ADHD is one of the commonest psychiatric disorders of childhood. Although most of the children are described as overactive by parents and teachers, severe and persistent behavioral changes which are functionally impairing and persistent can be defined as diseased.
Signs and Symptoms
- Inattention
- Hyperactivity
- Impulsiveness
Inattention can be defined as the prominent inability to sustain attention in tasks that do not provide a high level of stimulation or rewards and easy distractibility which also causes issues in organizational skills. Hyperactivity refers to excessive motor activity, being unable to remain still which is mostly visible in situations that require behavioral self-control. Impulsivity is acting in response to immediate stimulations without considering the risks and consequences that can occur later.
Diagnostic Criteria
According to ICD-11, attention deficit hyperactivity disorder can be diagnosed by, inattention and/or hyperactivity-impulsivity persistent for at least 6 months, with onset during the developmental period of early to mid-childhood. The severity of the above symptoms is exceeding the variation expected for age and level of intellectual functioning. These behavioral abnormalities must significantly interfere with the academic, occupational, or social functioning of the child.
Etiology
Genetic predisposition is observed in 80% of cases.
- Low birth-weight
- Use of drugs, alcohol, or tobacco during pregnancy
- Following head injury
- In some genetic and metabolic disorders
Clinical Presentations
- Inattention – Acts careless with important detail, appears as not listening and not paying attention, fails to finish tasks due to easy distractibility, forgetful and losses belongings and normally doesn’t like to engage in activities that require sustained attention.
- Hyperactivity- Plays with hands or feet, can’t stay sitting in the seat and tries to leave the seat, always on the go and can’t remain quiet
- Impulsiveness- Excessive speech, immediately answers without thinking when something is asked and interrupts others
Problems Related to ADHD
- Lack of sleep and dysfunctional sleep wake cycle
- Problems with relationships with peers and family members
- Low academic performance and reduced self esteem
- High susceptibility to get in to accidents due to hyperactivity
- Antisocial personality disorders can develop in long run
Management
Non- Pharmacological Management
- Parents of these children can be exhausted and psychosocial support can be essential for them.
- Educational interventions to support teachers regarding dealing with ADHD children is also important.
- Psychosocial interventions as parent training, social skills training, cognitive training, and specific classroom interventions can be used, with better effects when used combined with medications.
- Cognitive behavioral training for children with ADHD can benefit for children with comorbid anxiety or depressive disorders. Behavioral interventions can include encouraging realistic expectations, positive reinforcement of desired behaviors as small immediate rewards, consistent contingency management across home and school, break down tasks and reduce distractions.
- Free fatty acid supplementation and restriction of artificial food colorants can also help.
Pharmacological Management
Currently available drugs are used for the symptomatic management of patients.
- Methylphenidate which is central nervous system stimulant is licensed to treat children over 6yrs
- Atomoxetine which is a non -stimulant NE reuptake inhibitor and Dexamphetamine which is a CNS stimulant is also used for pharmacological management of ADHD
References
- ICD -11 , Classification of Mental and Behavioral Disorders- Diagnostic Criteria for Research
- Shorter Oxford Textbook of Psychiatry – 7th Edition – Paul Harrison, Philip Cowen, Tom Burns, Mina Fazel
- Oxford handbook of psychiatry- David Semple, Roger Smyth – 3rd Edition
