ABOUT ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD)

Transcription

1 ABOUT ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD) Many tddlers and yung children are restless and excitable. This is nrmal, as they have lts f energy and are cnstantly learning abut the wrld and mving frm ne experience t the next. Hwever, sme children are extremely veractive and d nt grw ut f this type f behaviur. It can be very difficult t keep them safe and calm. They may be diagnsed with attentin deficit hyperactivity disrder (ADHD) r attentin deficit disrder (ADD), if they d nt shw the symptms relating t hyperactivity. Children and yung peple with ADHD may experience the fllwing symptms: Issues arund attentin: Prblems with cncentratin, shrt attentin span, getting distracted, finding it hard t fllw instructins, lsing things r nt being rganised Issues arund hyperactivity: Struggling t sit still, finding it hard t keep sitting dwn, fidgeting and mving a lt, talking r making nises, fiddling with things. Issues arund impulsiveness: Interrupting ther peple, finding it hard t wait their turn, ding things r saying things withut thinking thrugh the cnsequences, having a reduced sense f danger. Children with ADHD find it really hard t cntrl their behaviur and have prblems cncentrating. They may d things withut cnsidering the cnsequences, and then get int truble They may have prblems at schl because they cannt cncentrate n their wrk, (whatever their level f intelligence) and they can have friendship prblems if they are nt able t listen t their peers r wait their turn. ADHD is diagnsed in arund ne t tw children ut f every 100. It is mre cmmn in bys than girls. It is thught t be caused by prblems in the part f the brain which cntrls impulses and cncentratin, but ther factrs may als have an impact.there is prbably als a genetic element, as ADHD can run in families.

2 Backgrund Infrmatin n ADHD Attentin deficit hyperactivity disrder is a cnditin, which affects thse parts f the brain which cntrl attentin, impulses and cncentratin (a neurbilgical cnditin). It is thught t affect 3 t 7% f schl age children There is sme evidence that bys are three times mre likely t suffer frm ADHD than girls. 4 Until recent years it was thught that children utgrew ADHD in adlescence. Hwever, it is nw knwn that in apprximately ne third t ne half f children with ADHD, the symptms cntinue int adulthd. 5 The best descriptin fr ADHD is that a child wh suffers frm this cnditin shws disruptive behaviurs, which cannt be explained by any ther psychiatric cnditin and are nt in keeping with thse f the same-aged peple with similar intelligence and develpment. These behaviurs are usually first nticed in early childhd, and they are mre extreme than simple misbehaving. Children with ADHD have difficulty fcussing their attentin t cmplete a specific task. Additinally they can be hyperactive and impulsive and can suffer frm md swings and scial clumsiness. Althugh peple with ADHD can be very successful in life, withut identificatin and prper treatment, ADHD may have serius cnsequences, which can include 4 : - Under- perfrmance at schl Depressin Prblems with relatinships Prblems finding and keeping a jb Criminal behaviur Early identificatin by a healthcare prfessinal is therefre very imprtant t ensure that the child can fulfil his/her full ptential. Children with ADHD tend t display the fllwing behaviurs: - Hyperactivity Impulsive behaviur Inattentin Scial clumsiness Pr crdinatin Disrganisatin Md swings Specific learning disabilities such as dyslexia, language prblems, difficulties with handwriting/written wrk In peple with ADHD, behaviural prblems are seen in several places i.e. nt just at schl. Sme children with ADHD have significant prblems with cncentratin and attentin but are nt necessarily veractive r impulsive. Symptms and Diagnsis Typically the symptms f ADHD develp in early childhd. Healthcare prfessinals use a list f symptms t fficially diagnse ADHD (knwn as the diagnstic criteria f the American Psychiatry Assciatin DSM-IV r the Wrld Health Organisatin ICD10). Althugh the diagnstic guidelines state that symptms

