Treatment of ADHD in children

by Dr Smita Pandey Bhat 9/7/2009 5:18:00 PM

Your child may be suffering from ADHD and you might not even know it! ADHD affects about 4 to 12% of school-age children in India and is more frequent in boys than in girls. Global prevalence for children is approximately 5%, with wide variability dependent on research methodologies utilized in studies. If the short attention span of your child poses problems for him, at school or home, and his hyperactivity is a cause of concern, chances are that he might be a victim of this neurobehavioral developmental disorder and needs serious medical attention. Don’t pass-off your child’s behavior as just ‘difficult’. Learn to detect and eliminate the symptoms and stop the disease before it strikes!

Attention parents and teachers! Learn to deal with inattentive, hyperactive & impulsive kids

Attention deficit hyperactivity disorder (AD/HD or ADHD) is a disorder of the brain and behavior. The symptoms start before seven years of age. ADHD is one of the most common mental disorders that develop in children. Children with ADHD have impaired functioning in multiple settings, including home, school, and in relationships with peers. If untreated, the disorder can have long-term adverse effects into adolescence and adulthood.

Symptoms: The most common symptoms of ADHD are:

  1. Impulsiveness: acting before thinking of consequences, jumping from one activity to another, disorganization, tendency to interrupt other peoples' conversations.
  2. Hyperactivity: restlessness, often characterized by an inability to sit still, fidgeting, squirminess, climbing on things, restless sleep.Inattention: easily distracted, day-dreaming, not finishing work, difficulty listening.

Subtypes: ADHD has three subtypes:

  1. Predominantly hyperactive-impulsive: Most symptoms (six or more) are in the hyperactivity-impulsivity categories.Fewer than six symptoms of inattention are present, although inattention may still be present to some degree.
  2. Predominantly inattentive: The majority of symptoms (six or more) are in the inattention category and fewer than six symptoms of hyperactivity-impulsivity are present, although hyperactivity-impulsivity may still be present to some degree.Children with this subtype are less likely to act out or have difficulties getting along with other children. They may sit quietly, but they are not paying attention to what they are doing. Therefore, the child may be overlooked, and parents and teachers may not notice that he or she has ADHD.
  3. Combined hyperactive-impulsive and inattentive: Six or more symptoms of inattention and six or more symptoms of hyperactivity-impulsivity are present.Most children have the combined type of ADHD

Causes: A specific cause of ADHD is not known. There are, however, a number of factors that may contribute to ADHD including genetics, diet and social and physical environments.

  1. Genetic factors: Studies indicate that the disorder is highly heritable and that genetics are a factor in about 75% of ADHD cases. Hyperactivity also seems to be primarily a genetic condition however other causes do have an effect.Researchers believe that a large majority of ADHD cases arise from a combination of various genes, many of which affect dopamine ( a chemical in the brain) transporters. The broad selection of targets indicates that ADHD does not follow the traditional model of a "genetic disease" and should therefore be viewed as a complex interaction among genetic and environmental factors.
  2. Environmental factors: Environmental factors implicated include alcohol and tobacco smoke exposure during pregnancy and environmental exposure to lead in very early life. Complications during pregnancy and birth—including - premature birth—might also play a role.
  3. Diet:
    • Additives: Studies have found that dietary elimination of artificial food coloring and preservatives provides a statistically significant benefit in children with ADHD
    • Sugar regulation: A number of studies have found that sucrose (sugar) has no effect on behavior and in particular it does not exacerbate the symptoms of children diagnosed with ADHD
    • Omega-3 supplement: Preliminary research suggests that Omega-3 supplementation might be effective in the treatment of ADHD; however some of the studies give conflicting results.
  4. Social factors: There is no compelling evidence that social factors alone can cause ADHD.[ Many researchers believe that relationships with caregivers have a profound effect on attentional and self-regulatory abilities. A study of foster children found that a high number of them had symptoms closely resembling ADHD, while other researchers have found behavior typical of ADHD in children who have suffered violence and emotional abuse.
  5. Head injury ADHD patients have been observed to have higher than average rates of head injuries, however current evidence does not indicate that head injuries are the cause of ADHD in the patients observed
  6. Pathophysiology: One study states that a delay in development of certain brain structures like frontal cortex and temporal lobe occurs by an average of three years of age. These structures are responsible for the ability to control and focus thinking. On the other hand the motor cortex develops faster than normal. It indicates the slower development of behavioral control and faster development for advanced motor development may cause increased attention deficits and hyperactivity.

    Another study states that there is unusual thinness of the cortex of the right side of the brain, accounting for about 30% of genetic risk for ADHD. Also it has been seen that this region normalizes in thickness during the teen years showing improvement in clinical symptoms Additionally, SPECT scans found people with ADHD to have reduced blood circulation (indicating low neural activity), and a significantly higher concentration of dopamine transporters in the striatum which is in charge of planning ahead.

    Medications focused on treating ADHD (such as methylphenidate) work by reducing dopamine reuptake in certain areas of the brain, such as those that control and regulate concentration. As dopamine is a stimulant, this increases neural activity and thus blood flow in these areas (blood flow is a marker for neural activity).

Treatment: Treatments can relieve many of the disorder's symptoms, but there is no cure. With treatment, most people with ADHD can be successful in school and lead productive lives. Researchers are developing more effective treatments and interventions, and using new tools such as brain imaging, to better understand ADHD and to find more effective ways to treat and prevent it. Methods of treatment usually involve some combination of medications, behavior modifications, life-style changes, and counseling.

