Attention deficit/Hyperactivity disorder AD/HD

ADHD

Attention deficit/Hyperactivity disorder, as the name suggests is a behavioral disorder characterized by developmentally elated levels of inattentionimpulsivity and hyperactivity.

Research suggests that this disorder is prevalent in 3% to 7% of school age population and 2% to 7% of adult population. It is more frequent in males than females with a ratio of 2:1 in children and 6:1 in adults.

Diagnostic features :

DSM-V specifies that if an individual exhibit any 6 or more of the under stated symptoms(A) and meets the criteria from B-E for atleast 6 months to a degree that is inconsistent with his developmental level and that has negative impact on his social and academic/occupational activities then he can be diagnosed for ADHD :

(A) (1) Inattention Symptoms :

  • Failure to pay attention
  • Difficulty in sustaining attention
  • Not listening
  • Not following through on instructions
  • Often losing things
  • Avoiding tasks that require sustained mental effort
  • Poor organizational skills
  • Being easily distracted
  • Being forgetful

(2) Hyperactivity/Impulsivity Symptoms :

  • Fidgeting
  • Inability to sit when expected
  • Behaving or feeling restless
  • Being compelled to stay active
  • Inability to play or engage in leisure activities quietly
  • Excessive Talking
  • Blurting out answers
  • Difficulty in waiting for his turn
  • Intruding others

(B) Several symptoms were present prior to age 12 years.

(C) Several symptoms are present in 2 or more social or academic/occupational settings.

(D) There is an evident negative impact on the social, academic or occupational functioning.

(E) The symptoms are not better explained by any other medical condition.

Depending on the cluster of symptoms 3 subtypes of ADHD are known :

  • Combined presentation – both inattention and hyperactivity/impulsivity symptoms are present.
  • Predominantly inattentive presentation.
  • Pre-dominantly Hyperactive/Impulsive presentation.

Diagnostic Tools :

  • DSM-V AD/HD rating scales
  • Broadband rating e.g. Child behavior checklist
  • Structured and semi structured interviews
  • Impairment rating scales : e.g. Children’s global assessment of functioning
  • Observation of behavior

Functional consequences of ADHD: ADHD is often diagnosed at the early school years and is relatively stable during adolescence, but in some cases it is known to worsen over the adult years. It is associated with poor academic or occupational performance. Children with ADHD are more prone to conduct disorder and anti social personality disorder in adulthood. Negative effect on relationship with parents and peers can affect the esteem levels, and increases the risk of suicide in some cases in adulthood.

Treatment : 

Following are some treatment known to help

(1) Stimulant medications

(2) Positive regard from parents/school,  Appraisal for positive behavior

(3) Being punished with caution

  • Response cost : On every unwanted behavior a privilege that the child likes (a toy or game) should be taken away.
  • Time out : The cause duration and place of time out should be chosen with care

(4) Another technique is token economy. A list of behaviors is made and for every positive behavior exhibited a token is given and for every negative behavior a token is taken back. After sometime the child can exchange the tokens for a gift of his choice.

          Vidhi Pipara Adolescent Psychologist – Guidance on personal or psychological problems in Ahmedabad,Gujarat and India.

Comments are closed.