ADHD in Children

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Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder that affects both children and adults. In children, ADHD is characterized by a persistent pattern of inattention, hyperactivity, and impulsivity that interferes with their functioning and development. ADHD is typically diagnosed in childhood, with symptoms often becoming apparent before the age of 12. The exact cause of ADHD is still not entirely understood, but it is believed to involve a combination of genetic, environmental, and neurological factors.

Symptoms:

ADHD symptoms in children are generally grouped into three categories: inattention, hyperactivity, and impulsivity. These symptoms can manifest in various ways:

1. Inattention:
   • Difficulty sustaining attention and focus on tasks or activities
   • Frequently making careless mistakes
   • Difficulty organizing tasks and activities
   • Often losing items necessary for tasks (e.g., pencils, books, or toys)
   • Being easily distracted by unrelated stimuli
   • Forgetfulness in daily activities
   • Struggling to follow instructions or complete tasks
2. Hyperactivity:
   • Excessive fidgeting, squirming, or tapping
   • Frequently leaving their seat in situations where sitting is expected (e.g., in the classroom)
   • Running or climbing in inappropriate situations
   • Difficulty engaging in quiet leisure activities
   • Talking excessively or interrupting others
3. Impulsivity:
   • Difficulty waiting for their turn (e.g., in games or group activities)
   • Blurting out answers before questions are completed
   • Acting without considering the consequences
   • Interrupting or intruding on others' activities

Diagnosis:

Diagnosing ADHD in children involves a comprehensive evaluation by a healthcare professional, such as a pediatrician, psychologist, or psychiatrist. This evaluation typically includes:

• Gathering information from parents, teachers, and other caregivers about the child's behavior and symptoms
• Assessing the child's performance at school and their social interactions
• Conducting psychological tests to rule out other conditions or identify coexisting conditions (e.g., learning disabilities, anxiety, or depression)
• Ensuring that symptoms are not due to another medical condition or external factors

Treatment:

ADHD treatment often involves a combination of behavioral therapy, medication, and support from parents, teachers, and other caregivers. Some common treatment approaches include:

1. Behavioral therapy: This can help children with ADHD develop skills to manage their symptoms, such as organizational strategies, social skills, and coping mechanisms for handling frustration and impulsivity.
2. Medication: Stimulant medications (e.g., methylphenidate, amphetamine) are commonly prescribed to help manage ADHD symptoms by increasing the levels of certain neurotransmitters in the brain. Non-stimulant medications (e.g., atomoxetine, guanfacine) may also be prescribed in some cases.
3. Parent training: Parents can benefit from learning strategies to help manage their child's ADHD symptoms, such as setting clear expectations, providing consistent routines, and using positive reinforcement.
4. School support: Teachers and school staff can play a crucial role in supporting children with ADHD by providing accommodations, such as extra time on tests, preferential seating, or modified assignments, as well as implementing behavioral interventions.

ADHD treatment should be tailored to the individual needs of the child, and it often requires ongoing monitoring and adjustments. Early intervention can help children with ADHD manage their symptoms and improve their overall functioning and quality of life.

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Topic Highlights:-

• ADHD is a common developmental and behavioral disorder observed in children.
• ADHD has been associated with structural and functional brain differences, especially in the frontal lobe and the striatum.
• It is characterized by poor concentration, hyperactivity and impulsiveness that are considered inappropriate for a child's age.
• This visual presentation helps in understanding the disorder and caring for the ADHD child.

Transcript:-
Attention deficit hyperactivity disorder or ADHD is a childhood behavioral and developmental disorder that often persists into adolescence and adulthood. Millions of school age children, at least 1 out of every 20, suffer from this disorder. These children are also at increased risk for school difficulties, problems with friends, and conflicts at home. Over their lifetime, many of these children also suffer greater problems with substance abuse, other emotional difficulties, and problems at work and in relationships.

Nearly 5-10% of school age children suffer from ADHD. 70% will retain the disorder into adolescence. ADHD is four to eight times more commonly diagnosed in boys as compared to girls. Girls are apt to be less hyperactive and therefore less likely to be referred for treatment. In adults, the ratio of men to women is approx 1.6:1.

