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. Subjects school age symptoms of inattention often lead to poor school performance. While this is uncomfortable, particularly in today's 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 registration of mental illness, revision IV and 1–2% when diagnosed using the ICD-10 criteria. The prevalence is similar among countries, depending largely 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 preschool children. 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 medical professionals 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 pleasurable.

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

Spout inappropriate comments, express emotion without restraint, and act without regard for 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:

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.

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.

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.

Hypokalemic sensory overstimulation is present in less than 50% of people with ADHD and may be the molecular mechanism for many ADHD sufferers.

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.

Anxiety disorders are more common in ADHD sufferers.

Disorders caused by the use of psychoactive substances. Adolescents and adults with ADHD are at increased risk of developing a substance use disorder. For the most part, it is associated with and. 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.

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 writing and colloquial speech, difficulty listening in distracting environments such as classrooms, and difficulty reading comprehension.

The reasons

The cause of most cases of ADHD is not known; however, it is assumed that environment. 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 approximately 9% of cases, and when this gene is present, people respond partially to the stimulant drug. Since ADHD is widespread, natural selection is likely to favor traits, at least individually, and these 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 environmental conditions, 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 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. A 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 a trigger 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 be indicative of family dysfunction or a poor educational system rather than an individual's problems. 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 Szasz, who supports this theory, argued that ADHD was "made up, 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 tegmental region and the locus coeruleus, target different regions of the brain and mediate many 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 tasks. Everyday 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.

Mixed ADHD 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

Excessive feeling of happiness

Hyperactivity

Leap of ideas

Aggression

Excessive talkativeness

Big crazy ideas

Decreased need for sleep

Unacceptable social behavior

Difficulty paying attention

Symptoms of ADHD such as low mood and low self-esteem, mood swings and irritability can be confused with dysthymia, cyclothymia or, 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. Most an 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 useful action, another found no benefit, and a third found 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's 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 stimulants are generally safe, there are side effects and contraindications to 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. The safety of these medicinal products during pregnancy has not been determined. 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. , and may also have an effect on ADHD symptoms. There is evidence of modest benefit from taking omega-3 fatty acids, but they are not recommended as a substitute for conventional medications.

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 about 30–50% of adults. 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 years and over when diagnosed using the DSM-IV criteria. When diagnosed using the ICD-10 criteria, the estimated prevalence in this age group is 1–2%. Children 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 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 related 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 agitation" in his book An Inquiry into the Nature and Origin of 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 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. 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 about 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 not in a large number 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.

Media comments

Several famous people made conflicting statements regarding ADHD. Tom Cruise referred to the drugs Ritalin and Aderal as "street drugs". Ushma S. Neil criticized given point view, stating that the doses of stimulants used in the treatment of ADHD are non-addictive and that there is some evidence of a relatively low risk of subsequent chemical dependence in children treated with stimulants. In the UK, Susan Greenfield spoke publicly in 2007 in the House of Lords about the need for a large-scale study into the dramatic increase in ADHD diagnoses in the UK and the possible reasons for this. Later on on the BBC's Panorama, she claimed a compelling study showing that drugs are no better than other forms of therapy in the long term. In 2010 The BBC Trust criticized the 2007 BBC Panorama program for summarizing the study as "no apparent improvement in children's behavior after taking ADHD medication for three years" when, in fact, "the study found that the drug did not provide significant improvement over time." ”, although the long-term benefit of the drugs was defined as “no better than in children treated with behavioral therapy.”

Specific populations

adults

It has been estimated that 2-5% of adults have ADHD. Approximately half of children with ADHD persist into adulthood. Approximately 25% of children continue to show symptoms of ADHD during puberty, while the remaining 75% show fewer or no symptoms. Most adults remain untreated. Many lead disorganized lives and use non-prescribed drugs or alcohol as coping mechanisms. Other problems may include relationship and work difficulties, as well as an increased risk of criminal activity. Associated mental health problems include: depression, anxiety disorder, and learning disabilities. Some of the symptoms of ADHD in adults are different from those in children. While children with ADHD may run and climb excessively, adults may experience an inability to relax or talk excessively in social situations. Adults with ADHD may impulsively initiate relationships, exhibit thrill seeking, and be short tempered. Behaviors such as abuse are common psychoactive substances and passion for gambling. The DSM-IV criteria have been criticized for being inappropriate for adults; subjects showing differing symptoms may lead to a claim that they have outgrown the diagnosis.

Children with a high IQ

The diagnosis of ADHD and its relevance to children with a high intelligence quotient (IQ) is controversial. Most studies have found similar impairments regardless of IQ, with a high degree of repetitive stages and social complexity. In addition, more than half of people with high IQs and ADHD experience major depressive disorder or oppositional defiant disorder at some point in their lives. General anxiety disorder, separation anxiety disorder, and social phobia are common. There is some evidence that subjects with high IQ and ADHD have a lower risk of developing chemical dependency and antisocial behavior compared to children with low and moderate IQ and ADHD. Children and adolescents with high IQs may have incorrectly measured IQ in the standard assessment process and may require more in-depth testing.

:Tags

List of used literature:

Caroline, SC, ed. (2010). Encyclopedia of Cross-Cultural School Psychology. Springer Science & Business Media. p. 133. ISBN 9780387717982.

Childress, AC; Berry, SA (February 2012). "Pharmacotherapy of attention-deficit hyperactivity disorder in adolescents". Drugs 72(3): 309–25. doi:10.2165/11599580-000000000-00000. PMID 22316347.

Cowen, P; Harrison, P; Burns, T (2012). Shorter Oxford Textbook of Psychiatry (6th ed.). Oxford University Press. p. 546. ISBN 9780199605613.

Singh, I (December 2008). "Beyond polemics: Science and ethics of ADHD". Nature Reviews Neuroscience 9(12): 957–64. doi:10.1038/nrn2514. PMID 19020513.

Parker J, Wales G, Chalhoub N, Harpin V (September 2013). "The long-term outcomes of interventions for the management of attention-deficit hyperactivity disorder in children and adolescents: a systematic review of randomized controlled trials". Psychol. Res. behavior. Manag. 6:87–99. doi:10.2147/PRBM.S49114. PMC 3785407. PMID 24082796. “Results suggest there is moderate-to-high-level evidence that combined pharmacological and behavioral interventions, and pharmacological interventions alone can be effective in managing the core ADHD symptoms and academic performance at 14 months. However, the effect size may decrease beyond this period. … Only one paper53 examining outcomes beyond 36 months met the review criteria. … There is high level evidence suggesting that pharmacological treatment can have a major beneficial effect on the core symptoms of ADHD (hyperactivity, inattention, and impulsivity) in approximately 80% of cases compared with placebo controls, in the short term.22”

Parrillo VN (2008). Encyclopedia of Social Problems. SAGE. p. 63. ISBN 9781412941655. Retrieved 2 May 2009.

Schonwald A, Lechner E (April 2006). "Attention deficit/hyperactivity disorder: complexities and controversies". Curr. Opin. Pediatr. 18(2): 189–195. doi:10.1097/01.mop.0000193302.70882.70. PMID 16601502.

Facts About ADHD. Centers for Disease Control and Prevention. National Center on Birth Defects and Developmental Disabilities. Retrieved November 13, 2012.

American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington: American Psychiatric Publishing. pp. 59–65. ISBN 0890425558.

Sotnikova TD, Caron MG, Gainetdinov RR (August 2009). "Trace amine-associated receptors as emerging therapeutic targets". Mol. Pharmacol. 76(2): 229–235. doi:10.1124/mol.109.055970. PMC 2713119. PMID 19389919.

Glover V (April 2011). "Annual Research Review: Prenatal stress and the origins of psychopathology: an evolutionary perspective". J Child Psychol Psychiatry 52(4): 356–67. doi:10.1111/j.1469-7610.2011.02371.x. PMID 21250994.

Behavioral neuroscience of attention deficit hyperactivity disorder and its treatment. New York: Springer. January 13, 2012. pp. 132–134. ISBN 978-3-642-24611-1.

De Cock M, Maas YG, van de Bor M (August 2012). “Does perinatal exposure to endocrine disruptors induce autism spectrum and attention deficit hyperactivity disorders? Review". Acta Paediatr. 101(8): 811–818. doi:10.1111/j.1651-2227.2012.02693.x. PMID 22458970.

Owens JA (October 2008). "Sleep disorders and attention-deficit/hyperactivity disorder". Curr Psychiatry Rep 10(5): 439–444. doi:10.1007/s11920-008-0070-x. PMID 18803919.

Sonuga-Barke EJ, Brandeis D, Cortese S, Daley D, Ferrin M, Holtmann M, Stevenson J, Danckaerts M, van der Oord S, Döpfner M, Dittmann RW, Simonoff E, Zuddas A, Banaschewski T, Buitelaar J, Coghill D, Hollis C, Konofal E, Lecendreux M, Wong IC, Sergeant J (March 2013). "Nonpharmacological interventions for ADHD: systematic review and meta-analyses of randomized controlled trials of dietary and psychological treatments". Am J Psychiatry 170(3): 275–289. doi:10.1176/appi.ajp.2012.12070991. PMID 23360949.

Kratochvil CJ, Vaughan BS, Barker A, Corr L, Wheeler A, Madaan V (March 2009). "Review of pediatric attention deficit/hyperactivity disorder for the general psychiatrist". Psychiatr. Clin. North Am. 32(1): 39–56. doi:10.1016/j.psc.2008.10.001. PMID 19248915.

Turkington, C; Harris, J (2009). The Encyclopedia of the Brain and Brain Disorders. Infobase Publishing. p. 47. ISBN 9781438127033.

Rommel AS, Halperin JM, Mill J, Asherson P, Kuntsi J (September 2013). "Protection from genetic diathesis in attention-deficit/hyperactivity disorder: possible complementary roles of exercise". J Am Acad Child Adolesc Psychiatry 52(9): 900–10. doi:10.1016/j.jaac.2013.05.018. PMID 23972692. “As exercise has been found to enhance neural growth and development, and improve cognitive and behavioral functioning in individuals and animal studies, we reviewed the literature on the effects of exercise in children and adolescents with ADHD and animal models of ADHD behaviors. A limited number of undersized non-randomized, retrospective and cross-sectional studies have investigated the impact of exercise on ADHD and the emotional, behavioral and neuropsychological problems associated with the disorder. The findings from these studies provide some support for the notion that exercise has the potential to act as a protective factor for ADHD. … Although it remains unclear which role, if any, BDNF plays in the pathophysiology of ADHD, enhanced neural functioning has been suggested to be associated with the reduction of remission of ADHD symptoms.49,50,72 As exercise can elicit gene expression changes mediated by alterations in DNA methylation38, the possibility emerges that some of the positive effects of exercise could be caused by epigenetic mechanisms, which may set off a cascade of processes instigated by altered gene expression that could ultimately link to a change in brain function.”