3 must start befre the age f 7, leading researchers in ADHD argue that the criteria shuld be bradened t include a child develping ADHD anytime during childhd. 2 Diagnsis can be quite challenging because: - There is n physical test fr ADHD (such as a bld test) All children may have sme prblems with self-cntrl Other prblems can result in behaviur similar t ADHD e.g. language r hearing difficulties, dyslexia r majr life disruptins ADHD exists in cnjunctin with many ther cnditins whse symptms can verlap and mask thse f ADHD e.g. Asperger s syndrme, language disrder, dyspraxia and bsessive cmpulsive disrder Children with ADHD are restless and cannt sit still r d any ne thing fr very lng. They are easily distracted and, because they find it s hard t pay attentin, they may ften be criticised fr being careless and making t many mistakes at schl. They appear nt t listen when smene is talking t them, they find it hard t wait their turn and they can be disruptive in play. Diagnstic Criteria fr ADHD The fficial list f symptms which healthcare prfessinals use t diagnse ADHD (diagnstic criteria DSM-IV1 r ICD-10)state that: - The child must display either inattentin r hyperactivity-impulsivity (r bth) and symptms must have been present fr at least 6 mnths. Inattentin. Usually at least 6 symptms are seen. Fails t pay clse attentin t details r makes careless errrs in schlwrk, wrk r ther activities Has truble keeping attentin n tasks r play Desn't appear t listen when being tld smething Neither fllws thrugh n instructins nr cmpletes chres, schlwrk, r jbs (nt due t failure t understand r a deliberate attempt t disbey) Has truble rganising activities and tasks Dislikes r avids tasks that invlve sustained mental effrt (hmewrk, schlwrk) Lses materials needed fr activities (assignments, bks, pencils, tls, tys) Easily distracted by irrelevant infrmatin Frgetful Hyperactivity-Impulsivity. Usually at least 6 symptms are seen. Hyperactivity Squirms in seat r fidgets Inapprpriately leaves seat

4 Inapprpriately runs r climbs (in adlescents r adults, there may be nly a subjective feeling f restlessness) Has truble quietly playing r engaging in leisure activity Appears driven r "n the g" Talks excessively Impulsivity Answers questins befre they have been cmpletely asked Has truble waiting his/her turn Interrupts thers Symptms begin befre age 7 Symptms must be present in at least 2 places, such as schl, wrk r hme The disrder negatively affects schl, scial r ccupatinal functining The symptms d nt ccur slely due t a psychtic disrder (such as schizphrenia) The symptms are nt better explained by an alternative disrder (such as a md, anxiety r persnality disrder) Prcess fr ADHD Diagnsis Only healthcare prfessinals can fficially diagnse ADHD. One (r mre) f the fllwing types f healthcare prfessinal culd be invlved in the prcess: - Child psychiatrist Child psychlgist Paediatrician Psychiatric scial wrker Educatinal psychlgist GP There are fur main steps which a child psychiatrist r paediatrician will use fr diagnsing ADHD and which yu can cnsider if yu think yur child may have ADHD The healthcare prfessinal will lk fr alarm signals: - The child wh significantly under-perfrms at schl, despite having a nrmal intellect and n majr specific learning disabilities The child wh has ADHD behaviur prblems which are cnsiderably wrse than wuld be expected They will exclude ADHD lk-alikes, such as: - The nrmal active pre-schl child Intellectual disability Hearing impairment Autism Epilepsy Depressin They may als use sme bjective pinters twards diagnsis: - Questinnaires by parents and teachers e.g. Cnners Teacher and Parent Rating Scales

