HYPERACTIVITY

ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD)

Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common childhood disorders and can continue through adolescence and adulthood. Symptoms include difficulty staying focused and paying attention, difficulty controlling behavior and hyperactivity.

Characteristics of ADHD

• Inattention
• Impulsivity
• Hyperactivity

Age of onset

ADHD symptoms are evident prior to age 12 years (according to DSM – V).

Causes of ADHD

A combination of factors is thought to be responsible :-

• Genetics - ADHD tends to run in families and, in most cases, it is thought that the genes you inherit from your parents are a significant factor in developing the condition.Research shows that both parents and siblings of a child with ADHD are four to five times more likely to have ADHD themselves. However, ADHD has also been diagnosed in individuals who have no family history of the condition. A person’s environment and a combination of other factors can also influence whether or not you develop this disorder.
• Brain function and structure - Research has identified a number of possible differences in the brains of people with ADHD compared to those who don't have the condition, although the exact significance of these is not clear.For example, studies involving brain imaging scans have suggested that certain areas of the brain may be smaller in people with ADHD, whereas other areas may be larger.Research has also shown that the brain may take an average of two to three years longer to mature in children with ADHD, compared to children who don't have the condition.Other studies have suggested that people with ADHD may have an imbalance in the level of chemicals in the brain called neurotransmitters, or that these chemicals may not work properly.
• Neurotoxins Linked to ADHD - Researchers have also found a connection between ADHD and certain common neurotoxic chemicals, namely lead and certain pesticides. Lead exposure in children under age six can hamper brain development, leading to learning disorders including ADHD. Exposure to organophosphate pesticides has also been linked to ADHD.
• Nutrition and ADHD Symptoms - According to the Mayo Clinic, some studies suggest that certain food dyes and preservatives may cause hyperactivity in some children. Foods with artificial coloring include most processed and packaged snack foods.
• Smoking and Alcohol Use During Pregnancy - According to the CDC, prenatal exposure to smoking is associated with the behaviors of children with ADHD. A study suggests that children who were exposed to alcohol and drugs while in the womb were more likely to have ADHD.
• Other possible causes
  • being born prematurely (before the 37th week of pregnancy)
  • having a low birthweight
  • brain damage either in the womb or in the first few years of life
  • drinking alcohol, smoking or misusing drugs while pregnant
  • exposure to high levels of toxic lead at a young age

Treatment

• Pharmacological Treatment - Medicines are used to treat both moderate and severe ADHD. They may be helpful for children, teens, and adults who have a hard time at school, work, or home.
  • Stimulant medications include:
    • Amphetamine sulfate
    • Dextroamphetamine
    • Dexmethylphenidate
    • Lisdexamfetamine
    • Methylphenidate
  • Non-stimulant medications include :
    • Atomoxetine
    • Clonidine hydrochloride
• Behavior Modification - Behavioral treatments have been used for more than three decades to treat children who exhibit disruptive or aggressive behavior (O’Leary & Becker, 1967). Behavioral treatments have been successfully applied to children with ADHD to facilitate in the management of disruptive behavior, inattention, social skills building, academic performance, etc.

Behaviour Modification focuses on reducing hyperactivity, impulsivity and inattentiveness

• Using behaviour charts
• Using drawing and colouring activities
• Use of positive reinforcement
• Motivation related to involvement in co-curricular and group activities
• Show videos related to good manners
• Practicing attention enhancement exercises
• Encouraging the child to perform responsible activities in the school and home
• Role plays
• Parental sessions and feedback

Dr. William Pelham, an expert in behavioral treatments for children with ADHD, describes five categories of behavioral treatment:

• cognitive-behavioral interventions
• clinical behavior therapy
• direct contingency management
• intensive, packaged behavioral treatments
• combined behavioral and pharmacological treatments
  • Cognitive-Behavioral Interventions (CBI) - The goal of this form of behavioral treatment is to teach self-control through verbal self-instructions, problem-solving strategies, cognitive modeling, self-monitoring, self-evaluation, self-reinforcement and other strategies.
  • Clinical Behavior Therapy (CBT) - The goal of this form of behavioral treatment is typically to train parents, teachers or other caregivers to implement contingency management programs with children. Parents generally attend parent training programs where they are given assigned readings and instruction in standard behavioral techniques. Therapists using CBT often work with teachers in a consultation model to teach behavioral strategies for application in the classroom.
  • Contingency Management (CM) - Contingency management is a behavioral treatment that involves a more intensive program of behavior modification. Typically this type of program is implemented in a specialized treatment facility or specialized classroom. The techniques used in such programs include token economies set up to encourage specific behavior through the use of rewards and consequences earned by the child, time out, etc.
  • Intensive Behavioral Treatments - The focus of intensive behavioral treatments is to combine clinical behavior therapy and contingency management into an intensive program to improve self-control and socialization.
  • Combined Pharmacological and Behavioral Interventions - This form of treatment focuses on the combined use of medication and behavioral treatment. This combination has been shown to be quite effective in treating children with ADHD and has several advantages over medication alone or behavioral treatment alone. With the addition of medication, the behavioral component of treatment may be able to be scaled down, thereby reducing the amount of time parents and teachers need to spend on shaping behavior.

• Remedial Education :This plays a vital role. Improving age appropriate reading and writing.
  • Focus on audio visual learning
  • Begin with short spellings two letter words, three letter words and then increase the level of difficulty
  • Give worksheets pattern drawing, fun activities
  • Games related to vocabulary
  • Provide tokens if the child takes efforts such as stars etc.
  • Appreciate the efforts, give positive suggestions
  • Give short assignments
  • Give her intervals while working
  • Provide a model of correct reading
  • Parental sessions and feedback

Risk factors

• Blood relatives (such as a parent or sibling) with ADHD or another mental health disorder
• Exposure to environmental toxins — such as lead, found mainly in paint and pipes in older buildings
• Maternal drug use, alcohol use or smoking during pregnancy
• Maternal exposure to environmental poisons — such as polychlorinated biphenyls (PCBs) — during pregnancy
• Premature birth

We at Mumbai Psychiatry Clinics have a dedicated team of counsellors and clinical psychologists who will help you with your problems, cite interventions and assess the progress on regular intervals. There are experienced psychiatrists who will be guiding you throughout your journey and our Multidisciplinary team will try to assure you with the best help possible.

Reference

• http://www.mayoclinic.org/diseases-conditions/adhd/basics/risk-factors/con-20023647
• http://www.healthline.com/health/adhd/causes#Overview1
• http://www.webmd.com/add-adhd/adhd-medical-treatment

American Academy of Pediatrics. (2001). Clinical practice guidelines: Treatment of the school-aged child with attention-deficit/hyperactivity disorder. J. of the Amer. Acad. of Pediatrics, 108 (4), 1033-1044.

Davila, R. R., Williams, M. L., & MacDonald, J. T. (1991), September 16). Clarification of policy to address the needs of children with attention deficit disorders within general and/or special education. Washington, DC: U.S. Department of Education, Office of Special Education and Rehabilitation.

Ingersoll, B., & Goldstein, S. (1993). Attention Deficit Disorder and Learning Disabilities: Realities, Myths, and Controversial Treatments. New York: Doubleday Publishing Group.