Castells X, Ramos-Quiroga JA, Bosch R, Nogueira M, Casas M (2011). Castells X, ed. "Amphetamines for Attention Deficit Hyperactivity Disorder (ADHD) in adults". Cochrane Database Syst. Rev. (6): CD007813. doi:10.1002/14651858.CD007813.pub2. PMID 21678370.

Hart H, Radua J, Nakao T, Mataix-Cols D, Rubia K (February 2013). "Meta-analysis of functional magnetic resonance imaging studies of inhibition and attention in attention-deficit/hyperactivity disorder: exploring task-specific, stimulant medication, and age effects". JAMA Psychiatry 70(2): 185–198. doi:10.1001/jamapsychiatry.2013.277. PMID 23247506.

Ashton H, Gallagher P, Moore B (September 2006). "The adult psychiatrist's dilemma: psychostimulant use in attention deficit/hyperactivity disorder". J. Psychopharmacol. (Oxford) 20 (5): 602–610. doi:10.1177/0269881106061710. PMID 16478756.

Molina BS, Hinshaw SP, Swanson JM et al. (May 2009). "The MTA at 8 years: prospective follow-up of children treated for combined-type ADHD in a multisite study". Journal of the American Academy of Child and Adolescent Psychiatry 48(5): 484–500. doi:10.1097/CHI.0b013e31819c23d0. PMC 3063150. PMID 19318991.

Antshel, KM (2008). "Attention-Deficit Hyperactivity Disorder in the context of a high intellectual quotient/giftedness". Dev Disabil Res Rev 14(4): 293–299. doi:10.1002/ddrr.34. PMID 19072757.

Someone thinks that this is just a character, someone considers it a wrong upbringing, but many doctors call it Attention Deficit Hyperactivity Disorder. Attention deficit hyperactivity disorder (ADHD) is a dysfunction of the central nervous system (mainly the reticular formation of the brain), manifested by difficulties in concentrating and maintaining attention, learning and memory disorders, as well as difficulties in processing exogenous and endogenous information and stimuli. This is one of the most common neuropsychiatric disorders in childhood, its prevalence ranges from 2 to 12% (average 3-7%), and is more common in boys than girls. ADHD can occur both in isolation and in combination with other emotional and behavioral disorders, having a negative impact on learning and social adaptation child.

The first manifestations of ADHD are usually observed from 3-4 years of age. But when the child gets older and enters school, he has additional difficulties, because the beginning schooling makes new, higher demands on the personality of the child and his intellectual abilities. It is during the school years that attention disorders become apparent, as well as difficulties in mastering school curriculum and poor academic performance, self-doubt and low self-esteem.

Children with Attention Deficit Disorder have normal or high intelligence, but tend to do poorly in school. In addition to learning difficulties, attention deficit disorder is manifested by motor hyperactivity, attention defects, distractibility, impulsive behavior, and problems in relationships with others. In addition to the fact that children with ADHD misbehave and perform poorly at school, as they grow older, they may be at risk for the formation of deviant and antisocial forms of behavior, alcoholism, and drug addiction. Therefore, it is important to recognize the early manifestations of ADHD and be aware of the possibilities for their treatment. It should be noted that attention deficit disorder is observed in both children and adults.

Causes of ADHD

A reliable and unique cause of the syndrome has not yet been found. It is believed that the formation of ADHD is based on neurobiological factors: genetic mechanisms and early organic damage to the central nervous system, which can be combined with each other. They determine the changes in the central nervous system, violations of higher mental functions and behavior, corresponding to the picture of ADHD. results contemporary research indicate the involvement in the pathogenetic mechanisms of ADHD of the system "associative cortex-basal ganglia-thalamus-cerebellum-prefrontal cortex", in which the coordinated functioning of all structures ensures control of attention and organization of behavior.

In many cases, an additional impact on children with ADHD is exerted by negative socio-psychological factors (primarily family factors), which in themselves do not cause the development of ADHD, but always contribute to an increase in the child's symptoms and adaptation difficulties.

genetic mechanisms. Among the genes that determine the predisposition to the development of ADHD (the role of some of them in the pathogenesis of ADHD is confirmed, while others are considered as candidates), include genes that regulate the metabolism of neurotransmitters in the brain, in particular dopamine and norepinephrine. Dysfunction of neurotransmitter systems of the brain plays an important role in the pathogenesis of ADHD. At the same time, disturbances in the processes of synaptic transmission are of primary importance, which entail dissociation, a break in connections between the frontal lobes and subcortical formations, and as a result of this, the development of ADHD symptoms. In favor of disorders of neurotransmitter transmission systems as the primary link in the development of ADHD is evidenced by the fact that the mechanisms of action of drugs that are most effective in the treatment of ADHD are to activate the release and inhibition of the reuptake of dopamine and norepinephrine in presynaptic nerve endings, which increases the bioavailability of neurotransmitters at the level of synapses. .

In modern concepts, attention deficit in children with ADHD is considered as a result of disturbances in the functioning of the posterior cerebral attention system regulated by norepinephrine, while disorders of behavioral inhibition and self-control characteristic of ADHD are considered as a lack of dopaminergic control over the flow of impulses to the forebrain attention system. The posterior cerebral system includes the superior parietal cortex, the superior colliculus, the thalamic cushion (the dominant role belongs to the right hemisphere); this system receives dense noradrenergic innervation from the locus coeruleus (blue spot). Norepinephrine suppresses spontaneous discharges of neurons, thereby preparing the posterior cerebral attention system, which is responsible for orienting to new stimuli, to work with them. This is followed by a switch in the mechanisms of attention to the anterior cerebral control system, which includes the prefrontal cortex and the anterior cingulate gyrus. The susceptibility of these structures to incoming signals is modulated by dopaminergic innervation from the ventral tegmental nucleus of the midbrain. Dopamine selectively regulates and limits excitatory impulses to the prefrontal cortex and cingulate gyrus, providing a reduction in excessive neuronal activity.

Attention deficit hyperactivity disorder (ADHD) is considered a polygenic disorder in which multiple disorders of dopamine and/or norepinephrine metabolism that exist simultaneously are due to the influence of several genes that override the protective effect of compensatory mechanisms. The effects of the genes that cause ADHD are complementary. Thus, ADHD is considered as a polygenic pathology with a complex and variable inheritance, and at the same time as a genetically heterogeneous condition.

Pre- and perinatal factors play an important role in the pathogenesis of ADHD. The formation of ADHD may be preceded by disturbances in the course of pregnancy and childbirth, in particular preeclampsia, eclampsia, the first pregnancy, the age of the mother is younger than 20 years or older than 40 years, prolonged labor, post-term pregnancy and prematurity, low birth weight, morphofunctional immaturity, hypoxic ischemic encephalopathy, a disease of a child in the first year of life. Other risk factors are the use of certain drugs by the mother during pregnancy, alcohol and smoking.

Apparently, a slight decrease in the size of the prefrontal areas of the brain (mainly in the right hemisphere), subcortical structures, corpus callosum, and cerebellum found in children with ADHD compared with healthy peers using magnetic resonance imaging (MRI) is apparently associated with early CNS damage. These data support the concept that the occurrence of ADHD symptoms is due to impaired connections between the prefrontal regions and subcortical ganglia, primarily the caudate nucleus. Subsequently, additional confirmation was obtained through the use of functional neuroimaging methods. Thus, when determining cerebral blood flow using single-photon emission computed tomography in children with ADHD, compared with healthy peers, a decrease in blood flow (and, consequently, metabolism) in the frontal lobes, subcortical nuclei and midbrain was demonstrated, and in most changes were expressed at the level of the caudate nucleus. According to the researchers, changes in the caudate nucleus in children with ADHD were the result of its hypoxic-ischemic damage during the neonatal period. Having close connections with the thalamus opticus, the caudate nucleus performs an important function of modulation (mainly of an inhibitory nature) of polysensory impulsations, and the absence of inhibition of polysensory impulsations may be one of the pathogenetic mechanisms of ADHD.

With the help of positron emission tomography (PET), it was found that cerebral ischemia transferred at birth leads to persistent changes in dopamine receptors of the 2nd and 3rd types in the structures of the striatum. As a result, the ability of receptors to bind dopamine decreases and a functional insufficiency of the dopaminergic system is formed.

A recent comparative MRI study of children with ADHD, the purpose of which was to assess regional differences in the thickness of the cerebral cortex and compare their age dynamics with clinical outcomes, showed that children with ADHD showed a global decrease in cortical thickness, most pronounced in the prefrontal (medial and upper) and precentral regions. At the same time, in patients with worse clinical outcomes during the initial examination, the smallest thickness of the cortex was found in the left medial prefrontal region. Normalization of the thickness of the right parietal cortex was associated with the best outcomes in patients with ADHD and may reflect a compensatory mechanism associated with changes in the thickness of the cerebral cortex.

The neuropsychological mechanisms of ADHD are considered from the standpoint of disorders (immaturity) of the functions of the frontal lobes of the brain, primarily the prefrontal area. Manifestations of ADHD are analyzed from the standpoint of a deficit in the functions of the frontal and prefrontal parts of the brain and insufficient formation of executive functions (EF). Patients with ADHD present with "executive dysfunction". The development of UV and the maturation of the prefrontal region of the brain are long-term processes that continue not only in childhood but also in adolescence. EF is a rather broad concept referring to the range of abilities that serve the task of maintaining the necessary sequence of efforts to solve a problem, aimed at achieving future goal. Significant components of the EF that are affected in ADHD are: impulse control, behavioral inhibition (restraint); organization, planning, management of mental processes; maintaining attention, keeping from distractions; inner speech; working (operative) memory; foresight, forecasting, a look into the future; retrospective assessment of past events, mistakes made; change, flexibility, ability to switch and revise plans; choice of priorities, the ability to allocate time; separating emotions from real facts. Some UV researchers emphasize "hot" social aspect self-regulation and the child's ability to control his behavior in society, while others emphasize the role of the regulation of mental processes - the "cold" cognitive aspect of self-regulation.

