It's normal for kids to sometimes forget to do homework daydreaming during class, acting without thinking, or being nervous about dining table. But inattention, impulsivity and hyperactivity are signs of Attention Deficit Hyperactivity Disorder (ADHD, ADD). ADHD leads to problems at home, school, affects the ability to learn, get along with others. The first step to solving a problem is to provide the help the person needs.

We all know kids who can't sit back, who never seem to listen, who don't follow instructions no matter how clearly you present them, or make inappropriate comments at the wrong time. Sometimes these children are called troublemakers, criticized for being lazy, undisciplined. However, it could be Attention Deficit Hyperactivity Disorder (ADHD), formerly known as Attention Deficit Disorder, ADD.

Is this normal behavior or ADHD?

Signs and symptoms of ADHD usually appear before the age of seven. However, it can be difficult to distinguish ADHD from normal "child behavior".

If only a few signs are noticed, or symptoms appear only in certain situations, it is probably not ADHD. On the other hand, if a child is showing a range of signs and symptoms of ADHD that are present in all situations - at home, at school, at play - it's time to take a closer look at the problem.

Once you understand the challenges your child is facing, e.g. forgetfulness, difficulties at school, work together to find creative solutions to capitalize on strengths.

Myths and facts about attention deficit disorder

Myth: All children with ADHD are hyperactive.

Fact: Some are hyperactive, but many others with attention problems are not. Not too active, seem dreamy, unmotivated.

Myth: They can never concentrate.

Fact: They often focus on their activities. But no matter how hard they try, they cannot concentrate if the task is boring or repetitive.

Myth: They can do better if they want to.

Fact: They do their best to be good, but still they cannot sit still, remain calm, concentrate. They may seem naughty, but this does not mean that they act on purpose.

Myth: children will eventually outgrow ADHD.

Fact: ADHD often continues into adulthood, so don't wait for your child to outgrow the problem.

Treatment will help you learn how to minimize symptoms.

Myth: medicine - the best option treatment.

Fact: medication is often prescribed for attention deficit disorder, but this may not be the best option.

Effective treatment for ADHD includes education, behavioral therapy, support at home, school, physical exercises, proper nutrition.

Key Features of ADHD

When many people think of Attention Deficit Disorder, they imagine an out-of-control child in constant motion, destroying everything around them. But this is not the only possible picture.

Some children sit quietly - their attention is scattered for several tens of kilometers. Some people pay too much attention to the task, they cannot switch to something else. Others are only slightly inattentive, but overly impulsive.

Three main

The three main characteristics of ADHD are inattention, hyperactivity, and impulsivity. The signs and symptoms of a child with attention deficit disorder depend on which characteristics predominate.

Which of these boys might have ADHD?

• A. A hyperactive boy who talks non-stop cannot sit still.
• B. Calm dreamer, sitting at the table, looking into space.
• C. Both
  Correct answer: "C"

Children with ADHD are:

• Inattentive, but not hyperactive or impulsive.
• Hyperactive and impulsive, but able to pay attention.
• Inattentive, hyperactive, impulsive (the most common form of ADHD).
• Children who only have attention deficit symptoms are often overlooked as they are not destructive. However, the symptoms of inattention have consequences: falling behind in school; conflicts with others, games without rules.

ADHD (diagnosis by a neurologist) - what is it? This topic is of interest to many modern parents. For childless families and people who are far from children in principle, this issue is not so important. The named diagnosis is a fairly common chronic condition. It occurs in both adults and children. But at the same time, attention should be paid primarily to the fact that minors are more susceptible to the negative influence of the syndrome. For adults, ADHD is not so dangerous. Nevertheless, sometimes it is useful to understand such a common diagnosis. What does he represent? Is it possible to somehow get rid of such a disorder? Why does it appear? All this really needs to be sorted out. It should be noted right away - if there are suspicions of hyperactivity in a child, this should not be ignored. Otherwise, until the moment of entry into adulthood, the baby will have some problems. Not the most serious, but they will bring trouble to the child, and parents, and people around them.

Syndrome Definition

ADHD (diagnosis by a neurologist) - what is it? It has already been said that this is the name of a neurological-behavioral disorder common throughout the world. It stands for "syndrome and hyperactivity". In common parlance, this syndrome is often referred to simply as hyperactivity.

ADHD (diagnosis by a neurologist) - what is it from a medical point of view? The syndrome is a special work of the human body, in which there is a disorder of attention. We can say that this is absent-mindedness, restlessness and the inability to concentrate on anything.

In principle, not the most dangerous disorder. This diagnosis is not a sentence. In childhood, hyperactivity can cause a lot of trouble. But in adult life, as a rule, ADHD fades into the background.

The studied disease is most often found in children of preschool and school age. Many parents believe that ADHD is a real death sentence, an end to a child's life. In fact, as already mentioned, this is not the case. In fact, hyperactivity is treatable. And again, for an adult, this syndrome will not cause so many problems. Therefore, you should not panic and upset.

The reasons

Diagnosis of ADHD in a child - what is it? The concept has already been disclosed previously. But why does this phenomenon occur? What should parents pay attention to?

Doctors still cannot say for sure why a child or an adult develops hyperactivity. The fact is that there are many options for its development. Among them are the following:

1. Complicated pregnancy of the mother. This also includes difficult births. According to statistics, children whose mothers gave birth according to a non-standard option are more likely to be affected by this syndrome.
2. The presence of chronic diseases in the child.
3. Severe emotional shock or change in a person's life. Particularly the baby. It doesn't matter if it was good or bad.
4. Heredity. This is the option most often considered. If the parents had hyperactivity, then it is not excluded in the child.
5. Lack of attention. Modern parents are constantly busy. Therefore, children quite often suffer from ADHD precisely because of the fact that this is how the body reacts to the lack of parental care.

Hyperactivity should not be confused with being spoiled. These are completely different concepts. The diagnosis being studied is not a sentence, but omissions in education quite often cannot be corrected.

Manifestations

Now it’s a little clear why Attention Deficit Hyperactivity Disorder occurs. Its symptoms are clearly visible in children. But not the little ones. It should be remembered that babies under 3 years old cannot be diagnosed appropriately. Because these are normal.

How does ADHD manifest itself? The following distinguishing features that are found in children can be distinguished:

1. The child is too active. He runs and jumps all day without any purpose. That is, to just run and jump.
2. The baby is observed. It is very difficult for him to concentrate on anything. It should also be noted that the child will be extremely restless.
3. Schoolchildren often have poor school performance. Poor grades are the result of problems concentrating on tasks. But as a sign, such a phenomenon is also isolated.
4. Aggression. The baby may be aggressive. Sometimes it's just unbearable.
5. Disobedience. Another seems to understand that he should calm down, but he cannot do this. Or generally ignores any comments addressed to him.

This is how you define ADHD. Symptoms in children resemble spoilage. Or banal disobedience. That is why at the first signs it is recommended to consult a doctor. But more on that later. First, it is worth understanding how the studied condition manifests itself in adults.

Symptoms in adults

Why? ADHD is diagnosed without much problem in children. But, as already mentioned, it is not so easy to detect it in an adult. After all, he seems to fade into the background. It takes place, but does not play an important role. ADHD in adults can often be confused with, for example, an emotional disorder. Therefore, it is recommended to pay attention to some common symptoms.

Among them are the following components:

• the first person begins to conflict over trifles;
• there are unreasonable and sharp outbursts of anger;
• when talking with someone, a person "hovers in the clouds";
• easily distracted while performing a task;
• even during intercourse, a person can be distracted;
• there is a failure to fulfill previous promises.

All of these points to the presence of ADHD. Not necessarily, but it is a possibility. Need to see a doctor for full study. And if the diagnosis of ADHD in adults is confirmed, a course of treatment will be required. If you follow the recommendations, you can quickly get rid of the disorder. True, in the case of children, you will have to show perseverance and determination. Childhood hyperactivity is difficult to treat.

Who to contact

The next question is which specialist to contact? On the this moment medicine has a huge number of doctors. Which of them is able to make the correct diagnosis? Attention deficit hyperactivity disorder in adults and children can be recognized by:

• neurologists (it is to them that they come with the disease most often);
• psychologists;
• psychiatrists;
• social workers.

This also includes family doctors. It should be noted that social workers and psychologists only make a diagnosis. But they do not have the right to prescribe medication. It is not in their competence. Therefore, most often parents and already adults simply go for a consultation with neurologists.

About diagnostics

Recognition with hyperactivity (ADHD) occurs in several stages. An experienced doctor will definitely follow a certain algorithm.

At the very beginning, you need to tell about yourself. If we are talking about children, the doctor asks to make a psychological portrait of a minor. The story will also need to include details of the patient's life and behavior.

