ADHD is a syndrome of increased physical and mental activity, characterized by the predominance of arousal processes over inhibition. A hyperactive child has difficulty concentrating and maintaining attention, self-regulating behavior, learning, processing and retaining information in memory. According to official statistics, in Russia from 4 to 18% of children have a diagnosis of ADHD.
Moreover, this syndrome is present in 3-5% of the adult population, since in half of the cases a hyperactive child grows up into a “hyperactive adult.” In boys, ADHD is diagnosed 3 times more often than in girls. ADHD is the subject of close study of pediatrics , child psychiatry , child neurology , child psychology.
Causes of ADHD
Professionals find it difficult to determine the exact causes of attention deficit hyperactivity disorder. It is believed that hyperactivity in children may be due to genetic factors and early organic damage to the central nervous system, which are often combined with each other. Modern studies indicate that in ADHD there is a mismatch in the functioning of structures that ensure the organization of voluntary behavior and attention control, namely the associative cortex, basal ganglia, thalamus, cerebellum, prefrontal cortex.
The genetic mechanism of ADHD is due to the inheritance of genes that regulate the metabolism of neurotransmitters (dopamine and norepinephrine) in the brain. Due to the dysfunction of neurotransmitter systems, the process of synaptic transmission is disrupted, which entails the dissociation of the connections between the frontal cortex and the subcortical structures. In favor of this theory indicates the fact that in the treatment of hyperactivity in children are effective drugs that promote the release and inhibition of the reuptake of neurotransmitters in presynaptic nerve endings.
Among the pre-and perinatal factors that determine the development of ADHD, various adverse effects should be noted, contributing to the development of minimal brain dysfunction in a hyperactive child. This may be the pathological course of pregnancy and childbirth in the mother ( preeclampsia , eclampsia , threatened miscarriage , hemolytic disease of the fetus , rapid or prolonged labor, the use of pregnant alcohol or certain drugs, smoking), asphyxia , prematurity , birth injuries in the child, etc. infectious diseases and TBI may lead to the development of hyperactivity syndrome in childrentransferred in the first months and years of life.
In the formation of hyperactivity in children, the influence of adverse environmental factors is not excluded, primarily the pollution of the natural environment by neurotoxicants (lead, arsenic, mercury, cadmium, nickel, etc.). In particular, the correlation between increased lead content in the hair according to spectral analysis and the level of hyperactivity, cognitive and behavioral disorders in children has been proved. The occurrence or increase in the manifestations of ADHD may be due to unbalanced nutrition, lack of micronutrient intake (vitamins, omega-3 fatty acids, trace elements – magnesium, zinc, iron, iodine). Adverse intra-familial relationships contribute to increased adaptation difficulties, behavior, and attention in a hyperactive child.
The International Psychiatric Classification (DSM) identifies the following options for ADHD:
- mixed – a combination of hyperactivity with attention disorder (occurs most often). Usually detected in boys with a particular phenotype – blond hair and blue eyes.
- inattentive – attention deficit prevails. It is more common in girls, characterized by a departure to their own world, a violent fantasy, the “soaring” of the child “in the clouds.”
- hyperactive – hyperactivity prevails (the most rare type). With equal probability, it can be caused by both the individual characteristics of the temperament of children, and certain disorders of the central nervous system.
Symptoms of ADHD
In early childhood, a hyperactive child often has an increased muscle tone, suffers from repeated and unmotivated vomiting, falls asleep poorly and sleeps anxiously, is easily excited, has an increased sensitivity to any external stimuli.
The first signs of hyperactivity syndrome in children are usually found at the age of 5-7 years. Parents usually begin to “sound the alarm” when the child goes to school, which requires him to be organized, independent, follow the rules, focus, etc. The second peak of manifestations occurs during the pubertal period (13-14 years) and is associated with a teenage hormonal surge.
The main clinical and diagnostic criteria for ADHD are inattention, hyperactivity and impulsivity.
The inattention of a hyperactive child is expressed in the inability to hold attention; inability to concentrate on the game or the task. Due to increased distractibility to extraneous stimuli, a hyperactive child makes many mistakes in homework, cannot fully fulfill the proposed instruction or responsibilities assigned. A hyperactive child has difficulty organizing independent activities, there is confusion, forgetfulness, constant switching from one occupation to another, a tendency to fail to start the work begun.
Actually hyperactivity in children suggests restless behavior, restlessness, excessive motor activity in situations that require the preservation of relative peace. When observing a hyperactive child, one can see constant stereotypical movements in the hands and feet, twitching, tics . A hyperactive child is characterized by the absence of arbitrary control over his behavior, so children with ADHD are constantly in aimless motion (run, spin, talk, etc.) in inappropriate situations, for example, during school hours. 75% of hyperactive children have dyspraxia – clumsiness, sluggishness, inability to perform movements and work that requires a certain dexterity.