Influence of adverse environmental factors. Anthropogenic pollution human environment natural environment, largely associated with trace elements from the group of heavy metals, can have negative consequences for the health of children. It is known that in the immediate vicinity of many industrial enterprises, zones with a high content of lead, arsenic, mercury, cadmium, nickel and other microelements are formed. The most common heavy metal neurotoxicant is lead, and its sources of environmental pollution are industrial emissions and vehicle exhaust gases. Lead exposure to children can cause cognitive and behavioral problems in children.

The role of nutritional factors and unbalanced nutrition. Nutritional imbalances (e.g., protein deficiency with an increase in easily digestible carbohydrates, especially in the morning), as well as micronutrient deficiencies, including vitamins, folates, omega-3 polyunsaturated fatty acids (PUFAs) can contribute to the onset or exacerbation of ADHD symptoms. , macro- and microelements. Micronutrients such as magnesium, pyridoxine and some others directly affect the synthesis and degradation of monoamine neurotransmitters. Therefore, micronutrient deficiencies can affect the neurotransmitter balance and hence the manifestation of ADHD symptoms.
Of particular interest among micronutrients is magnesium, which is a natural lead antagonist and promotes the rapid elimination of this toxic element. Therefore, magnesium deficiency, among other effects, can contribute to the accumulation of lead in the body.

Magnesium deficiency in ADHD can be associated not only with its insufficient intake with food, but also with an increased need for it during critical periods of growth and development, with severe physical and neuropsychic stress, and stress. Under conditions of environmental stress, nickel and cadmium, along with lead, act as magnesium displacing metals. In addition to a lack of magnesium in the body, the manifestation of ADHD symptoms can be influenced by zinc, iodine, and iron deficiencies.

Thus, ADHD is a complex neuropsychiatric disorder, accompanied by structural, metabolic, neurochemical, neurophysiological changes in the CNS, as well as neuropsychological disorders in the processes of information processing and UV.

Symptoms of ADHD in children

Symptoms of ADHD in a child may be the reason for the primary appeal to pediatricians, speech therapists, defectologists, psychologists. Often it is teachers of preschool and school educational institutions who first pay attention to the symptoms of ADHD, and not parents. The detection of such symptoms is a reason to show the child to a neurologist and neuropsychologist.

Main manifestations of ADHD

1. Attention disorders
Does not pay attention to details, makes many mistakes.
It is difficult to maintain attention when performing school and other tasks.
He does not listen to what is said to him.
Cannot follow instructions and follow through.
Unable to independently plan, organize the execution of tasks.
Avoids things that require prolonged mental stress.
Often loses his things.
Easily distracted.
Shows forgetfulness.
2a. Hyperactivity
Often makes restless movements with arms and legs, fidgets in place.
Cannot sit still when necessary.
Often runs or climbs somewhere when it is inappropriate.
Can't play quietly.
Excessive aimless physical activity is persistent, it is not affected by the rules and conditions of the situation.
2b. Impulsiveness
Answers questions without listening to the end and without thinking.
Can't wait for their turn.
Interferes with other people, interrupts them.
Chatty, unrestrained in speech.

The essential characteristics of ADHD are:

Duration: symptoms persist for at least 6 months;
- constancy, distribution to all spheres of life: adaptation disorders are observed in two or more types of environment;
- severity of violations: significant violations in training, social contacts, professional activities;
- other mental disorders are excluded: the symptoms cannot be associated exclusively with the course of another disease.

Depending on the predominant symptoms, there are 3 forms of ADHD:
- combined (combined) form - there are all three groups of symptoms (50-75%);
- ADHD with predominant attention disorders (20-30%);
- ADHD with a predominance of hyperactivity and impulsivity (about 15%).

Symptoms of ADHD have their own characteristics in preschool, primary school and adolescence.

Preschool age. Between the ages of 3 and 7, hyperactivity and impulsivity usually begin to appear. Hyperactivity is characterized by the fact that the child is in constant motion, cannot sit still during classes for even a short time, is too talkative and asks an endless number of questions. Impulsivity is expressed in the fact that he acts without thinking, cannot wait for his turn, does not feel restrictions in interpersonal communication, intervening in conversations and often interrupting others. Such children are often characterized as misbehaving or too temperamental. They are extremely impatient, arguing, making noise, shouting, which often leads them to outbursts of strong irritation. Impulsivity can be accompanied by recklessness, as a result of which the child endangers himself (increased risk of injury) or others. During games, energy is overflowing, and therefore the games themselves become destructive. Children are sloppy, often throw, break things or toys, are naughty, poorly obey the demands of adults, and can be aggressive. Many hyperactive children lag behind their peers in language development.

School age. After entering school, the problems of children with ADHD increase significantly. The learning requirements are such that a child with ADHD is not able to fulfill them fully. Because his behavior does not correspond to the age norm, he fails to achieve results in school that correspond to his abilities (while the general level of intellectual development in children with ADHD corresponds to the age range). During the lessons, they do not hear the teacher, it is difficult for them to cope with the proposed tasks, as they experience difficulties in organizing work and bringing it to the end, they forget in the course of fulfilling the conditions of the task, they do not master the teaching materials well and cannot apply them correctly. They quite soon turn off the process of doing the work, even if they have everything necessary for this, do not pay attention to details, show forgetfulness, do not follow the instructions of the teacher, switch poorly when the conditions of the task change or a new one is given. They are unable to do their homework on their own. Compared with peers, difficulties in the formation of skills in writing, reading, counting, logical thinking.

Relationship problems with others, including peers, teachers, parents, and siblings, are common among children with ADHD. Since all manifestations of ADHD are characterized by significant mood swings at different times and in different situations, the child's behavior is unpredictable. Hot temper, cockiness, oppositional and aggressive behavior are often observed. As a result, he cannot play for a long time, successfully communicate and establish friendly relations with peers. In the team, he serves as a source of constant anxiety: he makes noise without hesitation, takes other people's things, interferes with others. All this leads to conflicts, and the child becomes unwanted and rejected in the team.

Faced with this attitude, children with ADHD often consciously choose to play the role of class jester, hoping to build relationships with their peers. A child with ADHD not only does not study well on his own, but often "breaks" the lessons, interferes with the work of the class, and therefore is often called to the director's office. In general, his behavior creates the impression of "immaturity", inconsistency with his age. Only younger children or peers with similar behavior problems are usually ready to communicate with him. Gradually, children with ADHD develop low self-esteem.

At home, children with ADHD usually suffer constant comparisons to siblings who are well-behaved and learn better. Parents are annoyed by the fact that they are restless, obsessive, emotionally labile, undisciplined, disobedient. At home, the child is unable to take responsibility for the implementation of daily tasks, does not help parents, is sloppy. At the same time, comments and punishments do not give the desired results. According to the parents, “Something always happens to him”, that is, there is an increased risk of injuries and accidents.

Adolescence. In adolescence, pronounced symptoms of impaired attention and impulsivity continue to be observed in at least 50-80% of children with ADHD. At the same time, hyperactivity in adolescents with ADHD is significantly reduced, replaced by fussiness, a sense of inner restlessness. They are characterized by lack of independence, irresponsibility, difficulties in organizing and completing the execution of assignments and especially long-term work, which they are often unable to cope with without outside help. School performance often worsens, as they cannot effectively plan their work and distribute it over time, they postpone the execution of necessary tasks from day to day.

Difficulties in relationships in the family and school, behavioral disorders are growing. Many adolescents with ADHD are distinguished by reckless behavior associated with unjustified risk, difficulties in following the rules of behavior, disobedience to social norms and laws, failure to comply with the requirements of adults - not only parents and teachers, but also officials, such as school administration representatives or police officers. At the same time, they are characterized by weak psycho-emotional stability in case of failures, self-doubt, low self-esteem. They are too sensitive to teasing and ridicule from peers who think they are stupid. Adolescents with ADHD continue to be characterized by peers as immature and inappropriate for their age. In everyday life, they neglect the necessary safety measures, which increases the risk of injury and accidents.

Adolescents with ADHD are prone to being involved in teen gangs that commit various offenses, they may develop cravings for alcohol and drugs. But in these cases, they, as a rule, turn out to be led, obeying the will of stronger peers or older people and not thinking about the possible consequences of their actions.

Disorders associated with ADHD (comorbid disorders). Additional difficulties in intra-family, school and social adaptation in children with ADHD may be associated with the formation of concomitant disorders that develop against the background of ADHD as the underlying disease in at least 70% of patients. The presence of comorbid disorders can lead to worsening of the clinical manifestations of ADHD, worsening of long-term prognosis, and reduced effectiveness of treatment for ADHD. Behavioral and emotional disturbances associated with ADHD are considered as unfavorable prognostic factors for the long-term, up to chronic, course of ADHD.

Comorbid disorders in ADHD are represented by the following groups: externalized (oppositional defiant disorder, conduct disorder), internalized (anxiety disorders, mood disorders), cognitive (speech development disorders, specific learning difficulties - dyslexia, dysgraphia, dyscalculia), motor (static-locomotor failure, developmental dyspraxia, tics). Other comorbid ADHD disorders can be sleep disturbances (parasomnias), enuresis, encopresis.

Thus, learning, behavioral, and emotional problems can be associated with both the direct influence of ADHD and comorbid disorders, which should be diagnosed in a timely manner and considered as indications for additional appropriate treatment.

Diagnosis of ADHD

In Russia, the diagnosis of "hyperkinetic disorder" is approximately equivalent to the combined form of ADHD. To make a diagnosis, all three groups of symptoms (table above) must be confirmed, including at least 6 manifestations of inattention, at least 3 - hyperactivity, at least 1 - impulsiveness.

To confirm ADHD, there are no special criteria or tests based on the use of modern psychological, neurophysiological, biochemical, molecular genetic, neuroradiological and other methods. The diagnosis of ADHD is made by a doctor, but educators and psychologists should also be familiar with the diagnostic criteria for ADHD, especially since it is important to obtain reliable information about the child's behavior not only at home, but also at school or preschool in order to confirm this diagnosis.

