ADHD IN CHILDREN

1.What is ADHD?

The full form is “Attention Deficit Hyperactivity Disorder”. ADHD is one of the most common neurobehavioral disorder affecting children that makes difficult for children to control their behavior or has changing focus/attention. It affects 5% to 15% of school-aged children. It is 3 times more common in boys than girls.The symptoms affect a child’s cognitive, academic, behavioral, emotional, and social functioning, and the condition often continues into adulthood.

2.What are the symptoms of ADHD?

There are mainly 3 sets of symptoms: i)inattention, ii)hyperactivity, and iii)impulsivity.

i) Inattention: The following are the symptoms of inattention,

1. Often has a hard time paying attention, daydreams
2. Often does not seem to listen
3. Is easily distracted from work or play
4. Often does not seem to care about details, makes careless mistakes
5. Frequently does not follow through on instructions or finish tasks
6. Frequently loses a lot of important things
7. Often forgets things
8. Frequently avoids doing things that require ongoing mental effort

ii) Hyperactivity: The following are the symptoms of hyperactivity,

1. Is in constant motion, as if “driven by a motor”
2. Cannot stay seated
3. Frequently squirms and fidgets
4. Talks too much
5. Often runs, jumps, and climbs when this is not permitted
6. Cannot play quietly

iii) Impulsivity:The following are the symptoms of impulsivity,

1. Frequently acts and speaks without thinking
2. May run into the street without looking for traffic first
3. Frequently has trouble taking turns
4. Cannot wait for things
5. Often calls out answers before the question is complete
6. Frequently interrupts others

3.From what age ADHD starts and how long it may last?

Symptoms often begin by the time a child is 4 years old and can change over time. Children often continue to have symptoms as teenagers or adults.

4.Are there any subtypes of ADHD?

Based on combination of hyperactivity, inattention and impulsivity it is further subdivided to three subtypes:

i) Inattention only: Children with this form of ADHD are not overly active. Because they do not disrupt the classroom or other activities, their symptoms may not be noticed. They have difficulty focusing and has shifting attention.

ii) Hyperactive/Impulsive: Children with this type of ADHD show both hyperactive and impulsive behavior, but can pay attention. They are the least common group and are frequently younger.

iii) Combined Inattentive/Hyperactive/Impulsive: Children with this type of ADHD show a number of symptoms in all 3 dimensions. This is the most common type of ADHD.

5.Is there any test to diagnose ADHD?

There is no single test to diagnose ADHD. Consult pediatric neurologist if there is suspicion of ADHD.
The diagnosis id based considering many factors. It is more difficult to diagnose ADHD in children 5 years of age and younger. This is because children change very rapidly during the preschool years.The diagnosis is made if:

1. Symptoms are seen in more than 1 place, for example, at home and in school
2. Symptoms last at least 6 months
3. Symptoms start before age 7yrs
4. Affect his or her friendships or school work, impairing activity of daily life

6.What are the conditions that may look alike or coexist with ADHD?

Before considering the diagnosis pediatric neurologist does detailed physical and neurological examination along with detailed history from parents to consider look alike condition or mimics of ADHD or to see associated other conditions along with ADHD.

Some of the conditions that are considered while diagnosing ADHD are:

1. Hyperactive/inattentive behaviors but withinnormal range for the child’s developmental level
2. Intellectual disability/Mental retardation
3. Learningdisability
4. Autism/ASD
5. Language or communication disorder
6. Anxiety disorder

7.What is the cause of ADHD?

The cause(s) of ADHD are not clear, although there are a number of theories. Most experts agree that ADHD is a medical or neurodevelopmental disorder. Many experts believe there is an inherited imbalance of chemicals in the brain. This is supported by the improvements often seen with the use of medications that affect these chemicals.
In very rare cases, toxins in the environment may lead to ADHD. Significant head injuries may cause ADHD in some cases. Prematurity increases the risk of developing ADHD. Prenatal exposures, such as alcohol or nicotine from smoking, increase the risk of developing ADHD.
There is little evidence that ADHD is caused by: Eating too much sugar/ Food additives/ Allergies/ Immunizations.

8.How is ADHD treated?