Impulsiveness in a hyperactive child is expressed in impatience, haste of completing assignments, striving to give an answer without thinking about its correctness. A hyperactive child usually cannot play collective games with peers, because he constantly interferes with others, does not follow the rules of the game, conflicts, etc.
A hyperactive child often complains of headaches, fatigue, drowsiness. Some children have night and day enuresis . Among hyperactive children, psychomotor and speech developmental delays are common , at school age – dysgraphia , dyslexia , dyscalculia . According to children’s psychologists, 60-70% of children with ADHD are hidden left-handers or ambidexters.
Disinhibition and recklessness is accompanied by a decrease in the instinct of self-preservation, so a hyperactive child easily receives various injuries.
Diagnosis of ADHD
A hyperactive child is a patient of a child neurologist, child psychiatrist and child psychologist.
According to the criteria developed by the DSM in 1994, ADHD can be recognized if the child retains at least 6 signs of inattention, hyperactivity, and impulsivity for six months. Therefore, during the initial referral to specialists, no diagnosis of ADHD is made, and the child is monitored and examined. In the process of clinical and psychological examination of a hyperactive child, the methods of interview, conversation, direct observation are used; obtaining information from teachers and parents using diagnostic questionnaires, neuropsychological testing.
The need for a basic pediatric and neurological examination is due to the fact that behind the ADHD-like syndrome can hide various somatic and neurological disorders ( hyperthyroidism , anemia , epilepsy , chorea , impaired hearingand vision, and many others.). For the purpose of specifying diagnosis of a hyperactive child, consultations can be given to narrow pediatric specialists ( pediatric endocrinologist , pediatric otolaryngologist , pediatric ophthalmologist , epileptologist ), EEG , brain MRI , general and biochemical analysis of blood, etc. Consultationspeech therapist allows you to diagnose violations of writing and to outline a plan for remedial work with a hyperactive child.
Hyperactivity in children should be differentiated from fetal alcohol syndrome , post-traumatic CNS damage, chronic lead poisoning, manifestations of individual temperament characteristics, pedagogical neglect , oligophrenia , etc.
A hyperactive child needs complex individualized support, including psychological and pedagogical correction, psychotherapy, non-pharmacological and drug correction.
A hyperactive child is recommended a sparing mode of study (small class, reduced lessons, dosage tasks), adequate sleep, good nutrition, long walks, and sufficient physical activity. Due to increased excitability, the participation of hyperactive children in public events should be limited. Under the guidance of a child psychologist and psychotherapist, autogenic training, individual, group, family and behavioral psychotherapy, body-oriented therapy, and BOS technology are conducted. In the correction of ADHD, the whole environment of the hyperactive child should be actively involved: parents, tutors, school teachers.
Pharmacotherapy is an auxiliary method for the correction of ADHD. It involves the appointment of atomoxetine hydrochloride, blocking the reuptake of norepinephrine and improving synaptic transmission in various brain structures; nootropic drugs (pyritinol, cortexin, choline alfoscerate, phenibut, hopantenic acid); micronutrients (magnesium, pyridoxine), etc. In some cases, a good effect is achieved using kinesitherapy, massage of the cervical spine, manual therapy .
The elimination of writing disorders is carried out within the framework of purposeful speech therapy classes for the correction of dysgraphia and dyslexia .
Prognosis and prevention of ADHD
Timely and comprehensive remedial work allows the hyperactive child to learn how to build relationships with peers and adults, to control their own behavior, prevents the difficulties of social adaptation. Psychological and pedagogical support of a hyperactive child contributes to the formation of socially acceptable behavior. In the absence of attention to the problems of ADHD in adolescence and adulthood, the risk of social disadaptation, alcoholism and drug addiction increases.
Prevention of hyperactivity syndrome and attention deficit should begin long before the birth of the child and envisage the provision of conditions for the normal course of pregnancy and childbirth, concern for the health of children, and the creation of a favorable microclimate in the family and children’s team.
A hyperactive child is a child with attention deficit hyperactivity disorder (ADHD), neurological and behavioral disorders that develop in childhood. A hyperactive child is characterized by restlessness, distractibility, difficulty concentrating, impulsivity, increased motor activity, etc. A hyperactive child needs a neuropsychological and neurological (EEG, MRI) examination. Assistance to a hyperactive child involves individual psychological and pedagogical support, psychotherapy, non-drug and drug therapy.