ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD)
ADHD is a common behavioral disorder that affects an estimated 8% to 10% of school-age children.
Boys are about three times more likely than girls to be diagnosed with it, though it’s not yet understood why.
Kids with ADHD act without thinking, are hyperactive, and have trouble focusing. They may understand what’s expected of them, but have trouble following through because they can’t sit still, pay attention, or attend to details.
- In a child with ADHD symptoms are present over a longer period of time and occur in different settings.
- They impair a child’s ability to function socially, academically, and at home.
With appropriate treatment, kids with ADHD can learn to successfully live with and manage their symptoms.
ADHD used to be known as attention deficit disorder, or ADD. In 1994, it was renamed ADHD and broken down into three subtypes, each with its own pattern of behaviors:
- Inattentive type, with signs that include:
- Inability to pay attention to details or a tendency to make careless errors in schoolwork or other activities.
- Difficulty with sustained attention in tasks or play activities.
- Apparent listening problems.
- Difficulty following instructions.
- Problems with organization.
- Avoidance or dislike of tasks that require mental effort.
- Tendency to lose things like toys, notebooks, or homework.
- Easy distractibility.
- Forgetfulness in daily activities.
- hyperactive-impulsive type, with signs that include:
- Fidgeting or squirming
- Difficulty remaining seated
- Excessive running or climbing
- Difficulty playing quietly
- Always seeming to be “on the go”
- Excessive talking
- Blurting out answers before hearing the full question
- Difficulty waiting for a turn or in line
- Problems with interrupting or intruding
- Combined type, which involves a combination of the other two types and is the most common.
Although it can be challenging to raise kids with ADHD, it’s important to remember they aren’t “bad,” “acting out,” or being difficult on purpose. And they have difficulty controlling their behavior without medication or behavioral therapy.
Because there’s no test that can determine the presence of ADHD, a diagnosis depends on a complete evaluation. Differential diagnosis -Tourette syndrome, a learning disability, anxiety, or depression.
Criteria for diagnosis of ADHD:
- A child must display behaviors from one of the three subtypes before age 7
- These behaviors must be more severe than in other kids the same age
- The behaviors must last for at least 6 months
- The behaviors must occur in and negatively affect at least two areas of a child’s life (such as school, home, daycare settings, or friendships)
- Stress at home. Kids who have experienced a divorce, a move, an illness, a change in school, or other significant life event may suddenly begin to act out or become forgetful. extreme stress, depression, and anxiety To avoid a misdiagnosis, it’s important to consider whether these factors played a role in the onset of symptoms.
- Deaf mutism :
Hearing and vision evaluation is must ,so other medical conditions can be ruled out, like deaf mutism
You’ll be asked many questions about your child’s development and behaviors at home, school, and among friends. Other adults who see your child regularly (like teachers, who are often the first to notice ADHD symptoms) probably will be consulted, too. An educational evaluation, which usually includes a school psychologist, may also be done. It’s important for everyone involved to be as honest and thorough as possible about your child’s strengths and weaknesses.
Causes of ADHD
ADHD is not caused by poor parenting.
ADHD has biological origins that aren’t yet clearly understood. No single cause has been identified, but researchers are exploring a number of possible genetic and environmental links. Studies have shown that many kids with ADHD have a close relative who also has the disorder.
Although experts are unsure whether this is a cause of the disorder, they have found that certain areas of the brain are about 5% to 10% smaller in size and activity in kids with ADHD. Chemical changes in the brain also have been found.
- Smoking during pregnancy
- Premature delivery, very low birth weight, and birth asphyxia
3.A link between excessive early television watching and future attention problems, is suggested. Parents should follow the American Academy of Pediatrics’ (AAP) guidelines, which say that children under 2 years old should not have any “screen time” (TV, DVDs or videotapes, computers, or video games) and that kids 2 years and older should be limited to 1 to 2 hours per day, or less, of quality television programming.
Nearly 2/3 of children have co morbid conditions.
- Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD)
At least 35% of kids with ADHD also have oppositional defiant disorder, which is characterized by stubbornness, outbursts of temper, and acts of defiance and rule breaking. Conduct disorder is similar but features more severe hostility and aggression. Kids who have conduct disorder are more likely to get in trouble with authority figures and, later, possibly with the law. These are seen most commonly with the hyperactive and combined subtypes of ADHD.
- Mood Disorders.
About 18% of kids with ADHD, particularly the inattentive subtype, also experience depression. These children feel inadequate, isolated, frustrated by school failures and social problems, and have low self-esteem.
- Anxiety Disorders.
Anxiety disorders affect about 25% of kids with ADHD. Symptoms include excessive worry, fear, or panic, which can also lead to physical symptoms such as a racing heart, sweating, stomach pains, and diarrhea. Obsessive-compulsive disorder and Tourette syndrome, as well as motor or vocal tics (movements or sounds that are repeated over and over) can also be associated.
- Learning Disabilities.
- Autism spectrum disorder
If identification of co-existent condition modifies the treatment plans, addressing specific combinations of symptoms.
ADHD can’t be cured, but it can be successfully managed. Your child’s doctor will work with you to develop an individualized, long-term plan. The goal is to help a child learn to control his or her own behavior and to help families create an atmosphere in which this is most likely to happen.
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, and your doctor may make adjustments along the way. Because it’s important for parents to actively participate in their child’s treatment plan, parent education is also considered an important part of ADHD management.
Sometimes the symptoms of ADHD become less severe as a person grows older. Hyperactivity tends to get less as people grow up, although the problems with organization and attention often remain. More than half of kids who have ADHD will continue to have symptoms as young adults.
Several different types of medications may be used to treat ADHD:
- Stimulants are the best-known treatments — they’ve been used for more than 50 years in the treatment of ADHD. Some require several doses per day, each lasting about 4 hours; some last up to 12 hours. Possible side effects include decreased appetite, stomachache, irritability, and insomnia. There’s currently no evidence of long-term side effects.
- Nonstimulants represent a good alternative to stimulants or are sometimes used along with a stimulant to treat ADHD. The first nonstimulant was approved for treating ADHD in 2003. They may have fewer side effects than stimulants and can last up to 24 hours.
- Antidepressants are sometimes a treatment option; however, in 2004 the U.S. Food and Drug Administration (FDA) issued a warning that these drugs may lead to a rare increased risk of suicide in children and teens. If an antidepressant is recommended for your child, be sure to discuss these risks with your doctor.
Medications can affect kids differently, and a child may respond well to one but not another. When determining the correct treatment, the doctor might try various medications in various doses, especially if your child is being treated for ADHD along with another disorder.
Research has shown that medications used to help curb impulsive behavior and attention difficulties are more effective when combined with behavioral therapy.
Behavioral therapy attempts to change behavior patterns by:
- reorganizing a child’s home and school environment
- giving clear directions and commands
- setting up a system of consistent rewards for appropriate behaviors and negative consequences for inappropriate ones
Here are examples of behavioral strategies that may help a child with ADHD:
- Create a routine. Try to follow the same schedule every day, from wake-up time to bedtime. Post the schedule in a prominent place, so your child can see what’s expected throughout the day and when it’s time for homework, play, and chores.
- Get organized. Put schoolbags, clothing, and toys in the same place every day so your child will be less likely to lose them.
- Avoid distractions. Turn off the TV, radio, and computer games, especially when your child is doing homework.
- Limit choices. Offer a choice between two things (this outfit, meal, toy, etc., or that one) so that your child isn’t overwhelmed and overstimulated.
- Change your interactions with your child. Instead of long-winded explanations and cajoling, use clear, brief directions to remind your child of responsibilities.
- Use goals and rewards. Use a chart to list goals and track positive behaviors, then reward your child’s efforts. Be sure the goals are realistic (think baby steps rather than overnight success).
- Discipline effectively. Instead of yelling or spanking, use timeouts or removal of privileges as consequences for inappropriate behavior. Younger kids may simply need to be distracted or ignored until they display better behavior.
- Help your child discover a talent. All kids need to experience success to feel good about themselves. Finding out what your child does well — whether it’s sports, art, or music — can boost social skills and self-esteem.