ADHD can be treated in different ways. Treatment can improve symptoms and help children do better at school, at home, and with friends. Children with ADHD might have 1 or more of the following treatments:

i) Medicines – Pediatric neurologist can prescribe different medicines to help children pay attention and concentrate better. Medicines are more helpful for children more than 4yrs of age. The commonly used medications are stimulants(methylphenidate) or nonstimulant(atomoxetine).

ii) Behavior treatment – Behaviour therapy is the way to learn the handling technique and plan the childs activity at home or school. You might find that you can improve your child’s behavior by making changes at home. For instance, you can make a checklist for your child to use every morning so that he or she remembers what to do. Or you can have your child keep homework in the same place so he or she doesn’t lose it. Combining medicine with behaviour therapy gives better result.

iii)Educational intervention – Teachers can make changes in the classroom to help children with ADHD do better in school. For example, a teacher might write down what the homework is every day so the child does not forget. Or a teacher might allow a child to have extra time to finish school work. Parents should work with the teacher and school to create a “school plan” that is right for their child. Keep in mind that a school plan might need to change over time as a child gets older or if symptoms change.

Some of the changes that can be made in schools are

1. Having assignments written on the board
2. Sitting near the teacher
3. Having extended time to complete tasks
4. Being allowed to take tests in a less distracting environment

Some children with ADHD have other problems, too. These can include problems with learning, anxiety, or trouble sleeping. Pediatric neurologist will help to treat these problems if needed. Sometimes, this can even help improve ADHD symptoms.

9.Which medication is best for my child?

1. It may take some time to find the best medication, dosage, and schedule for your child.
2. Your child may need to try different types of stimulants or other medication. Some children respond to one type of stimulant but not another.
3. The amount of medication (dosage) that your child needs also may need to be adjusted. The dosage is not based solely on his weight. Pediatric neurologist will vary the dosage over time to get the best results and control possible side effects.
4. The medication schedule also may be adjusted depending on the target outcome. For example, if the goal is to get relief from symptoms mostly at school, your child may take the medication only on school days.
5. It is important for your child to have regular medical check-ups to monitor how well the medication is working and check for possible side effects.

10.Does my children need treatment for ADHD?

Some parents wonder if treatment for ADHD is necessary. Most experts agree that unrecognized and untreated ADHD can have serious consequences, including school failure and drop out, depression, poor behavior, failed relationships, poor performance in the workplace, and increased risk of accidents. Treatment can help a child to:

1. Have better relationships with parents, teachers, siblings, or peers (eg, play without fighting at recess)
2. Perform better in school (eg, finish school work)
3. Follow rules (eg, not appear to be disobedient to the teacher)

11.What are the side effects of stimulants?

Stimulants are the commonest used medicine for ADHD.Side effects occur sometimes. These tend to happen early in treatment and are usually mild and short-lived, but in rare cases can be prolonged or more severe. The most common side effects include:

1. Decreased appetite/weight loss
2. Sleep problems
3. Social withdrawal
4. Rebound effect (increased activity or a bad mood as the medication wears off)
5. Transient tics

Most side effects can be relieved by changing the medication dosage,adjusting the schedule of medication or using a different stimulant or atomoxetine.

12. Tips for helping your child control his behavior

1. Keep your child on a daily schedule. Try to keep the time that your child wakes up, eats, bathes, leaves for school, and goes to sleep the same each day.
2. Cut down on distractions. Loud music, computer games, and TV can be overstimulating to your child. Make it a rule to keep the TV or music off during mealtime and while your child is doing homework. Whenever possible, avoid taking your child to places that may be too stimulating, like busy shopping malls.
3. Organize your house. If your child has specific and logical places to keep his schoolwork, toys, and clothes, he is less likely to lose them. Save a spot near the front door for his school backpack so he can grab it on the way out the door.
4. Reward positive behavior. Offer kind words, hugs, or small prizes for reaching goals in a timely manner or good behavior. Praise and reward your child’s efforts to pay attention.
5. Set small, reachable goals. Aim for slow progress rather than instant results. Be sure that your child understands that he can take small steps toward learning to control himself.
6. Help your child stay “on task.” Use charts and checklists to track progress with homework or chores. Keep instructions brief. Offer frequent, friendly reminders.
7. Limit choices. Help your child learn to make good decisions by giving him only 2 or 3 options at a time.
8. Find activities at which your child can succeed. All children need to experience success to feel good about themselves.
9. Use calm discipline. Use consequences such as time-out, removing the child from the situation or distraction. Sometimes it is best to simply ignore the behavior. Physical punishment, such as spanking or slapping, is not helpful. Discuss your child’s behavior with him when both of you are calm.