Attention deficit/hyperactivity disorder (ADD/ADHD)

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Attention deficit/hyperactivity disorder (ADD/ADHD)

Most common neuropsychological disorder in children – but also an umbrella term for variety of children with common features (poor impulse control; short attention span; motor hyperactivity). Boys up to 6-8x> girls; affects 6-9% of children; 30-50% are familial

Unknown aetiology, but theories involving neuronal pathway dysregulation, especially involving the monoamine neurotransmitters (norepinephrine, serotonin, dopamine) – drugs used to treat act by promoting the release of these neurotransmitters. The hypodopaminergic state  decreased inhibitory areas in cortex  reduced ability to control attention, impulses and motor activity.

Clinical features:
Usually starts between ages 3 to 7; child is fidgety; has problems concentrating; impatient; impulsive; excessively switches from one activity to another; very often does not complete tasks; does not pay close attention to details; often does not listen when spoken to directly; easily distracted; fidgets and squirms when sitting; difficulty playing quietly; usually talks excessively; commonly interrupts others.

Co-morbidity is common – 50% have obsessive compulsive disorder; 30-50% have conduct disorders; 20% have anxiety disorders; 20% have mood disorders.

Management:
Many strategies:
• family therapy; behavioural/cognitive approaches; structured behavioural modification strategies/predictable routines
• methylphenidate (Ritalin™)  usually respond rapidly and dramatically

Prognosis – 30% outgrow it; 60% continue to have symptoms into adulthood; 50% develop psychopathology (eg substance abuse)

Advice to parents of the child with ADHD :
• ADHD is a real disease with a real treatment- it is not a personal failure
• Consistency is one of the keys to effective treatment
• Make it easier for your child to succeed rather than punish failure
• Celebrate your child’s strengths – work with your child’s weaknesses
• Use behaviour techniques, such as enforcing time out, setting limits, and remaining calm
• Minimise negativity – it will destroy your child’s self-esteem
• Pay positive attention
• Feedback must be immediate and more powerful with ADHD children
• Do it – don’t talk about doing it
• Home environments should be as structured and orderly as possible
• Give clear, powerful instructions, and ask your child to repeat them to you
• Concrete reward systems are helpful, particularly with younger children

https://www.understood.org/en/learning-attention-issues/child-learning-disabilities/add-adhd/the-difference-between-sensory-processing-issues-and-adhd

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