The next step is the appointment of additional studies. For example, a neurologist may ask for an ultrasound of the brain and tomography. Attention deficit hyperactivity disorder in adults and children in these pictures will be clearly visible. With the disease being studied, the work of the brain changes slightly. And this is reflected in the results of ultrasound.

Perhaps that's all. In addition, the neurologist will study the patient's disease map. After all of the above, a diagnosis is made. And, accordingly, treatment is prescribed. Correction of ADHD is a very long process. In any case, in children. Treatment is prescribed differently. It all depends on the cause of hyperactivity.

Medicines

Now it’s clear what the attention deficit hyperactivity disorder is. Treatment, as already mentioned, for children and adults is prescribed varied. The first method is medical correction. As a rule, this option is not suitable for very young children.

What can be prescribed for a child or adult diagnosed with ADHD? Nothing dangerous. As a rule, among the medicines there are only vitamins, as well as sedatives. Sometimes antidepressants. Signs of ADHD are eliminated in this way quite successfully.

No other essential drugs are prescribed. All pills and drugs prescribed by a neurologist are aimed at calming the nervous system. Therefore, you should not be afraid of the prescribed sedative. Regular intake - and soon the disease will pass. Not a panacea, but this kind of solution works quite effectively.

Folk methods

Some people do not trust the action of medicines. Therefore, you can consult a neurologist and use folk methods treatment. They often turn out to be no less effective than pills.

What can be advised if ADHD is observed? Symptoms in children and adults can be relieved by taking:

• chamomile tea;
• sage;
• calendula.

Baths with essential oils help well, as well as salt with a calming effect. Children can be given warm milk with honey at night. However, the medical effectiveness of these techniques has not been proven. The person will act at their own peril and risk. However, many adults refuse any treatment for ADHD in themselves. But in the case of children, as already mentioned, the problem under study should not be overlooked.

Treatment of children without pills

What other treatments are available for ADHD? The drugs prescribed by doctors are, as already mentioned, sedatives. Something like Novopassit. Not all parents are ready to give their children this kind of pills. Some point out that sedatives are addictive. And by getting rid of ADHD in this way, it is possible to provide the child with dependence on antidepressants. Agree, not the best solution!

Fortunately, in children, hyperactivity can be corrected even without pills. The only thing to consider: parents must be patient. After all, hyperactivity is not quickly treated. And this must be remembered.

1. Spend more time with children. Especially if hyperactivity is a consequence of a lack of attention from parents. It's good when one of the parents can stay "on maternity leave". That is, not to work, but to deal with the child.
2. Send the baby to educational circles. Good way increase the child's attention, and develop it comprehensively. You can even find specialized centers that organize classes for children with hyperactivity. Now this is not such a rarity.
3. Students need to do more. But do not force him to sit for days on homework. It should also be understood that poor grades are a consequence of ADHD. And scolding a child for it is at least cruel.
4. If you need to find a use for his energy. In other words, sign up for some sports activities. Or just give a day to run enough. The idea with sections interests parents the most. A good way to spend time usefully, and at the same time throw out the accumulated energy.
5. Calmness is another point that should take place. The fact is that when correcting ADHD in children who show aggression, parents scold them for bad behavior, and as a result, they cannot cope with the child's condition. Only in a calm environment is it possible to heal.
6. The last point that helps parents is to support the child's hobbies. If the baby is interested in something, it must be supported. Do not confuse this with permissiveness. But it is not necessary to suppress the desire of children to explore the world, even if it is too active. You can try to interest the baby in some more peaceful activity. Things that you can do with your child help a lot.

By following these rules, parents have a high likelihood of success in treating ADHD in children. Rapid progress, as already mentioned, will not come. Sometimes it takes up to several years to correct. If you start treatment on time, you can easily defeat such a chronic condition completely.

conclusions

Diagnosis of ADHD in a child - what is it? What about an adult? The answers to these questions are already known. In fact, you should not be afraid of the syndrome. No one is safe from him. But with timely access to a specialist, as practice shows, there is a high probability of successful treatment.

Self-medication is not recommended. Only a neurologist is able to prescribe the most effective therapy, which will be selected in individually based on the reasons that led to the diagnosis. If the doctor is completely little child prescribes a sedative, it is better to show the baby to another specialist. It is possible that parents communicate with a non-professional who is not able to distinguish spoiled from ADHD.

It is not necessary to get angry at the child and scold him for his activity. Punish and intimidate - too. Under any circumstances, it should be remembered that hyperactivity is not a sentence. And in adulthood, this syndrome is not so noticeable. Often with age, hyperactive behavior normalizes on its own. But it can show up at any time.

In fact, ADHD is observed most often in schoolchildren. And do not consider it a shame or some kind of terrible sentence. Children with hyperactivity are often more talented than their peers. The only thing that prevents them from succeeding is the problem of concentration. And if you help to solve it, the child will please his parents more than once. ADHD (diagnosis by a neurologist) - what is it? which does not surprise modern doctors and is corrected with the right treatment!

ADHD Attention Deficit Hyperactivity Disorder is characterized by poor concentration, excessive impulsivity and activity.

How can parents identify ADHD in a child?

Causes of ADHD in children:

• heredity;
• heavy pregnancy of the mother;
• the presence of severe chronic diseases in a child;
• dangerous infectious diseases transferred in infancy or early childhood.

A third of children with this diagnosis "outgrow" this condition. Only a specialist (psychiatrist, psychologist or neuropathologist) can reliably determine ADHD in a child with the help of special techniques. However, only parents (or teachers) can pay attention to the atypical behavior of the child and attach serious importance to this.

Until the age of 3-5 years, parents can rarely independently determine concentration disorders or excessive activity in a child. From the moment of attending kindergarten, parents (or caregivers) may notice that the child has difficulty concentrating.

Features of the behavior of children with ADHD:

• Children with ADHD find it difficult play educational or, focus on the task.
• A child with ADHD is unable to start a task and see it through to the end , he often starts tasks and abandons them, switching to something else.
• Manifestations of hyperactivity in children are frequent active movements of the child. He cannot sit still, but tends to get up and go somewhere or run away. It is difficult for him to play quietly and behave calmly.
• An impulsive child cannot calmly wait for his turn, interrupts others and does not allow them to say their thoughts to the end, shouts at the lessons, interferes in the activities of other children, talks a lot of irrelevant things. Manifestations of impulsivity in children are more clearly visible in late preschool or early school age.

Hyperdynamic syndrome is especially common in children. Active, noisy, mobile children - they are often called "nimble" - attract the attention of everyone who sees and hears them. The main signs of this syndrome are motor disinhibition, extreme mobility, inability to precise movements, distractibility, inattention, inability to concentrate on something. Being in constant motion hyperactive child He always knocks on something, fills bruises and bumps - and immediately forgets about them, absorbed without a trace by the opportunity to personally participate in the fast-flowing process of life. He can leave the premises of the group and even from the territory of the kindergarten, get into a trolleybus going nowhere. ( Psychological and pedagogical support of hyperactive preschoolers: textbook.-method. allowance Ed. Tokar O.V., Zimarevoy T.T., Lipai N.E. Source )

If parents or teachers have suspicions that a child has ADHD, then it is worth observing him for some time in different settings (at home, in kindergarten, on the street), and then draw the appropriate conclusions.

Diagnostic criteria for ADHD by classificationDSM-IV (1994)

ADHD is classified into 3 types:

• ADHD with predominance of hyperactivity/impulsivity.
• ADHD with a predominance of impaired concentration.
• Mixed type, which includes all three symptoms (hyperactivity, impulsivity, inattention).

Table for determining the type of ADHD in children.

Based on the above signs, observing the child for 6 months, it is necessary to systematize all manifestations of his character. Only a specialist can diagnose ADHD specialized education(psychiatrist, psychologist or neuropathologist).

• If the child has manifestations of all the symptoms listed in the table, then a diagnosis is made. mixed form ADHD .
• If a child for six months of observation mainly showed signs of inattention, and hyperactivity and impulsivity were not so pronounced, then the diagnosis will be « ADHD with predominant attention disorder and, conversely, with the predominance of hyperactivity, a diagnosis is made "ADHD with predominance of hyperactivity and impulsivity" .

To clarify the diagnosis of ADHD, additionally carry out:

• studying the history of health from the moment of birth;
• psychological examination;
• laboratory and instrumental studies according to pediatrician's indications;
• neurological examination;
• examination by an endocrinologist and the appointment of hormonal tests;
• genealogy study.