5 Achenbach Child Behaviur Checklists Edelbrck Child Attentin Prblems Rating Scale Barley and DuPaul ADHD Rating Scale DSM-IV r ICD-10 criteria Tests which measure the length and type f mental prcess (psychmetric tests and prfiles) Tests f attentin and persistence e.g. The Paired Assciatin Learning Test Cntinuus Perfrmance Test Healthcare prfessinals have been trained t lk at a detailed histry f smene with suspected ADHD in rder that they may recgnise the smallest signs and symptms. It is therefre imprtant that they are cnsulted t ensure an accurate diagnsis. ADHD can be exhibited in mild, mderate and severe frms. The mild and mderate frms may be respnsive t psych-scial interventins (i.e. thse nt requiring medicatin) Treatment Mst experts agree that the mst effective way t treat ADHD is with a variety f different appraches. Depending n the needs f the individual child, a cmbinatin f medical, teaching and behaviural supprt can help the child t reach his/her full ptential and live as nrmal a life as pssible, having meaningful relatinships and reducing family stress. Sme treatment ptins are utlined belw: - 1. Psychiatry/psychlgy Psychiatrists and psychlgists have a majr rle in diagnsing ADHD, implementing behaviural prgrammes, prescribing medicatin (psychiatrists) and supprting parents 2. Behaviural Therapies Behaviural interventins can include: Family therapy fcusing n management strategies Individual therapy fcusing n changing behaviurs 3. Medicatins Parents, in cnsultatin with dctrs, shuld decide if they wuld like their child t try medicatin Where medicatins are prescribed t treat ADHD these are mainly psychstimulants. There are sme cncerns with these current treatments and yu must speak t yur healthcare prfessinal if yu have any wrries. Psychstimulants wrk by changing the levels f natural chemicals in the brain, which appear t be incrrectly balanced

6 in ADHD children. These treatments help the cntrlling and inhibiting part f the brain t wrk in a mre nrmal way and the child is able, t cncentrate better and behave in a calmer way. Tricyclic antidepressants are als used 4. Schl-based Interventins and Preventive Measures Schl-based interventin can include: Help with reading, spelling, maths and rganisatin Speech therapy Physical educatin therapy Cunselling 5. Scial Skills Training Many children with ADHD have difficulty scialising. Because they dn t recgnise the mre subtle rules f cmmunicatin, they frequently make mistakes and are teased by ther children. In scial skills training, children are taught in grups t think hw their wrds and behaviur affect thse arund them 6. Crdinatin Training Since many children with ADHD have crdinatin prblems, there are a few therapies that specifically help develp crdinatin (knwn as sensry-mtr integratin). Sme children receive this therapy in schls 7. Diet Sme parents see an imprvement in their child s behaviur when the fllwing fds are remved frm the child s diet: - Caffeine fund in chclate, cffee and sme fizzy drinks Sme crdials Artificial clurings 8. Parenting supprt Supprt fr parents is a vital cmpnent in the cmbinatin f therapies advised t tackle the disrder. It is particularly imprtant as services t diagnse and treat ADHD are seriusly underfunded and verladed

7 Althugh children with ADHD have unique prblems, many f the principles f parenting still apply. They particularly need cnsistent discipline and a structured lifestyle Parents can attend parenting classes, as well as jin assciatins and self-help grups t ensure their cncerns and pinins are heard Attentin Deficit Hyperactivity Disrder (ADHD) is a cmplex cnditin in which the child can have several f a grup f symptms. Due t the range f ptential symptms, and the fact that sme f these symptms can be present due t ther cnditins r prblems, the diagnsis f ADHD can be quite challenging. Hwever, early identificatin s that treatment (whether behaviural, psychlgical r medicatin) can be started is very imprtant, s that the child is able t achieve his/her full ptential. References 1 American Psychiatric Assciatin DSM IV diagnstic criteria 2 Barkley RA et al. ADHD: a handbk fr diagnsis and treatment. New Yrk Guilfrd Press Barkley RA 3 Wlraich ML et al. Cmparisn f diagnstic criteria fr ADHD in a cuntrywide sample. Jurnal f the America Academy f Child and Adlescent Psychiatry 1996;35: Green C and Chee K. Understanding ADHD A Parent s Guide t Attentin Deficit Hyperactivity Disrder in Children. Vermillin Publishing ISBN Murphy KR and Barkley RA. The prevalence f DSM-IV symptms in adult licensed drivers. Implicatins fr clinical diagnsis. Cmprehensive Psychiatry 1996;37: Essential Reading Green C and Chee K. Understanding ADHD A Parent s Guide t Attentin Deficit Hyperactivity Disrder in Children. Dr Geffrey Kewley, ADHD Recgnitin Reality and Reslutin