Attention deficit hyperactivity disorder (ADHD) appears to be a combination of neurological dysfunction and a behavioral disorder in childhood affecting a small percentage of school-going children.It is marked by poor attention span, impulsiveness, restlessness, poor academic achievement and social skills. It is 3 times more common in boys than girls. Attention deficit disorder, with or without the hyperactivity component, may also be seen in adults who typically had the disorder from childhood.
For most children, no cause is identified. Twin and family studies suggest that genetic factors may play a role. Molecular genetic studies have identified abnormalities in certain genes in some patients. However, it has not been conclusively proven that this is the cause of the disorder. There may be various other psychological, social and behavioral components involved in attention deficit hyperactivity disorder that has not as yet been well defined in terms of its role in ADHD.
Children with ADHA display some or all of the following symptoms :
- Inattention and easily distracted.
- Frequently makes careless mistakes in schoolwork or other activities.
- Experiences difficulty sustaining attention in task or play activities.
- Tends to be forgetful in daily activities.
- Does not seem to listen to instructions or follow it as expected.
- Often fails to finish schoolwork or other chores.
- Impulsive behavior such as blurting out answers when a question is addressed to another child.
- Displaying restlessness and hyperactivity like running about or climbing excessively in situations where it is inappropriate.
- Fidgets with hands and feet and squirms in seat.
- Has difficulty awaiting their turn in games or group situations.
- Difficulty with planning and organizing tasks.
- Emotional liability
The above symptoms must begin before 7 years of age, be present for at least 6 months and in at least 2 different settings and impair the child’s ability to function normally. These symptoms should be evaluated to exclude other causes.
Diagnosis is made after a thorough interview with parents and by use of behavior rating scales. Physical examination includes direct observation of the child and ruling out any other illness that may affect child’s attention span.
Neuropsychological evaluation tests (tests to check brain function and personality) are done to exclude other learning disorders or mental retardation. Education of parents about the effect of ADHD on child learning, behavior and social skills is imperative to help them set realistic goals of treatment.
Treatment includes combination of behavioral therapy and medications.
Behavioral modification methods such as clear and explicit instructions to the child about desirable and non-desirable behavior is important.
Rewarding the child with praise and other small tangible things that the child desires for desirable behavior is an effective means for teaching appropriate behavior. Punishment strategies like verbal reprimand and non-verbal gestures or ‘time out’ for undesirable behavior is also important to highlight unacceptable behavior.
Providing a well-structured and organized routine for the child at home as well as when at school with the help of teachers. Brief and clear instructions need to be given with a clear and consistent response to the child’s behavior. In school, seating in an area with few distractions and allowing the child to change activities and move about periodically are helpful.
These methods have been used with variable success.
The psychiatrist may prescribe two main classes of stimulants such as methylphenidate and its related drugs and amphetamine. These medications often bring symptomatic relief in 70 and 80% children. However, no improvement is noted in academic achievement or social skills without proper behavioral modification.
The side effects are usually mild and include abdominal discomfort, initial weight loss and loss of appetite. A class of antidepressant drugs such as imipramine and bupropinone are also considered helpful, especially if signs of depression are also present with ADHD.