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Loice Vavi Mental Health Watch

Attention-deficit /Hyperactivity  Disorder (ADHD) is a chronic condition that affects millions of children and often persists into adulthood. ADHD includes a combination of problems, such as difficulty sustaining attention, hyperactivity and impulsive behaviour. Children with ADHD also may struggle with low self-esteem, troubled relationships and poor performance in school. Symptoms sometimes lessen with age. However, some people never completely outgrow their ADHD symptoms. But they can learn strategies to be successful. 

While treatment won’t cure ADHD, it can help a great deal with symptoms. Treatment typically involves medications and behavioural interventions. 

Early diagnosis and treatment can make a big difference in outcome. 

SYMPTOMS 

Attention-deficit/hyperactivity disorder (ADHD) has been called attention-deficit disorder (ADD) in the past. But ADHD is now the preferred term because it describes both of the primary features of this condition: inattention and hyperactive-impulsive behaviour. In some children,signs of ADHD are noticeable as early as 2 or 3 years of age. Signs and symptoms of ADHD may include:

Difficulty paying attention

Frequently daydreaming

Difficulty following through on instructions and apparently not listening

Frequently has problems organising tasks or activities

Frequently forgetful and loses needed items, such as books, pencils or toys

Frequently fails to finish schoolwork, chores or other tasks

Easily distracted

Frequently fidgets or squirms

Difficulty remaining seated and seemly in constant motion Excessively talkative

Frequently interrupts or intrudes on others’ conversations or games

Bed wetting and defecation

Frequently has trouble waiting for his or her turn ADHD occurs more often in males than in females, and behaviours can be different in boys and girls. For example, boys may be more hyperactive and girls may tend to be quietly inattentive.

Normal behaviour vs ADHD

Most healthy children are inattentive, hyperactive or impulsive at one time or another. It’s normal for preschoolers to have short attention spans and be unable to stick with one activity for long. Even in older children and teenagers, attention span often depends on the level of interest. The same is true of hyperactivity. Young children are naturally energetic — they often wear their parents out long before they’re tired. In addition, some children just naturally have a higher activity level than others do. Children should never be classified as having ADHD just because they are different from their friends or siblings. Children who have problems in school but get along well at home or with friends are likely struggling with something other than ADHD. The same is true of children who are hyperactive or inattentive at home, but whose schoolwork and friendships remain unaffected. 

When to see a doctor. If you’re concerned that your child shows signs of ADHD, see your paediatrician or family doctor. Your doctor may refer you to a specialist, but it’s important to have a medical evaluation first to check for other possible causes of your child’s difficulties. If your child is already being treated for ADHD, he or she should see the doctor regularly until symptoms have largely improved, and then every three to four months if symptoms are stable. 

Call the doctor if your child has any medication side effects, such as loss of appetite, trouble sleeping, increased irritability, or if your child’s ADHD has not shown much improvement with initial treatment. 

Causes

While the exact cause of ADHD is not clear, research efforts continue. Multiple factors have been implicated in the development of ADHD. It can run in families, and studies indicate that genes may play a role. Certain environmental factors also may increase risk, as can problems with the central nervous system at key moments in development. Risk factors for ADHD may include: 

Blood relatives (such as a parent or sibling) with ADHD or another mental health disorder 

Exposure to environmental toxins — such as lead, found mainly in paint and pipes in older buildings

Maternal drug use, alcohol use or smoking during pregnancy

Maternal exposure to environmental poisons during pregnancy

Premature birth 

Although sugar is a popular suspect in causing hyperactivity, there’s no reliable proof of this.

