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Attention Deficit Hyperactivity Disorder. Causes, Symptoms, Treatment

22.05.2019 Author: psiholog pavel horoshutin

“I am confused and do not know what to do next. My son is 8 years old, goes to a regular school, is very active, ants in his pants, and always has been like that. He’s clever, but at the same time very absent-minded and inattentive. He makes mistakes writing down a task from the board. If you need to say something to him, you have to take him by the hand and wait until he looks back, otherwise he will not hear anything. And what the teacher says also misses his ears. Because of this, his grades are already bad, and it is only the second year. He talks a lot; sometimes he can even fall asleep in the middle of a phrase in the evening. In also talks a lot in class, sliding down the desk, knocking there and muttering to himself. And other parents are already pushing me, because he bothers all children in class! I don’t understand what to do next. The neurologist said that the child had ADHD and prescribed glycine, we took the course, but there were no changes, the child remained as hyperactive as he was, so what should I do? How to help my son and myself?”

– Natalya, 27

ADHD, or attention deficit hyperactivity disorder, is one of the most common disorders in children. According to various sources, it is diagnosed in 5-7% of children [1] of school age worldwide, and 4 times more often in boys than in girls. About 60% of children with ADHD do not outgrow it [2] and retain all the symptoms in adulthood (yes, adults also have this syndrome, and often). We note right away that not all specialists “believe” in this diagnosis, but nevertheless, ADHD is included in the International Classification of Diseases (ICD-11) and lends itself to medical and behavioral correction.

Let’s try to understand what exactly attention deficit hyperactivity disorder is, what symptoms and problems accompany it, how to diagnose it and how to treat a hyperactive child. Let’s talk about what we as parents can do to make our lives and the lives of our children easier and more enjoyable.

Contents:

  1. ADHD – what is it and how to diagnose it
  2. Classification of ADHD
  3. Why ADHD manifests
  4. Symptoms of ADHD in children
  5. Mandatory conditions for diagnosis
  6. Problems that accompany ADHD
  7. Can ADHD be cured: a long-term prognosis
  8. ADHD correction
  9. About medication: what works and what doesn’t

ADHD – what is it and how to diagnose it

attention deficit in a child

Attention deficit hyperactivity disorder in children is a neurological developmental disorder that manifests itself in childhood, meaning that it cannot begin to develop in adolescence or adulthood. Symptoms are always found already at preschool age, but most often it is the beginning of schooling that becomes a serious test. It is difficult for children with ADHD to concentrate, to stay at one place during the lesson, they are impulsive and have difficulty controlling their desires and emotions; for example, they can get up and walk around the classroom, shout out, sing songs not only at music lessons, and so on.

In terms of neurology, ADHD is a persistent and chronic disorder for which there is currently no guaranteed cure. It is important to understand that this is not a perception disorder. Children with ADHD are smart, active and perceive reality quite adequately; they can analyze and draw conclusions. This is, first of all, an impairment of the ability to perform tasks, plan them and bring them to the end, as adults expect.

Despite the fact that the problem is rather widespread, cases of incorrect diagnosis are quite common. Either hyperactive children are not diagnosed with ADHD and then parents just get advice “to parent their children properly and be more strict”, or this diagnosis is made to an ordinary active child with prescribing unnecessary medications.

“Everything was already clear in kindergarten. I was distracted in class and interrupted daytime sleep. But they told me that this is just bad behavior, and that I need to be educated properly. This continued at school, teachers constantly scolded me, said that “you just have to try”; they made me sit at the back desk, from where nothing was visible at all. I constantly blamed myself for not being able to organize myself; I did not know how to explain to my family that I simply could not do what they asked me to. I can’t sit still for 40 minutes, I can’t do my homework for 2 hours and not be distracted, I can’t stop myself when I want to get up. I only found out about ADHD when I was 29, and I was finally able to breathe. Now I am undergoing treatment and learning to control my behavior and I am very sorry that no one told me in childhood that everything was fine with me, and this is a condition for which I am not to blame”.

– Julia, 31 

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Some adults think that their children behave this way because they are spiteful or spoiled, and parents just do not know how to calm their hyperactive child. But in reality, the advice “just try and pull yourself together” does not work. Many children can tell themselves how to behave at school – they hear and understand all the instructions perfectly. “Don’t twist around, sit upright, don’t twitch, don’t get up, write, watch carefully,” but as soon as it comes down to business, they really cannot follow all these rules.

ADHD is a feature of the brain, not a child’s whim or caprice. Saying to a child with ADHD: “Just try and don’t be lazy” is the same as saying to a person with myopia: “Just look carefully and clearly”.