Methods for correcting ADHD and effective methods of treatment in children

• The approach and method of treating ADHD should be individualized for each child. First of all, it is applied non-drug therapy , which includes psychotherapy, pedagogical methods of behavior correction, behavioral therapy . The purpose of non-drug treatment is to improve the child's concentration on tasks, develop patience, teach correct behavior in different situations, etc.
• In cases where non-drug therapy does not give the desired effect, in addition to it, psychoactive drugs . The appointment of psychostimulants to children should be carried out very carefully and only by a specialist with a higher medical education, since the improper use of such drugs is addictive and worsens the mental state of the child.

10 Helpful Tips for Parents of Children with ADHD: Do's and Don'ts

10 tips on how to behave and how not to act as an adult with children with ADHD

Psychologists Lyutova E, Monina G. in his book "Crib for adults" Parents are advised to adhere to the following rules when working with children with ADHD:

1. Work with the child at the beginning of the day, not in the evening.
2.Reduce the child's workload.
3. Divide work into shorter but more frequent periods. Use physical exercises.
4. Be a dramatic, expressive parent and educator.
5. Reduce the requirements for accuracy at the beginning of work to create a sense of success.
6.Place the child during classes next to the teacher.
7. Use tactile contact (elements of massage, touch, stroking).
8. Agree with the child about certain actions in advance.
9. Give short, clear and specific instructions.
10. Use a flexible system of rewards and punishments.
11. Encourage the child right away, do not put it off for the future.
12. Give the child the opportunity to choose.
13. Stay calm. No composure - no advantage.

Parents will find a lot of useful information on raising children with ADHD in the book. child psychiatrist, psychotherapist Oleg Igorevich Romanchuk. An interesting quote from this book:

Probably all of us are at least partially familiar with these children (with ADHD) thanks to the famous children's cartoon character Petya Pyatochkin. He has typical signs of this disorder - he is hyperactive, is in constant motion and, according to the teacher, "in this boy, like in a fluffy bunny, an extraordinary bouncing spring is hidden." It is because of this excessive activity that Petya creates constant problems around him: he knocks down a bucket to a neighbor, his parents must constantly control him so that he does not run away somewhere, in kindergarten he turns everything upside down and cannot be controlled and managed. There is also impulsiveness in Petya, typical for children with ADHD - when he sees a dog on the opposite side of the street, he runs across the street without thinking, without looking back, ignoring the danger and breaking the rules. And there are also obvious problems with attention - carried away by the game, the boy simply does not hear the teacher ... The cartoon with brilliant accuracy indicates what Petya can help - a wise pedagogical approach based on love, patience, understanding. However, unfortunately, in life, changes do not come as quickly as in the cartoon - and become the result of a long, consistent upbringing ... ("Attention deficit and hyperactivity disorder in children" Romanchuk O.I.)

Attention deficit hyperactivity disorder (ADHD), similar to ICD-10 hyperkinetic disorder), is an evolving neuropsychiatric disorder in which there are significant problems with executive functions (for example, attention-related control and inhibitory control) that cause attention deficit hyperactivity or impulsiveness inappropriate for the person's age. These symptoms may begin between the ages of six and twelve and persist for more than six months from the time of diagnosis. In school-aged subjects, symptoms of inattention often lead to poor school performance. Although this causes inconvenience, in particular in modern society Many children with ADHD have good attention spans for tasks they find interesting. Although ADHD is the most well-studied and diagnosed psychiatric disorder in children and adolescents, the cause is unknown in most cases.

The syndrome affects 6-7% of children when diagnosed using the criteria of the manual for the diagnosis and statistical accounting of mental illness, revision IV and 1-2% when diagnosed using the criteria. Prevalence is similar among countries dependent for the most part on how the syndrome is diagnosed. Boys are approximately three times more likely to be diagnosed with ADHD than girls. About 30-50% of people diagnosed in childhood have symptoms in adulthood, and approximately 2-5% of adults have the condition. The condition is difficult to distinguish from other disorders, as well as from a state of normal increased activity. Management of ADHD usually involves a combination of psychological counseling, lifestyle changes, and medications. Medications are only recommended as first-line treatment in children who show severe symptoms and may be considered for children with moderate symptoms who refuse or do not respond to psychological counseling.

Therapy with stimulant drugs is not recommended for children preschool age. Treatment with stimulants is effective up to 14 months; however, their long-term effectiveness is not clear. Adolescents and adults tend to develop coping skills that apply to some or all of their disabilities. ADHD, its diagnosis and treatment have remained controversial since the 1970s. The controversy spans practitioners, teachers, politicians, parents and the media. Topics include the cause of ADHD and the use of stimulant drugs in its treatment. Most of medical workers recognize ADHD as a congenital disorder, and the debate in the medical community is largely focused on how it should be diagnosed and treated.

Signs and symptoms

ADHD is characterized by inattention, hyperactivity (an agitated state in adults), aggressive behavior, and impulsivity. Often there are learning difficulties and relationship problems. Symptoms can be difficult to define as it is difficult to draw the line between normal levels of inattention, hyperactivity, and impulsivity and significant levels requiring intervention. DSM-5-diagnosed symptoms must have been present in a variety of environments for six months or more, and to a degree that is significantly greater than in other subjects of the same age. They can also cause problems in a person's social, academic and professional life. Based on the symptoms present, ADHD can be divided into three subtypes: predominantly inattentive, predominantly hyperactive-impulsive, and mixed.

A subject with inattention may have some or all of the following symptoms:

Easily distracted, missing details, forgetting things, and frequently switching from one activity to another

He finds it difficult to keep his attention on the task

The task becomes boring after only a few minutes if the subject is not doing something enjoyable.

Difficulty focusing on organizing and completing tasks, learning new things

Has trouble completing or turning in homework, often loses items (eg, pencils, toys, assignments) needed to complete an assignment or activity

Doesn't listen when talking

Soaring in the clouds, easily confused and moving slowly

Has difficulty processing information as quickly and accurately as others

Difficulty following instructions

A subject with hyperactivity may have some or all of the following symptoms:

Restlessness or fidgeting in place

Talks non-stop

Throws at everything, touches and plays with everything in sight

Difficulty sitting during lunch, in class, doing homework and while reading

Constantly on the move

Difficulty doing quiet tasks

These symptoms of hyperactivity tend to disappear with age and turn into "inward restlessness" in adolescents and adults with ADHD.

A subject with impulsivity may have all or more of the following symptoms:

Be very impatient

Blabber inappropriate comments, show emotions without restraint, and act without thinking about the consequences

Difficulty looking forward to the things he wants or looking forward to returning to the game

Frequently interrupts communication or activities of others

People with ADHD are more likely to have difficulty with communication skills, such as social interaction and education, and maintaining friendships. This is true for all subtypes. About half of children and adolescents with ADHD exhibit social withdrawal compared to 10-15% of non-ADHD children and adolescents. People with ADHD have an attention deficit that causes difficulty with verbal and non-verbal language, which negatively affects social interaction. They may also fall asleep during social interaction and lose social stimulus. Difficulty managing anger is more common in children with ADHD, as are poor handwriting and slow speech, language, and motor development. While this is a significant inconvenience, particularly in today's society, many children with ADHD have good attention spans for tasks they find interesting.

Associated violations

In children with ADHD, other disorders are observed in about ⅔ of cases. Some common violations include:

1. Learning disabilities occur in approximately 20-30% of children with ADHD. Learning disabilities can include speech and language disorders, as well as learning disabilities. ADHD, however, is not considered a learning disability, but often causes learning difficulties.
2. Tourette's syndrome is more common among ADHD sufferers.
3. Oppositional defiant disorder (ODD) and conduct disorder (CD), which are observed in ADHD in approximately 50% and 20% of cases, respectively. They are characterized by antisocial behavior such as stubbornness, aggression, frequent temper tantrums, duplicity, lying and stealing. Approximately half of those with ADHD and ODD or CD develop antisocial personality disorder in adulthood. Brain scans prove that conduct disorder and ADHD are separate disorders.
4. Primary attention disorder, which is characterized by low attention and concentration, as well as difficulty staying awake. These children tend to fidget, yawn, and stretch, and have to be hyperactive in order to remain alert and active.
5. Hypokalemic sensory overstimulation is present in less than 50% of people with ADHD and may be the molecular mechanism for many ADHD sufferers.
6. Mood disorders (especially bipolar disorder and major depressive disorder). Boys diagnosed with the mixed subtype of ADHD are more likely to have a mood disorder. Adults with ADHD also sometimes have bipolar disorder, which requires careful evaluation to make an accurate diagnosis and treat both conditions.
7. Anxiety disorders are more common in ADHD sufferers.
8. Obsessive-compulsive disorder (OCD) can occur with ADHD and shares many of its characteristics with it.
9. Disorders caused by the use of psychoactive substances. Adolescents and adults with ADHD are at increased risk of developing a substance use disorder. Most of it is associated with alcohol and cannabis. The reason for this may be a change in the reinforcement pathway in the brain of subjects with ADHD. This makes ADHD more difficult to identify and treat, with serious substance use problems usually being treated first due to the higher risk.
10. Restless legs syndrome is more common in people with ADHD and is often associated with iron deficiency anemia. However, restless leg syndrome may be just a subset of ADHD and requires precise evaluation to distinguish between the two disorders.
11. Sleep disorders and ADHD usually coexist. They can also occur as a side effect of drugs used to treat ADHD. In children with ADHD, insomnia is the most common sleep disorder, with behavioral therapy as the treatment of choice. Trouble falling asleep is common among ADHD sufferers, but more often they are deep sleepers and have significant difficulty waking up in the morning. Melatonin is sometimes used to treat children who have difficulty falling asleep.

