ADHD

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What is ADHD?
Attention-deficit/hyperactivity disorder (ADHD) is a chronic disorder that is considered to be neuro-psychiatric disorder or a disorder of nervous system. In simple terms the child’s functioning is not matching with that of his/her peers.

How common is it?
ADHD is the most commonly diagnosed behavioural disorder of childhood. It affects about 3 – 5% of school aged children. In India there is very little research in ADHD in children. The few studies that are available report prevalence rates ranging from 10 to 20%.

ADHD may run in families and is noticed more often in boys than in girls.

 

 

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The subtypes

 ADHD is divided into three groups:
1- Lack of attention (inattentiveness)
2- Hyperactivity
3- Impulsive behaviour (impulsivity)    

 

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Inattentive Symptoms-

  1. Fails to give close attention to details or makes careless mistakes in schoolwork.
  2. Has difficulty keeping attention during tasks or play
  3. Does not seem to listen when spoken to directly
  4. Does not follow through on instructions and fails to finish school work, chores, or duties in the workplace
  5. Has difficulty organizing tasks and activities
  6. Avoids or dislikes tasks that require sustained mental effort (such as schoolwork)
  7. Often loses toys, assignments, pencils, books, or tools needed for tasks or activities
  8. Is easily distracted
  9. Is often forgetful in daily activities

Hyperactivity Symptoms-

  1. Fidgets with hands or feet or squirms in seat
  2. Leaves seat when remaining seated is expected
  3. Runs about or climbs in inappropriate situations
  4. Has difficulty playing quietly
  5. Is often “on the go,” acts as if “driven by a motor,” talks excessively

 

    Impulsivity Symptoms-

  1. Blurts out answers before questions have been completed
  2. Has difficulty awaiting turn
  3. Interrupts or intrudes on others (butts into conversations or games)

Criteria for Diagnosis-

Nowadays because of increased awareness among parents and teachers about the symptoms of ADHD, children may either be incorrectly labelled with ADHD (over diagnosis) or may remain undiagnosed because of the social pressure. The need of the hour is to recognise this behavioural problem early to help the child’s mental growth in the right direction.

According to The American Academy of Paediatrics (AAP) the diagnosis should be based on very specific symptoms, which must be present in more than one setting.

To simplify this, few important points are

  • Age – few symptoms and behavioural changes should be present before age 7.
  • Duration- symptoms must be present for at least for 6 months without any specific cause
  • Severity- symptoms should be serious enough to cause difficulties in daily activities like at school , home etc

In older children, ADHD is in partial remission when they still have symptoms but no longer meet the full definition of the disorder.

Method of Evaluation-

Parents and teacher should keep a watch on the changing behaviour. Once ADHD is suspected the child should have a complete evaluation by a doctor. Evaluation may include:

  • Parent and teacher questionnaires
  • Psychological evaluation of the child and family, including I Q test and psychological testing
  • Complete developmental, mental, nutritional, physical, and psychosocial examination

Intervention-

  • Medical
  • Counselling

Role of parents and teachers-
Children with ADHD need guidance and understanding from their family and teachers. When the child is diagnosed as ADHD, frustration and bad feelings may build up within a family. Along with medical treatment psychotherapy plays a major role .Psychotherapists/ Counsellors provide individual and family counselling and also educate them about methods of handling an ADHD child.

Parenting Tips–
Parents play a major role in the development of such a child. As they can help their child overcome daily challenges and also channel their energy towards positive areas.

Educate your self- read about ADHD, needs of the child, behavioural risks.

Help the child get organized- follow same routine every day, keep all things in place

Enforce discipline regularly- daily home work.

Teach manners- like method of eating, importance of hand wash

Develop social responsibility- teach them to make friends, to help others

Offer incentives- child with ADHD receive criticism, praising or giving incentives gives a moral boost to them.

Share a relaxing technique- listen to music, yoga etc

Help the child to eat right- eating small and frequent meals, avoid unhealthy foods

Have a good sense of humour

Empathize with your child

Stay healthy and take time for yourself

Continuous supervision may be required

Prevention

Although there is no proven way to prevent ADHD, but a holistic approach (early identification and treatment ) can prevent many problems associated with ADHD.

ADHD is Overdiagnosed

Source: Hindustan Times New Delhi Edition April 02, 2013

ADHD has historically been estimated to affect 3 to 7 % of children. The disorder has no definitive test and is determined only by speaking extensively with patients, parents and teachers, and ruling out other possible causes — a subjective process that is often skipped under time constraints and pressure from parents. It is considered a chronic condition that is often carried into adulthood.

The CDC director, Dr. Thomas R Frieden, likened the rising rates of stimulant prescriptions among children to the overuse of pain medications and antibiotics in adults.

“We need to ensure balance,” Dr. Frieden said. “The right medications for A.D.H.D., given to the right people, can make a huge difference. Unfortunately, misuse appears to be growing at an alarming rate.”

Experts cited several factors in the rising rates. Some doctors are hastily viewing any complaints of inattention as full-blown A.D.H.D., they said, while pharmaceutical advertising emphasizes how medication can substantially improve a child’s life. Moreover, they said, some parents are pressuring doctors to help with their children’s troublesome behavior and slipping grades.

“There’s a tremendous push where if the kid’s behavior is thought to be quote-unquote abnormal — if they’re not sitting quietly at their desk — that’s pathological, instead of just childhood,” said Dr. Jerome Groopman, a professor of medicine at Harvard Medical School and the author of “How Doctors Think.”

 

Fifteen % of school-age boys have received an A.D.H.D. diagnosis, the data showed; the rate for girls was 7 %.

Diagnoses among those of high-school age — 14 to 17 — were particularly high, 10 % for girls and 19 % for boys. About one in 10 high-school boys currently takes A.D.H.D. medication, the data showed.

Rates by state are less precise but vary widely. Southern states, like Arkansas, Kentucky, Louisiana, South Carolina and Tennessee, showed about 23 % of school-age boys receiving an A.D.H.D. diagnosis. The rates in Colorado and Nevada were less than 10 %.

The medications — primarily Adderall, Ritalin, Concerta and Vyvanse — often afford those with severe A.D.H.D. the concentration and impulse control to lead relatively normal lives. Because the pills can vastly improve focus and drive among those with perhaps only traces of the disorder, an A.D.H.D. diagnosis has become a popular shortcut to better grades, some experts said, with many students unaware of or disregarding the medication’s health risks.

“There’s no way that one in five high-school boys has A.D.H.D.,” said James Swanson, a professor of psychiatry at Florida International University and one of the primary A.D.H.D. researchers in the last 20 years.

“If we start treating children who do not have the disorder with stimulants, a certain %age are going to have problems that are predictable — some of them are going to end up with abuse and dependence. And with all those pills around, how much of that actually goes to friends? Some studies have said it’s about 30 %.”

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An A.D.H.D. diagnosis often results in a family’s paying for a child’s repeated visits to doctors for assessments or prescription renewals. Taxpayers assume this cost for children covered by Medicaid, who, according to the C.D.C. data, have among the highest rates of A.D.H.D. diagnoses: 14 % for school-age children, about one-third higher than the rest of the population.

References-

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002518/
http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder/complete-index.shtml
http://www.indianpediatrics.net/nov2000/nov-1256-1260.htm
http://add.about.com/od/childrenandteens/a/ADD-Family-Tips.htm
http://www.helpguide.org/mental/adhd_add_parenting_strategies.htm

For Further reading:

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002518/
http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder/complete-index.shtml
http://www.helpguide.org/mental/adhd_add_parenting_strategies.htm

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