“It is a cry from the soul. I heard 100 times that I need to teach my son better, and then everything will be fine, that I just need to tell him: “Do your homework and go to bed on time”, and then he will immediately do so. As if I didn’t really know what I needed to say. All children are different, and the reasons for similar behavior may be different. If some method worked for you, it doesn’t mean that others didn’t try it; maybe it just didn’t work for them. We all wander around in the dark and look for what suits the child, which doctor will feel him and choose the right treatment. We train, treat, look for ways to rehabilitate our children, but the circumstances and resources are different for everyone. Finances, relatives, place of residence, parents’ health – it all matters”.

– Margo, 39 

I would like to immediately warn parents against making a diagnosis “according to the book”. There are situations when, for example, it seems to parents that the child should be calm and quiet (we were just like that, right?), And he/she turns out to be active and inquisitive. And parents are surprised: “How come? The child does not want to assemble the puzzle for an hour? He probably has hyperactivity”.

Of course, you may suspect that your child has ADHD, but in order to be convinced of this, it is necessary to visit doctors – a neurologist and a psychiatrist. They will confirm or refute your suspicions. If you think the doctor was wrong, visit another doctor to get a second opinion. It is important that the doctor really tries to find an individual approach to your child, takes into account the circumstances and developmental peculiarities, and does not prescribe medications for show.

Classification of ADHD

The name ADHD, attention deficit hyperactivity disorder, can be misleading. You might think that a child with this syndrome must be inattentive and hyperactive. In fact, when making a diagnosis, the signs of hyperactivity and attention deficit in a child are considered separately.

ICD-11 [3] (International Classification of Diseases) and DSM-5 [4] (American Psychiatric Association) distinguish following types of ADHD:

  1. ADHD with a predominance of attention deficit, that is, the child is inattentive, distracted, but not hyperactive.
  2. ADHD with a predominance of hyperactivity and impulsivity, that is, the child is hyperactive, but organized and attentive.
  3. ADHD of mixed type, that is, the child is both hyperactive and distracted.

Why ADHD begins

There are many misconceptions about the causes of this syndrome. One of the main ones is that this syndrome is fully and completely the result of the child’s behavioral problems – they were not educated, taught or restricted. But this is not so. We repeat, ADHD is a dysfunction of the brain. [5]

Even the brain structure of people with ADHD can be different – a thinner cortex that provides attention and control over their behavior. There are also abnormalities in the production of dopamine, which helps the brain switch from one task to another and concentrate.

And when a schoolchild says that they cannot concentrate, they really cannot concentrate, because, for example, the brain did not provide enough “chemicals” to concentrate or makes poor use of it. Of course, mistakes in upbringing can aggravate the symptoms, but don’t serve as a reason for the development of these disorders.

Sometimes ADHD is perceived as a delayed maturation disorder [5], since the behavior of children and adults with this syndrome seems immature and appropriate for a younger age (for example, if a child cannot sit at one place being 3-4 years old, this is a physiological norm, but the same restlessness of a child being 8-9 old is perceived as a behavioral disorder).

So what is the cause of these violations?

There is no definite answer, but there are some risk factors that increase the likelihood of developing ADHD.

  1. Heredity. ADHD in parents increases the likelihood of this syndrome appearing in children. [6] Both the structure of the brain and the peculiarity of the production of various hormones can be inherited.
  2. Smoking mother or father during pregnancy. [7] The harm of maternal smoking is obvious, but it turns out that father’s smoking, as well as passive smoking of a pregnant woman, increase the risk of ADHD. The same applies to other diseases, for example, heart disease [8].
  3. Parental depression or severe maternal stress during pregnancy also increases the risk of developing ADHD. [9]
  4. Dietary restrictions during pregnancy. [10]
  5. Low body weight or prematurity [11], difficult pregnancy.
  6. The general state of ecology [11]. Presumably, exposure to pesticides, lead, or other toxins during pregnancy may affect brain formation.

Symptoms of ADHD in children

inattention symptoms

All symptoms, depending on the type of syndrome, can be divided into 2 groups: attention deficit disorder and hyperactivity disorder in children and / or impulsivity. [12]

Signs of attention deficit

Children with this problem display the following features:

  • they often make random mistakes;
  • lose things;
  • listen inattentively;
  • are easily distracted;
  • do not finish the task, can stop it in the middle;
  • inattentively read or rewrite exercises;
  • do not follow instructions;
  • avoid tasks that require effort and focus;
  • hardly return to the interrupted task;
  • put off a lot for later.