In childhood, ADHD “imitators” are quite common: in 15-20% of children, forms of behavior outwardly similar to ADHD are periodically observed. In this regard, ADHD must be distinguished from a wide range of conditions that are similar to it only in external manifestations, but differ significantly both in causes and methods of correction. These include:

Individual characteristics of personality and temperament: the characteristics of the behavior of active children do not go beyond the age norm, the level of development of higher mental functions is good;
- Anxiety disorders: the characteristics of the child's behavior are associated with the action of psychotraumatic factors;
- consequences of traumatic brain injury, neuroinfection, intoxication;
- asthenic syndrome in somatic diseases;
- specific disorders of the development of school skills: dyslexia, dysgraphia, dyscalculia;
- endocrine diseases (pathology of the thyroid gland, diabetes mellitus);
- sensorineural hearing loss;
- epilepsy (absence forms; symptomatic, locally conditioned forms; side effects of anti-epileptic therapy);
- hereditary syndromes: Tourette, Williams, Smith-Mazhenis, Beckwith-Wiedemann, fragile X-chromosome;
- mental disorders: autism, affective disorders (mood), mental retardation, schizophrenia.

In addition, the diagnosis of ADHD should be built taking into account the peculiar age dynamics of this condition.

Treatment for ADHD

At the present stage, it becomes obvious that the treatment of ADHD should be aimed not only at controlling and reducing the main manifestations of the disorder, but also at solving other important tasks: improving the functioning of the patient in various areas and his fullest realization as a person, the emergence of his own achievements, improving self-esteem , normalization of the situation around him, including within the family, the formation and strengthening of communication skills and contacts with people around him, recognition by others and increasing satisfaction with his life.

The conducted research confirmed the significant negative impact of the difficulties experienced by children with ADHD on their emotional condition, family life, friendships, schooling, leisure activities. In this regard, the concept of an expanded therapeutic approach has been formulated, which implies the extension of the influence of treatment beyond the reduction of the main symptoms and taking into account functional outcomes and quality of life indicators. Thus, the concept of an expanded therapeutic approach involves addressing the social and emotional needs of a child with ADHD, which should be given special attention both at the stage of diagnosis and treatment planning, and in the process of dynamic monitoring of the child and evaluation of the results of therapy.

The most effective for ADHD is complex assistance, which combines the efforts of doctors, psychologists, teachers working with the child, and his family. It would be ideal if a good neuropsychologist takes care of the child. Treatment for ADHD must be timely and must include:

Helping the family of a child with ADHD - family and behavioral therapy techniques that provide better interaction in families of children with ADHD;
- development of parenting skills for children with ADHD, including parent training programs;
- educational work with teachers, correction of the school curriculum - through a special one - the presentation of educational material and the creation of such an atmosphere in the classroom that maximizes the chances of successful education of children;
- psychotherapy of children and adolescents with ADHD, overcoming difficulties, developing effective communication skills in children with ADHD during special remedial classes;
- drug therapy and diet, which should be long enough, since improvement extends not only to the main symptoms of ADHD, but also to the socio-psychological side of the patients' lives, including their self-esteem, relationships with family members and peers, usually starting from the third month of treatment . Therefore, it is advisable to plan drug therapy for several months up to the duration of the entire school year.

Medications to treat ADHD

An effective drug specifically designed for the treatment of ADHD is atomoxetine hydrochloride. The main mechanism of its action is associated with the blockade of norepinephrine reuptake, which is accompanied by an increase in synaptic transmission involving norepinephrine in various brain structures. In addition, experimental studies have found an increase in the content of not only norepinephrine, but also dopamine selectively in the prefrontal cortex under the influence of atomoxetine, since in this area dopamine binds to the same transport protein as norepinephrine. Since the prefrontal cortex plays a leading role in providing executive functions of the brain, as well as attention and memory, an increase in the concentration of norepinephrine and dopamine in this area under the action of atomoxetine leads to a decrease in the manifestations of ADHD. Atomoxetine has a beneficial effect on the behavioral characteristics of children and adolescents with ADHD, its positive effect is usually manifested already at the beginning of treatment, but the effect continues to grow during the month of continuous use of the drug. In most patients with ADHD, clinical efficacy is achieved by prescribing the drug in the dose range of 1.0-1.5 mg/kg of body weight per day with a single dose in the morning. The advantage of atomoxetine is its effectiveness in cases of ADHD combined with destructive behavior, anxiety disorders, tics, enuresis. The drug has many side effects, so the reception is strictly under the supervision of a doctor.

Russian specialists in the treatment of ADHD traditionally use nootropic drugs. Their use in ADHD is justified, since nootropic drugs have a stimulating effect on cognitive functions that are not sufficiently formed in children of this group (attention, memory, organization, programming and control of mental activity, speech, praxis). Given this circumstance, the positive effect of drugs with a stimulating effect should not be taken as paradoxical (given the hyperactivity in children). On the contrary, the high efficiency of nootropics seems to be natural, especially since hyperactivity is only one of the manifestations of ADHD and is itself caused by violations of higher mental functions. In addition, these drugs have a positive effect on metabolic processes in the central nervous system and contribute to the maturation of the inhibitory and regulatory systems of the brain.

A recent study confirms the good potential hopantenic acid preparation in the long-term treatment of ADHD. A positive effect on the main symptoms of ADHD is achieved after 2 months of treatment, but continues to increase after 4 and 6 months of its use. Along with this, the beneficial effect of long-term use of the drug hopantenic acid on the characteristic disorders of adaptation and functioning in children with ADHD was confirmed. various areas, including the difficulties of behavior in the family and in society, studying at school, lowering self-esteem, lack of formation of basic life skills. However, in contrast to the regression of the main symptoms of ADHD, longer periods of treatment were needed to overcome the disorders of adaptation and socio-psychological functioning: a significant improvement in self-esteem, communication with others and social activity was observed according to the results of parental questionnaires after 4 months, and a significant improvement in behavioral and schooling, basic life skills along with a significant regression of risk-taking behavior - after 6 months of using the drug hopantenic acid.

Another direction of ADHD treatment is to control negative nutritional and environmental factors that lead to the intake of neurotoxic xenobiotics (lead, pesticides, polyhaloalkyls, food colorings, preservatives) into the child's body. This should be accompanied by the inclusion in the diet of the necessary micronutrients that help reduce ADHD symptoms: vitamins and vitamin-like substances (omega-3 PUFAs, folates, carnitine) and essential macro- and microelements (magnesium, zinc, iron).
Among the micronutrients with a proven clinical effect in ADHD, magnesium preparations should be noted. Magnesium deficiency is determined in 70% of children with ADHD.

Magnesium is an important element involved in maintaining the balance of excitatory and inhibitory processes in the central nervous system. There are several molecular mechanisms through which magnesium deficiency affects neuronal activity and neurotransmitter metabolism: magnesium is required to stabilize excitatory (glutamate) receptors; magnesium is an essential cofactor of adenylate cyclases involved in signal transmission from neurotransmitter receptors to controlling intracellular cascades; magnesium is a cofactor for catechol-O-methyltransferase, which inactivates excess monoamine neurotransmitters. Therefore, magnesium deficiency contributes to the imbalance of the "excitation-inhibition" processes in the CNS towards excitation and can affect the manifestation of ADHD.

In the treatment of ADHD, only organic magnesium salts (lactate, pidolate, citrate) are used, which is associated with a high bioavailability of organic salts and the absence of side effects when they are used in children. The use of magnesium pidolate with pyridoxine in solution (ampoule form of Magne B6 (Sanofi-Aventis, France)) is allowed from the age of 1 year, lactate (Magne B6 in tablets) and magnesium citrate (Magne B6 forte in tablets) - from 6 years . The magnesium content in one ampoule is equivalent to 100 mg of ionized magnesium (Mg2+), in one tablet of Magne B6 - 48 mg of Mg2+, in one tablet of Magne B6 forte (618.43 mg of magnesium citrate) - 100 mg of Mg2+. The high concentration of Mg2+ in Magne B6 forte allows you to take 2 times fewer tablets than when taking Magne B6. The advantage of the drug Magne B6 in ampoules is also the possibility of more accurate dosing, the use of the ampoule form of Magne B6 provides rapid rise the level of magnesium in the blood plasma (within 2-3 hours), which is important for the rapid elimination of magnesium deficiency. At the same time, taking Magne B6 tablets contributes to a longer (within 6-8 hours) retention of an increased concentration of magnesium in erythrocytes, that is, its deposition.

The emergence of combined preparations containing magnesium and vitamin B6 (pyridoxine) has significantly improved the pharmacological properties of magnesium salts. Pyridoxine is involved in the metabolism of proteins, carbohydrates, fatty acids, the synthesis of neurotransmitters and many enzymes, has a neuro-, cardio-, hepatotropic, and hematopoietic effect, contributes to the replenishment of energy resources. The high activity of the combined preparation is due to the synergistic action of the components: pyridoxine increases the concentration of magnesium in plasma and erythrocytes and reduces the amount of magnesium excreted from the body, improves magnesium absorption in the gastrointestinal tract, its penetration into cells, and fixation. Magnesium, in turn, activates the process of transformation of pyridoxine into its active metabolite pyridoxal-5-phosphate in the liver. Thus, magnesium and pyridoxine potentiate each other's action, which allows their combination to be successfully used to normalize magnesium balance and prevent magnesium deficiency.

The combined intake of magnesium and pyridoxine for 1-6 months reduces the symptoms of ADHD and restores normal values ​​of magnesium in red blood cells. Already after a month of treatment, anxiety, attention disorders and hyperactivity decrease, concentration of attention, accuracy and speed of task performance improve, and the number of errors decreases. There is an improvement in gross and fine motor skills, a positive dynamics of EEG characteristics in the form of the disappearance of signs of paroxysmal activity against the background of hyperventilation, as well as bilateral-synchronous and focal pathological activity in most patients. At the same time, taking Magne B6 is accompanied by the normalization of magnesium concentration in erythrocytes and blood plasma of patients.

