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Attention deficit hyperactivity disorder

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VOL: 102, ISSUE: 16, PAGE NO: 19

What is it?

 

What is it?
- Attention deficit hyperactivity disorder (ADHD) usually presents in children in the preschool and early school years.

 

 

- Children with ADHD find it difficult to control their behaviour, have problems paying attention and are easily distracted. They may also be overactive and restless.

 

 

- It has an incidence of 5%, although not all these cases require treatment (NICE, 2006).

 

 

- ADHD can affect performance at school as well as impair the development of social skills.

 

 

- There are three main types:

 

 

- Predominantly hyperactive and impulsive;

 

 

- Predominantly inattentive (commonly known as attention deficit disorder);

 

 

- A combination of the two. Most cases come under this category.

 

 

Causes
- Precise causes are not known. There is thought to be a genetic component as it runs in families and is more common in males.

 

 

- Research suggests that the frontal lobes may be altered, affecting impulse control and concentration. There may also be a lack of dopamine in this part of the brain.

 

 

- Environmental factors such as watching too much television or poor parenting are not thought to be a trigger. Parental stress is thought to be a result of having a child with ADHD rather than being the cause of the ADHD.

 

 

Symptoms
- Symptoms vary depending on ADHD type. They can include:

 

 

- Continuous restlessness;

 

 

- Irritability;

 

 

- Aggression;

 

 

- Emotional immaturity;

 

 

- Disregard for danger;

 

 

- Lack of discipline;

 

 

- Clumsiness;

 

 

- Speech development problems.

 

 

- Antisocial behaviour becomes more common as the child becomes older.

 

 

- Beginning school can often expose ADHD. Learning can be hampered by attention and concentration deficits, although it is not linked to intelligence.

 

 

- Social skills can start to be a problem when the child begins to mix with other children and is exposed to authority figures.

 

 

- If ADHD is untreated, symptoms will persist into adolescence and even adulthood. This can result in social problems such as difficulties in sustaining employment and forming relationships.

 

 

Diagnosis
- There is no definitive diagnosis. A specific list of criteria must be met:

 

 

- Symptoms need to occur in more than one environment, for example, at home and at school;

 

 

- The child must have six or more symptoms of inattention or six or more symptoms of hyperactivity/impulsivity;

 

 

- Symptoms must have begun before the child was seven;

 

 

- Symptoms must have persisted for at least six months.

 

 

Treatment
- Medication is combined with behavioural therapies.

 

 

- NICE has issued new guidance on the use of medicines in ADHD recommending methylphenidate, atomoxetine and dexamfetamine for the treatment of children and adolescents (NICE, 2006).

 

 

- Behavioural therapies include:

 

 

- Cognitive behavioural therapy;

 

 

- Counselling;

 

 

- Social skills training;

 

 

- Parenting skills training.

 

 

- Research into the role of diet is ongoing.

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