ADHD has been associated with structural and functional brain differences, especially in the frontal lobes, striatum and cerebellar regions. The brain’s frontal lobes help us evaluate choices before making a decision. The striatum converts impulsive thoughts into actions. The cerebellum is involved in the coordination of complex activities. These areas of the brain are linked by neurons or brain cells that form a circuit and communicate through neurochemical impulses. These impulses are carried from one neuron to another through chemicals called neurotransmitters that are released by neurons into the synapse or the space between two connecting neurons. Norepinephrine is linked with attentiveness, learning, memory and mood. Dopamine affects the way brain controls movements and activity. Dopamine is also associated with memory, attention and problem solving. Scientists believe that these neurotransmitters are involved in the pathophysiology of ADHD.

Heredity is the most common risk factor for ADHD. The heritability of ADHD is in the range of 80%, making the condition almost as inheritable as height. There is about a 35% chance that any child with ADHD will have at least one ADHD adult. Fetal exposure to toxic substances during pregnancy, for example a mother who smoked and consumed alcohol during pregnancy; or childhood exposure to lead have been associated with increased risk for developing ADHD. Premature babies born less than 32 weeks gestation or with a birth weight of less than 1400 grams also demonstrate increased risk for ADHD. ADHD is not due to a child’s having low intelligence or being lazy, nor is it due to external factors such as poor parenting, excessive television viewing or diet.

ADHD is characterized by inattention, hyperactivity and impulsivity that are particularly severe when compared with most individuals of the same age. Children with ADHD exhibit six or more symptoms of either inattention and/or hyperactivity/impulsivity as defined by the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM-IV. These symptoms generally cause difficulties in multiple settings such as home, school, or with friends. Hyperactive/impulsive symptoms are generally detected prior to the beginning of school. Inattentive symptoms are often not evident until age 8 or 9, or even later in some cases.

The inattentive type of ADHD is typified by children who have difficulty paying attention to small details and who often rush through their work and make careless mistakes in school. For example, they might lose points on tests because they fail to read directions properly or do not complete both sides of a handout. They also might have difficulty listening when spoken to directly and might not follow through on instructions, particularly with complicated tasks. They often have difficulty organizing tasks and activities and avoid work that requires long periods of mental effort. They might frequently lose toys, books and other belongings. They can be easily distracted by extraneous stimuli and often forget routine tasks. Parents often become frustrated when homework takes much more time to complete than expected.

Children with the hyperactive/impulsive subtype of ADHD often fidget and squirm in a way that is annoying to others. They are frequently restless, particularly when bored or unchallenged. This may manifest in the form of finger drumming or shaking legs. They are frequently unable to remain seated for long and may indulge in excessive running and climbing. They have difficulty in playing quietly and tend to talk excessively. These children may blurt out answers before questions are completed and have difficulty standing in line or waiting their turn. They are prone to interrupt and intrude on others even when they are busy, such as when parents are speaking with someone else on the telephone. On the playground, they might engage in risky or unsafe behaviors.

Children who exhibit both inattentive and hyperactive/impulsive symptoms are characterized as having the combined ADHD subtype. Manifestations of the disorder usually appear in varying degrees at home, in school, at work, and in social situations. Symptoms usually get worse in situations demanding sustained attention, such as classrooms.

Children with ADHD often display academic underachievement, regardless of their intelligence. Without treatment, these children are at increased risk for developing low self-esteem around school issues. These children are often rejected or receive negative attention for their behaviors, and consequently develop feelings of inadequacy and failure. Similarly, children with ADHD often have difficulties sustaining friendships and developing skills necessary for getting along well with others. This creates additional pitfalls in which ADHD children are more likely to become involved with delinquent behavior or conduct disordered activities, as well as problems with using tobacco, alcohol, and other forms of drug abuse.