Replenishment of magnesium deficiency should last at least two months. Considering that alimentary deficiency of magnesium occurs most often, when drawing up nutritional recommendations, one should take into account not only the quantitative content of magnesium in foods, but also its bioavailability. So, fresh vegetables, fruits, herbs (parsley, dill, green onions) and nuts have the maximum concentration and activity of magnesium. When preparing products for storage (drying, canning), the concentration of magnesium decreases slightly, but its bioavailability drops sharply. This is important for children with ADHD who have a deepening of magnesium deficiency that coincides with the period of school from September to May. Therefore, the use of combined preparations containing magnesium and pyridoxine is advisable during the school year. But, alas, the problem cannot be solved by drugs alone.

Home psychotherapy

Any classes are desirable to be carried out in a playful way. Any games where you need to hold and switch attention will do. For example, the game "find the pairs", where cards with images are opened and turned over in turn, and you need to remember and open them in pairs.

Or even take a game of hide and seek - there is a queue, certain roles, you need to sit in the shelter certain time, and you also need to figure out where to hide and change these places. All this is a good training of programming and control functions, moreover, it takes place when the child is emotionally involved in the game, which helps to maintain the optimal tone of wakefulness at this moment. And it is needed for the emergence and consolidation of all cognitive neoplasms, for the development of cognitive processes.

Remember all the games you played in the yard, they are all selected human history and are very useful for the harmonious development of mental processes. Here, for example, is a game where you need to "do not say yes and no, do not buy black and white" - after all, this is a wonderful exercise for slowing down a direct answer, that is, for training programming and control.

Teaching Children with Attention Deficit Hyperactivity Disorder

With such children, a special approach to learning is needed. Often children with ADHD have problems maintaining optimal tone, which causes all other problems. Due to the weakness of the inhibitory control, the child is overexcited, restless, cannot concentrate on anything for a long time, or, conversely, the child is lethargic, he wants to lean against something, he quickly gets tired, and his attention can no longer be collected by any means until some upswing and then downswing again. The child cannot set tasks for himself, determine how and in what order he will solve them, do this work without being distracted and test himself. These children have difficulties in writing - omissions of letters, syllables, merging two words into one. They do not hear the teacher or are accepted for the task without listening to the end, hence, the problems in all school subjects.

We need to develop the child's ability to program and control own activities. While he himself does not know how to do this, these functions are taken over by the parents.

Training

Choose a day and address the child with these words: "You know, they taught me how to do homework quickly. Let's try to do them very quickly. It should work out!"

Ask the child to bring a portfolio, lay out everything you need to complete the lessons. Say: well, let's try to set a record - do all the lessons in an hour (let's say). Important: the time while you are preparing, clearing the table, laying out textbooks, figuring out the task, is not included in this hour. It is also very important that the child has all the tasks recorded. As a rule, children with ADHD do not have half of the tasks, and endless calls to classmates begin. Therefore, we can warn you in the morning: today we will try to set a record for completing tasks in the shortest possible time, only one thing is required of you: carefully write down all the tasks.

First item

Let's get started. Open the diary, see what is given. What will you do first? Russian or math? (It does not matter what he chooses - it is important that the child chooses himself).

Take a textbook, find an exercise, and I time it. Read the assignment aloud. So, I did not understand something: what needs to be done? Please explain.

You need to reformulate the task in your own words. Both - both the parent and the child - must understand what exactly needs to be done.

Read the first sentence and do what needs to be done.

It is better to first do the first trial action orally: what do you need to write? Speak aloud, then write.

Sometimes a child says something correctly, but immediately forgets what was said - and when it is necessary to write it down, he no longer remembers. Here the mother should work as a voice recorder: to remind the child what he said. The most important thing is to be successful from the very beginning.

It is necessary to work slowly, not to make mistakes: pronounce it as you write, Moscow - "a" or "o" next? Speak in letters, in syllables.

Check this out! Three and a half minutes - and we have already made the first offer! Now you can easily finish everything!

That is, the effort should be followed by encouragement, emotional reinforcement, it will allow maintaining the optimal energy tone of the child.

The second sentence takes a little less time than the first.

If you see that the child began to fidget, yawn, make mistakes - stop the clock. "Oh, I forgot, I have something left unfinished in my kitchen, wait for me." The child should be given a short break. In any case, you need to ensure that the first exercise is done as compactly as possible, in fifteen minutes, no more.

Turn

After that, you can already relax (the timer turns off). You are hero! You did the exercise in fifteen minutes! So, in half an hour we will do the whole Russian! Well, you already deserve compote. Instead of compote, of course, you can choose any other reward.

When you give a break, it is very important not to lose your mood, not to let the child be distracted during the rest. Well, are you ready? Let's do two more exercises the same way! And again - we read the condition aloud, we pronounce it, we write it.

When the Russian is finished, you need to rest more. Stop the timer, take a break of 10-15 minutes - like a school break. Agree: at this time you can’t turn on the computer and TV, you can’t start reading a book. You can do physical exercises: leave the ball, hang on the horizontal bar.

Second subject

We do the same math. What is given? Open textbook. Let's start time again. Separately, we retell the conditions. We pose a separate question that needs to be answered.

What is asked in this problem? What is needed?

It often happens that the mathematical part is perceived and reproduced easily, but the question is forgotten, formulated with difficulty. The question should be given special attention.

Can we answer this question right away? What needs to be done for this? What do you need to know first?

Let the child most in simple terms tell you what needs to be done in what order. At first it is external speech, then it will be replaced by internal. Mom should insure the child: in time to hint to him that he went the wrong way, that it is necessary to change the course of reasoning, not to let him get confused.

The most unpleasant part of a mathematical task is the rules for solving problems. We ask the child: did you solve a similar problem in class? Let's see how to write so as not to make a mistake. Let's take a look?

You need to pay special attention to the recording form - after that it costs nothing to write down the solution to the problem.

Then check. Did you say you need to do this and that? Did it? And this? It? Checked, now you can write the answer? Well, how long did the task take us?

How did you do it in such a short amount of time? You deserve something delicious!

The task is done - we take up the examples. The child dictates and writes to himself, the mother checks the correctness. After each column we say: amazing! Are we taking on the next column or compote?

If you see that the child is tired - ask: well, will we work some more or will we go to drink compote?

Mom should be in good shape on this day herself. If she is tired, wants to get rid of it as soon as possible, if her head hurts, if she cooks something in the kitchen at the same time and runs there every minute - this will not work.

So you need to sit with the child once or twice. Then the mother should begin to systematically eliminate herself from this process. Let the child tell his mother the whole semantic part in his own words: what needs to be done, how to do it. And the mother can go away - go to another room, to the kitchen: but the door is open, and the mother imperceptibly controls whether the child is busy with work, whether he is distracted by extraneous matters.

It is not necessary to focus on mistakes: it is necessary to achieve the effect of effectiveness, it is necessary that the child has the feeling that he is succeeding.

Thus, early detection of ADHD in children will prevent future learning and behavioral problems. The development and application of complex correction should be carried out in a timely manner, wear individual character. Treatment for ADHD, including drug therapy, should be long enough.

Prognosis for ADHD

The prognosis is relatively favorable, and in a significant proportion of children, even without treatment, symptoms disappear during adolescence. Gradually, as the child grows, disturbances in the neurotransmitter system of the brain are compensated, and some of the symptoms regress. However, clinical manifestations of attention deficit hyperactivity disorder (excessive impulsivity, irascibility, absent-mindedness, forgetfulness, restlessness, impatience, unpredictable, rapid and frequent mood changes) can also be observed in adults.

The factors of the unfavorable prognosis of the syndrome are its combination with mental illness, the presence of mental pathology in the mother, as well as the symptoms of impulsivity in the patient himself. Social adaptation of children with attention deficit hyperactivity disorder can only be achieved with the interest and cooperation of the family and school.

In recent years, great progress has been made in the study of one of the most urgent problems of neuropediatrics - attention deficit hyperactivity disorder in children. The urgency of the problem is determined by the high frequency of this syndrome in the child population and its great social significance. Children with Attention Deficit Disorder have normal or high intelligence, but tend to do poorly in school. In addition to learning difficulties, attention deficit disorder is manifested by motor hyperactivity, attention defects, distractibility, impulsive behavior, and problems in relationships with others. It should be noted that attention deficit disorder is observed in both children and adults. In recent years, its genetic nature has been proven. It is quite obvious that the interests of various specialists - pediatricians, teachers, neuropsychologists, speech pathologists, neurologists - are concentrated in the focus of scientific problems of attention deficit hyperactivity disorder.

1. Attention Deficit Hyperactivity Disorder- dysfunction of the central nervous system (mainly the reticular formation of the brain and spinal cord. The reticular formation (lat. rete - network) is a collection of cells, cell clusters and nerve fibers located throughout the brainstem (medulla oblongata, bridge, middle and diencephalon ) and in the central parts of the spinal cord.The reticular formation receives information from all sense organs, internal and other organs, evaluates it, filters and transmits it to the limbic system and cortex big brain. It regulates the level of excitability and tone of various parts of the central nervous system, including the cerebral cortex, plays an important role in consciousness, thinking, memory, perception, emotions, sleep, wakefulness, autonomic functions, purposeful movements, as well as in the mechanisms of formation of integral reactions of the body. The reticular formation primarily performs the function of a filter that allows sensory signals important for the body to activate the cerebral cortex, but does not allow habitual or repetitive signals to pass through.), Manifested by difficulties in concentrating and maintaining attention, learning and memory disorders, as well as difficulties in processing exogenous and endogenous information and incentives.

The term "attention deficit disorder" was isolated in the early 80s from the broader concept of "minimal brain dysfunction". The history of the study of minimal brain dysfunction is associated with the studies of E. Kahn, although some studies have been carried out earlier. Observing school-age children with such behavioral disorders as motor disinhibition, distractibility, impulsive behavior, the authors suggested that the cause of these changes is brain damage of unknown etiology, and proposed the term "minimal brain damage". Later, learning disorders (difficulties and specific impairments in learning writing, reading, counting skills; disorders of perception and speech) were included in the concept of "minimal brain damage". Subsequently, the static "minimal brain damage" model gave way to a more dynamic and more flexible "minimal brain dysfunction" model.

