What is Attention Deficit Hyperactivity Disorder(ADHD) & Types and Management of ADHD?

 Attention Deficit Hyperactivity Disorder (ADHD)

 

ADHD  involves an inadequate attention span, impulsivity, and hyperactivity; marked by a lack of task performance and easy distractibility.

The normal attention span is said to be 3-5 minutes per year of age i.e. a 3-year-old child will have an attention span of 15 minutes. Attention span increases with age.

 

Etiology:

·       The cause of ADHD is multifactorial, no single cause is currently accepted.

·       Genetic factor

·       Perinatal adversity

·       Neurologic immaturity

·       Dopamine production disturbance

·       Toxins (lead, food, dye, salicylate)

·       Psychological factors

·       Inappropriate social & teacher expectations.

Diagnosis of ADHD:

DSM-Ⅳ Diagnostic criteria for ADHD :

A)  Either (1) or (2)

1.    Six (or more) of the following symptoms of inattention have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:

 

Inattention:

(a)  often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities.

(b)  Often has difficulty sustaining attention in tasks or play activities

(c)  Often does not seem to listen when spoken to directly

(d)  Often does not follow through on instructions and fails to finish schoolwork, or duties in the workplace (and due to oppositional behavior or failure to understand instructions)

(e)  Often has difficulty organizing tasks and activities.

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

(g)  Often loses things necessary for tasks or activities (e.g. toys, school assignments, pencils, books, or tools)

(h)  Is often easily distracted by extraneous stimuli

(i)    Is often forgetful in daily activities

 

2.    Six (or more) of the following symptoms of hyperactivity/ impulsivity have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:

 

Hyperactivity:

 

(a)  Often fidgets with hands or feet

(b)  Often leaves seat in classroom or in other situations in which remaining seated is expected

(c)  Often runs about or climbs excessively in situations in which it is inappropriate

(d)  Often has difficulty playing or engaging in leisure  activities quietly

(e)  Is often ‘on the go’ or often acts as if ‘driven by a motor

(f)   Often talks excessively.

 

Impulsivity:

(g)  Often blurts out answers before questions have been completed

(h)  Often has difficulty awaiting turn

(i)    Often interrupts or intrudes on others (e.g bursts into conversations or games)

 

B. some hyperactive-impulsive or inattentive symptoms that caused impairment were present before age 7 years.

 

Investigations:

No single test establishes the diagnosis of ADHD.

·       Blood lead testing may be done to exclude lead toxicity and thyroid studies to exclude thyrotoxicosis.

·       EEG and CT scans appear to have no role in diagnosis.

 

Treatment:

This is a chronic condition and needs special attention from parents, teachers,s and the doctor.

 

1.    Behavioral management:

Parent counseling helps them to understand the problem, accept the child’s condition and tell them that the hyperactive behavior is not intentional.

·       These children need to be provided with outdoor activities; playing with minimal instruction

·       Need adequate sleep and rest

·       Structured home schedule for daily activities like wakeup time, mealtime, bedtime, etc.

·       Aggressive behavior such as biting, hitting, and pushing should not be tolerated; all risks must be enforced with nonphysical punishment

·       Big gatherings should be avoided till the child learns to control himself.

·       Positive reinforcement should be employed.

 

2.    Special education:

Highly structured classrooms with a low student-teacher ratios.

 

3.    Medication:

-        Methylphenidate

-        Ritalin 10mg

-        Dextroamphetamine

-        Magnesium pemoline

-        Tricyclic antidepressants

-        Clonidine

-        Tricyclic antidepressants

 

4.    Dietary management:

Better to avoid salicylate food additives, and food having artificial colors.