Attention-Deficit Hyperactivity Disorders (ADHD)They are disorders characterized by a combination of inattention, hyperactivity and impulsivity. Therefore, a child with this disorder may exhibit extreme activity, difficulty with friends or family, be disruptive in school and have a degree of impulsivity or doing things without thinking.
ADHD has been classified as a developmental disorder, although it has increasingly been considered a disruptive behavioural disorder.
ADHD affects an estimated 3 to 10% of school-aged-children. However, many experts say it is overdiagnosed, largely because criteria are applied inaccurately. According to DSM-IV, there are three types of ADHD: 1. Predominantly inattentive. 2. Predominantly hyperactive-impulsive. 3. Combined. Diagnostic and Statistical Manual, Fourth Edition (DSM-IV) Sypmtom Criteria for ADHD
I. INATTENTION
1. Does not pay attention to details. 2. Has difficulty sustaining attention at school 3. Does not seem to listen when spoken to. 4. Does not follow through on instructions or finish tasks. 5. Has difficulty organizing tasks and activities. 6. Avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort. 7. Often loses things. 8. Is easily distracted. 9. Is forgetful. 
II. HYPERACTIVITY
1. Often fidgets with hands or feet or squirms. 2. Often leaves seat in class-room or elsewhere. 3. Often runs about or climbs excessively. 4. Has difficulty playing quietly. 5. Often on the go, acting as if driven by a motor. 6. Often talks excessively.
III. IMPULSIVITY 1. Often blurts out answers before questions are completed. 2. Often has difficulty awaiting turn. 3. Often interrupts or intrudes on others.
ADHD DiagnosisDiagnosis is clinical and is based on comprehensive medical, developmental, educational, and psychological evaluations.Diagnosis by DSM-IV criteria requires that symptom criteria must be present in at least two situations (eg. home and school) and present before age 7.
1. Predominantly Inattentive Type: Diagnosis requires at least 6 of the 9 possible symptoms of inattention. 2. Hyperactive-Impulsive Type: Diagnosis requires at least 6 of the 9 possible symptoms of hyperactivity and impulsivity. 3. The Combined Type: Diagnosis requires at least 6 symptoms each of inattention and hyperactivity-impulsivity. For the proper management of ADHD, the defected child has to go through three types of assessments:
A. Medical Assessment: Which is an assessment that focuses on identifying potentially treatable conditions that may contribute to or worsen symptoms and signs. B. Developmental assessment: Another aspect of assessment that focuses on determining the onset and the course of symptoms and signs. C. Educational assessment: Which focuses on documenting core symptoms and signs; it may involve reviewing educational records and the use of rating scales or checklists. Checklists alone often cannot distinguish ADHD from other developmental disorders or from behavioural disorders. Treatment
According to studies, combining behavioural therapy with stimulant drugs is more effective than using any kind of therapy alone.
Drugs are effective in alleviating ADHD symptoms; they permit participation in activities previously inaccessible because of poor attention and impulsivity. Drugs often interrupt the cycle of inappropriate behaviour, enhancing behavioural and academic interventions, motivation and self-esteem. Drugs used include methylphenidate(Retalin) or dextroamphetamine(Dexedrine). Response varies greatly and dosage depends on the severity of the behaviour and the child's ability to tolerate the drug. Common adverse effects of stimulant drugs include: Sleep disturbances. Depression. Headache. Stomachache. Appetite suppression. Elevated heart rate. Elevated blood pressure. Growth suppression if used more than two years. Other drugs used include: 1. Atomoxetine (Strattera), a selective norepinephrine reuptake inhibitor. 2. Antidepressants such as Bupropion, alpha 2 antagonists like clonidine and guanfacine. Behavioural Therapy: Cognitive-Behavioural therapy (forexample, goal-setting, self-monitoring, modeling..etc.) is often effective and helps the child understand ADHD. Classroom behaviour is often improved by environmental control of noise and visual stimulation, appropriate task length, coaching, and teacher proximity. When difficulties persist at home, parents should be encouraged to seek additional professional assistance and training in bahaviour management techniques. Adding incentives and token rewards reinforces behaviour management and is often effective. PrognosisRemission prior to age 12.70-80% continue into adolescence and 65% into adulthood. Adult outcome: Antisocial personality disorder(ASPD), Attention Deficit Hyperactivity Disorder ADHD, poor educational and employment performance.
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