There is an association with persistent bedwetting, slow speech and dyspraxia (DCD), with about half of people with dyspraxia having ADHD. Slow speech in people with ADHD may include problems with hearing impairments such as poor short-term auditory memory, difficulty following instructions, slow speed in processing written and spoken language, difficulty hearing in distracting environments such as in the classroom, and difficulty understanding read.

The reasons

The cause of most cases of ADHD is not known; however, environmental involvement is assumed. Certain cases are associated with a previous infection or brain injury.

Genetics

See also: Hunter-Farmer Theory Twin studies show that the disorder is often inherited from one parent, with genetics accounting for about 75% of cases. Siblings of children with ADHD are three to four times more likely to develop the disorder than siblings of non-ADHD children. Genetic factors are thought to be relevant to whether ADHD persists into adulthood. Usually several genes are involved, many of which directly affect dopamine neurotransmission. Genes involved in dopamine neurotransmission include DAT, DRD4, DRD5, TAAR1, MAOA, COMT, and DBH. Other genes associated with ADHD include SERT, HTR1B, SNAP25, GRIN2A, ADRA2A, TPH2, and BDNF. A common gene variant called LPHN3 is estimated to be responsible for about 9% of cases and when this gene is present, people respond partially to the stimulant drug. Since ADHD is widespread, natural selection likely favors characteristic features, at least individually, and they may provide a survival advantage. For example, some women may be more attractive to male risk-takers by increasing the frequency of genes that predispose to ADHD in the genetic pool.

Since the syndrome is most common in children of anxious or stressed mothers, some have suggested that ADHD is an adaptation that helps children cope with stressful or dangerous environments, such as increased impulsivity and exploratory behavior. Hyperactivity can be useful from an evolutionary perspective in situations that involve risk, competition, or unpredictable behavior (such as exploring new places or finding new food sources). In these situations, ADHD can be beneficial to society as a whole, even if harmful to the subject himself. In addition, in certain environments, it can confer benefits on the subjects themselves, such as quick responses to predators or superior hunting skills.

Environment

Environmental factors are thought to play a lesser role. Alcohol use during pregnancy can cause fetal alcohol spectrum disorder, which may include ADHD-like symptoms. Exposure to tobacco smoke during pregnancy can cause problems with the development of the central nervous system and increase the risk of ADHD. Many children exposed to tobacco smoke do not develop ADHD or have only mild symptoms that do not reach the limit of a diagnosis. The combination of genetic predisposition and exposure to tobacco smoke may explain why some children exposed during pregnancy may develop ADHD while others do not. Children exposed to even low levels of lead or PCBs can develop problems that resemble ADHD and lead to a diagnosis. Exposure to the organophosphate insecticides chlorpyrifos and dialkyl phosphate has been associated with an increased risk; however, the evidence is not conclusive.

Very low birth weight, preterm birth, and early exposure to adverse factors also increase risk, as do infections during pregnancy, birth, and early childhood. These infections include, among others, various viruses (finnosis, varicella, rubella, enterovirus 71) and streptococcal bacterial infection. At least 30% of children with traumatic brain injury later develop ADHD, and about 5% of cases are associated with brain damage. Some children may react negatively to food coloring or preservatives. It is possible that certain colored foods may act as triggers in those with a genetic predisposition, but the evidence is weak. The UK and the EU have introduced regulation based on these issues; The FDA didn't.

Society

A diagnosis of ADHD may indicate family dysfunction or poor educational system and not about the problems of the individual. Some cases may be explained by heightened educational expectations, with the diagnosis in some cases representing a way for parents to obtain additional financial and educational support for their children. The youngest children in a class are more likely to be diagnosed with ADHD, presumably because they lag behind their older classmates in development. Behavior typical of ADHD is more common in children who have experienced abuse and moral humiliation. According to social order theory, societies define the boundary between normal and unacceptable behavior. Members of the community, including physicians, parents, and teachers, determine which diagnostic criteria to use and thus the number of people affected by the syndrome. This has led to the present situation where the DSM-IV shows an ADHD level three to four times the ICD-10 level. Thomas Szas, who supports this theory, argued that ADHD was "invented, not discovered."

Pathophysiology

Current models of ADHD suggest that it is associated with functional impairments in several brain neurotransmitter systems, in particular those involving dopamine and norepinephrine. Dopamine and norepinephrine pathways, which originate in the ventral tegmenta and the locus coeruleus, target different regions of the brain and mediate a variety of cognitive processes. Dopamine and norepinephrine pathways, which target the prefrontal cortex and striatum (particularly the pleasure center), are directly responsible for regulation of executive function (cognitive control of behavior), motivation, and reward perception; these pathways play a major role in the pathophysiology of ADHD. Larger models of ADHD with additional pathways have been proposed.

Structure of the brain

Children with ADHD have a general decrease in the volume of certain brain structures, with a proportionately large decrease in the volume of the left-sided prefrontal cortex. The posterior parietal cortex also shows thinning in ADHD subjects compared to controls. Other brain structures in the prefrontal-striate-cerebellar and prefrontal-striate-thalamic circuits also differ between people with and without ADHD.

Neurotransmitter pathways

It used to be thought that the increased number of dopamine transporters in people with ADHD was part of the pathophysiology, but the increased number appears to be related to adaptation to stimulant exposure. Current models include the mesocorticolimbic dopamine pathway and the coeruleus-noradrenergic system. Psychostimulants for ADHD are effective treatments because they increase the activity of neurotransmitters in these systems. Additionally, pathological abnormalities in the serotonergic and cholinergic pathways may be observed. Also relevant is the neurotransmission of glutamate, a dopamine cotransmitter in the mesolimbic pathway.

Executive function and motivation

Symptoms of ADHD include problems with executive function. Executive function refers to several mental processes that are required to regulate, control, and manage the tasks of daily life. Some of these impairments include problems with organization, timing, excessive procrastination, concentration, execution speed, emotion regulation, and short-term memory use. People generally have good long-term memory. 30-50% of children and adolescents with ADHD meet the criteria for executive function deficit. One study found that 80% of subjects with ADHD were impaired in at least one executive function task compared to 50% of subjects without ADHD. Due to the degree of brain maturation and the increased demand for executive control as people get older, ADHD disorders may not fully manifest themselves until adolescence or even late adolescence. ADHD is also associated with motivational deficits in children. Children with ADHD have difficulty focusing on long-term rewards over short-term rewards and also show impulsive behavior towards short-term rewards. In these subjects, a large amount of positive reinforcement effectively increases performance. ADHD stimulants can increase resilience in children with ADHD equally.

Diagnostics

ADHD is diagnosed through an assessment of a person's childhood behavior and mental development, including ruling out exposure to drugs, medications, and other medical or psychiatric problems as explanations for symptoms. Feedback from parents and teachers is often taken into account, with most diagnoses made after the teacher has raised concerns about it. It can be seen as an extreme manifestation of one or more permanent human traits found in all humans. The fact that someone responds to medication does not confirm or rule out a diagnosis. Since brain imaging studies did not provide reliable results in subjects, they were only used for research purposes and not diagnosis.

The DSM-IV or DSM-5 criteria are often used for diagnosis in North America, while European countries generally use the ICD-10. At the same time, the DSM-IV criteria make the diagnosis of ADHD 3-4 times more likely than the ICD-10 criteria. The syndrome is classified as a developmental neurodevelopmental disorder. In addition, it is classified as a social conduct disorder along with oppositional defiant disorder, conduct disorder, and antisocial personality disorder. The diagnosis does not suggest a neurological disorder. Comorbid conditions that should be screened for include anxiety, depression, oppositional defiant disorder, conduct disorder, learning and speech impairment. Other conditions to be considered are other neurodevelopmental disorders, tics and sleep apnea. The diagnosis of ADHD using quantitative electroencephalography (QEEG) is an area of ​​ongoing research, although the value of QEEG in ADHD is not clear to date. In the United States, the Food and Drug Administration has approved the use of QEEG to estimate the prevalence of ADHD.

