Attention Deficit Hyperactivity Disorder (Adhd)

Symptoms

General signs:

Clinically, attention deficit hyperactivity disorder is manifested by a triad of signs: hypermobility, impulsivity and lack of concentration.

Hyperactivity is characterized by excessive motor disinhibition, while the movements of the child are chaotic, uncoordinated, clumsy. The child cannot remain motionless for a minute, behave calmly, obey the rules and discipline. He is restless, restless, constantly grimaces, aimlessly runs and jumps, breaks toys, thereby attracting attention to himself and disorganizing other children.

Impulsivity is expressed in field behavior - any stimulus causes an immediate reaction. The child is impatient, overly talkative, does not listen to questions, interrupts the interlocutor, performs out of turn during a game or sports competition. Often actions and deeds are rash in nature, go against common sense and the instinct of self-preservation.

Attention deficit is manifested by difficulties in concentrating and keeping the program of action. ADHD is characterized by increased distractibility to external stimuli, inertia, forgetfulness, and a slow pace of activity. The child is constantly immersed in his thoughts, looks with an unseeing eye, "dreams in reality." He finds it difficult to perform stereotypical actions in the game, makes a large number of mistakes in educational tasks, and does not finish what he started.

Preschool age:

In the first years of life, as a rule, there is a delay in motor development , ZRR, late mastery of complex movements (eat with a spoon, drink from a cup, jump). After 3 years of age, children with ADHD become uncontrollable, disobedient, disinhibited. They switch endlessly from one activity to another, aimlessly run around the room, are prone to noisy and “destructive” games, which is why their peers do not want to be friends with them.

Dysarthria , stuttering, ONR, dyspraxia can be diagnosed . Children are curious, but not inquisitive, their interest in something new quickly passes. They have childish tantrums . Such behavior is often attributed to bad manners, spoiledness, age crisis, therefore, appeals to specialists in preschool childhood are rare.

School age:

Symptoms of hyperactivity and attention deficit worsen with the onset of schooling. In the classroom, children are easily distracted, often do not complete tasks to the end, make mistakes due to inattention, answer inappropriately, interrupt peers and teachers. They cannot organize their homework on their own, they constantly lose notebooks and textbooks.

80% of schoolchildren with ADHD have learning difficulties - dysgraphia , handwriting disorders, dyslexia and dyscalculia. In general, such children demonstrate low academic performance, often violate discipline and disrupt lessons. Difficulties in relationships with peers are manifested by the inability to compromise, aggressiveness , conflict, pugnacity. It is generally accepted that, on average, there are 1-2 children with ADHD in each class.

Due to risky behaviour among adolescents, the risk of injuries and accidents increases. They suffer from low self-esteem, constantly conflict with parents, teachers, and peers. In an effort to attract attention, they often show antisocial behaviour, commit offenses. They often join informal associations, use alcohol and illegal substances.

ADHD in adults:

About half of people with ADHD symptoms persist into adulthood. They are expressed in disorganization, inability to rationally plan one's time, inability to finish the work begun. Usually such adults do not reach heights in their professional careers, they are dissatisfied with their social and material status. They often report conflicts in the family, divorces. They lack long-term interests and hobbies. They are known as people with a "difficult", unbridled character, often get into unpleasant stories, accidents, violate public order and the law.

Complications:

Most children with ADHD have persistent school failure and low self-esteem. Adolescents demonstrate deviant behavior , a tendency to vagrancy, suffer from various addictions (alcohol, drugs). Comorbid conditions are often found: oppositional defiant disorder (35-50%), anxiety disorder (20-30%), depression (15%), bipolar disorder (5%). These conditions cause difficulties in interpersonal relationships, worsen adaptation in society, and cause social failure in adulthood.
 

Causes

Despite the close study of the problem for several decades, the leading factors and exact mechanisms of attention deficit hyperactivity disorder have not yet been identified. It is assumed that the disorder is caused by a complex of neurobiological factors leading to impaired maturation of brain structures and subsequent CNS dysfunction:

1.    Genetic. According to available data, ADHD is one of the inherited pathologies. In support of the genetic theory, there is a high prevalence of the syndrome among children whose fathers suffered from ADHD (8 times more often), as well as among homozygous twins. Mutations have been described in the genes of dopamine receptors (D1, D2, D4, D5), dopamine and serotonin transporters, in the gene for the synaptosomal protein SNAP-25, etc., which are significantly more common in people with ADHD.

