Attention deficit hyperactivity disorder
According to the National Institute of Mental Health, it is estimated that about 3% to 5% children have ADHD (Attention Deficit Hyperactivity Disorder), or approximately 2 million children in the United States. Boys are about three times more likely to be diagnosed with it than girls, though it is not yet understood why. Children with ADHD act without thinking, and are hyperactive and have trouble focusing. They may understand what is expected of them, but have trouble following through because they cannot sit still and/or pay attention to details.
The difference between children with ADHD and those children who are excited and anxious, is that children with ADHD have symptoms that are present over a longer period of time and occur in different setting. They impair a child’s ability to function socially, academically, and at home.
ADHD was first described by Dr. Heinrich Hoffman in 1845. But it was not until 1902 that Sir George F. Still published a series of lectures to the Royal College of Physicians in England in which he described a group of impulsive children with significant behavior problems caused by a genetic dysfunction, and not by poor child rearing–children who today would easily be recognized as having ADHD.
The symptoms of ADHD include:
· Inattention, which is having a short attention span and being easily distracted.
· Impulsivity, which can cause a person to do dangerous or unwise things without thinking of the consequences.
· Hyperactivity, which is excessive and inappropriate activity.
Many normal children may display these symptoms, but at a low level. So it is important that a thorough examination and appropriate diagnosis be made on the child by a highly qualified professional.
It may also be hard to identify these symptoms in pre-school children. All these major symptoms can be perceived as normal behavior among these children. ADHD is distinguished from normal behavior by the severity and consistency of the symptoms.
ADHD is divided into three subtypes, each with its own pattern of behaviors:
The predominantly hyperactive-impulsive type:
· restless, often fidgeting with hands and feet or squirming while seated
· running, climbing or leaving a seat in situations where sitting and quiet behavior is expected
· blurting out answers before hearing the whole question
· having difficulty waiting in line or taking turns
The predominantly inattentive type:
· often becoming easily distracted by irrelevant sights and sounds
· often failing to pay attention to details and making careless mistakes
· rarely following instructions carefully and completely forgetting and losing things like toys, pencils, books and tools needed for the task
· often skipping from one uncompleted activity to another
The combined type displays both inattentive and hyperactive-impulsive type.
There is little evidence that ADHD is caused by child-rearing or from social factors. No single cause of ADHD has been identified, but researchers have been exploring a number of possible genetic and environmental links. Studies have shown that children with the disorder have close relatives who also have ADHD.
Recent research also links smoking during pregnancy to later ADHD in a child. Other risk factors may include premature delivery, very low birth weight, and injuries to the brain at birth.
ADHD cannot be cured, but it can be successfully managed. The goal is to help the child learn to control his or her behavior.
In most cases, ADHD is best treated with a combination of medication and behavior therapy. Any good treatment plan will require close follow-up and monitoring. It is also important for parents to actively participate in their child’s treatment plan. Parent education is considered an important part of ADHD management.
Several different types of medications may be used to treat ADHD:
· Stimulants are the best known treatments—they have been used for more than fifty years in the treatment of ADHD. Possible side effects include decreased appetite, stomachache, irritability, and insomnia. There is currently no evidence of any long-term side effects.
· Non-stimulants were approved for treating ADHD in 2003. These appear to have fewer side effects than stimulants.
· Antidepressants are sometimes a treatment option; however, in 2004, the FDA has issued a warning that these drugs may lead to a rare increased risk of suicide in teens and children.
Research has shown that medications used to help control impulsive behavior and attention difficulties are more effective when they are combined with behavioral therapy. Behavior patterns are changed by:
· Reorganizing your child’s home and school environment. This can be shown by helping your child create a routine like putting his things in the same place everyday. It would also help to remove distractions like the computer and television while he or she is doing the homework.
· Giving clear directions and commands. Instead of long-winded explanations and cajoling, it would be wise to use clear, brief directions to remind your child of his or her responsibilities.
· Setting up a system of consistent rewards for appropriate behaviors and negative consequences for inappropriate ones.
· Helping your child discover a talent. Kids need to experience success to feel good about their selves. Finding out his talents can boost social skills and self-esteem.
NEW STUDIES ON HOW ADHD IS DIAGNOSED
A genetic variation that boosts risk for ADHD paradoxically appears to predict who will outgrow the learning disability. Scientists found that brain development in ADHD-afflicted children with this variation was out of whack at age 8 but normalized by 16. ADHD symptoms with this group were also more likely to disappear with age. The study is the first to identify a genetically determined pattern of brain development linked to ADHD and indicates a real neurological basis for the disorder.
Scientists have already uncovered several genetic variations that raise risk for ADHD, which is likely caused by a complex combination of genetic and other factors. The biggest genetic culprit identified to date is a variation in the receptor for dopamine—one of the brain’s signaling molecules–which increases risk for the disorder by 20 to 30 percent.
Philip Shaw, a neuroscientist at the National Institute of Mental Health in Bethesda, MD, who led the study, said that this is the first step in individualizing treatment for ADHD based on genetic make-up.
Research scientists also have focused their studies on the different parts of the brain, including the frontal lobes of the cerebrum. The frontal lobes allow us to solve problems, plan ahead, understand the behavior of others, and restrain our impulses.
All these parts of the brain have been studied through the use of various methods for seeing into or imaging the brain. These methods include functional magnetic resonance imaging (MRI), positron emission tomography (PET), and single photon emission computed tomography (SPECT).
Scientists caution that it is too early to use their findings to diagnose the disorder or to influence treatment. But with more research it may be possible to do an MRI study before starting medication and then predict what type of treatment might be best for the individual based on their brain image.
National Institute of Mental Health. Attention Deficit Hyperactivity Disorder-Complete Publication. <http//www.nimh.nih.gov/publicat/adhd.cfm> Accessed 14 February 2008.
Singer, Emily. “A Neurological Basis for ADHD”. 9 August 2007. <http//www.technology review.com./Biotech/19197> Accessed 14 February 2007.
Tynan, W Douglas. “What is Attention Deficit Hyperactivity Disorder?”. March 2005. <http//www.kidshealth.org/parents/emotions/behavior/adhd.html> Accessed 14 February 2008.