Deficit -ADHD is a very common psychiatric disorder especially in children. Almost 10 million cases in India suffer from this disorder annually. It is a brain disorder marked by an ongoing pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development. ADHD is more common in males than females, and females with ADHD are more likely to have problems primarily with inattention.
RISK FACTORS (CAUSES)
⚫Genetic (most common)
⚫Cigarette smoking, alcohol use, or drug use during pregnancy
⚫Exposure to environmental toxins during pregnancy
⚫Exposure to environmental toxins, such as high levels of lead, at a young age
⚫Low birth weight
⚫Brain injuries
SIGNS AND SYMPTOMS
Inattention and hyperactivity/impulsivity are the key behaviors of ADHD. Some people with ADHD only have problems with one of the behaviors, while others have both inattention and hyperactivity-impulsivity.Most children have the combined type of ADHD. In preschool, the most common ADHD symptom is hyperactivity.
INATTENTION
People with symptoms of inattention may often:
⚫Overlook or miss details, make careless mistakes in schoolwork, at work, or during other activities
⚫Have problems sustaining attention in tasks or play, including conversations, lectures, or lengthy reading
⚫Not seem to listen when spoken to directly
⚫Not follow through on instructions and fail to finish schoolwork, chores, or duties in the workplace or start tasks but quickly lose focus and get easily sidetracked
⚫Have problems organizing tasks and activities, such as what to do in sequence, keeping materials and belongings in order, having messy work and poor time management, and failing to meet deadlines
⚫Avoid or dislike tasks that require sustained mental effort, such as schoolwork or homework, or for teens and older adults, preparing reports, completing forms or reviewing lengthy papers
⚫Lose things necessary for tasks or activities, such as school supplies, pencils, books, tools, wallets, keys, paperwork, eyeglasses, and cell phones
⚫Be easily distracted by unrelated thoughts or stimuli
⚫Be forgetful in daily activities, such as chores, errands, returning calls, and keeping appointments
HYPERACTIVITY-IMPULSIVITY
People with symptoms of hyperactivity-impulsivity may often:
⚫Fidget and squirm in their seats
⚫Leave their seats in situations when staying seated is expected, such as in the classroom or in the office
⚫Run or dash around or climb in situations where it is inappropriate or, in teens and adults, often feel restless
⚫Be unable to play or engage in hobbies quietly
⚫Be constantly in motion or “on the go,” or act as if “driven by a motor”
⚫Talk nonstop
⚫Blurt out an answer before a question has been completed, finish other people’s sentences, or speak without waiting for a turn in conversation
⚫Have trouble waiting his or her turn
⚫Interrupt or intrude on others, for example in conversations, games, or activities.
COMORBIDITIES
Oppositional Defiant Disorder (ODD), Conduct Disorder (CD), Obsessive – Compulsive Disorder (OCD), Specific Learning Disabilities, Autistic Spectrum Disorder, Sensory Integration Disorder, Anxiety, Depression,Bipolar Disorder, Substance Abuse.
DIAGNOSIS OF ADHD
To confirm a diagnosis of ADHD, the child must exibit at least six symptoms in more than one setting, for at least six months. ADHD symptoms can appear as early as between the ages of 3 and 6 and can continue through adolescence and adulthood. To assess a child’s neurological and psychological status, the tests include:
⚫A medical and social history of both the child and the family.
⚫A physical exam and neurological assessment that includes screenings of vision , hearing, and verbal and motor skills.
⚫An evaluation of intelligence, aptitude, personality traits, or processing skills.
⚫A scan, called the Neuropsychiatric EEG – Based Assessment Aid (NEBA) System, that measures theta and beta brain waves. The theta/beta ratio has been shown to be higher in children and adolescents with ADHD than in children without it.
TREATMENT AND THERAPIES
Treatments include medication, psychotherapy, education or training, or a combination of treatments.
MEDICATION :
1.Stimulants : The most common type of medication used for treating ADHD is called a “stimulant.” It works because it increases the brain chemicals dopamine and norepinephrine, which play essential roles in thinking and attention. Under medical supervision, stimulant medications are considered safe. However, there are risks and side effects, especially when misused or taken in excess of the prescribed dose. For example, stimulants can raise blood pressure and heart rate and increase anxiety. Common stimulants in use include Methylphenidate, Dexmethylphenidate, Amphetamine, Dextroamphetamine, Lisdexamfetamine.
2 .Non-stimulants : A few other ADHD medications are non-stimulants. These medications take longer to start working than stimulants, but can also improve focus, attention, and impulsivity in a person with ADHD. These are prescribed when a person has bothersome side effects from stimulants; when a stimulant was not effective; or in combination with a stimulant to increase effectiveness. It includes atomoxetine, guanfacine, antidepressants, certain blood pressure medications. Antidepressants can be helpful in combination with stimulants if a patient also has another condition, such as an anxiety disorder, depression, or another mood disorder.
PSYCHOTHERAPY
Adding psychotherapy to treat ADHD can help patients and their families to better cope with everyday problems.
1 . Behaviour Therapy : It provides support for carers of children with ADHD, and may involve teachers as well as parents. Behaviour therapy usually involves behaviour management, which uses a system of rewards to encourage the child to try to control their ADHD.
2 .Cognitive Behavioral Therapy : It can teach a person mindfulness techniques, or meditation. A person learns how to be aware and accepting of one’s own thoughts and feelings to improve focus and concentration.
3 .Family And Marital Therapy : It can help family members and spouses find better ways to handle disruptive behaviors, to encourage behavior changes, and improve interactions with the patient.
EDUCATION AND TRAINING
Children and adults with ADHD need guidance and understanding from their parents, families, and teachers to reach their full potential and to succeed.
1. Parenting skills training (behavioral parent management training) teaches parents the skills they need to encourage and reward positive behaviors in their children. It helps parents learn how to use a system of rewards and consequences to change a child’s behavior.
2. Stress management techniques can benefit parents of children with ADHD by increasing their ability to deal with frustration so that they can respond calmly to their child’s behavior.
3. Support groups can help parents and families connect with others who have similar problems and concerns. Groups often meet regularly to share frustrations and successes, to exchange information about recommended specialists and strategies, and to talk with experts.
TIPS TO HELP KIDS WITH ADHD STAY ORGANIZED
Parents and teachers can help kids with ADHD stay organized and follow directions with tools such as:
⚫Keeping a routine and a schedule.
⚫Keep the same routine every day, from wake-up time to bedtime.
⚫Include times for homework, outdoor play, and indoor activities.
⚫Keep the schedule on the refrigerator or on a bulletin board in the kitchen.
⚫Write changes on the schedule as far in advance as possible.
⚫Organizing everyday items.
⚫Have a place for everything, and keep everything in its place. This includes clothing, backpacks, and toys.
⚫Using homework and notebook organizers.
⚫Use organizers for school material and supplies.
⚫Stress to your child the importance of writing down assignments and bringing home the necessary books.
⚫Being clear and consistent.
⚫Children with ADHD need consistent rules they can understand and follow.
⚫Giving praise or rewards when rules are followed.
⚫Children with ADHD often receive and expect criticism. Look for good behavior, and praise it.
(The author is presently working at Acharya Shri Chander College of Medical Sciences and Hospital(ASSCOM), Jammu /Social Activist /Educator at Unacademy, India’s largest online education platform. He is the author of a course titled “Attention – Deficit Hyperactivity Disorder (ADHD)” that is published online on Unacademy, India’s largest online education platform. Author’s views are personal)