Attention-deficit hyperactivity disorder :-

          It is composed of symptoms in three areas :

•    Short attention span,
•    Impulsivity
•    Hyperactivity.
•    The behavioural disturbances are for more than six months.
•    Symptoms appear before the age of 7.

Extent of Problem :-

•    About 3 to 5 per cent children suffer from ADHD.
•    Incidence is more in boys than in girls, with ratio being from 4 to 1.
•    It is most common in firstborn boys.
•    The parents of children with ADHD show an increased incidence of hyperkinesia, sociopath, alcoholism, and Hysteria.

Causes :-

GENETIC FACTORS :

A genetic basis of ADHD has been suggested by data.

BRAIN DAMAGE :

Some children with the disorder may have minimal and subtle brain damage from    Adverse circulatory,    Toxic,    Metabolic, or mechanical insults during fetal and perinatal periods.

Frontal lobe dysfunction causes ADHD.

Maturational Lag :-

Some children have a maturational delay in developmental sequence and may show a clinical picture of ADHD that is temporary and disappears as maturational lags catch up to normal at around puberty.

Psychosocial Factors :-

Children in institutions are frequently overactive and have poor attention spans.

These symptoms result from prolonged emotional deprivation and disappear through placement in foster home or adoption.

Stressful psychic events, a disruption of family equilibrium and other anxiety-inducing factors contribute to the initiation or perpetuation of ADHD.

Clinical Features :-

• The disorder may have its onset in infancy.
• Infants with ADHD are unduly sensitive to stimuli and are easily upset by noise, light, temperature and other environmental changes.
• It is more common, though, for infants with ADHD to be active in the crib, sleep little and cry a great deal.
• In school ADHD children may rapidly attack a test but answer a few questions. They may be unable to wait to be called on in school and may respond for everyone else
• At home ADHD children cannot be put off for even a minute.
• These children are often explosively irritable. This irritability may be set off by relatively minor stimuli, which may puzzle and dismay others.
• They are frequently emotionally labile, easily set of to laughter or to tears and their mood and performance are apt to be variable and unpredictable.
• Impulsiveness and an inability to delay gratification are characteristic.
• They are often accident prone.
• Emotional difficulties are frequent.
• Children with ADHD show behavioural symptoms of aggression and defiance.
• School difficulties, both learning and behavioural, are common.

Course :-

•    The course of ADHD is highly variable.
•    Symptoms may persist into adolescence or adult life.
•    Symptoms may remit at puberty, or the hyperactivity may disappear but the decreased attention span and impulse control problems may persist.
•    The over activity is usually the first symptom to remit and distractibility the last.
•    Remission occurs usually between the ages of 12 and 20.
•    In about 20 percent of cases, the symptoms of ADHD persist into adulthood.
•    Those with the disorder maybe impulsive and accident prone.
•    Their educational attainment is lower than that of others.
•    Many children with ADHD become delinquent in adolescence.

Treatment :-

Medicines :

The CNS stimulants are for those 6 years & older are:

•    Dextroamphetamine.
•    Methylphenidate.
•    Pemoline.
•    These drugs may suppress growth slightly.
•    There is possibility of abuse and habit formation with these drugs.

Antidepressants :

•   Imipramine
•   Desipramine

Psychotherapy :

•    Individual psychotherapy,
•    Behaviour modification
•    Parent counselling D
•    For those who are 6 years & older
•    Dispel misconceptions.
•    These children need to understand that they need not always be perfect.
•    Allow & help ADHD children to structure their environment.
•    Help the parents recognize that permissiveness is not helpful to their child.
•    Children with ADHD should not be exempted from being exempted from the requirements, expectations and planning applicable to other children.

Evaluation of Therapeutic Progress :-

Special attention is given to establishing and maintaining a close collaborative working relationship with the child’s school to evaluate improvement.