ADHD is generally diagnosed by Child and Adolescent Psychiatrists, Child Neurologists, Pediatricians, and Clinical Psychologists. The child should show symptoms persistently over the previous six months and the behavior should be more severe than children of the same age. These behaviors should be exhibited in more than two settings such as at school, home, day care or in social interactions. The behavior should impair the child’s ability to make friends, to progress at school or to get along with parents or siblings.

Clinicians generally meet with parents and child to get an overview of the problem and assess developmental, medical, and social history. It is likely that parents and teachers will be asked to complete several behavioral rating scales to help the clinician assess the child’s behavior over multiple settings. Tests of intelligence and learning achievement might be performed if there are concerns about other potential learning issues. It is usually assumed that the child has had normal pediatric care, and that general medical conditions, such as vision or hearing problems, have been ruled out as the likely cause of symptoms.

Medication is the only treatment that has been shown to be effective in reducing the core symptoms of ADHD. In most cases, a clinician will recommend medication as part of a comprehensive approach to helping patients and their families address the disorder. Psychosocial treatments such as parent management training, behavioral charts, social skills training, and accommodations at school might also be helpful and will be discussed with the family after careful consideration of an individual patient’s needs. Parents of children with mild ADHD-related difficulties might chose to delay initiation of medication therapy. This is a reasonable option to discuss with the treating physician, but a trial of ADHD medication is usually warranted if the child is suffering from observable impairments.

Medications for ADHD are effective in controlling symptoms in the great majority of patients. The most commonly used types of medications for ADHD are classified as stimulants. These medications increase the levels of neurotransmitters in the brain. Some commonly used stimulants are methylphenidate, dextroamphetamine and mixed amphetamine salts. The common side effects of stimulants are decreased appetite, headache, stomachache, irritability and insomnia, although many of these “side-effects” occur in ADHD children whether or not they are receiving medication.

Antidepressant drugs like tricyclic antidepressants, venlafaxine and bupropion are sometimes prescribed for reducing hyperactivity and improving attention, since they also increase the levels of neurotransmitters in the brain. Side effects may include dry mouth, blurred vision or drowsiness.

In general, physicians will only try non-stimulant medications if a patient does not do well with stimulants. Currently atomoxetine is the only approved non-stimulant, but other non-stimulants will be approved soon. Atomoxetine is a selective norepinephrine reuptake inhibitor. It strengthens the neurochemical signal between the neurons that use norepinephrine to send messages. Common side effects are headache, abdominal pain, nausea, vomiting, weight loss, anxiety, sleepiness and insomnia.

The doctor may try different types of medications at a variety of doses to determine what is best for the child. Ongoing use of medication is often necessary to help the patient reduce the risk of long-term problems associated with ADHD.

Taking care of a child with ADHD can be demanding. Siblings may resent the impulsiveness and other behavioral problems of the child with ADHD and also the child receiving a greater share of the parent's time. It is important for the other members of the family to understand the child’s differences. Set a routine for the child that includes a regular mealtime, studies, watching TV, playing, bedtime and wake-up time. Each family should find the schedule that suits it best, but all children benefit from consistent expectations and routines.

Children with ADHD generally respond well to parenting practices that benefit all children. Help the child organize his or her school bag and keep a diary for daily activities. Make sure the child has a quiet place to study that is free from distractions like traffic noises or street sounds. Use simple, direct commands for giving directions. Avoid long explanations. Be calm even when the child is out of control and speak in a reassuring tone of voice. Do not yell. Instead, withdraw privileges as a consequence of unacceptable behavior, and more importantly, finds ways to reward behavior that you approve of.

Talk to the child’s teachers at school and obtain daily feedback. Inform the teachers about the child’s condition so that they can provide understanding and support. If medications are prescribed, make sure that they are given in the correct doses to the child at home. It is important to set realistic goals both for the child and the parents. Focus on the good aspects of the child’s personality and try to stimulate them through positive reinforcement.

Other interventions that might be useful at school include a seat assignment close to the teacher, extended time on tests, taking tests in a quiet work area, getting breaks during exams, and modified homework assignments. These interventions are easy to implement, but should be applied on an individual basis after discussion with a child’s school.