Attention-Deficit/Hyperactivity Disorder (Hyperkinetic Disorders)
ADHD or ADD is
characterized by a majority of the following symptoms being present
in either category (inattention or hyperactivity). These symptoms
need to manifest themselves in a manner and degree which is inconsistent
with the child's current developmental level. That is, the child's
behavior is significantly more inattentive or hyperactive than that
of his or her peers of a similar age:
Persisting for at least 6 months to a degree that is maladaptive and
immature, the patient has either inattention or hyperactivity-impulsivity
(or both) as shown by:
Inattention. At least 6 of the
following often apply:
Fails to pay
close attention to details or makes careless errors in schoolwork,
work or other activities.
Has trouble keeping attention on tasks or play.
Doesn't appear to listen when being told something.
Neither follows through on instructions nor completes chores, schoolwork,
or jobs (not due to oppositional behavior or failure to understand).
Has trouble organizing activities and tasks.
Dislikes or avoids tasks that involve sustained mental effort (homework,
schoolwork).
Loses materials needed for activities (assignments, books, pencils,
tools, toys).
Easily distracted by extraneous stimuli.
Forgetful.
Hyperactivity-Impulsivity.
At least 6 of the following often apply:
Squirms in
seat or fidgets.
Inappropriately leaves seat.
Inappropriately runs or climbs (in adolescents or adults, the may
be only a subjective feeling of restlessness).
Has trouble quietly playing or engaging in leisure activity.
Appears driven or "on the go".
Talks excessively.
Impulsivity
Answers questions
before they have been completely asked.
Has trouble or awaiting turn.
Interrupts or intrudes on others.
Begins before age 7.
Symptoms must be present in at least 2 types of situations, such as
school, work, home.
The disorder impairs school, social or occupational functioning.
The symptoms do not occur solely during a Pervasive
Developmental Disorder or any psychotic disorder including Schizophrenia.
The symptoms are not explained better by a Mood,
Anxiety, Dissociative
or Personality Disorder.
Associated
Features:
Learning Problem.
Hyperactivity.
Differential
Diagnosis:
Some disorders have similar symptoms. The clinician, therefore, in
his diagnostic attempt has to differentiate against the following
disorders which need to be ruled out to establish a precise diagnosis.
The clinician, therefore, in his diagnostic attempt has to differentiate
against the following disorders which need to be ruled out to establish
a precise diagnosis.
Age-appropriate
Behaviors in Active Children;
Mental Retardation;
Understimulating Environments;
Oppositional Behavior;
Another Mental Disorder;
Pervasive
Developmental Disorder;
Psychotic Disorder;
Other
Substance-Related Disorder Not Otherwise Specified.
Cause:
ADHD is not caused
by poor parenting or family problems. One early theory was that attention
disorders were caused by minor head injuries or damage to the brain,
and thus for many years ADHD was called "minimal brain damage"
or "minimal brain dysfunction." The vast majority of people
with ADHD however have no history of head injury or evidence of brain
damage however.
ADHD is likely to be caused by biological factors which influence
neurotransmitter activity in certain parts of the brain, and which
have a strong genetic basis. Studies have shown a link between a person's
ability to pay continued attention and the level of activity in the
brain. Specifically researchers measured the level of glucose used
by the areas of the brain that inhibit impulses and control attention.
In people with ADHD, the brain areas that control attention used less
glucose, indicating that they were less active. It appears from this
research that a lower level of activity in some parts of the brain
may cause inattention and other ADHD symptoms.
Treatment:
A wide variety
of treatments have been used for ADHD including, but not limited to,
various psychotropic medications, psychosocial treatment, dietary
management, herbal and homeopathic treatments, biofeedback, meditation,
and perceptual stimulation/training. Of these treatment strategies,
stimulant medications and psychosocial interventions have been the
major foci of research. Overall, these studies support the efficacy
of stimulants and psychosocial treatments for ADHD and the superiority
of stimulants relative to psychosocial treatments. However, there
are no long-term studies testing stimulants or psychosocial treatments
lasting several years.
Counseling
and Psychotherapy [ See
Therapy Section ]:
Psychosocial treatment
of ADHD has included a number of behavioral strategies such as contingency
management such as those utilising; point/token reward systems, timeout,
response cost. Clinical behavior therapy (parent, teacher, or both
are taught to use contingency management procedures), and cognitive-behavioral
treatment (e.g., self-monitoring, verbal self-instruction, problem-solving
strategies, self-reinforcement). Cognitive-behavioral treatment has
not been found to yield beneficial effects in children with ADHD.
In contrast, clinical behavior therapy, parent training, and contingency
management have produced beneficial effects.
Pharmacotherapy
[ See Psychopharmacology
Section ] :
Methylphenidate
(MPH).
Desipramine.
Dextroamphetamine.
Pemoline.
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Read the
following articles:
Non-Medical
Treatment of
Attention Deficit Hyperactivity Disorder (ADHD)
By Preeti Gupta, Clinical Psychologist
Click here to read
Attention-Deficit
Disorder
By Jef Gazley, M.S.
Click
here to read
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