Complications

ADHD can make life difficult for children. Children with ADHD:

They often struggle in the classroom, which can lead to academic failure and judgment by other children and adults

Tend to have more accidents and injuries of all kinds than children who don’t have the disorder 

Poor self-esteem

Are more likely to have trouble interacting with and being accepted by peers and adults

Are at increased risk of alcohol and drug abuse and other delinquent behaviour

Coexisting conditions

ADHD doesn’t cause other psychological or developmental problems. However, children with ADHD are more likely than are other children to also have conditions such as: Learning disabilities, including problems with understanding and communicating

Anxiety disorders, which may cause overwhelming worry, nervousness and worsening of ADHD symptoms until the anxiety is treated and under control

Depression, which frequently occurs in children with ADHD

Bipolar disorder, which includes depression as well as manic behaviour

Oppositional defiant disorder (ODD), generally defined as a pattern of negative, defiant and hostile behaviour toward authority figures

Conduct disorder, marked by antisocial behaviour such as stealing, fighting, destroying property, and harming people or animals

Tourette syndrome, a neurological disorder characterised by repetitive muscle or vocaltics

Tests and Diagnosis

In general, a child shouldn’[t receive a diagnosis of ADHD unless the core symptoms of ADHD start early in life and create significant problems at home and at school on an ongoing basis. There is no specific test for ADHD, but making a diagnosis will likely include:

Medical exam, to help rule out other possible causes of symptoms

Information gathering, such as any current medical issues, personal and family medical history and school records

Interviews or questionnaires for family members, your child’s teachers or other people who know your child well, such as baby sitters and coaches

ADHD rating scales to help collect and evaluate information about your child

Diagnostic criteria for ADHD

To be diagnosed with ADHD, your child must meet the criteria in the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association. 

For a diagnosis of ADHD, a child must have six or more signs and symptoms from one or both of the two categories below. 

Inattention

Often fails to give close attention to details or makes careless mistakes in schoolwork and other activities

Often has difficulty sustaining attention in tasks or play activities

Often doesn’t seem to listen when spoken to directly

Often doesn’t follow through on instructions and fails to finish schoolwork or chores

Often has difficulty organising tasks and activities

Often avoids, dislikes or is reluctant to engage in tasks that require sustained mental effort, such as schoolwork or homework

Often loses items necessary for tasks or activities (for example, toys, school assignments, pencils, books)

Is often easily distracted

Is often forgetful in daily activities

Hyperactivity and impulsivity

Often fidgets with hands or feet or squirms in seat

Often leaves seat in classroom or in other situations when remaining seated is expected

Often runs about or climbs excessively in situations when it’s inappropriate

Often has difficulty playing or engaging in leisure activities quietly

Is often “on the go” or often acts as if “driven by a motor”

Often talks too much

Often blurts out answers before questions have been completed

Often has difficulty awaiting turn

Often interrupts or intrudes on others’ conversations or games

In addition to having at least six signs or symptoms from these two categories, a child with ADHD:

Has inattentive or hyperactive-impulsive signs and symptoms that cause impairment

Has behaviours that aren’t normal for children the same age who don’t have ADHD

Has symptoms for at least six months

Has symptoms that affect school, home life or relationships in more than one setting (such as at home and at school). 

A child diagnosed with ADHD is often given a more specific diagnosis (a subtype), such as:

Predominantly inattentive type ADHD. A child has at least six signs and symptoms from the inattention list above. 

This child may sit quietly and appear to get along with others, but he or she is not paying attention. Predominantly hyperactive-impulsive type ADHD. A child has at least six signs and symptoms from the hyperactivity and impulsivity list above.

This may be misjudged as an emotional or disciplinary problem. Combined-type ADHD. A child has six or more signs and symptoms from each of the two lists above. 

Read more on www.herald.co.zw

Other conditions that resemble ADHD

A number of medical conditions or their treatments may cause signs and symptoms similar to

those of ADHD, or exist along with ADHD. Examples include:

Learning or language problems

Mood disorders (such as depression)

Anxiety disorders

Seizure disorders

Vision or hearing problems

Tourette syndrome

Sleep disorders

Thyroid medication

Substance abuse

Brain injury

Diagnosing ADHD in young children

Although signs of ADHD can sometimes appear in preschoolers or children even younger,

diagnosing the disorder in very young children is difficult. That’s because developmental

problems such as language delays can be mistaken for ADHD. For that reason, children

preschool age or younger suspected of having ADHD are more likely to need evaluation by a

specialist, such as a psychologist or psychiatrist, speech pathologist, or developmental

pediatrician. TREATMENTS AND DRUGS

Standard treatments for ADHD in children include medications, education, training and counseling. These treatments can relieve many of the symptoms of ADHD, but they don’t cure it. It may take some time to determine what works best for your child. Stimulant medications