Signs of hyperactivity

Hyperactivity in children can be recognized by its characteristic manifestations:

  • they are fussy, are in constant motion;
  • often get up, cannot sit still for a long time;
  • run, jump when it is inappropriate;
  • fidget, constantly moving when sitting;
  • speak a lot and quickly;
  • speak out of turn, often interrupt, shout out from desk;
  • rarely play calmly, are not assiduous;
  • no sense of danger, do not respond to reprimands;
  • violate the rules, are short-tempered.

Combined type

According to the DSM-5 classification, children with this type of ADHD have more than 6 symptoms from each group of the above symptoms. [4]

Symptoms depending on age

Preschoolers (period when ADHD can be suspected a priori):

  • Attention deficit: they drop out and do not finish what has been started, ignore the words of adults, do not play games for more than 3-5 minutes.
  • Hyperactivity and impulsivity: they move a lot and speak, cannot sit still for more than 5 minutes, do not pay attention to danger.

Elementary school (hyperactivity correction is advisable to start no later than this period):

  • Attention deficit: constantly forgetting something, are unorganized, uncollected, cannot do one thing for more than 10 minutes.
  • Hyperactivity and impulsivity: make noise when they need to be quiet (lesson, presentation, etc.). They shout, interrupt others, cannot wait, break the rules without malicious intent.

High school

  • Attention deficit: are less diligent than other children, cannot stay in place for more than 30 minutes, inattentive, do not notice the details, cannot plan.
  • Hyperactivity and impulsivity: they worry and fuss a lot, don’t think what to say to anyone, they take risky, reckless actions.

Mandatory conditions for diagnosis

There is no single test for accurate diagnosis. A doctor (usually a psychiatrist) makes a diagnosis based on several sources:

  • opinions of other doctors,
  • school assessment,
  • communication with parents,
  • child’s behavior.
Most of the symptoms should appear before the age of 7 and be present continuously for more than 6 months and under different conditions.

For example, if a child starts the 1st year and seems restless and absent-minded for 2-3 months, but at the same time behaves at home as usual, is attentive and calm, then talking about ADHD is early.

A cause for concern is a behavior uncharacteristic of the age of the schoolchild. For example, children in elementary school can run along the corridor during a break or fidget in a chair by the last lesson, but if a schoolchild cannot sit for just 5 minutes, you should start paying attention.

Also, the basis for the diagnosis is the behavior of the schoolchild, which negatively affects them, their interaction with people around them and the quality of education. In this case, constant physical activity in combination with the 7Spsy behavior modification technique – a method of behavioral therapy – will help correct the behavior.

Pseudo-ADHD

When diagnosing ADHD, it is also important to take into account that some other diseases and conditions can give similar symptoms [13], for example, poor performance can be caused by problems with vision or dyslexia, aggressiveness and sleep problems – by severe stress, and inattention and distraction – by impaired functions of thyroid gland. Therefore, you should undergo a full examination and exclude conditions that give similar symptoms, but require a different treatment than ADHD.

Problems that accompany ADHD

problems in the relationship of children

Learning difficulties

The main and most obvious problem a child with ADHD has is difficulty in learning. The schoolchild may forget to write down the task, inattentively listens to the teacher, is distracted; because of this, he/she may not have time to complete a test paper and so on. All this affects the performance, quality of assimilation of the material and relations with the teacher.

Conflicts with brothers and sisters

Children with ADHD often conflict with siblings [14], and family relationships become less warm and friendly. This is caused to some extent by impulsivity and inability to control their actions.

Sleep problems

Poor sleep can be either a separate symptom of ADHD, or aggravate the manifestations of this syndrome [15]. For example, schoolchildren who sleep little and poorly can be even more restless than ones with ADHD who have good quality sleep.

Disorders or diseases

Up to 87% of children with ADHD [15] have at least one concomitant mental disorder; up to 20% of children have three or more: anxiety, depression, autism, obsessive actions, tics, and so on.

ADHD alone and in combination with poor sleep can contribute to the development of anxiety and depressive disorders [16].

Anger and child aggression

The presence of ADHD in the schoolchild and at least one concomitant disorder makes him/her angrier, quick-tempered [17], which is associated with increased emotionality and problems with self-regulation of emotions [18].

Smoking, alcoholism, drug use

Impulsivity increases the risk of developing bad habits: smoking and the use of prohibited substances in adolescents. ADHD diagnosed between 11-14 years old significantly increases the risk of addiction [19] by 18.

