ADHD

Share

Share Article ✕

• 
• 
• 
• 
• 
• 
• Copied

Medically Verified By: Dr. Bhushan Ambadkar

• All
• News

Attention deficit hyperactivity disorder (ADHD), a disorder that appears in early childhood, makes it difficult for individuals to restrain their spontaneous responses—responses that can involve everything from movement to speech to attentiveness.

The specific causes of ADHD are unclear. However, a number of factors such as genetics, diet and social and physical environments may contribute to or increase ADHD. Environmental factors include alcohol and tobacco smoke exposure during pregnancy and exposure to lead in very early life.

Complications during pregnancy and birth, including premature birth, infections during pregnancy, at birth, and in early childhood are linked to an increased risk of ADHD development.

Typically, signs and symptoms appear before the age of seven; there are basically three important symptoms: poor concentration, hyperactivity and impulsivity. Only if a child shows all three symptoms in different environments such as school and home, and are unable to control their behaviour are they considered for diagnosis. ADHD can affect adults too, and adults with ADHD have difficulty following directions, remembering information, concentrating, organizing tasks or completing work within time limits. If these difficulties are not appropriately dealt with, they can cause associated behavioural, emotional, social, vocational and academic problems.

Usually, treatment involves both medication and therapy. Behavioural therapy involves adjusting the environment to promote additional successful social interactions. Social skills training can help a child learn behaviours that will help them develop and maintain social relationships. Both education and support for the parents can be an integral part of treating ADHD in children.

Types

The following are the different types of this disease -  

• Combined type (Inattentive/Hyperactive/Impulsive)


• Hyperactive type


• Impulsive type


• Inattentive type

Symptoms

On the onset of symptoms, ADHD appear to be a very normal aspect of a child’s behaviour. Most of these behaviours disappear as the child grows. ‘A parent should be wary if the symptoms of attention deficit, hyperactivity and impulsiveness prolongs for at least six months at a stretch in every situation such as in the playground, home or the school. However, if you notice that these symptoms are seen only suppose in the school and your baby is calm and composed at home or during play, it might not be a case of ADHD,’ says Dr Deshpande. The symptoms can range from mild, moderate to severe, and children suffering from ADHD often:

• Are in constant motion.


• Squirm and fidget.


• Do not seem to listen.


• Have difficulty playing quietly.


• Often talk excessively.


• Interrupt or intrude others.
  


• Are easily distracted.


• Do not complete tasks.

• Major life events or traumatic experiences (e.g. a recent move, death of a loved one, bullying, and divorce).


• Medical disorders affecting brain function such as neurological conditions, epilepsy and sleep disorders.


• Psychological disorders, including anxiety, depression and bipolar disorder.


• Behavioural disorders such as conduct disorder and oppositional defiant disorder.


• Learning disabilities or problems with reading, writing, motor skills or language.

Causes And Risk Factors

Causes

Researchers are yet to determine the exact reason of what causes ADHD, although it is believed that it is an outcome of a combination of certain factors that leads to the existence of this disorder at the moment. There are many studies underway attempting to establish a cause and effect link for ADHD; some of the common causes that are supposed to give rise to this disorder are listed below:

• Genetics

• Environmental factors

• Premature birth


• Temperament: difficulty in controlling impulses, novelty seeking behaviors and harboring negative emotions


• Use of alcohol, tobacco and other drugs by the mother during pregnancy


• Complications during pregnancy or birth, including low birth weight, fetal distress and poor health of mother


• Family history of ADHD


• Psychological and social distress, including parental criminal activity, parental mental disorders, marital conflicts in the house, child abuse, poverty and neglect


• Exposure to toxic substances such as lead

Diagnosis

There is no specific test to diagnose ADHD; however, multiple assessments and other information gathering by the doctor can help one come to the conclusion and accurately diagnose the condition.

One helpful diagnostic technique is the use of Connors’ rating scale. This is a questionnaire filled by the parent and has 27 questions while another questionnaire has to be filled by a teacher that knows the child well and has 28 questions. Questions are based on a child’s behavioural characteristics. For each question, a score of 0–3has to be given with 0for never/not true at all and 3 for very often/very much true. The questionnaire should be filled and brought to the doctor for additional diagnosis.   

Conners’ Rating Scales

There are two versions of the CRS-R, one to be completed by a parent (CPRS-R), the other by a teacher (CTRS-R). The CPRS-R has 27 questions and the CTRS-R has 28 questions. Both are designed for use in children aged 3–17 years. Most of the questions are loosely based on behavioural characteristics that are described in the DSM-IV diagnostic guidelines for ADHD (American Psychiatric Association 1994). Each question asks for a score from 0to 3to be chosen, where 0=not true at all/never, 1=just a little true/occasionally, 2=pretty much true/often, and 3=very much true/ very often. The questions can be divided into four different groups. This allows four separate subtotals to be calculated, as well as an overall score (which is the sum of the subgroups). The different subtotals are: A: oppositional; B: cognitive problem/inattention; C: hyperactivity; and D: ADHD index. For the screening of ADHD, subtotals C and D, and the overall total score are seen as the most useful. Therefore, the minimum total score according to both scales could be ‘0’ and the maximum could be ‘81’ and ‘84’ for the CPRS-R and the CTRS-R respectively. 