In 1980, the American Psychiatric Association developed a working classification - DSM-IV (the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition), - according to which cases previously described as minimal brain dysfunction were proposed to be considered as attention deficit hyperactivity disorder and hyperactivity disorder. . The underlying premise was that the most common and significant clinical symptoms of minimal brain dysfunction included impaired attention and hyperactivity. In the latest DSM-IV classification, these syndromes are grouped under one name "Attention Deficit Hyperactivity Disorder". In the ICD-10, the syndrome is covered under "Emotional and behavioral disorders with onset usually in childhood and adolescence" under "Activity and attention impairment" (F90.0) and "Hyperkinetic conduct disorder" (F90.1).

The frequency of attention deficit hyperactivity disorder, according to different authors, varies from 2.2 to 18% in children of school age. Such differences are explained by non-compliance with clear criteria for diagnosis. According to the American Psychiatric Association, about 5% of school-age children suffer from Attention Deficit Hyperactivity Disorder. Almost every school class has at least one child with this condition. In the study of N.N. Zavodenko, the frequency of attention deficit disorder in schoolchildren was 7.6%. Boys are affected twice as often as girls.

Classification. According to DSM-IV, there are 3 variants of the course of attention deficit hyperactivity disorder, depending on the prevailing clinical symptoms:

A syndrome that combines attention deficit hyperactivity disorder;

Attention deficit disorder without hyperactivity;

Attention Deficit Hyperactivity Disorder.

Some researchers question the association of attention deficit hyperactivity disorder and hyperactivity disorder, since up to 40% of all patients suffer only attention deficit without hyperactivity. Attention deficit without hyperactivity disorder is more common in girls.

Attention deficit disorder can be both primary and result from other diseases, that is, it can be secondary or symptomatic (genetically determined syndromes, mental illness, consequences of perinatal and infectious lesions of the central nervous system).

The etiology is not well understood. Most researchers suggest the genetic nature of the syndrome. Families of children with attention deficit hyperactivity disorder often have close relatives who had similar disorders at school age. To identify hereditary burden, a long and detailed questioning is necessary, since the difficulties of learning at school by adults are consciously or unconsciously "amnesiac". Pedigrees of children with attention deficit hyperactivity disorder also often show a burden of obsessive-compulsive disorder (obsessive thoughts and compulsive rituals), tics, and Gilles de la Tourette's syndrome. Probably, there is a genetically determined relationship of neurotransmitter disorders in the brain in these pathological conditions.

It is assumed that attention deficit/hyperactivity disorder is determined by mutations in 3 genes that regulate dopamine metabolism - the D4 receptor gene, the D2 receptor gene, and the gene responsible for dopamine transport (a neurotransmitter). S. Faraone, J. Biederman discussed the hypothesis that the carriers of the mutant gene are children with the most pronounced hyperactivity.

Along with genetic factors, family, pre- and perinatal risk factors for the development of attention deficit hyperactivity disorder are distinguished. Family factors include the low social status of the family, the presence of a criminal environment, severe disagreements between parents. Neuropsychiatric disorders, alcoholism and deviations in sexual behavior in the mother are considered especially significant. Pre- and perinatal risk factors for the development of attention deficit disorder include neonatal asphyxia, maternal alcohol consumption during pregnancy, certain drugs, and smoking.

It is assumed that the pathogenesis of the syndrome is based on disturbances in the activating system of the reticular formation, which contributes to the coordination of learning and memory, the processing of incoming information, and the spontaneous maintenance of attention. Violations of the activating function of the reticular formation, apparently, are associated with a lack of norepinephrine in it (in protein synthesis it follows dopamine). The impossibility of adequate processing of information leads to the fact that various visual, sound, emotional stimuli become redundant for the child, causing anxiety, irritation and aggressiveness. Violations in the functioning of the reticular formation predetermine secondary disorders of the neurotransmitter metabolism of the brain. The theory of the relationship of hyperactivity with dopamine metabolism disorders has numerous confirmations, in particular, the success of the treatment of attention deficit hyperactivity disorder with dopaminergic drugs. It is possible that disorders of neurotransmitter metabolism leading to hyperactivity are associated with mutations in genes that regulate the functions of dopamine receptors. Separate biochemical studies in children with attention deficit hyperactivity disorder indicate that the metabolism of not only dopamine, but also other neurotransmitters, serotonin and norepinephrine, is disturbed in the brain.

In addition to the reticular formation, dysfunction of the frontal lobes (prefrontal cortex), subcortical nuclei and the pathways connecting them are likely to be important in the pathogenesis of attention deficit hyperactivity disorder. One of the confirmations of this assumption is the similarity of neuropsychological disorders in children with attention deficit disorder and in adults with damage to the frontal lobes of the brain. Spectral tomography of the brain revealed a decrease in blood flow in the prefrontal cortex of the brain during intellectual loads in 65% of children with attention deficit hyperactivity disorder, while in the control group - only 5%.

Criteria for diagnosis and clinical manifestations. Adequate diagnosis of attention deficit hyperactivity disorder is impossible without strict adherence to the diagnostic criteria. These, according to DSM-IV, include:

The presence of attention deficit and / or hyperactivity in the child;

Early (up to 7 years) onset of symptoms and duration (more than 6 months) of their existence;

Some symptoms are observed both at home and at school;

The symptoms are not a manifestation of other diseases;

learning disorder and social functions.

It should be noted that the presence of learning disorders and social functions is a necessary criterion for establishing the diagnosis of "attention deficit hyperactivity disorder". In addition, the diagnosis of attention deficit hyperactivity disorder can only be made when learning difficulties are evident (i.e. not earlier than 5-6 years of age).

According to the DSM-IV, a diagnosis of attention deficit disorder can be made if at least 6 of the symptoms described below are present. A child has an attention deficit if he:

Does not pay attention to details and makes mistakes in work;

With difficulty maintains attention in work and play;

Does not listen to what is said to him;

Unable to follow instructions;

Cannot arrange play or activity;

Has difficulty performing tasks that require prolonged concentration of attention;

Often loses things;

Frequently and easily distracted;

Be forgetful.

At least 5 of the following symptoms must be present to diagnose hyperactivity. A child is hyperactive if he:

Makes fussy movements with arms and legs;

Often jumps up from his seat;

Hypermobile in situations where hypermobility is unacceptable;

Cannot play "silent" games;

Always in motion;

He talks a lot.

A child is impulsive (i.e. unable to stop and think before speaking or acting) if they:

Answers a question without listening to it;

Can't wait for their turn;

Intervenes in the conversations and games of others.

In a significant percentage of cases, the clinical manifestations of the syndrome occur before the age of 5-6 years, and sometimes already in the 1st year of life. Children of the 1st year of life, who subsequently develop hyperactivity, often suffer from sleep disorders and hyperexcitability. In the future, they become extremely naughty and hyperactive, their behavior is hardly controlled by their parents. At the same time, children who later have attention deficit disorder without hyperactivity may moderately lag behind in motor (they begin to roll over, crawl, walk 1-2 months later) and speech development in infancy, they are inert, passive, not very emotional. As the child grows, attentional disturbances become apparent, which parents usually do not pay attention to at first.

Violation of attention and the phenomena of hyperactivity-impulsivity lead to the fact that a school-age child with normal or high intelligence has impaired reading and writing skills, does not cope with school assignments, makes many mistakes in work performed and is not inclined to listen to the advice of adults. The child is a source of constant anxiety for others (parents, teachers, peers), as he interferes in other people's conversations and activities, takes other people's things, often behaves completely unpredictably, overreacts to external stimuli (the reaction does not correspond to the situation). Such children hardly adapt in the team, their distinct desire for leadership has no actual reinforcement. Due to their impatience and impulsiveness, they often come into conflict with peers and teachers, which exacerbates existing learning disabilities. The child is also unable to foresee the consequences of his behavior, does not recognize authorities, which can lead to antisocial acts. Especially often antisocial behavior is observed in adolescence, when children with attention deficit hyperactivity disorder have an increased risk of developing persistent behavioral disorders and aggressiveness. Adolescents with this pathology are more likely to start smoking early and take narcotic drugs, they are more likely to experience traumatic brain injuries. Parents of a child with attention deficit hyperactivity disorder (ADHD) are sometimes moody and impulsive themselves. Outbursts of rage, aggressive actions, and a child's stubborn refusal to behave in accordance with parental rules can lead to an uncontrollable reaction from the parents and to physical abuse.

On neurological examination of a child with attention deficit disorder with or without hyperactivity, focal neurological symptoms are usually absent. There may be a lack of fine motor skills, impaired reciprocal coordination of movements and moderate ataxia. More often than in the general child population, speech disorders are observed.

Differential diagnosis of attention deficit hyperactivity disorder should be carried out with specific learning disorders (dyscalculia, dyslexia. dyscalculia is a specific learning disorder in counting, manifested at different ages of the preschool and school population. The term dyslexia comes from two Greek words "dis" - complexity and "lexis" -word, literally translated dyslexia means "difficulty with words". Dyslexia manifests itself in violations of the reading process, in constantly repeating mistakes. People suffering from dyslexia skip sounds, change letters in places or add unnecessary ones, distort the sound of words, sometimes "swallow" whole syllables.), asthenic syndromes (this condition is manifested by increased fatigue, weakening or loss of the ability for prolonged physical and mental stress. Patients experience irritable weakness, which is expressed by increased excitability and exhaustion quickly following it, affective lability with a predominance I eat low mood with features of capriciousness and displeasure, as well as tearfulness.) against the background of intercurrent diseases (comorbidities), thyroid diseases, mild oligophrenia and schizophrenia. Differential diagnosis is often difficult, since attention deficit disorder can be combined with a number of other diseases and conditions, most often with psychiatric pathology (depression, panic attacks, obsessive thoughts).

The system of treatment and observation of children with attention deficit is not developed enough, due to the ambiguity of the pathogenesis of the disease. There are non-drug and drug methods of correction.

