a chronic behavioral disorder of children characterized by difficulty in maintaining attention (poor attention span, inattentiveness) or hyperactivity (over activity) and impulsiveness or both. It has gained significant media attention over the past 20 years as a better understanding of the condition, and its treatment, has raised awareness. ADHD causes restlessness, impulsiveness, reduced attention span, poor ability to focus on any task thereby affecting the child’s family life and school performance. Management is mainly through medication, behavioral modification, lifestyle changes and counseling of both parents and children.
Depending upon the symptoms ADHD can classified in three groups :
1. Mainly suffers from inattentiveness :
- Easy to distract, forgetful, frequent switching between activities.
- Difficulty in concentrating on a specific task, organizing and completing them
- Often loses personal belongings.
- Day dreaming.
- Difficulty in understanding instruction.
2. Mainly suffer from hyperactivity and impulsiveness :
- Constantly moving, running, dashing out.
- Difficulty in sitting at a place silently.
- Non-stop talking.
- Difficulty in doing quiet tasks (dinner, story time, during class).
- Unrestrained emotions, making improper comments.
- Minimal patience: inability to wait for things or wait for their turn of play
3. Combination of all the above symptoms.
Symptoms ADHD affect social interaction negatively (relationships, school performances etc). Sometime ADHD patients have poor handwriting, delayed speech and motor development.
In order to make a diagnosis of ADHD signs and symptoms must appear before 7 years of age. In about 30 to 50% of children, ADHD symptoms will persist in adulthood. Adults and teenagers are seen to develop compensatory coping mechanisms to deal with the symptoms.
ADHD children are more prone to oppositional defiant disorder (ODD) which is characterized by defiant attitude towards people, conduct disorder (antisocial attitude), depression, bipolar disorder and/or anxiety.
The exact cause of ADHD is unknown. It appears to be an outcome of interplay among environmental and genetic factors. Parenting patterns as such do not cause ADHD. A hereditary component seems to be responsible as ADHD may run in families. Exposure to toxins during pregnancy like maternal smoking, alcohol consumption and exposure to various environmental toxins may damage the development of brain and make the child more susceptible to ADHD.
- Exposure to toxin (smoking, alcohol, dyes)
- Family history of ADHD, other mood or behavioral disorder
- May be associated with other psychiatric illness (bipolar disease, depression)
- Low birth weight
Despite the use of several drugs to manage the condition, there is no cure for ADHD. The condition should be diagnosed by a psychologist or psychiatrist and parents should not be premature in assuming that their child is suffering from ADHD until the diagnosis is complete and definitive.
- Psychostimulants: methylphenidate, dextroamphetamine, amphetamine are available both as short-acting and long-acting forms. The common side-effects are reduced sleep, appetite, weight loss, temporary slow growth.
- Non-stimulant drugs like atomoxetin are prescribed when stimulants fail or cause side-effects. Important side-effects are liver problem (jaundice) and suicidal tendencies.
- Antidepressants and clonidine may also be prescribed.
These drugs have abuse potential although the right dose of drug is usually safe.
- Behavior therapy
- Family therapy
- Social skills therapy
Usually children outgrow symptoms but it may persist in some even in adulthood.