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ADHD

 

Attention-deficit/hyperactivity disorder (ADHD) is characterized by developmentally inappropriate levels of inattention, impulsivity, overactivity, or a combination of these, resulting in chronic functional impairment (American Psychiatric Association, 2000). Approximately 5% of the school-age children in the United States can be diagnosed with this disorder, with boy-to-girl ratios ranging between 2:1 and 6:1.

ADHD always begins in childhood and may be followed by a lifelong expression of symptoms. Evidence suggesting right frontal lobe dysfunction as the basis of ADHD. Frontal lobe functions are executive in nature and are involved in developing plans and organising resources. They are also critical in mediating inhibitory behaviours such as controlling motor behaviour and inhibiting attentional focus on distractor or irrelevant stimuli.

The etiology of ADHD is unknown, although evidence from family studies of ADHD suggests a genetic origin for some forms of this disorder. Studies of twins suggest a genetic link to ADHD. In 80-90 per cent of identical twins where one has ADHD so does the other. Recent research also suggests there is a greater chance of inheriting the condition from male relatives such as grandfathers.

ADHD often occurs alongside other difficulties and is not the sole cause of problem behaviour. Children may exhibit temper tantrums, sleep disorders, and be clumsy. Other behavioural problems that occur with ADHD include:

  • confrontational defiant behaviour, which occurs in 60 per cent of children. The child loses their temper, argues and refuses to comply with adults and deliberately annoys others.
  • conduct disorders occur in at least 25 per cent of children. The child may be destructive or show deceitful behaviour such as lying, breaking rules and stealing.
  • specific learning difficulties, including dyslexia, occur in 25-30 per cent of children.
  • severe clinical depression occurs in 33 per cent of children.
  • anxiety disorders occur in 30 per cent of children.


What are the symptoms of ADHD?



Attention difficulties


A child must have exhibited at least six of the following symptoms for at least six months to an extent that is unusual for their age and level of intelligence.

  • Fails to pay close attention to detail or makes careless errors during work or play.
  • Fails to finish tasks or sustain attention in play activities.
  • Seems not to listen to what is said to him or her.
  • Fails to follow through instructions or to finish homework or chores (not because of confrontational behaviour or failure to understand instructions).
  • Disorganised about tasks and activities.
  • Avoids tasks like homework that require sustained mental effort.
  • Loses things necessary for certain tasks or activities, such as pencils, books or toys.
  • Easily distracted.
  • Forgetful in the course of daily activities.


Hyperactivity


A child must have exhibited at least three of the following symptoms for at least six months to an extent that is unusual for their age and level of intelligence.

  • Runs around or excessively climbs over things. (In adolescents or adults only feelings of restlessness may occur.)
  • Unduly noisy in playing, or has difficulty in engaging in quiet leisure activities.
  • Leaves seat in classroom or in other situations where remaining seated is expected.
  • Fidgets with hands or feet or squirms on seat.


Impulsivity


At least one of the following symptoms must have persisted at least for six months to an extent that is unusual for their age and level of intelligence.

  • Blurts out answers before the questions have been completed.
  • Fails to wait in lines or await turns in games or group situations.
  • Interrupts or intrudes on others, e.g. butts into others conversations or games.
  • Talks excessively without appropriate response to social restraint.

Pervasiveness of attention difficulties and hyperactivity


For a diagnosis or description of ADHD a child would be expected to show the above difficulties in more than one setting, eg at school and at home.


Current ADD/ADHD treatment consist of the traditional approaches of symptom management using stimulant medication, behaviour modification and cognitive behaviour modification and more recent approaches focus on neuropsychological rehabilitation. (Barabasz & Barabasz , 2008).


How is ADHD diagnosed?


ADHD requires a medical diagnosis by a doctor, usually a child or adolescent psychiatrist, a paediatrician or paediatric neurologist or a GP.

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