During a counseling session, the questions addressed with the pediatrician while diagnosing the condition are listed below:

• How severe are the symptoms? The symptoms must have a negative impact on the child’s life.


• When did the symptoms start? How early the symptoms appeared?


• How long have the symptoms been bothering the child? Symptoms must have been going on for at least six months before ADHD can be diagnosed.


• When and where do the symptoms appear? The ADHD symptoms must be present in multiple settings such as at home and school. If the symptoms only appear in one environment, it is impossible that ADHD is to blame.

Treatment

Although it is imperative to seek treatment for ADHD, one should know that there are not any cures for it. ADHD is treated with the help of medications, multiple types of psychotherapy, education and training, or using a combination of treatments.

• Medications: Stimulants such as methylphenidate and amphetamines are the most common type of medication used for treating ADHD. Non-stimulant medication such as atomoxetine may be used. These drugs demonstrate results slower than stimulants, and symptoms improve over two months. The primary aim of prescribing medications is to maintain symptoms such as hyperactivity and impulsiveness under control. Medications can improve their ability to focus, work, and learn and may improve physical coordination.

• Behavioural treatments: Behavioural treatment for children with ADHD involves adjusting to the environment to promote additional successful social interactions. Such adjustments include creating additional structures, encouraging routines, and clearly stating expectations of the child with ADHD.

Lifestyle/management

While a child might have to live and deal with the condition, there is a lot parents can do to help streamline the child’s behaviour pattern

• Practice effective parenting: Inconsistent parenting is one common mistake that parents make with children suffering from ADHD. ‘Behaviour, as we see it, is a combination of nature vs nurture. Certain children are inherently overactive while others are not. Good parenting skills are required to deal with such children. However, it must be made clear that bad parenting cannot cause ADHD,’ says Dr Deshpande. Nevertheless, if a child with the condition is not carefully handled, the symptoms might worsen. Parents are required to set boundaries and limits for all children.


• Limit use of gadgets and electronic instruments: Early and excessive exposure to electronic media such as mobile phones, televisions and computers can be detrimental for your child. Multiple studies have demonstrated that these devices have a negative impact on a child’s communication and socialisation skills. Television and other electronic media provide passive stimulation, which stifles creativity. ‘The brain of a young child gets used to this passive stimulation from an electronic device and they find that normal life does not match up in the excitement stakes. This is when they start acting up to create a situation that is more exciting. Therefore, I inform all parents that TV should not be used as a substitute for a babysitter or a parent,’ says Dr Deshpande.


• Help your child be organized: To ensure your baby follows rules and is organized, maintain things at fixed places and encourage the habit of doing the same. You should ensure a fixed routine from waking up to getting back to bed constant to help your baby deal with everyday niggles. This has to include homework, outdoor play and indoor activities.


• Practice an activity together: Multiple therapists believe that parental involvement in a positive manner can help correct a lot of behaviours in children, including symptoms of ADHD. Practise an activity with your child that could help him cultivate the habit of focus and relive stress to some extent. This can help to effectively deal with the symptoms of ADHD.

Prognosis And Complications

Prognosis

ADHD can lead to problems in all facets of life, including emotional, social and educational aspects. Obtaining an early diagnosis and appropriate treatment helps in managing the condition and letting children lead a relatively successful and happy life. The symptoms in certain children may subside as they enter their adolescent age while in others the symptoms last for their entire life.

Complications

If ADHD is left untreated, it could cause certain serious problems in forming healthy, meaningful relations with friends and family; it could affect schoolwork. In teenagers with ADHD, the rates of car accidents are higher. Adults with untreated ADHD have problems with retaining jobs and have a higher divorce rate. Obtaining the correct treatment at the correct time can help children and adults to carry on with their lives without any major issues. 

References

1. Harvard Health Publishing. Attention-deficiency hyperactivity disorder [Internet][Updated on Nov, 2018]. Available at: https://www.health.harvard.edu/a_to_z/attention-deficit-hyperactivity-disorder-adhd-a-to-z. (https://www.health.harvard.edu/a_to_z/attention-deficit-hyperactivity-disorder-adhd-a-to-z)


2.  Deb S, et al. J Intellect Disabil Res. 2008 Nov;52(11):950-65.


3. Brown KA, et al. Transl Pediatr. 2018 Jan; 7(1): 36–47.


4. American Academy of Child & Adolescent Psychiatry. ADHD frequently asked questions [Internet]. Available at: https://www.aacap.org/AACAP/Families_and_Youth/Resource_Centers/ADHD_Resource_Center/FAQ.aspx. (https://www.aacap.org/AACAP/Families_and_Youth/Resource_Centers/ADHD_Resource_Center/FAQ.aspx)

All

News

Page 4 of 5

Previous 2345 Next