Diagnostics and statistical guidance

As with other psychiatric disorders, a formal diagnosis is made by a qualified professional based on a combination of several criteria. In the United States, these criteria are defined by the American Psychiatric Association in the Diagnostic and Statistical Manual of Mental Illness. Based on these criteria, three subtypes of ADHD can be distinguished:

Predominantly inattentive ADHD (ADHD-PI) presents with symptoms including mild distractibility, forgetfulness, daydreaming, disorganization, low concentration, and difficulty completing tasks. Often people refer to ADHD-PI as "attention deficit disorder" (ADD), however, the latter has not been formally approved since the 1994 revision of the DSM.

ADHD predominantly hyperactive-impulsive type manifests as excessive anxiety and agitation, hyperactivity, difficulty waiting, difficulty staying still, infantile behavior; destructive behavior can also be observed.

ADHD mixed type is a combination of the first two subtypes.

This division is based on the presence of at least six of the nine long-term (lasting at least six months) symptoms of inattention, hyperactivity-impulsivity, or both. To be taken into account, symptoms must appear between the ages of six and twelve and be observed at more than one environmental stop (for example, at home and at school or at work). The symptoms must not be acceptable to children at this age, and there must be evidence that they cause school or work-related problems. Most children with ADHD have a mixed type. Children with the inattentive subtype are less likely to pretend or have difficulty getting along with other children. They may sit quietly but not paying attention, whereby difficulties may be overlooked.

International classifier of diseases

In the ICD-10, the symptoms of "hyperkinetic disorder" are similar to ADHD in the DSM-5. When a conduct disorder (as defined by ICD-10) is presented, the condition is referred to as hyperkinetic conduct disorder. Otherwise, the impairment is classified as activity and attention impairment, other hyperkinetic disorders, or unspecified hyperkinetic disorders. The latter are sometimes referred to as the hyperkinetic syndrome.

adults

Adults with ADHD are diagnosed according to the same criteria, including signs that may be present between the ages of six and twelve. Questioning parents or caregivers about how the person behaved and developed as a child may form part of the assessment; a family history of ADHD also contributes to the diagnosis. While the main symptoms of ADHD are the same in children and adults, they often manifest themselves differently, for example, excessive physical activity observed in children can manifest as a feeling of restlessness and constant mental activity in adults.

Differential Diagnosis

Symptoms of ADHD that may be associated with other disorders

Depression:

Feelings of guilt, hopelessness, low self-esteem, or unhappiness

Loss of interest in hobbies, ordinary activities, sex, or work

Fatigue

Too short, poor or excessive sleep

Appetite changes

Irritability

Low stress tolerance

Suicidal thoughts

unexplained pain

Anxiety disorder:

Restlessness or a persistent feeling of anxiety

Irritability

Inability to relax

overexcitation

easy fatigue

Low stress tolerance

Difficulty paying attention

Mania:

Excessive feeling of happiness

Hyperactivity

Leap of ideas

Aggression

Excessive talkativeness

grandiose crazy ideas

Decreased need for sleep

Unacceptable social behavior

Difficulty paying attention

Symptoms of ADHD such as Bad mood and low self-esteem, mood swings, and irritability may be confused with dysthymia, cyclothymia, or bipolar disorder, as well as borderline personality disorder. Some symptoms that are associated with anxiety disorders, antisocial personality disorder, developmental or mental retardation, or chemical dependency effects such as intoxication and withdrawal may overlap with some of the symptoms of ADHD. These disorders sometimes occur along with ADHD. Medical conditions that can cause ADHD symptoms include: hypothyroidism, epilepsy, lead toxicity, hearing loss, liver disease, sleep apnea, drug interactions, and traumatic brain injury. Primary sleep disturbances can affect attention and behavior, and ADHD symptoms can affect sleep. Thus, it is recommended that children with ADHD be monitored regularly for sleep problems. Sleepiness in children can lead to symptoms ranging from classic yawning and eye rubbing to hyperactivity with inattention. Obstructive sleep apnea can also cause ADHD-type symptoms.

Control

Management of ADHD usually involves psychological counseling and medication, alone or in combination. While treatment may improve long-term outcomes, this does not rule out negative outcomes in general. Drugs used include stimulants, atomoxetine, alpha-2 adrenergic agonists, and sometimes antidepressants. Dietary changes may also be helpful, with evidence supporting free fatty acids and reduced exposure to food coloring. Removing other foods from the diet is not supported by the evidence.

Behavioral Therapy

There is strong evidence for the use of behavioral therapy for ADHD, and it is recommended as a first-line treatment for those with mild symptoms or for preschool children. Physiological therapies used include: psychoeducational stimulus, behavioral therapy, cognitive behavioral therapy (CBT), interpersonal therapy, family therapy, school interventions, social skills training, parenting training, and neural feedback. The preparation and education of parents has short-term benefits. There is little high-quality research on the effectiveness of family therapy for ADHD, but the evidence suggests that it is equivalent to health care and better than placebo. There are some specific ADHD support groups as information sources that can help families deal with ADHD.

Social skills training, behavioral modification, and drugs may have limited benefits to some extent. The most important factor in alleviating late psychological problems such as major depression, delinquency, school failure, and substance use disorder is the formation of friendships with people who are not involved in delinquent activities. Regular exercise, in particular aerobic exercise, is an effective adjunct to the treatment of ADHD, although the best type and intensity is not currently known. In particular, physical activity causes better behavior and motor abilities without any side effects.

Medications

Stimulant drugs are the preferred pharmaceutical treatment. They have at least a short-term effect in about 80% of people. There are several non-stimulant medications such as atomoxetine, bupropion, guanfacine, and clonidine that can be used as alternatives. There are no good studies comparing different drugs; however, they are more or less equal in terms of side effects. Stimulants improve academic performance while atomoxetine does not. There is little evidence regarding its effect on social behavior. Medicines are not recommended for preschool children, since the long-term effect in this age group not known. The long-term effects of stimulants are generally unclear, with only one study finding beneficial effects, another finding no benefit, and a third finding harmful effects. Magnetic resonance imaging studies suggest that long-term treatment with amphetamine or methylphenidate reduces the pathological abnormalities in brain structure and function found in subjects with ADHD.

Atomoxetine, due to the lack of addictive potential, may be preferable for those at risk of addiction to stimulant drugs. Recommendations for when to use drugs vary between countries, with the UK National Institute for Health and Care Excellence recommending their use only in severe cases, while US guidelines recommend the use of drugs in almost all cases. While atomoxetine and stimulants are generally safe, there are side effects and contraindications for their use.

Stimulants can cause psychosis or mania; however, this is a relatively rare occurrence. For those undergoing long-term treatment, regular check-ups are recommended. Stimulant therapy should be temporarily discontinued to assess the subsequent need for the drug. Stimulant drugs have the potential to develop addiction and dependency; Several studies suggest that untreated ADHD is associated with an increased risk of chemical dependency and conduct disorders. The use of stimulants either reduces this risk or does not affect it. Data security medicines during pregnancy is not defined.

Zinc deficiency has been associated with symptoms of inattention, and there is evidence that zinc supplementation is beneficial for children with ADHD who have low zinc levels. Iron, magnesium, and iodine may also have an effect on ADHD symptoms.

Forecast

An 8-year study of children diagnosed with ADHD (mixed type) found that adolescents often have difficulty with or without treatment. In the US, less than 5% of subjects with ADHD receive a degree in higher education compared to 28% of the general population aged 25 and over. The proportion of children meeting the criteria for ADHD drops to about half within three years of diagnosis, regardless of the treatment used. ADHD persists in adults in about 30-50% of cases. Sufferers of the syndrome are likely to develop coping mechanisms as they grow older, thus compensating for previous symptoms.

Epidemiology

It is estimated that ADHD affects about 6-7% of people aged 18 and over when diagnosed using the DSM-IV criteria. When diagnosed using the ICD-10 criteria, the prevalence in this age group is estimated to be 1-2%. Children in North America have a higher prevalence of ADHD than children in Africa and the Middle East; this is presumably due to differing diagnostic methods rather than differences in the incidence of the syndrome. If the same diagnostic methods were used, the prevalence in different countries would be more or less the same. The diagnosis is made approximately three times more often in boys than in girls. This gender difference may reflect either a difference in predisposition or that girls with ADHD are less likely to be diagnosed with ADHD than boys. The intensity of diagnosis and treatment has increased in both the UK and the US since the 1970s. This is presumably due initially to changes in the diagnosis of the disease and how willing people are to take medication, rather than to changes in the prevalence of the disease. Changes in diagnostic criteria in 2013 with the release of the DSM-5 are expected to have increased the percentage of people diagnosed with ADHD, especially among adults.