Non-drug correction includes methods of behavior modification, psychotherapy, pedagogical and neuropsychological correction. The child is recommended a sparing mode of learning - the minimum number of children in the class (ideally no more than 12 people), a shorter duration of classes (up to 30 minutes), the child's stay in the first desk (eye contact between the teacher and the child improves concentration). From the point of view of social adaptation, it is also important to purposefully and long-term education of socially encouraged norms of behavior in a child, since the behavior of some children has antisocial features. Psychotherapeutic work is needed with parents so that they do not regard the child's behavior as "hooligan" and show more understanding and patience in their educational activities. Parents should monitor the observance of the day regimen of a "hyperactive" child (meal time, homework, sleep), provide him with the opportunity to expend excess energy in physical exercises, long walks, running. Fatigue while performing tasks should also be avoided, as this may increase hyperactivity. "Hyperactive" children are extremely excitable, so it is necessary to exclude or limit their participation in activities associated with the accumulation of a large number of people. Since the child has difficulty concentrating, you need to give him only one task for a certain period of time. The choice of partners for games is important - the child's friends should be balanced and calm.

Drug therapy for attention deficit hyperactivity disorder is appropriate when non-drug methods of correction are ineffective. Psychostimulants, tricyclic antidepressants, tranquilizers and nootropic drugs are used. In international pediatric neurological practice, the effectiveness of two antidepressant drugs, amitriptyline and Ritalin, belonging to the amphetamine group, has been empirically established.

The drug of first choice in the treatment of attention deficit hyperactivity disorder is methylphenidate (Ritalin, Centedrin, Meredil). The positive effect of methylphenidate is observed in 70-80% of children. The drug is administered once in the morning at a dose of 10 mg (1 tablet), but the daily dose can reach 6 mg/kg. The therapeutic effect occurs quickly - during the first days of admission. Despite the high efficacy of methylphenidate, there are limitations and contraindications to its use associated with frequent side effects. The latter include growth retardation, irritability, sleep disturbance, loss of appetite and body weight, provocation of tics, dyspeptic disorders, dry mouth and dizziness. The drug may develop addiction. Contraindications to taking the drug are the child's age less than 6 years, pronounced states of anxiety and agitation, as well as the presence of a family history of tics and Tourette's syndrome. Unfortunately, methylphenidate is not available on the Russian pharmaceutical market. In domestic pediatric practice, the drug amitriptyline, which has fewer side effects, is more widely used. Amitriptyline is prescribed for children under 7 years old at a dose of 25 mg / day, for children over 7 years old - at a dose of 25-50 mg / day. The initial dose of the drug is 1/4 tablet and increases gradually over 7-10 days. The effectiveness of amitriptyline in the treatment of children with attention deficit disorder is 60%.

Single domestic studies also prove the effectiveness of the use of nootropic drugs (nootropil, piracetam and instenon) in the treatment of children with attention deficit hyperactivity disorder. N.N. Zavodenko and observed the positive effect of instenon in 59% of patients. Instenon was administered at a dose of 1.5 tablets per day to children aged 7-10 years for 1 month. There was an improvement in the characteristics of behavior, motor skills, attention and memory.

The greatest effect in the treatment of attention deficit hyperactivity disorder is achieved by combining various methods of psychological work (both with the child himself and with his parents) and drug therapy.

The prognosis is relatively good, as in a significant proportion of children, symptoms disappear during adolescence. Gradually, as the child grows, disturbances in the neurotransmitter system of the brain are compensated, and some of the symptoms regress. However, in 30-70% of cases, clinical manifestations of attention deficit hyperactivity disorder (excessive impulsivity, irascibility, absent-mindedness, forgetfulness, restlessness, impatience, unpredictable, rapid and frequent mood changes) can also be observed in adults. The factors of the unfavorable prognosis of the syndrome are its combination with mental illness, the presence of psychopathology in the mother, as well as the symptoms of impulsivity in the patient himself. Social adaptation of children with attention deficit hyperactivity disorder can be achieved only with the interest and cooperation of the family, school and society.

ADHD- This is a developmental disorder of a neurological-behavioral nature, in which the hyperactivity of babies is pronounced along with a lack of attention. Among the hallmarks of this disorder, the presence of which provides the basis for establishing the diagnosis of ADHD, there are symptoms such as difficulty concentrating, increased activity and impulsivity that cannot be controlled. Due to the fact that it is difficult for babies to pay attention, they often cannot correctly perform study tasks or solve problems, as they make mistakes due to their own inattention and restlessness (hyperactivity). Also, they may not listen to the explanations of teachers or simply do not pay attention to their explanations. Neurology considers this disorder as a stable chronic syndrome for which no cure has yet been found. Doctors believe that ADHD (attention deficit and hyperactivity disorder) goes away without a trace as kids grow up or adults adapt to live with it.

Causes of ADHD

Today, unfortunately, the exact causes of ADHD (Attention Deficit Hyperactivity Disorder) have not been established, but several theories can be distinguished. So, the causes of organic disorders can be: an unfavorable ecological situation, immunological incompatibility, infectious diseases of the female part of the population during pregnancy, anesthesia poisoning, the intake of certain medications, drugs or alcohol by women during the period of bearing a baby, some chronic diseases of the mother, threats of miscarriage, premature or prolonged labor, stimulation of labor activity, caesarean section, malpresentation of the fetus, any diseases of the newborn that occur with high temperature, taking strong drugs by babies.

Also, diseases such as asthmatic conditions, heart failure, pneumonia, diabetes can be factors that provoke a violation in the brain activity of babies.

Scientists have also found that there are genetic prerequisites for the formation of ADHD. However, they appear only when interacting with the outside world, which can either strengthen or weaken such prerequisites.

ADHD syndrome can also cause negative effects in the postnatal period on the child. Among these impacts, both social causes and biological factors can be distinguished. Methods of upbringing, the attitude towards the baby in the family, the socio-economic status of the cell of society are not the reasons that provoke ADHD, in and of themselves. However, often, these factors develop the adaptive capabilities of the crumbs to the outside world. Biological factors that provoke the development of ADHD include feeding the baby with artificial food additives, the presence of pesticides, lead, and neurotoxins in the child's food. Today, the degree of influence of these substances on the pathogenesis of ADHD is under study.

The ADHD syndrome, in summary, is a polyetiological disorder, the formation of which is due to the influence of several factors in combination.

Symptoms of ADHD

The main symptoms of ADHD include impaired attention function, increased activity of children and their impulsiveness.

Attention disorders are manifested in the baby by the inability to keep attention on the elements of the subject, the assumption of many mistakes, the difficulty of maintaining attention in the course of performing educational or other tasks. Such a child does not listen to speech addressed to him, does not know how to follow instructions and complete the work, is not able to plan or organize tasks on his own, tries to avoid things that require prolonged intellectual stress, tends to constantly lose his own things, shows forgetfulness, is easily distracted.
Hyperactivity is manifested by restless movements of the arms or legs, fidgeting in place, restlessness.

Children with ADHD often climb or run somewhere when it is inopportune, they cannot calmly and quietly play. This aimless hyperactivity is persistent and unaffected by the rules or conditions of the situation.

Impulsivity is manifested in situations where the kids, without listening to the question and without thinking, answer it, are not able to wait for their turn. Such children often interrupt others, interfere with them, are often talkative or unrestrained in speech.

Characteristics of a child with ADHD. The listed symptoms should be observed in babies for at least six months and apply to all areas of their life (disturbances in adaptation processes are noted in several types of environments). Disorders in learning, problems in social contacts and labor activity in such children are pronounced.

The diagnosis of ADHD is made with the exclusion of other pathologies of the psyche, since the manifestations of this syndrome should not be associated only with the presence of another disease.

The characteristics of a child with ADHD has its own characteristics depending on the age period in which he is.

In the preschool period (from three to 7 years), children often begin to show increased activity and impulsivity. Excessive activity is manifested by the constant movement in which the kids are. They are characterized by extreme restlessness in the classroom and talkativeness. The impulsiveness of babies is expressed in the commission of rash actions, in the frequent interruption of other people, interference in extraneous conversations that do not concern them. Usually such children are considered ill-mannered or overly temperamental. Often, impulsiveness can be accompanied by recklessness, as a result of which the baby can endanger himself or others.

Children with ADHD are rather sloppy, naughty, often throw or break things, toys, may show, sometimes lag behind their peers in speech development.

Problems of a child with ADHD after admission to educational institution only aggravated, due to school requirements, which he is not fully able to fulfill. Children's behavior does not meet the age norm, therefore, in educational institution he is not able to obtain results corresponding to his potential (the level of intellectual development corresponds to the age interval). Such children do not hear the teacher during classes, it is difficult for them to solve the proposed tasks, because they experience difficulties in organizing work and bringing it to completion, in the process of performing they forget the conditions of the tasks, they poorly learn the educational material and are not able to correctly apply it. Therefore, kids pretty quickly disconnect from the process of completing tasks.

Children with ADHD do not notice details, are prone to forgetfulness, poor switching and not following the instructions of the teacher. At home, such kids are unable to cope on their own with the implementation of tasks in the lessons. They are much more likely, in comparison with their peers, to have difficulties in the formation of logical thinking skills, the ability to read, write and count.

Schoolchildren suffering from ADHD syndrome are characterized by difficulties in interpersonal relationships, problems in establishing contacts. Their behavior is prone to unpredictability, due to significant mood swings. There is also ardor, cockiness, opposing and aggressive actions. As a result, such kids cannot devote a long time to the game, successfully interact and establish friendly contacts with their peers.

In the team, kids suffering from ADHD are sources of constant anxiety, as they make noise, interfere with others, take other people's things without asking. All of the above leads to the emergence of conflicts, as a result of which the baby becomes unwanted in the team. Encountering such an attitude, kids often consciously become "jesters" in the class, hoping thereby to establish relationships with their peers. As a result, not only the school performance of children with ADHD suffers, but also the work of the class as a whole, so they can disrupt the lessons. AT in general terms their behavior gives the impression of inconsistency with their age period, so peers are reluctant to communicate with them, which gradually forms an underestimated level in children with ADHD. In the family, such babies often suffer due to constant comparison with other children who are more obedient or learn better.

ADHD hyperactivity in adolescence is characterized by a significant decrease. It is replaced by a feeling of inner restlessness and fussiness.

Adolescents with ADHD are characterized by lack of independence, irresponsibility, difficulties in completing assignments, assignments and in organizing activities. In the pubertal period, pronounced manifestations of disorders in the function of attention and impulsivity are observed in approximately 80% of ADHD adolescents. Often, children with such a disorder have a deterioration in school performance, due to the fact that they are not able to effectively plan their own work and organize it in time.