- Currently, the only ADHD therapies that have been proven effective in scientific studies are medications and behavioral therapy. But your doctor may recommend additional treatments and interventions depending on your child’s symptoms and needs. Some kids with ADHD, for example, may also need special educational interventions such as tutoring, occupational therapy, etc. Every child’s needs are different.
- A number of other alternative therapies are promoted and tried by parents including: megavitamins, body treatments, diet manipulation, allergy treatment, chiropractic treatment, attention training, visual training, and traditional one-on-one “talking” psychotherapy. However, scientific research has not found them to be effective, and most have not been studied carefully, if at all.
- Parenting a child with ADHD often brings special challenges. Kids with ADHD may not respond well to typical parenting practices. Also, because ADHD tends to run in families, parents may also have some problems with organization and consistency themselves and need active coaching to help learn these skills.
- Experts recommend parent education and support groups to help family members accept the diagnosis and to teach them how to help kids organize their environment, develop problem-solving skills, and cope with frustrations. Training can also teach parents to respond appropriately to a child’s most trying behaviors with calm disciplining techniques. Individual or family counseling can also be helpful.
ADHD in the Classroom
As your child’s most important advocate, you should become familiar with your child’s medical, legal, and educational rights.
Kids with ADHD are eligible for special services or accommodations at school under the Individuals with Disabilities in Education Act (IDEA) and an anti-discrimination law known as Section 504. Keep in touch with teachers and school officials to monitor your child’s progress.
In addition to using routines and a clear system of rewards, here are some other tips to share with teachers for classroom success:
- Reduce seating distractions. Lessening distractions might be as simple as seating your child near the teacher instead of near the window.
- Use a homework folder for parent-teacher communications. The teacher can include assignments and progress notes, and you can check to make sure all work is completed on time.
- Break down assignments. Keep instructions clear and brief, breaking down larger tasks into smaller, more manageable pieces.
- Give positive reinforcement. Always be on the lookout for positive behaviors. Ask the teacher to offer praise when your child stays seated, doesn’t call out, or waits his or her turn instead of criticizing when he or she doesn’t.
- Teach good study skills. Underlining, note taking, and reading out loud can help your child stay focused and retain information.
- Check that your child goes and comes from school with the correct books and materials. Sometimes kids are paired with a buddy to can help them stay on track.
- Be sensitive to self-esteem issues. Ask the teacher to provide feedback to your child in private, and avoid asking your child to perform a task in public that might be too difficult.
- Involve the school counselor or psychologist. He or she can help design behavioral programs to address specific problems in the classroom.
Helping Your Child
You’re a stronger advocate for your child when you foster good partnerships with everyone involved in your child’s treatment — that includes teachers, doctors, therapists, and even other family members. Take advantage of all the support and education that’s available, and you’ll help your child navigate toward success.
Caring for a Child with MD
Though there’s no cure for MD yet, doctors are working to improve muscle and joint function, and slow muscle deterioration.
If your child is diagnosed with MD, a team of medical specialists will work with you and your family, including: a neurologist, orthopedist, pulmonologist, physical and occupational therapist, nurse practitioner, cardiologist, registered dietician, and a social worker.
Muscular dystrophy is often degenerative, so kids may pass through different stages as it progresses and require different kinds of treatment. During the early stages, physical therapy, joint bracing, and medications are often used.
During the later stages, doctors may use assistive devices such as:
- physical therapy and bracing to improve flexibility
- power wheelchairs and scooters to improve mobility
- a ventilator to support breathing
- robotics to help your child perform routine daily tasks
If a child has Duchenne muscular dystrophy, the doctor may prescribe the steroid prednisone to help slow the rate of muscle deterioration. By doing so, the child may be able to walk longer and live a more active life.
There is some debate over the best time to begin prednisone treatment, but most doctors prescribe it when a child is 5 or 6 years old or when the child’s strength begins to significantly decline. Prednisone does have side effects, though. It can cause weight gain, which can put even greater strain on already weak muscles. It also can cause a loss of bone density and, possibly, lead to fractures. If prescribing prednisone, your doctor will closely monitor your child.