Currently, psychostimulants are the most commonly prescribed medications for ADHD. Stimulants appear to boost and balance levels of brain chemicals called neurotransmitters. These medications help improve the signs and symptoms of inattention and hyperactivity sometimes dramatically. Examples include methylphenidate (Concerta, Metadate, Ritalin, others), dextroamphetamine (Dexedrine), dextroamphetamine-amphetamine (Adderall XR) and lisdexamfetamine (Vyvanse). Stimulant drugs are available in short-acting and long-acting forms. A long-acting patch is

available that can be worn on the hip. The right dose varies from child to child, so it may take some time to find the correct dose. And the dose may need to be adjusted if significant side effects occur or as your child matures. Ask

your doctor about possible side effects of stimulants.

Stimulant medications and heart problems

Although rare, several heart-related deaths occurred in children and teenagers taking stimulant

medications. The possibility of increased risk of sudden death is still unproved, but if it exists,

it’s believed to be in people who already have underlying heart disease or a heart defect. Your

child’s doctor should make sure your child doesn’t have any signs of a heart condition and

should ask about family risk factors for heart disease before prescribing a stimulant

medication. Therapy includes:

Behaviour therapy. Teachers and parents can learn behaviour-changing strategies for dealing with difficult

situations. These strategies may include token reward systems and time outs. 

Psychotherapy. This allows older children with ADHD to talk about issues that bother them, explore negative behavioural patterns and learn ways to deal with their symptoms. Parenting skills training. This can help parents develop ways to understand and guide their child’s behaviour. 

Family therapy. Family therapy can help parents and siblings deal with the stress of living with someone who has ADHD. Social skills training. This can help children learn appropriate social behaviours. The best results usually occur when a team approach is used, with teachers, parents, and therapists or physicians working together. Educate yourself about ADHD, and then work with your child’s teachers and refer them to reliable sources of information to support their efforts in the classroom. 

Techniques for coping

Many parents notice patterns in their child’s behavior as well as in their own responses to that behaviour. Both you and your child may need to change behavior. But substituting new habits for old ones isn’t easy it takes a lot of hard work. It’s important to have realistic expectations. Set small goals for both yourself and your child and don’t try to make a lot of changes all at once. To help manage ADHD:

Structure your child’s life. Structure doesn’t mean rigidity or iron discipline. Instead, it means arranging things so that a child’s life is as predictable, calm and organized as possible. Children with ADHD don’t handle change well, and having predictable routines can make them feel safe as well as help improve behaviour. Give your child a few minutes warning with a countdown

when it’s necessary to change from one activity or location to another. Provide positive discipline. Firm, loving discipline that rewards good behaviour and discourages destructive actions is the best place to start. Also, children with ADHD usually respond well to

positive reinforcement, as long as it’s earned. Rewarding or reinforcing a new good behaviour

every time it occurs can encourage new habits. Stay calm and set a good example. Set a good example by acting the way you want your child to

act. Try to remain patient and in control even when your child is out of control. If you speak

quietly and calmly, your child is more likely to calm down too. Learning stress management

techniques can help you deal with your own frustrations. Strive for healthy family relationships. The relationship among all family members plays a large

part in managing or changing the behaviour of a child with ADHD. Couples who have a strong

bond often find it easier to face the challenges of parenting than those whose bond isn’t as

strong. That’s one reason it’s important for partners to take time to nurture their own

relationship. Give yourself a break. If your child has ADHD, give yourself a break now and then. Don’t feel

guilty for spending a few hours apart from your child. You’ll be a better parent if you’re rested

and relaxed. And don’t hesitate to ask relatives and friends for help. Make sure that baby sitters

or other caretakers are knowledgeable about ADHD and mature enough for the task. 

For more information contact [email protected] or 0772 224 231