WHAT IS ADHD?
ADHD is a disorder characterized by the presence of the 3 main behavioral problems: attention deficit, hyperactivity, impulsivity, in more than one situation (at school, at home, in the clinic), more important than for chronological age or mental development, from a young age (under 7 years).
Any child can have a lack of concentration, distractibility, impulsivity, hyperactivity sometimes, but the child with ADHD presents these symptoms and behaviors more frequently and more severely than other children of the same age or with the same level of development.
ADHD occurs in 3-5% of school-aged children.
In approximately 50% of children, the disorder remits in adolescence, and in 25% of adolescents it remits in adulthood. For approximately 25% of children, the disorder has a chronic evolution, which may require lifelong treatment.
CAUSE
strong genetic influences
environmental influences:
- prenatal - alcohol, tobacco, benzodiazepines, anticonvulsants
– perinatal suffering
- the inconsistency of the primary attachment figure in early childhood
- the reaction of some children to certain foods (wheat flour, cow's milk, citrus fruits)
CLASSIFICATION
There are three types of ADHD.
Some people just have problems with attention and organization. This is ADHD inattentive subtype.
Other people only have symptoms of hyperactivity and impulsivity. This is the hyperactive subtype.
The third type, and the most common, consists of those people who have difficulties with attention and hyperactivity, or the combined subtype.
DIAGNOSTIC CRITERIA
Group 1 of criteria: Inattention
At least 6 of the following:
1 - often makes mistakes because he does not pay attention to details: he makes mistakes at school, at play or in other activities
2 - fails to have sustained attention during lessons or even at play
3 - often seems not to listen to what is being said
4- fails to pay attention to instructions and complete lessons or tasks (this is not due to opposition or inability to understand)
5 - often he is unable to plan and organize his activity
6 - often avoids tasks that require sustained effort and attention
7 - often loses personal items or items needed in activities: pens, notebooks, toys, etc.
8 - is often distracted by external stimuli
9 - he is forgetful most of the day
Group 2 criteria: Hyperactivity
1 - At least 3 of the following:
2 - he often waves his hands or feet, and shifts in his chair
3 - he gets up from his chair, he has no patience to sit down
4 - climbs or hops and runs in situations where he should be quiet
it cannot be played quietly, it is noisy
5 - shows an excessively active motor pattern that is not explained by changes in the environment
ADHD
Group 3 criteria: Impulsivity
1 - At least 1 of the following criteria:
2- often answers before the question is asked
3 - he often has no patience to wait his turn
4 - often interrupts or interferes with others' play or conversation
often talks too much
THERAPEUTIC INTERVENTIONS
Without proper treatment, the child may fall behind in school, and his friendships may suffer. The child experiences failure more than success and is criticized by teachers and family who do not recognize a health problem.
The approach with the best results is multimodal, combining drug treatment, behavioral therapy and specific educational methods. The target symptoms will be mainly addressed (those that the family or teachers consider important and those that constantly disrupt the child's functionality).
Counseling and counseling of the family is necessary to understand the nature of this condition and to participate in educational programs. Psychoeducation, parenting techniques, training and family therapy have a very important role.
Research clearly demonstrates that drug treatment can help improve attention, concentration, goal-directed behavior, and organizational skills. First-line drugs are stimulants (methylphenidate) and non-stimulants (atomoxetine). For comorbid disorders, other categories of substances can be associated, in doses adapted to body weight and age.
Other treatment methods may include cognitive-behavioral therapy, social skills training, and changes in the child's educational program.
Behavioral therapy can help your child control aggression, modulate social behavior, and be more productive.
Cognitive therapy can help a child build self esteem, reduce -ve thoughts, & improve problem solving skills.
Educational modifications can address ADHD symptoms and co-existing learning disabilities. There is a need for additional educational support, remediation of learning disorders, differentiated pedagogy.
The principles of behavioral interventions do not differ from those used in the therapy of other behavioral problems in childhood, but:
1- consequences must be applied very quickly (if they are delayed they will not have an impact on the child's behavior)
2- special attention must be paid to the explanations given to the child on the behavior rewarded or sanctioned
3- rewards can quickly lose their effect, therefore they must be renewed, varied, there must be something new
4- children with hyperkinetic disorders do not understand the relationship between their actions and the way others behave with them, so verbal correlations must be made, at first passively (explaining them), then actively (encouraging them to verbalize or write down the reasons...)
The child's behaviors are always motivated by a need
Emotional needs: love, honesty, respect, understanding, acceptance, patience, fairness, time - attention.
The most effective ways to help a child improve his behavior are to reduce the utility of the undesirable behavior and to help the child feel better about himself and get his emotional needs met through more appropriate means
Children learn much more from adults' actions than from their words
Talk to children in a respectful manner ("thank you", "please", etc.)
Don't scream. Anger is practically never productive
Do not reward a child materially for good behavior
Encourage children by showing them the usefulness or uselessness of their behavior
Help children to know their resources and qualities through your comments.
Try to approach your children who want power; it will be harder for them to fight with a friend.
Encourage the children by inviting them to have a contribution or play a helping role. Children like to feel useful, responsible
Listen to children actively, giving open answers that show you understand their feelings
Learn the language of encouragement
Sometimes, although the child knows what you expect from him, he does not want to do that thing. In such situations you can use the method of logical and natural consequences
Criticize the behavior, not the person, use the principles of effective communication, assertive messages, in the first person.
When a child is asked to leave a group, make it clear that they are welcome back when they are ready to cooperate
Tell yourself “STOP” when you are angry and frustrated – sit down, wait, relax, instead of arguing
Encourage each other, share useful ideas and seek ideas from colleagues when you need help.
prognosis
Hyperactivity tends to be persistent over time and leaves its mark on the child's development.
Compared to typically developing children, those with hyperkinetic disorder have a much higher rate of conduct disorders.
Other risks: problems in social adaptation - lack of friends, lack of constructive recreational activities; antisocial activities, accidents.