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Conservative use of drug therapy
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A psychological approach that emphasizes the present and future of the patient, rather than the past.
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Emphasis on nutrition and physical exercise
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Family participation, if appropriate
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Psychoeducation for patients and relatives
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What is ADHD?
Attention-Deficit/Hyperactivity Disorder is a pattern of behaviors in which a child shows developmentally inappropriate levels of inattention, hyperactivity, or impulsivity. It is the most common mental health problem of childhood.
Children with ADHD show symptoms that cause problems are present in a greater degree than other same age-children. Their behavior often results in serious disturbances in their relationships with parents, teachers, peers and siblings as well as academic problems.
The current psychiatric diagnostic manual (DSM-IV) offers the following definition of ADHD:
- At least six symptoms of hyperactivity-impulsivity or inattention for at least 6 months to a degree that is maladaptive and inconsistent with developmental level.
- Some of the symptoms that cause impairment were present before age 7.
- Some impairment from the symptoms is present in two or more settings (e.g. at school, work home)
- The symptoms cause a significant impairment in social, academic, or occupational functioning.
- The symptoms do not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or other psychotic disorder and are not better accounted for by another mental disorder.
Hyperactivity Symptoms:
- often fidgets with hands or feet or squirms in seat
- often leaves seat in classroom or in other situations in which remaining seated is expected
- often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)
- often has difficulty playing or engaging in leisure activities quietly
- is often "on the go" or often acts as if "driven by a motor"
- often talks excessively
Impulsivity Symptoms:
- often blurts out answers before questions have been completed
- often has difficulty awaiting turn
- often interrupts or intrudes on others (e.g. butts into conversations or games)
Inattention Symptoms
- often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities.
- often has difficulty sustaining attention in tasks or play activities
- often does not seem to listen when spoken to directly
- often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace
- often has difficulty organizing tasks and activities
- often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)
- often loses things necessary for tasks or activities
- is often easily distracted by extraneous stimuli
- is often forgetful in daily activities
Who suffers from ADHD?
It is estimated that about 3 to 5% of the population suffer from ADHD. It is more common in boys than in girls.
Children with ADHD often exhibit other problems including defiant and non compliant behavior toward adults, verbal and physical aggression towards peers and siblings, low self-esteem (particularly in adolescents) and learning disabilities. Family problems often accompany ADHD and may also need to be assessed and treated.
There is no apparent single cause of ADHD. Most professionals believe that the cause is based in the brain, but the exact nature of the cause is unclear. Neurological findings suggest "underactivity" in specific areas of the brain. Other findings also suggest an imbalance in dopamine and norepinephrine neurotransmitters. ADHD also appears to run in families.
Environmental toxins have been suggested as possible contributors to ADHD. Specifically, nutritional factors (such as sugar or artificial food coloring), lead poisoning, and prenatal exposure to drugs or alcohol have been studied. Results of well-controlled studies indicate that they are not causes of ADHD.
Hyperactivity and impulsivity may reflect problems with behavioral inhibition. Inattention may be due to difficulties filtering and managing sensory input.
What Treatments are Available?
Effective evaluation and treatment involves the cooperation of the child's physician, school personnel, and mental health professionals such as psychologists and psychiatrists.
A comprehensive treatment program implemented in the child's home and school environments and in settings in which the child interacts with peers is the most effect. Behavioral interventions are the most widely recommended and effective, non-medical, short-term treatment for ADHD. They include:
- establishing and consistently enforcing clear rules for children
- giving clear and appropriate commands
- using rewards to encourage good behaviors
- using appropriate, nonphysical punishments to discourage bad behaviors.
It usually takes 8-12 sessions for parents and teachers to learn these techniques. Treatment for peer difficulties must be conducted in a natural setting and requires intensive and long-term involvement.
Following a 1991 ruling of the US Department of Education, children with ADHD are now eligible to receive special educational services in school settings under Public Law 94-142, the Individuals with Disabilities Education Act, and Section 504 of the 1973 Rehabilitation Act. This legislation mandates that appropriate educational services be provided to all children with special needs, including children with ADHD.
With adolescents and adults, cognitive therapies may also be useful in developing problem solving skills by identifying different ways of reacting to events. Behavioral management techniques focus on the consequences of actions and teaching organizational skills.
Medications used to treat ADHD are psychostimulant drugs and can be effective in short-term treatment for ADHD, but only when combined with other therapies. Other medications for ADHD carry considerably greater risks than these three drugs and should be used only as treatments of last resort.
Common Psychostimulant Drugs
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Consultations