2.    Biological. Among prenatal factors, the most significant are maternal age (under 18 and over 35), prenatal stress , chronic diseases and bad habits of the mother, gestosis . Perinatal factors include fetal hypoxia , complicated childbirth, prematurity and postmaturity of the child, trauma to the SHOP. During infancy, neuroinfections , poisoning with neurotropic poisons, TBI, and taking drugs can have a damaging effect.

3.    Psychosocial. The most important among them is the family microclimate, social conditions, parent-child relationships. Scandals in the family, alcoholism of parents, overprotection and pedagogical neglect , physical methods of punishment, and family breakdown have an unfavorable effect on the development of the child.

4.    Toxic. Some authors associate ADHD with an excessive content of certain substances in the body (salicylates, flavors, lead), a deficiency of omega-3 PUFAs , trace elements (iron, magnesium), vitamins (folic acid, etc.). The association of the syndrome with increased consumption of fast carbohydrates against the background of protein deficiency is also indicated.
The role of various pathogenic conditions at different stages of child development is not the same. So, biological factors are predominant up to 1.5-2 years, and psychosocial ones become leading after 2-3 years. However, in most children, there is a causal relationship between several factors and ADHD. Early organic damage to the CNS is detected in 84% of patients, genetic mechanisms - in 57%, psychosocial causes - in 63%.
 

Treatment

The main goals of therapy are to reduce the manifestations of hyperactivity, inattention / impulsivity, increase adaptive mechanisms and self-esteem, develop social interaction skills. For this, the concept of expanded therapeutic care has been developed, including treatment, dynamic monitoring, and evaluation of the effectiveness of ADHD therapy. Neurologists, psychologists, teachers work with the patient and his family. The multimodal approach provides for the following areas:

•    Behavior correction. It is important to ensure that the child observes the daily routine, a favorable family climate, and properly organize the workplace. Hyperactive children are not recommended to engage in power sports, participate in competitions and competitions. Health-improving swimming, cycling, skiing, hiking are useful for them. It is necessary to create situations of success, increase learning motivation.
•    Psychotherapy . For ADHD , cognitive behavioral therapy , family therapy, and autogenic trainingare usedTrainings are organizedfor parents whose children suffer from attention deficit hyperactivity disorder.

•    Drug therapy. It is connected only with the ineffectiveness of non-drug treatment. Psychostimulants, nootropics, antipsychotics, antidepressants, anticonvulsants are used. Long-term (several years) pharmacotherapy is required to reduce symptoms.

•    Instrumental methods. Promising areas that improve adaptive self-regulation are EEG-BFB-therapy , Tomatis-therapy . Also, transcranial micropolarization (TCMP) helps to stabilize psychophysiological functions.

Tests Required for Diagnosis

The average age of seeking medical help is 8-10 years. An important diagnostic marker for a child psychologist is a detailed anamnestic interview of parents regarding the course of pregnancy and childbirth, child development, and family relationships. For diagnosis use:

•    Clinical Criteria DSM – 5 : The manual on mental disorders describes in detail the signs that characterize the various aspects of ADHD: inattention, hyperactivity, impulsivity. It is necessary to have 6 or more signs from the specified list, which have been observed in the child for at least 6 months. And appear in all situations.

•    Psychological testing . With the help of rating scales and tests, cognitive functions, motor sphere, speech development, learning activities, behavior are studied (Wechsler scale, Stroop test, test for long-term maintenance of function, Wisconsin card sorting test, etc.). The analysis of workbooks, drawings, crafts is carried out, the speed of completing tasks, switchability, etc. are evaluated. Adapted versions of tests for parents, teachers and children have been developed.

•    Electroencephalography . Allows you to assess the activity of various parts of the brain, identify the prevailing rhythms and compare indicators with age norms. As a rule, with ADHD, increased convulsive readiness and immaturity of deep cerebral structures are recorded. More detailed information is provided by EEG with intellectual load.

Differential Diagnosis:

For economically prosperous countries, over diagnosis of ADHD is a serious problem. Very often, other problems are mistaken for hyperactivity and attention deficit:

•    Autism Spectrum Disorders (ASD ;
•    Anxiety disorder;
•    Asthenic and cerebrasthenic syndromes;
•    Sensorineural hearing loss ;
•    Specific learning difficulties ;
•    High motor activity as a feature of temperament, education;
•    Side effects of pharmacotherapy;
•    Other neurological, psychiatric, hereditary pathologies.