Lifestyle: Aerobic fitness may improve cognitive functioning and neural organization related to executive control during pre-adolescent development, though more studies are needed in this area. One study suggests that athletic performance in boys with ADHD may increase peer acceptance when accompanied by fewer negative behaviors

Medications: The most common type of medication used for treating ADHD is called a "stimulant." Although it may seem unusual to treat ADHD with a medication considered a stimulant, it actually has a calming effect on children with ADHD. Many types of stimulant medications are available. A few other ADHD medications are non-stimulants and work differently than stimulants.

For many children, ADHD medications reduce hyperactivity and impulsivity and improve their ability to focus, work, and learn. Medication also may improve physical coordination. However, a one-size-fits-all approach does not apply for all children with ADHD. What works for one child might not work for another. One child might have side effects with a certain medication, while another child may not. Sometimes several different medications or dosages must be tried before finding one that works for a particular child.

Any child taking medications must be monitored closely and carefully by caregivers and doctors. Stimulant medications come in different forms, such as a pill, capsule, liquid, or skin patch. Some medications also come in short-acting, long-acting, or extended release varieties. In each of these varieties, the active ingredient is the same, but it is released differently in the body.

Long-acting or extended release forms often allow a child to take the medication just once a day before school, so they don't have to make a daily trip to the school nurse for another dose. Parents and doctors should decide together which medication is best for the child and whether the child needs medication only for school hours or for evenings and weekends, too.

The side effects of stimulant medications: The most commonly reported side effects are decreased appetite, sleep problems, anxiety, and irritability. Some children also report mild stomachaches or headaches. Most side effects are minor and disappear over time or if the dosage level is lowered.

  • Decreased  appetite. Be sure your child eats healthy meals. If this side effect does not go away, talk to your child's doctor. Also talk to the doctor if you have concerns about your child's growth or weight gain while he or she is taking this medication.
  • Sleep problems. If a child cannot fall asleep, the doctor may prescribe a lower dose of the medication or a shorter-acting form. The doctor might also suggest giving the medication earlier in the day, or stopping the afternoon or evening dose. Adding a prescription for a low dose of an antidepressant or a blood pressure medication called clonidine sometimes helps with sleep problems. A consistent sleep routine that includes relaxing elements like warm milk, soft music, or quiet activities in dim light, may also help.
  • Less common side effects. A few children develop sudden, repetitive movements or sounds called tics. These tics may or may not be noticeable. Changing the medication dosage may make tics go away. Some children also may have a personality change, such as appearing "flat" or without emotion.

Psychotherapy: Different types of psychotherapy are used for ADHD. Behavioral therapy aims to help a child change his or her behavior. It might involve practical assistance, such as help organizing tasks or completing schoolwork, or working through emotionally difficult events. Behavioral therapy also teaches a child how to monitor his or her own behavior.

Learning to give oneself praise or rewards for acting in a desired way, such as controlling anger or thinking before acting, is another goal of behavioral therapy. Parents and teachers also can give positive or negative feedback for certain behaviors. In addition, clear rules, chore lists, and other structured routines can help a child control his or her behavior.

Therapists may teach children social skills, such as how to wait their turn, share toys, ask for help, or respond to teasing. Learning to read facial expressions and the tone of voice in others, and how to respond appropriately can also be part of social skills training. Parenting skills training helps parents learn how to use a system of rewards and consequences to change a child's behavior.

Parents are taught to give immediate and positive feedback for behaviors they want to encourage, and ignore or redirect behaviors they want to discourage. In some cases, the use of "time-outs" may be used when the child's behavior gets out of control. In a time-out, the child is removed from the upsetting situation and sits alone for a short time to calm down.

Parents are also encouraged to share a pleasant or relaxing activity with the child, to notice and point out what the child does well, and to praise the child's strengths and abilities. They may also learn to structure situations in more positive ways. For example, they may restrict the number of playmates to one or two, so that their child does not become over stimulated. Or, if the child has trouble completing tasks, parents can help their child divide large tasks into smaller, more manageable steps.

Also, parents may benefit from learning stress-management techniques to increase their own ability to deal with frustration, so that they can respond calmly to their child's behavior. Sometimes, the whole family may need therapy. Therapists can help family members find better ways to handle disruptive behaviors and to encourage behavior changes.

Finally, support groups help parents and families connect with others who have similar problems and concerns. Groups often meet regularly to share frustrations and successes, to exchange information about recommended specialists and strategies, and to talk with experts.

 

Dr Smita Pandey Bhat is a Counselor and Clinical Psychologist. She has completed her M.Phil and PhD in Clinical Psychology, from Central Institute of Psychiatry (C.I.P), Ranchi. She has seven years of experience in this field at different places. She provides psychological counseling, psychotherapies like, Supportive Therapy, Cognitive Behavior Therapy, Interpersonal Therapy, Social Skills Training, Assertiveness Training etc. as per the requirement of the people. She also provides assessments like Intelligence Tests and Personality Assessments for Children as well as Adults.

Dr. Smita Pandey Bhat
Clinical Psychologist
Gurgaon, Delhi

Email  :   dr.smitapandey@gmail.com
Url      :   http://psychologist.rediffblogs.com 


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