Story

Hyperactivity has long been part of human nature. Sir Alexander Crichton describes "mental excitement" in his book An Inquiry into Nature and Origin mental disorder written in 1798. ADHD was first clearly described by George Still in 1902. The terminology used to describe the condition has changed over time and includes: in the DSM-I (1952) "minimal brain dysfunction", in the DSM- II (1968) "hyperkinetic childhood reaction", in DSM-III (1980) "attention deficit disorder (ADD) with or without hyperactivity". In 1987, it was renamed ADHD to the DSM-III-R, and the DSM-IV in 1994 reduced the diagnosis to three subtypes, ADHD of the inattentive type, ADHD of the hyperactive-impulsive type, and ADHD of the mixed type. These concepts were retained in the DSM-5 in 2013. Other concepts included "minimal brain damage" used in the 1930s. The use of stimulants for the treatment of ADHD was first described in 1937. In 1934, benzedrine became the first amphetamine drug approved for use in the United States. Methylphenidate was discovered in the 1950s and enantiopure dextroamphetamine in the 1970s.

Society and culture

controversy

ADHD, its diagnosis and treatment have been the subject of debate since the 1970s. Doctors, teachers, politicians, parents and the media are involved in the controversy. Opinions regarding ADHD range from being merely the extreme limit of normal behavior to being the result of a genetic condition. Other areas of controversy include the use of stimulant drugs and especially their use in children, as well as the method of diagnosis and the likelihood of overdiagnosis. In 2012, the UK National Institute for Health and Care Excellence, acknowledging the controversy, argues that current treatments and diagnostics are based on the prevailing academic literature.

In 2014, Keith Conners, one of the first advocates for disease confirmation, spoke out against overdiagnosis in an article in the NY Times. On the contrary, in 2014 a peer-reviewed review of the medical literature found that ADHD is rarely diagnosed in adults. Due to the widely varying intensity of diagnosis among countries, states within countries, races, and ethnic groups, several confounding factors other than the presence of ADHD symptoms play a role in diagnosis. Some sociologists believe that ADHD is an example of the medicalization of "deviant behavior" or, in other words, the transformation of a previously non-medical problem of school performance into one. Most medical professionals recognize ADHD as a congenital disorder, at least in a small number of people with severe symptoms. The controversy among healthcare professionals is mainly focused on diagnosing and treating a larger population of people with less severe symptoms.

In 2009, 8% of all US Major League Baseball players were diagnosed with ADHD, making the syndrome highly prevalent in this population. The raise coincides with the League's 2006 ban on stimulants, raising concerns that some players were faking or faking ADHD symptoms to get around the ban on stimulant use in sports.

Attention deficit hyperactivity disorder (ADHD) is a neurobehavioral disorder that is typically characterized by the following symptoms:

inattention;
- distractibility;
- impulsiveness;
- hyperactivity.

Kinds

Attention Deficit Hyperactivity Disorder is divided into three subtypes:

Predominantly hyperactive or impulsive type. The behavior is marked by hyperactivity and impulsivity, but not by inattention;
- mostly inattentive type. The behavior is marked by inattention, but not by hyperactivity and impulsivity;
- combined type. The combination of symptoms of hyperactivity and impulsivity - with symptoms of inattention. This is the most common type of Attention Deficit Hyperactivity Disorder.

in children

Attention Deficit Hyperactivity Disorder (ADHD) is sometimes described as a decrease in brain function. It refers to the cognitive abilities needed to plan, organize, and complete tasks. Deficiency in the performance function can cause the following problems:

The inability to store information in short-term memory;
- violation of organization and planning skills;
- Difficulties in establishing and using behavioral guidelines such as the choice of strategy and monitoring objectives;
- overwhelming inability to cope with emotions;
- inability to effectively transition from one mental activity to another.

Symptoms of Attention Deficit Hyperactivity Disorder in Children

- Hyperactivity. The term "hyperactive" is often misleading as it suggests to some that the child is in constant, non-stop motion. However, boys with ADHD, while playing a game, for example, may have the same level of activity as children without the syndrome. But when a child is given increased attention, his brain increases motor activity. In a busy environment - a classroom or a crowded store - children with ADHD are often distracted and overreact to everything. They can take goods from the shelves without asking a parent, beat people - in a word, everything gets out of control for them, resulting in unstable and strange behavior.

- Impulsivity and hysteria. Tantrums, which are normal in young children, are usually exaggerated in children with ADHD and are not necessarily associated with a specific negative event.

- Attention and concentration. Children with Attention Deficit Hyperactivity Disorder tend to be distracted and inattentive towards environment(for example, big class). In addition, they are inattentive when the atmosphere is calm or boring. On the contrary, they may have a kind of "super concentration" when there is a high stimulating activity (for example, a video game or very specific interests). Such children may even become overly attentive - they are so absorbed in an activity that is interesting for them that they cannot completely change the direction of their attention.

- Violation of short-term memory. An important feature in attention deficit hyperactivity disorder, including in learning, is a violation of working (or short-term) memory. People with ADHD cannot hold groups of sentences and images in their minds long enough to generate clear, coherent thoughts. They are not necessarily inattentive. A person with ADHD may not be able to remember a full explanation (for example, homework) or be unable to complete processes that require sequential memorization (such as a building model). Children with ADHD are often attracted to activities (television, computer games, active individual sports) that do not overload working memory or produce distractions. Children with ADHD do not differ from other children in long-term memory.

- Inability to manage time. Children with Attention Deficit Hyperactivity Disorder (ADHD) may have difficulty being everywhere on time and scheduling the right time for certain tasks (which may coincide with short-term memory problems).

- Lack of adaptability. Children with Attention Deficit Hyperactivity Disorder (ADHD) often find it very difficult to adapt to even minor changes in routines, such as getting up in the morning, putting on shoes, eating new foods, or changing sleep patterns. Any situation with a change in something can cause them a strong and noisy negative reaction. Even when they are in good mood, they may suddenly become hysterical if they encounter an unexpected change or disappointment. These children can focus their attention directly on cues in a particular place, but have difficulty shifting their attention to something else.

- Hypersensitivity and sleep problems. Children with ADHD are often hypersensitive to objects, sounds, and touch. They may complain of excessive stimuli that seem minor or mild to others. Many children with ADHD often have trouble sleeping during the night.

Attention Deficit Hyperactivity Disorder in adults

Attention Deficit Hyperactivity Disorder (ADHD) is a chronic disorder that begins in childhood. Adult Attention Deficit Hyperactivity Disorder (ADHD) is an extension of the symptoms of childhood ADHD.

Symptoms of attention deficit hyperactivity disorder in adults

- Mental disorders. About 20% of adults with ADHD also have major depression or bipolar disorder. Up to 50% have anxiety disorders. Bipolar disorders can be very difficult to distinguish from ADHD, not only in adults but also in children.

- Disorders accompanying learning. About 20% of adults with Attention Deficit Hyperactivity Disorder have learning disabilities in the brain. These are usually dyslexia and auditory processing problems.

- Influence on work. Compared with adults without ADHD, those with ADHD tend to have lower levels of education, earn less money, and as a result, are more likely to be fired.

- Substance abuse. About 1 in 5 adults with ADHD also struggle with substance abuse. Studies show that teens with ADHD are twice as likely to smoke cigarettes than their peers who do not have ADHD. Smoking during adolescence is a risk factor for the development of substance abuse in adulthood.

The reasons attention deficit hyperactivity disorder

- The structure of the brain. Studies using modern imaging techniques show a difference in size certain parts brain in children with attention deficit hyperactivity disorder compared with children without ADHD. Areas with changes include: prefrontal cortex, caudate nucleus, globus pallidus, and cerebellum;

- Brain chemicals. Increased activity of certain brain chemicals in the prefrontal cortex may contribute to ADHD. The chemicals dopamine and norepinephrine are of particular interest. Dopamine and norepinephrine are neurotransmitters (chemical messengers in the brain) that affect mental and emotional functioning. They also play a role in reward response. This response occurs when a person experiences pleasure in response to certain stimuli (such as food or love). Research shows that elevated levels of the brain chemicals glutamate, glutamine and GABA - interact with dopamine and norepinephrine;

- Genetic factors. Genetic factors most likely play an important role in ADHD. Relatives of children with ADHD (boys and girls) have a much higher percentage of ADHD, as well as antisocial anxiety and disorders, substance abuse, than families without children with attention deficit hyperactivity disorder. Some twin studies show that up to 90% of children diagnosed with ADHD share it with their twin. Most research is being done on the underlying genetic mechanisms of the neurotransmitter dopamine. Changes in the genes that regulate specific dopamine receptors have been found in a large number of people with ADHD.

