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Conditions

  • ATTENTION DEFICIT/HYPERACTIVITY DISORDER (ADHD) IN CHILDREN
    ATTENTION DEFICIT/HYPERACTIVITY DISORDER (ADHD) IN CHILDREN
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It affects about 6-7% of children when diagnosed by DSM-IV criteria.About 30-50% of people diagnosed in childhood continue to have symptoms into adulthood and between 2-5% of adults have the condition.

Symptoms include:

Inattention e.g. does not seem to listen when spoken to, has difficulty sustaining attention on tasks or play activities, is forgetful in daily activities. etc

Impulsivity e.g. has difficulty awaiting turn, blurts out answers before the questions have been completed, interrupts or intrudes on others etc

Hyperactivity e.g. fidgets with hands or feet or squirms in seat, talks excessively, is “on the go” or often acts as if “driven by a motor”.

  • How to diagnose Attention Deficit/Hyperactivity Disorder (ADHD) ?

    It is diagnosed by DSM-IV or DSM-5 or by ICD-10 criterion which includes the following:

    • Developmentally inappropriate levels of Inattentiveness, Impulsivity and hyperactivity.

    • In at least two (2) settings (home/ school / play).

    • Symptoms present for at least 6 months.

    • Onset before 7 years of age.

    • Behaviours result in significant handicap in academic, occupational and social functioning.

  • What are the risk factors and causes of Attention Deficit/Hyperactivity Disorder (ADHD)?

    Attention Deficit/Hyperactivity Disorder (ADHD) is currently considered to have multiple causes however exact etiology of Attention Deficit/Hyperactivity Disorder (ADHD) is unknown.

    A. Genetic: Research supports a strong genetic component. For example, first degree relatives (parents, siblings and children) of people with Attention Deficit/Hyperactivity Disorder (ADHD) have a 3 to 5 times increased risk.

    B. Environmental factors : Low birth weight, prenatal and perinatal obstetric complications, intrauterine toxins such as nicotin or alcohol, severe early deprivation, institutional rearing.

  • How to manage a child with Attention Deficit/Hyperactivity Disorder (ADHD)?

    A. Management of primary problem:
    Treatment includes various forms of psychotherapy, medications, education or training or a combination of treatments. With treatment, most people with Attention Deficit/Hyperactivity Disorder (ADHD) can be successful in school and lead a productive life.

    B. Behavioural and Psychological Treatment:
    Psychoeducation: It includes an assessment of the child and parents’ beliefs and understanding about Attention Deficit/Hyperactivity Disorder (ADHD), its causes and its consequences, followed by an informed discussion of the current scientific and clinical knowledge about Attention Deficit/Hyperactivity Disorder (ADHD), its comorbidities and its treatment including acknowledgement of both what is and is not known.

    C. Cognitive Behavioural Therapy: It aims to help a child change his or her behaviour. It teaches children social skills, to control anger, to think before acting, behaviours to share things with other etc. It also can help change one’s poor self –image by examining the experiences that produced it.

    •  Parent training and school-based intervention.

    •  Reinforcement of behaviours by praise or by providing incentives like (gold star or happy face) in daily consistency charts.

    •  Providing a distraction-free environment in school and at home for children.

    •  Social skills training.

    •  Adapting tasks to the child's abilities.

  • Are there any medicines available for treatment?

    It includes the use of:

    •  Stimulant medications: Methylphenidate and Atomoxetine.

    •  Non-stimulant medications: These are useful in around 30% of children who may not tolerate or respond to stimulant medicines.

  • What is the advice to manage secondary co-morbid conditions?

    •  Specific learning disability: special education and remedial teaching

    •  Oppositional Defiant Behavior (negativistic, defiant, disobedient and hostile behavior toward authority figures): Behavior modification techniques and management.

    •  Conduct Disorder: Behavior modification and appropriate medication.

    •  Anxiety and depression: Medication and psychological intervention.

    •  Epilepsy: Use of anti epileptic drugs.

  • What measures can be taken to prevent Attention Deficit/Hyperactivity Disorder (ADHD) ?

    A. Primary :

    Avoiding environmental risk factors such as maternal smoking during pregnancy and lead exposure.

    B. Secondary :

    Early identification of the symptoms and early institution of appropriate treatment.

    C. Tertiary

      In school:

    •  Provision of integrated and inclusive education in schools.

    •  Close monitoring in the classroom, preferably seated in the front row in the class.

    •  Predictable schedules and brief study periods.

    •  Special education and remedial teaching.

     At home :

    •  Regular daily routine.

    •  Reinforcement of good behavior.

    •  Loving but consistent and firm behavior with the child.

    •  Support groups help parents connect with other people who have similar problems and concerns Attention Deficit /Hyperactivity Disorder.

  • What is the Referral Pattern?

    •  High index of suspicion and early identification: By increasing awareness among parents, primary physicians, pediatricians and teachers (play schools and regular schools).

    •  Creating a network of agencies that can diagnose such children so that appropriate and timely referral can be possible.

  • What support can be provided to the family within affected child?

    •  The multidisciplinary team can counsel the child and the family, helping them to develop new skills, attitudes, and ways of relating to each other.

    •  Assist the family in finding better ways to handle the disruptive behaviors and promote change.

    •  In a young child, parents should be taught techniques for coping with and improving the child's behavior.

  • How do I give methylphenidate to my child?

    A. Usually, it can be started on a low dose with careful monitoring of side-effects. This dose is often increased gradually, usually over 4-6 weeks, to a maximum daily according to how well it is working and whether side-effects occur. The most common side-effects to look out for with methylphenidate are difficulty with sleep (insomnia), loss of appetite and weight loss.


    B. Once the total daily dose has been determined, one may switch to a once-daily, long-acting version of methylphenidate.


    C. When your child is on medication, he or she should be reviewed regularly to check that the dose is working and that there are minimal side-effects. Your child will also have height, weight, pulse and blood pressure measured at regular intervals.

  • How quickly does methylphenidate work?

    The short-acting methylphenidate begins working within about 20 minutes and lasts for 3-4 hours. The longer-acting version takes longer to start working but lasts for about 12 hours and gives a more stable level of medicine in the bloodstream throughout the day. It may take several weeks to see the full benefit of medication.

  • How long will my child be on medication?

    May continue medication for several years. Once children become teenagers, it is recommended to taper off the medication each year.

  • What about diet in Attention Deficit/Hyperactivity Disorder (ADHD)?

    A. Diet probably does not cause Attention Deficit/Hyperactivity Disorder (ADHD), but a change in diet may help in some cases, but not in all cases. If you notice that an ingredient or food makes your child's symptoms worse, take a note of it and discuss this further with your doctor or a dietician.

    B. It is recommended that all people with Attention Deficit/Hyperactivity Disorder (ADHD) have at least a normal healthy balanced diet, and also do some regular exercise.