Can ADHD be cured: a long-term prognosis

Up to 30% of children outgrow ADHD completely, treatment of hyperactivity for most children proves effective – the symptoms disappear, but inattention can become habitual behavior and go into adulthood.

Moreover, the child’s behavior will not necessarily be the same throughout life. Stressful situations (exams, tests) can aggravate the condition, and during the holidays or in the middle of the school year the schoolchild will feel better.

It is important to conduct a comprehensive treatment of ADHD in children: medical support, correction of schoolchildren’s behavior using behavioral therapy, for example, using the 7Spsy technique-based behavioral modification course, changing child-rearing style, and, if possible, correcting educational work with hyperactive children and changing attitudes towards them by teachers. It is this approach that can give the maximum effect.

ADHD correction

Since the difficulties for a schoolchild with this syndrome are complex and affect not only study, but also health, friendship, communication with relatives, the treatment of hyperactivity and attention deficit disorder in children should be comprehensive, as we said earlier.

Which doctors to visit

It is important to make an appointment with the following specialists:

  1. Pediatrician. He/she will evaluate the general health status of the schoolchild, help identify chronic diseases, and, if necessary, refer to specialist doctors.
  2. Невролог. Он проверит, как работает нервная система школьника, нет ли органических повреждений мозга, например, в результате родовой травмы, может исключить эпилепсию, направить на электроэнцефалограмму (оценить активность мозга), допплер (состояние сосудов) и т. д. Может назначить лечение.
  3. Psychologist. Usually, behavioral problems are superimposed on physiological problems. The psychologist’s task in this case is to see what actions of the child are hindering him/her and others and suggest ways that will help change his/her behavior: concentrate on learning, controlling emotions, and so on.
  4. Psychiatrist. This doctor is not only concerned with “psychos”; all diseases that change a person’s behavior, including ADHD are in his/her area of competence. A psychiatrist will also help rule out other disorders such as autism or depression, and can prescribe medication.

In addition to these doctors, you may be invited to visit a neuropsychologist, a defectologist or a neuropsychiatrist.

But what should parents do if their children are hyperactive, in addition to visiting doctors?

What parents can do

hyperactive children in the family

It will be very difficult for a schoolchild to cope with problems without the help of parents. Therefore, it is important not only to treat hyperactivity in children of school age with pills, but also to help them adapt to school life. What needs to be done for this?

  1. Do not forget about yourself. Often parents are tormented by guilty feelings, feel ashamed for their “wrong” child, worry, fall into depression.

What could help here:

  • communication with a psychologist;
  • medication, if necessary;
  • search for mothers with similar problems, support and communication.

2. Create a relaxed atmosphere in the family. A schoolchild’s problems with ADHD bring chaos and confusion into family life per se. But it is better to consider the condition of the child with understanding. Treatment is important, but interpersonal relationships and an atmosphere of unconditional love allow children to achieve the greatest results. Seek help from a psychologist if something is stopping you from accepting and loving your child as he/she is.

3. Implement simple and straightforward rules. The more structured the schoolchild’s life, the easier it will be for him/her to adapt and maintain self-control. Regular hours, daily routine, family traditions will make the child’s life more predictable and calm.

4. Tell the children what is happening to them. Often children are frightened of their condition and upset because they cannot behave as calmly as other children do. Understanding what is happening to them can already improve the condition and reduce anxiety. It is important to talk about ADHD with schoolchildren [20], not to blame them and not to label them.

5.Use psychological therapy. Even if your doctor has not referred the child to a psychologist, find a good specialist yourself. A comprehensive MTA study, which was designed to analyze all methods of treating ADHD and identify the most effective of them, showed that behavioral therapy gives very good results in combination with drug treatment [21] (better than just taking medication or just therapy). As a result, children undergoing a course of behavioral therapy took less medication and better adapted to school life.

And in situations where the diagnosis of ADHD is wrong and there is no real brain disorder, behavioral therapy can be an effective way to help a hyperactive child change his/her behavior.

Why is this type of therapy better?

Behavioral psychology is not aimed at searching for causes (and the causes in this case are organic – impaired brain function), but at changing behavior. For example, an impulsive schoolchild will be able to master techniques that will help him/her restrain and control outbursts of anger.

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One of the methods of behavioral therapy is the patented 7Spsy behavior modification technique, which was created to teach children with ADHD to control and change their behavior. Children take classes independently, at home, and our psychologists will answer questions and support children in online chats, by phone and by e-mail. This format of work is more effective than short-term weekly visits to a full-time psychologist, since the schoolchild works every day and can turn to a specialist for help at any time.

Taking the course of ADHD correction will allow you to free up a little more time in order to take care of yourself and restore energy.