Risk factors attention deficit hyperactivity disorder

- Floor . ADHD is more commonly diagnosed in boys than girls. Boys are more likely to have a combined type of ADHD. Girls are more likely to have a predominantly inattentive type;

- Family history. A child who has parents or siblings with Attention Deficit Hyperactivity Disorder has an increased risk of also getting ADHD;

- Environmental factors. Some research suggests that maternal alcohol consumption, drug abuse, and smoking during pregnancy can lead to the development of attention deficit hyperactivity disorder in the child. Low birth weight may be associated with ADHD. Environmental exposure to lead before age 6 may also increase the risk of ADHD;

- Nutritional factors. Several nutritional factors have been investigated in association with ADHD, including sensitivity to certain chemicals in nutrition, deficiencies in fatty acids (compounds from fats and oils) and zinc, as well as sensitivity to sugar. However, there is no clear evidence that any of these dietary factors imply risk factors for ADHD.

Diagnostics attention deficit hyperactivity disorder

Diagnosis of Attention Deficit Hyperactivity Disorder in Children

There is no single test to diagnose ADHD. The doctor conducts a physical examination of the child to make sure that the underlying condition is not causing ADHD symptoms. However, the diagnosis of "ADHD" is based mainly on the child's observations and questionnaire, as well as on the patterns of behavior of the SAO (this is the Scale of activity and optimism). A child with SAD may be referred by a pediatrician to a psychiatric hospital where doctors are experienced in dealing with childhood disorders such as ADHD.

- History of behavior. The doctor will ask questions for a detailed history of the child, will identify SAO of his behavior. Parents must describe specific problems encountered with the child, SAO development, family history of ADHD and all last changes family life that may have affected the child. The doctor will learn everything important about the child, about all the details of his life outside the home: written reports from teachers, school psychologists, guardians or others related to the child, etc.

- Medical examination. The physical examination should include a hearing test to rule out any hearing problems for the child. The doctor should ask about a history of medical problems, including allergies, sleep disturbances, poor eyesight, and chronic ear infections.

For the diagnosis of ADHD to be made, at least six of the following symptoms must have been present for at least 6 months (in preschool children, 9 months).
Symptoms of inattention (at least six of them should be):

The child often fails to pay close attention to details or makes inattentive mistakes;
- often has difficulty maintaining attention in tasks or games;
- often does not seem to listen when spoken directly to him;
- often does not complete tasks, assignments;
- has difficulty organizing tasks and activities;
- avoids or dislikes tasks that require sustained mental effort;
- often loses things necessary for tasks or activities;
- often easily distracted by extraneous stimuli;
- Often forgetful in daily activities.

Symptoms of hyperactivity and impulsivity (at least six of them must be present):

Often fidgets or writhes while sitting;
- has difficulty sitting when required;
- often works or often rises in inappropriate situations;
- can't play calmly;
- often on the move
- often talks too much
- often blurts out answers to questions before they have been asked to the end;
- has difficulty waiting in line
- often interrupts others.

Based on these symptoms, a child may be diagnosed with predominantly inattentive ADHD, predominantly hyperactive - impulsive ADHD, or combined ADHD.

Diagnosis of Attention Deficit Hyperactivity Disorder in Adults

Children's Attention Deficit Hyperactivity Disorder can affect children between the ages of 4 and 18. Adult ADHD always occurs as a continuation of childhood ADHD. Symptoms that begin in adulthood are due to factors unrelated to ADHD.

Attention deficit hyperactivity disorder in adults is often difficult to diagnose. The doctor should find out the history or symptoms of childhood ADHD. The patient may ask parents or former teachers for school records or other useful information about the patient. The doctor will ask the patient questions about the following types of symptoms:

Inattention and problems with memory (the patient may forget or lose things, being absent-minded, not finishing things, underestimating the time, the order of things, he has problems starting or changing work, halfway through it);
- hyperactivity and anxiety (the patient is always on the go, fussy, slightly bored, he strives for an active and fast pace in work and activities);
- impulsiveness and emotional instability(the patient says things without hesitation, interrupts others, gets irritated with other people, is easily disappointed, his mood is unpredictable, reckless);
- problems with self-esteem (the patient avoids new tasks, he has confidence in others, but not in himself).

Complications attention deficit hyperactivity disorder

Attention Deficit Hyperactivity Disorder (ADHD) can be a problem for children and their loved ones.

- Emotional problems. Children with ADHD, especially those who also have anxiety or depressive disorders, usually suffer from low self-esteem.

- Social problems. ADHD can affect children in their relationships with peers. Children with Attention Deficit Hyperactivity Disorder may have difficulty with social skills and appropriate behaviors that can lead to bullying (both victim and perpetrator) and rejection. Impulsivity and aggression can provoke fights and negative relationships with other children. Children with Attention Deficit Hyperactivity Disorder and high levels of aggression may have a higher risk of delinquent behavior (the antisocial illegal behavior of an individual, embodied in his misdeeds - actions or inactions that harm individuals and society as a whole) during adolescence and to criminal activity in adulthood.

- Risk of injury. Impulsivity in young people with ADHD can put them at risk of not thinking about the consequences. Children with Attention Deficit Hyperactivity Disorder have an increased risk of accidents and injuries. For example, a child with ADHD cannot be tested for responsiveness to oncoming traffic while riding a bicycle, or whether they can participate in high-risk, high-impact groups. All these problems of children with ADHD carry over into their adult lives.

- Abuse of alcohol or drugs. According to research, young people with ADHD - in particular those with conduct or mood disorders - have an above-average risk of substance abuse that starts at a young age. Biological factors associated with ADHD may make these individuals susceptible to substance abuse. Many of these young people can bring themselves out of this condition on their own.

- Problems with learning. Although speech and learning disorders are common in children with ADHD, they do not affect their intelligence. People with attention deficit hyperactivity disorder have the same IQ (intelligence quotient) range as the general population. Many children with ADHD are falling behind in school. Some evidence suggests that inattention may be a major contributor to underachievement in these children. Difficulties in reading can also create problems for them. Poor academic performance can affect a child's self-esteem and self-confidence, and influence various social problems in peer relationships.

- Influence on the family. The time and attention required to solve problems in children with ADHD can change the internal family relationships and lead to conflicts with parents, brothers and sisters.

Other disorders associated with ADHD

Some disorders may mimic or accompany ADHD. Many of these disorders require other treatments and must be diagnosed separately, even if they accompany ADHD.

- Opposition-producing disorder (THIEF). It is often associated with Attention Deficit Hyperactivity Disorder. The most common symptom of this disorder is negative, cocky, and hostile behavior towards authority figures that lasts for more than half a year. In addition to inattention and impulsive behavior, these children exhibit aggression, frequent tantrums, and display antisocial behavior. A significant number of children with VOR also have anxiety and depression, which should be considered separately. Many children who develop VOR at an early age go on to develop conduct disorder.

- Conduct disorder. Some children with ADHD also have conduct disorder, which is described as a complex group of behavioral and emotional disorders. It includes aggression towards humans and animals, destruction of property, seduction, deceit, theft, and general violation of social rules.

- Developmental disorder. The developmental disorder is rare and is usually characterized by behavioral autism, hand-clapping, repetitive statements, and slow speech and motor development. If a child who has been diagnosed with ADHD does not respond to treatment, parents may see it as a developmental disorder that often responds to antidepressants. Some of these children may also benefit from stimulant medications.

- Auditory disorders. Hearing problems can mimic the symptoms of ADHD and should be evaluated at the time of diagnosis. Auditory disorders are another condition that can affect children's ability to process sound information. Children with this type of disorder have normal hearing, but something in their brain prevents them from filtering out background noises and distinguishing between similar sounds. An auditory disorder may be misdiagnosed as ADHD and may occur along with it.

- Bipolar disorder. Children diagnosed with Attention Deficit Disorder may also suffer from Bipolar Disorder, formerly known as Manic-Depressive Psychosis. Bipolar disorder is characterized by episodes of depression and mania (with symptoms of irritability, rapid speech, thoughts turning off). Both disorders often cause inattention and distractibility and can be difficult to tell apart, especially in children. In some cases, ADHD in children and adolescents can be a marker for developing bipolar disorder.

- Anxiety disorders. Anxiety disorders often accompany ADHD. Obsessive Compulsive Disorder is a specific anxiety disorder that shares many of the characteristics of ADHD, with some genetic components. Young children who have experienced a traumatic event (including sexual or physical abuse or neglect) may exhibit ADHD characteristics, including impulsivity, emotional outbursts, and oppositional behavior.

- Sleep disturbance. Sleep disorders are often associated with attention deficit hyperactivity disorder: these are insomnia, restless legs syndrome and sleep apnea (breathing disorders during sleep).