Gradually, children develop difficulties in family and other relationships. Most teenagers with this syndrome are distinguished by the presence of problems in following the rules of behavior, reckless behavior associated with unreasonable risk, disobedience to the laws of society and disobedience to social norms. Along with this, they are characterized by a weak emotional stability of the psyche in case of failures, indecision,. Adolescents are overly sensitive to teasing and taunts from their peers. Educators and others characterize adolescent behavior as immature and out of proportion to their age. In everyday life, children ignore safety measures, which leads to an increased risk of accidents.

Children in puberty with a history of ADHD are much more likely than their peers to be drawn into various gangs that commit offenses. Adolescents may also develop a craving for the abuse of alcohol or drugs.

Work with children with ADHD can cover several areas: or, the key purpose of which is the development of social skills.

Diagnosis of ADHD

Based on international signs, containing lists of the most characteristic and clearly traced manifestations of this disorder, it is possible to diagnose ADHD.

The essential characteristics of this syndrome are:

- the duration of symptoms over time is not less than six months;

- prevalence in at least two types of environment, persistence of manifestations;

- the severity of symptoms (there are significant learning disorders, disorders of social contacts, professional sphere);

- exclusion of other mental disorders.

ADHD hyperactivity is defined as the primary disorder. However, there are several forms of ADHD, caused by the presence of predominant symptoms:

- combined form, which includes three groups of symptoms;

- ADHD with prevailing attention disorders;

- ADHD with dominance of impulsivity and increased activity.

In the childhood age period, the so-called states-imitators of this syndrome are relatively often observed. Approximately 20 percent of children periodically experience ADHD-like behaviors. Therefore, ADHD should be distinguished from a wide range of conditions that are similar to it only in external manifestations, but differ significantly in causes and methods of correction. These include:

– individual personal characteristics and features (the behavior of overly active babies does not go beyond the age norm, the degree of formation higher functions psyche at the level);

- anxiety disorders (features of children's behavior are associated with the impact of psycho-traumatic causes);

- consequences of a brain injury, intoxication, neuroinfection;

- in case of somatic diseases, the presence of asthenic syndrome;

- characteristic violations of the formation of school skills, such as dyslexia or dysgraphia;

- diseases of the endocrine system (diabetes mellitus or thyroid pathology);

- sensorineural hearing loss;

- hereditary factors, for example, the presence of Tourette's syndrome, Smith-Magenis or a fragile X chromosome;

- epilepsy;

In addition, the diagnosis of ADHD should be made taking into account the specific age dynamics of this condition. The manifestations of ADHD are characteristic features according to a certain age period.

ADHD in adults

According to current statistics, approximately 5% of adults are affected by ADHD. Along with this, such a diagnosis is noted in almost 10% of students at school. Approximately half of children with ADHD continue into adulthood with the condition. At the same time, the adult population is much less likely to go to the doctor because of ADHD, which significantly minimizes the detection of the syndrome in them.

The symptoms of ADHD are individual. However, in the behavior of patients, three core signs can be noted, namely, a violation of the function of attention, increased activity and impulsivity.

Attention disorder is expressed in the impossibility of concentrating attention on a certain object or things. An adult in the course of performing an uninteresting monotonous task becomes bored after a few minutes. It is difficult for such people to consciously focus on any subject. Patients with ADHD are considered by the environment to be optional and non-executive, as they can begin to do several things and not bring any to completion. Increased activity is found in the constant movement of individuals. They are characterized by restlessness, fussiness and excessive talkativeness.

Patients with ADHD suffer from restlessness, wander aimlessly around the room, grab everything in a row, tap on the table with a pen or pencil. Moreover, all such actions are accompanied by increased excitement.

Impulsivity is manifested in being ahead of the actions of thoughts. , suffering from ADHD, tends to voice the first thoughts that come to mind, constantly inserts his own remarks out of place into the conversation, and makes impulsive and often thoughtless actions.

In addition to these manifestations, individuals suffering from ADHD are characterized by forgetfulness, anxiety, lack of punctuality, low self-esteem, disorganization, poor resistance to stress factors, melancholy, depressive states, marked mood swings, and difficulty in reading. Such features complicate the social adaptation of individuals and form a fertile ground for the formation of any form of dependence. The inability to concentrate breaks careers and destroys personal relationships. If patients turn to a competent specialist in a timely manner and receive adequate treatment, then in most cases, all problems with adaptation will come to naught.

Treatment of ADHD in adults should be comprehensive. They are usually prescribed drugs that stimulate the nervous system, such as methylphenidate. These medications do not cure ADHD, but they do help control the symptoms.

Treatment of ADHD in adults leads to improvement in the condition of most patients, but it can be quite difficult for them. Psychological counseling helps to acquire self-organization skills, the ability to competently adjust the daily routine, restore broken relationships and improve communication skills.

Treatment for ADHD

Treatment of ADHD in children has certain methods aimed at reviving the frustrated functions of the nervous system and their adaptation in society. Therefore, therapy is multifactorial and includes diet, non-drug treatment and drug therapy.

In the first turn, you should deal with the normalization of the gastrointestinal tract. Therefore, preference in the daily diet should be given to natural products. Dairy products and eggs, pork, canned and dye-containing foods, refined sugar, citrus fruits and chocolate should be excluded from the diet.

Non-drug treatment of ADHD in children involves modification of behavior, psychotherapeutic practices, pedagogical and neuropsychological corrective impact. Toddlers are offered a facilitated learning mode, that is, the quantitative composition of the classroom is reduced and the duration of classes is reduced. Children are encouraged to sit at the first desks to be able to concentrate. It is also necessary to work with parents so that they learn to treat the behavior of their own children with patience. Parents need to explain the need for their control over the observance of the daily regimen of hyperactive children, providing kids with the opportunity to expend excess energy through exercise or long walks. In the process of children performing tasks, fatigue must be minimized. Since hyperactive kids are distinguished by increased excitability, it is recommended that they be partially isolated from interaction in large companies. Also, their partners in the game must have restraint and have a calm character.

Non-drug treatment also includes the use of some psychotherapeutic techniques, for example, correction of ADHD is possible with the help of role-playing games or art therapy.

Correction of ADHD with the help of drug therapy is prescribed if there is no result from other methods used. Psychostimulants, nootropics, tricyclic antidepressants and tranquilizers are widely used.

In addition, work with children with ADHD should be focused on solving several problems: conducting a comprehensive diagnosis, normalizing the family environment, establishing contacts with teachers, increasing self-esteem in children, developing obedience in children, teaching them to respect the rights of other individuals, correct verbal communication, control over your own emotions.

The condition of a person with symptoms of impulsivity and persistent inattention is called Attention Deficit Hyperactivity Disorder. The disease is typical for children, who experience its symptoms more vividly, but it also manifests itself at an older age. It is useful to know how to deal with the disease, to identify its causes and signs.

What is ADHD

Encountering an incomprehensible abbreviation ADHD - what it is, many want to know. Doctors and scientists explain that ADHD is attention deficit hyperactivity disorder. This disease is a mental type, and it occurs several times more often in children than in adults. According to statistics, up to 7% of modern children show signs of hyperactivity, of which only a third are girls - the rest are boys.

Patients note different symptoms of ADHD, but in general, the manifestations are as follows: they are all extremely active, hardly restrain themselves, and are not able to concentrate on one goal. If the activity is normal, they only talk about attention deficit disorder. With age, the signs disappear, but there remains increased impulsivity, hyperactivity, the demand for attention by any means, including eccentric ones.

Causes of ADHD

Until now, doctors cannot say exactly what the causes of ADHD are. Scientists believe that the symptoms are caused by a complex of factors that cause hyperactivity syndrome at any age. These factors include:

• genetic predisposition - the disease can be transmitted from father and mother;
• prematurity, premature birth;
• abuse of alcoholic beverages, nicotine during pregnancy;
• head and brain injuries, infectious diseases in early childhood.

The mechanism of development of mental deviation includes a deficit of special chemical substances. If dopamine and norepinephrine are not enough in certain areas of the brain, then the child becomes hyperactive, impulsive, and attracts attention. According to these data, it can be argued that the disease is mental, it needs proper diagnosis and treatment based on the identified symptoms.

ADHD - symptoms in children

Before diagnosing the disease, it is helpful to learn more about ADHD, the symptoms that indicate that patients are experiencing problems. Attention deficit disorder in children is manifested in the following 3 categories:

1. Inattention - Children are constantly distracted, forget tasks or information, and cannot or have difficulty concentrating on one subject. They cannot complete tasks, assemble themselves, organize work, and follow directions. Looking at them, you might think that they do not hear when they are spoken to. They have mistakes due to lack of concentration, they are distracted, they can lose their things.
2. Hyperactive qualities - schoolchildren are impatient, communicate a lot and excessively, fuss, cannot accustom themselves to sit in one place for a long time. In a kindergarten or school, they are not in one place, they run away, ignoring the instructions of teachers.
3. Impulsive - tend to always be the first to answer, interrupt others, do not tolerate waiting in line. They cannot put off getting pleasure, they need to realize their idea here and now. Preschool children and schoolchildren do not succumb to persuasion, they want to get everything at once.

Diagnosis of ADHD

It is not easy to identify ADHD in a child - the diagnosis is made only on the basis of comparing the behavior of their peers at the same level of development in the same social conditions. The analysis takes at least six months to accurately diagnose the disease, and not just identify an inattentive or hyperactive member of society. The symptoms of the disorder occur in preschool age, manifesting itself in the future depending on social situations and family relationships.

With significantly pronounced symptoms, the child is often socially maladjusted, which leads to mental problems, withdrawal to oneself. It is important to bring him to the doctor in time so that he examines him and excludes other diseases that cause behavioral disorders. Based on the main symptoms, doctors diagnose attention deficit disorder with a predominance of inattention, hyperactivity, impulsivity, or a combination of both.

Some patients, in addition to the main characteristic, suffer from other diseases associated with the disorder. It:

• poor development of learning skills, poor school performance;
• oppositional disorder - deliberate lack of obedience, violent behavior;
• emotional disorder - nervousness, tearfulness;
• tics - unintentional twitching of facial muscles, sniffling, sudden screams.

ADHD - treatment

Hyperactivity in children is treated so that you do not have to suffer from its symptoms. Efficiency depends on complex therapy, the efforts of doctors, parents and teachers. Treatment for ADHD in children includes techniques such as.