About medication: what works and what doesn’t

Of course, the final decision on the prescription of the drug remains with the doctor, but we ourselves try to adhere only to scientifically based methods for the correction of hyperactivity, so we consider it necessary to provide such information. Sometimes doctors prescribe medications that do not have proven effectiveness [22] and are not used anywhere except in post-Soviet countries. These include glycine, actovegin, tenoten, mexidol and other nootropics and homeopathic medicines. However, none of these drugs has been properly investigated: clinical trials have either not been conducted at all, or have not shown any significant results.

Therefore, it is highly likely that such treatment for ADHD will not help, and your children’s symptoms may continue. Reviews on forums are also very controversial. Some mothers noted improvements, but in these cases, medication was almost always accompanied by intensive activities with children

In the USA, Israel and Europe, psychostimulants are used (the first study on their use was published in 1937), which have proved effective, but they are banned in Russia, therefore one of the most effective drugs [23] for treating ADHD, from the point of view of evidence-based medicine, is atomoxetine (trade name “Strattera”). It is a noradrenaline reuptake inhibitor, that is, a drug that normalizes the “chemistry” of the brain. Do not prescribe treatment yourself! Take the drug only as directed by your doctor!

Also, for the treatment of attention deficit disorder, including in children, antidepressants that normalize the work of hormones and neurotransmitters can be prescribed. In very rare cases, for example, to treat tics or control severe aggression, antipsychotics can be prescribed.

To doubt the decision of a doctor is normal. If something causes you doubt or questions – discuss your concerns and doubts with him/her or seek a second opinion from another specialist.

References

  1. Statistika: rasprostranennost SDVG (https://www.ncbi.nlm.nih.gov/pubmed/25733754/)
  2. Statistika: SDVG u vzroslyh (https://www.webmd.com/add-adhd/adhd-adults)
  3. MKB-11 (https://icd.who.int/browse11/l-m/en)
  4. DSM-5 (https://www.webmd.com/add-adhd/childhood-adhd/types-of-adhd)
  5. Osobennosti raboty mozga pri SDVG (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4893880/)
  6. Nasleduemost SDVG (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4574913/)
  7. Svyaz kureniya roditelej i SDVG (https://nplus1.ru/news/2018/08/09/adhd-smoking-depression)
  8. Kurenie roditelej (v tom chisle i otcov) i porok serdca (https://nplus1.ru/news/2019/03/25/Quit)
  9. Depressiya u roditelej i SDVG (https://nplus1.ru/news/2018/08/09/adhd-smoking-depression)
  10. Plohoe pitanie vo vremya beremennosti i SDVG (http://neuronovosti.ru/adhd-pregnancy-omega/)
  11. Nedonoshennost, nizkij ves i vliyanie ekologii (https://www.webmd.com/add-adhd/childhood-adhd/adhd-causes)
  12. Tipy i simptomy SDVG (https://www.webmd.com/add-adhd/childhood-adhd/types-of-adhd)
  13. Psevdo-SDVG (https://www.webmd.com/add-adhd/guide/adhd-conditions-similar)
  14. Konflikty s brat’yami i syostrami (https://www.ncbi.nlm.nih.gov/pubmed/17494830/)
  15. Svyaz sna i SDVG (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4340974/)
  16. Razvitie trevozhno-depressivnyh i vyzyvayushchih oppozicionnyh rasstrojstv https://www.ncbi.nlm.nih.gov/pubmed/16127966/
  17. Gnev i vrazhdebnost i SDVG (https://www.ncbi.nlm.nih.gov/pubmed/18597170/)
  18. Problemy s kontrolem za emociyami (https://www.ncbi.nlm.nih.gov/pubmed/20686097/)
  19. Giperaktivnost i risk vozniknoveniya zavisimostej (https://www.ncbi.nlm.nih.gov/pubmed/17909126/)
  20. Rebyonku o SDVG (http://www.adhd-kids.narod.ru/articles/kids_guide.html)
  21. Luchshee lechenie SDVG — povedencheskaya terapiya + medikamenty. Obzor MTA (https://www.nimh.nih.gov/funding/clinical-research/practical/mta/the-multimodal-treatment-of-attention-deficit-hyperactivity-disorder-study-mta-questions-and-answers.shtml)
  22. Preparaty s nedokazannoj effektivnostyu, informaciya s vrachebnogo foruma (https://forums.rusmedserv.com/showpost.php)
  23. Preparaty s dokazannoj effektivnostyu, informaciya s vrachebnogo foruma (https://forums.rusmedserv.com/showpost.php)