What you didn’t know about attention deficit hyperactivity disorder (ADHD)

The study of hyperactivity in children has been a concern for doctors and educators since the mid-19th century. In 1845, the German physician Heinrich Hoffmann in poetic form described an extremely agile child and gave him the nickname "Fidget Philip."

The subject of close study by doctors of this disease was at the beginning of the XX century. In 1902, a lecture by the English physician George Frederick Still appeared in Lancet magazine, with which he had previously spoken before the doctors of the Royal Academy. The author associated hyperactivity with the biological basis, and not with poor parenting, as was considered at that time.

History of the term

In 1980, the DSM-I (Diagnostic and Statistical Manual for Mental Disorders) classification introduced the terms Attention Deficit Disorder (ADD) and its variant Attention Deficit Disorder (Hyperactivity Disorder) (ADD+H).

Manifestations of ADHD

The clinical manifestations of the disease are determined by three main symptom set: inattentiveness, hyperactivity and impulsivity.

- Inattention. Talking about ADHD, most often they mean severe distractibility and a decrease in the concentration of attention in such children. In children with ADHD, there is a lack of continuous attention, which is manifested in the impossibility of a long-term performance of an uninteresting task. At the same time, they can do hours for something interesting for them (for instance, computer games). In addition, there is a lack of selective attention, which is manifested in increased distractibility to extraneous stimuli, especially if these stimuli are bright and interesting. So, a car driving in the yard makes you look out the window and take your mind off homework for a long time. Often, switching attention is also reduced.

- Hyperactivity. Hyperactivity in children with ADHD is usually understood as increased motor (movement) activity. Children with ADHD cannot sit still during a class. When such a child enters the doctor’s office, there is concern about the condition of the office equipment in the office: computer, monitor, printer, etc. Unlike just energetic children, activity in children with ADHD is pointless. Unfortunately, hyperactivity sometimes leads to injuries in the child.

- Impulsiveness. By impulsivity is understood the impossibility of control over one’s impulses. Impulsive kids cannot wait their turn when playing. In the educational situation, such children have an “impulsive work style”: they shout out answers in the lesson, not answering them completely, interrupt other students or teachers. Due to impulsiveness, children often end up in dangerous situations without realizing the consequences. A risk thirst causes injuries and accidents.

Causes of Attention Deficit Disorder

It is believed that the bottom line for detecting ADHD is three to four years of age. Up to the age of three, children demonstrate an undifferentiated set of behaviors, which are called an undercontrolled pattern of conduct. However, at about the age of three this pattern becomes differentiated. It should be noted that, there also can be a so-called “crisis of three years”. The contents of this period are negativism, stubbornness and obstinacy.

At preschool age, the main manifestation of the disease is hyperactivity. Such children roam aimlessly around the kindergarten group, chatting incessantly, and interfere with the activities of other children. Increased activity during this period may be a variant of normal development, due to temperament or stringent requirements of adults. Violation can be detected by the severity and chronic nature of the problematic behavior.

The majority of complaints about ADHD happen in elementary school age. But since training programs are also present in preschool educational institutions, the main patterns of school-age behavior are already visible at the age of five.

ADHD is classified as multifactorial developmental disorder, and you should always bear in mind the possibility of several factors affecting each other. Among the causative factors of ADHD, genetic and perinatal (before birth) factors are primarily identified.

Great importance is given to the dopamine D4 receptor gene (DRD4) and the dopamine transporter gene (DAT1). These features determine the decrease in the functioning of the dopaminergic neurotransmitter system of the brain.

It is interesting to note that ADHD is more common in twins, siblings. The risk of developing ADHD in families with history of the disorder about 30%. ADHD is more common among premature babies. Of particular importance for the formation of ADHD among perinatal factors is smoking the mother during this pregnancy. In addition, it should be said about the role of anxiety disorders in the mother during pregnancy.

Studies show that in mothers with increased the likelihood of development of ADHD in children is higher. Mothers with anxiety have the tendency for improper parenting patterns such as overprotection or excessive criticality. They can also help children develop both anxiety disorders and ADHD. Parents of a child with ADHD who themselves suffer from this disease often have a parenting style characterized by intemperance and impaired interaction with the child.

Types of ADHD

Traditionally, it is considered that there are two types of ADHD:

- With predominant attention deficit;- Combined.

The second type is more common. Children with predominant attention deficit seem a bit slow, sleeping on the go. They perceive information more slowly than their peers and remember worse. Such children give the impression of drowsy, timid, shy, and lethargic.

Besides these two types, some studies suggest that there is also a complicated and uncomplicated forms of ADHD. The complicated form besides the mentioned symptoms also has such symptoms as tics, headaches, stuttering, phobic disorders.

How is ADHD treated?

In the United States and Europe, psychostimulants are most commonly used in the treatment of ADHD. The effect of psychostimulants is based on an elevation in the level of dopamine and norepinephrine.

Here you can find the comparison based on the main features of two most popular ADHD drugs – Ritalin (Methylphenidate) and Strattera (Atomoxetine).

Besides drugs, ADHD therapy should include psychotherapeutic methods. Parents should be also instructed on parenting suitable for kids with ADHD.

To change (modify) the behavior of children, methods of behavioral psychotherapy are used, based on the operant approach (operant conditioning). The main principle of such therapy is the reward of the child for the required behavior and punishment for incorrect behavior. However, the focus should be not on punishment but rather on reward and lack of reward. Rewards can be trips to cafes, computer games, watching TV shows, pocket money. An unconditional improvement factor is the creation of a positive model of attitude towards the child.