Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by persistent patterns of inattention, hyperactivity, and impulsivity that interfere with functioning, learning, and development. It typically presents in childhood, often before the age of 12, and may persist into adolescence and adulthood. Early recognition and management are crucial to support educational attainment, social development, and overall quality of life.
Causes and Risk Factors
The exact cause of ADHD is not fully understood, but it is thought to result from a combination of genetic, neurobiological, and environmental factors:
-
Genetics: Strong hereditary component, with higher prevalence in children with a parent or sibling diagnosed with ADHD.
-
Brain differences: Variations in brain structure, connectivity, and neurotransmitter activity (particularly dopamine and norepinephrine).
-
Environmental influences: Premature birth, low birth weight, prenatal exposure to alcohol, nicotine, or drugs, and early exposure to environmental toxins (e.g., lead).
-
Family and psychosocial stressors: Although these do not cause ADHD, they may worsen symptoms.
Symptoms
ADHD symptoms generally fall into two main categories: inattention and hyperactivity-impulsivity. Children may present predominantly with one or both types.
Inattention
-
Difficulty sustaining attention in tasks or play
-
Easily distracted by extraneous stimuli
-
Frequent careless mistakes in schoolwork
-
Difficulty organizing tasks and activities
-
Avoids or dislikes tasks requiring sustained effort
-
Frequently loses items necessary for tasks (e.g., books, pencils, toys)
-
Forgetfulness in daily activities
Hyperactivity and Impulsivity
-
Fidgeting or tapping hands and feet, inability to remain seated
-
Excessive talking, running, or climbing in inappropriate situations
-
Difficulty engaging in quiet activities
-
Often “on the go” or acting as if “driven by a motor”
-
Impatience and difficulty waiting their turn
-
Interrupts or intrudes on others (e.g., butting into conversations or games)
Symptoms must be:
-
Present for at least 6 months
-
Occur in two or more settings (home, school, social situations)
-
Cause clear evidence of functional impairment
Diagnosis
Diagnosis is clinical, based on detailed history and observation, and guided by standard diagnostic manuals such as:
-
DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition)
-
ICD-11 (International Classification of Diseases)
Evaluation includes:
-
Parent and teacher reports (behavior rating scales, e.g., Conners’ Rating Scale, SNAP-IV)
-
School performance and psychosocial functioning
-
Rule out differential diagnoses (learning disorders, anxiety, depression, hearing/vision problems, sleep disorders, thyroid dysfunction)
Complications
If untreated, ADHD can lead to:
-
Academic underachievement and school dropout
-
Low self-esteem and poor peer relationships
-
Increased risk of accidents and injuries
-
Substance misuse in adolescence/adulthood
-
Development of comorbid conditions (anxiety, depression, conduct disorder, oppositional defiant disorder)
Treatment and Management
Treatment involves a multimodal approach, combining behavioral, psychological, educational, and pharmacological interventions.
1. Behavioral and Psychological Interventions
-
Parent training and education programs: Teaching parents strategies for managing behavior, setting routines, and positive reinforcement.
-
Behavior therapy: Reward systems, structured tasks, time management strategies.
-
School-based support: Classroom accommodations (e.g., seating placement, extra time for tasks, shorter assignments, individualized education plans).
-
Cognitive-behavioral therapy (CBT): Useful in older children and adolescents for coping skills and emotional regulation.
2. Pharmacological Treatment
Medication is often considered when ADHD symptoms are severe, persist despite behavioral interventions, or significantly impair daily functioning.
a. Stimulant Medications (first-line treatment)
-
Methylphenidate
-
Immediate-release: 5–20 mg orally, 2–3 times daily (maximum 60 mg/day)
-
Modified-release: Once daily formulations (18–54 mg for children; up to 72 mg for adolescents)
-
-
Dexamphetamine
-
2.5–20 mg/day orally in divided doses (maximum 40 mg/day)
-
-
Lisdexamfetamine (a prodrug of dexamphetamine)
-
Starting dose: 20–30 mg once daily, titrated up to a maximum of 70 mg/day
-
b. Non-Stimulant Medications
-
Atomoxetine (selective norepinephrine reuptake inhibitor)
-
0.5 mg/kg/day, increased to 1.2 mg/kg/day (maximum 100 mg/day)
-
-
Guanfacine (alpha-2 adrenergic agonist)
-
Starting 1 mg once daily, titrated up to 4 mg/day (children 6–12) or 7 mg/day (adolescents 13–17)
-
-
Clonidine (used less commonly, often as adjunct)
-
0.05–0.3 mg/day in divided doses
-
Medication Considerations
-
Stimulants are effective in 70–80% of children, but require careful titration and monitoring.
-
Side effects include appetite suppression, sleep disturbances, abdominal pain, headache, and irritability. Rare but serious risks: growth delay, cardiovascular effects, misuse or diversion.
-
Regular follow-up is essential (height, weight, blood pressure, heart rate, and symptom monitoring).
Lifestyle and Supportive Measures
-
Healthy routines: Adequate sleep, balanced diet, regular physical activity.
-
Structured environment: Consistent daily schedules and clearly defined rules.
-
Parental support groups: Help families manage stress and share coping strategies.
-
Psychoeducation for teachers: Enables appropriate classroom adjustments and support.
Prognosis
-
ADHD persists into adolescence in about 60–70% of cases and into adulthood in about 50%.
-
With early diagnosis, comprehensive support, and consistent treatment, many children manage symptoms effectively and achieve academic and social success.
No comments:
Post a Comment