Diseases with similar symptoms

- Tourette syndrome and other genetic disorders. Several genetic disorders cause ADHD-like symptoms, including Tourette's syndrome. For many patients with Tourette's syndrome and ADHD, some of the treatments are similar.

- Lead poisoning. Children who ingest even small amounts of lead may experience symptoms similar to ADHD. The child can be easily distracted, disorganized and unable to think logically. The main cause of lead poisoning is exposure to paint containing lead, especially in older houses that are in poor condition.

Ltreatment attention deficit hyperactivity disorder

Attention Deficit Hyperactivity Disorder is considered a chronic condition that requires long-term, ongoing monitoring and adjustment of symptoms, medications, and other treatment programs. While symptoms may lessen over time, ADHD usually doesn't "go away." Patients can, however, learn to control their condition through behavioral techniques, which are often supported with medication.

Treatment for attention deficit hyperactivity disorder does not reverse the condition, but focuses on controlling the symptoms and improving the functioning of the affected individual. Treatment usually involves a combination of psychostimulants. These are usually: Methylphenidate (Ritalin) and behavioral therapy (other drugs may also be used for older children and adults). Treatment often involves systems approach which includes: a pediatrician for the child, other healthcare professionals, parents and teachers.

For preschool children (ages 4-5), behavioral therapy provided by parents and teachers should be considered first. For many children, behavioral therapy alone leads to significant improvement. If further treatment is needed and the benefits likely outweigh the risks, the doctor may prescribe the stimulants Methylphenidate (Ritalin, etc.);
- for school-age children (aged 6-11 years) a combination of medication, stimulant and behavioral therapy is needed. Stimulant alternatives, in order of recommendation: Atomoxetine (Strattera), Guanfacine (Tenex), or Clonidine (Catapres);
- Adolescents (aged 12-18 years) should be treated with medication and, if necessary, behavioral therapy. Some patients at this age may temporarily stop taking their medications. The doctor at this time should carefully monitor the child. Adolescents should also have their doses of medication adjusted as they grow and change during puberty;
- treatment of adult ADHD. As with children, treatment for adults with ADHD is a combination of drugs and psychotherapy. For drugs, stimulant drugs, or non-narcotic stimulants, atomoxetine (Strattera) is usually the first line treatment, and with antidepressants it is the secondary option. Most stimulant medications, as well as Atomoxetine, are approved for adults with ADHD. Adults who have heart problems or risk factors should be aware of the cardiovascular risks associated with ADHD treatment.

Medications for the treatment of attention deficit hyperactivity disorder

Several types of medications are used to treat Attention Deficit Hyperactivity Disorder:

- Psychostimulants. These are the main drugs used to treat Attention Deficit Hyperactivity Disorder. Although these drugs stimulate the central nervous system(CNS), they have a calming effect on people with ADHD. These drugs include methylphenidate and amphetamine. These drugs increase dopamine, a neurotransmitter important for cognitive functions such as attention.

- Alpha-2 agonists. Alpha-2 agonists stimulate the neurotransmitter norepinephrine, which may be important for concentration. They include guanfacine and clonidine. Alpha-2 agonists are used for Tourette syndrome and may be useful when other drugs fail to help children with attention deficit hyperactivity disorder with severe impulsivity and aggression. These drugs may be prescribed in combination with stimulants.

- Antidepressants. Because antidepressants work just as well as behavioral therapy, doctors recommend that patients first try psychotherapy before using antidepressants.

Behavior Correction

Behavioral management in a child with ADHD is not immediately clear to most parents and teachers. To get to know them, they all may need the help of qualified psychologists and medical professionals or ADHD support groups. At first, the idea of ​​changing the behavior of a very energetic and stubborn child is intimidating. It is useless and harmful to force a child with attention deficit hyperactivity disorder to be like most other healthy children. It is possible, however, to limit his destructive behavior and to instill in a child with ADHD a sense of self-worth that will help to overcome all the negative.

Raising a child with ADHD, like raising any child, is a complex process. The child's self-esteem will develop as the ability to take a step back and think about the consequences of a possible action increases, and then control the action before taking it. But it doesn't happen quickly. The growing child with ADHD is different from other children in very specific ways and presents challenges at any age.
Parents must first create their own tolerance levels. Some parents are calm and can accept a wide range of their child's behaviors, while others are not. Helping a child achieve self-discipline requires empathy, patience, love, and loyalty.

- Setting agreed rules for the child. Parents should be as consistent as possible in their approach to their child, should reward good behavior and discourage destructive behavior. The rules of conduct for the child should be clearly defined but flexible enough to include harmless features. It is important to understand that children with ADHD have a much harder time adapting to change than other children. Parents should create predictable situations and ensure a neat and stable environment at home (especially in the children's room).
Also, through useful literature and work with psychologists and doctors, parents should learn how to competently manage the aggression of their child with attention deficit hyperactivity disorder. .

In addition, it is absolutely necessary for parents of children with attention deficit hyperactivity disorder to learn how to reward such children for all good and calm behavior. Ways are many.

- Improved concentration and attention. Children with ADHD perform much better on learning tasks when they have an interest in the subject. Parents should be on the lookout for all activities that keep the child's concentration. Options include: swimming, tennis, and other sports that focus attention and limit peripheral stimuli (children with ADHD may have difficulty playing team sports that require constant alertness, such as football or basketball).

- Interaction with the school. Even if one parent successfully manages their child at home, it is common for a child with ADHD to have difficulty at school. The ultimate goal of any educational process is the happy, prosperous and healthy social integration of children with Attention Deficit Hyperactivity Disorder with their peers.

- Teacher training. Any teacher should be prepared for the peculiarities of the behavior of children with attention deficit hyperactivity disorder in order to competently manage these children. They also, like the parents of such children, need to study the relevant medical, pedagogical and other literature and also actively consult with psychologists and doctors on this matter.

- The role of parents in the school. Parents can help their child by talking to the teacher before the start of the school year about their child's situation. The first priority for parents is to develop a positive, and not aggressive, impatient, overly strict, attitude of the teacher towards the child. Finding a mentor who can help your child keep going after school can also be very helpful.

- Special education programs. High-quality special education can be very helpful in improving learning and developing a child's self-esteem. However, programs vary in their ability to provide quality education. Parents should be aware of some of the limitations and issues with special education:

Special education programs in a normal school environment often increase a child's sense of social exclusion;
- if the educational strategy focuses only on the child's abnormal, morbid behavior, it will not be able to take advantage of the creative, competitive and dynamic energy that often accompanies ADHD;
- the best approach may be to treat this syndrome - the training of teachers to manage such children in normal classes.

Other treatments attention deficit hyperactivity disorder

- Dietary approach. Certain diets have been suggested for people with ADHD. Several well-conducted studies do not support the effects of dietary sugar and food additives, suggesting that they negatively affect the behavior of ADHD patients, except perhaps in a very small percentage of children. However, various studies have shown behavioral improvement with diets that limit potential allergens (such as citrus fruits) in the diet. Parents may want to discuss with their doctor the elimination of a food-focused diet.

Possible stimuli that influence behavior change include:

Any artificial dyes (in particular, yellow, red or green);
- other chemical additives;
- milk;
- chocolate;
- eggs;
- wheat;
- foods containing salicylates, including all berries, ground red pepper, apples and cider, cloves, grapes, oranges, peaches, peppers, plums, prunes, tomatoes;
- essential fatty acids. Omega-3 fatty acids, found in fatty fish and certain vegetable oils, are important for normal brain function and may provide some benefits for people with ADHD. It has not yet been clarified whether additives to polyunsaturated fatty acid compounds, such as docosahexaenoic and eicosapentaenoic acids, provide benefits;
- zinc. Zinc is an important metabolic mediator that plays a role in ADHD. Its deficiency in some cases may be associated with ADHD. Long-term use of zinc, however, can lead to anemia and other side effects in people without deficiencies, and in these patients it has no effect on ADHD. In any case, testing for micronutrients such as zinc is not a standard procedure in evaluating children with suspected ADHD;
- sugar. Although parents often believe that sugar is bad for children, because. because of it, they become impulsive or hyperactive, - studies do not confirm this.

- Alternative methods. A number of alternative approaches help children and adults with mild symptoms of ADHD. For example, daily massage may help some people with ADHD feel happier, less agitated, less hyperactive, and focus on tasks. Other alternative approaches that may be helpful include: relaxation training and music therapy. These treatments may be helpful for symptomatic treatment, but have not been shown to benefit the underlying disorder.

- Herbs and supplements. Many parents resort to alternative remedies - psychostimulants and other medications. These products include: St. John's wort, ginseng, melatonin, pine bark extract, etc. However, there is no scientific evidence that they are effective.