Attention Deficit Hyperactivity Disorder (ADHD) in children

What is Attention Deficit Hyperactivity Disorder (ADHD or AD/HD or ADD)?

Attention deficit hyperactivity disorder (ADHD) is a disorder that appears in early childhood. It makes it difficult for individuals to restrain their spontaneous responses—responses that can involve everything from movement to speech to attentiveness.

The signs and symptoms of ADD/ADHD typically appear before the age of seven. However, it can be difficult to distinguish between attention deficit disorder and normal “kid behaviour.” If the signs and the symptoms appear only in some situations, it’s probably not ADD/ADHD. The child has to show six or more specific symptoms of inactivity and/or hyperactivity on a regular basis for more than six months in more than two settings.

Causes

The specific causes of ADHD are not known.There are, however, a number of factors that may contribute to, or increase ADHD. They include genetics, diet and the social and physical environments.

Evolutionary theories proposes the hunter vs. farmer theory as per which hyperactivity may be an adaptive behaviour in pre-modern humans and that those with ADHD retain some of the older “hunter” characteristics associated with early pre-agricultural human society. According to this theory, individuals with ADHD may be more adept at searching and seeking and less adept at staying put and managing complex tasks over time.

Environmental factors include alcohol and tobacco smoke exposure during pregnancy and environmental exposure to lead in very early life. Complications during pregnancy and birth—including premature birth, infections during pregnancy, at birth, and in early childhood are also linked to an increased risk of developing ADHD.

Links between children’s ingestion of many commonly used artificial food colours have been debated as one of the factors.

Theories also suggest that relationships with caregivers have a profound effect on attentional and self-regulatory abilities.

Social construction theory states that it is societies that determine where the line between normal and abnormal behaviour is drawn. Thus society members including physicians, parents, teachers, and others are the ones who determine which diagnostic criteria are applied and, thus, determine the number of people affected.

The low arousal theory suggests that people with ADHD need excessive activity as self-stimulation because of their state of abnormally low arousal. The theory states that those with ADHD cannot self-moderate, and their attention can be gained only by means of environmental stimuli, which in turn results in disruption of attentional capacity and an increase in hyperactive behaviour.

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Symptoms of ADHD

The three primary characteristics of ADD/ADHD are inattention, hyperactivity, and impulsivity. The signs and symptoms a child with attention deficit disorder has depends on which characteristics dominate.

Children with ADHD show signs of inattention, hyperactivity, and/or impulsivity in specific ways. These children:

• Are in constant motion.
• Squirm and fidget.
• Do not seem to listen.
• Have difficulty playing quietly.
• Often talk excessively.
• Interrupt or intrude on others.
• Are easily distracted.
• Do not finish tasks.

Children who only have inattentive symptoms of ADD/ADHD are often overlooked, since they’re not disruptive. But, the symptoms of inattention have consequences: like unable to follow directions; underperforming in school; or clashing with other kids over not playing by the rules.

Some behaviours can appear to be ADHD-related, but are not. Some causes of ADHD-like behaviour are:

-       Major life events or traumatic experiences (e.g. a recent move, death of a loved one, bullying, divorce).

-       Medical disorders affecting brain function like neurological conditions, epilepsy, and sleep disorders.

-       Psychological disorders including anxiety, depression, and bipolar disorder.

-       Behavioural disorders such as conduct disorder and oppositional defiant disorder.

-       Learning disabilities or problems with reading, writing, motor skills, or language.

Diagnosis of ADHD

To be diagnosed with ADD/ADHD, the child must display a combination of strong ADD/ADHD symptoms, namely hyperactivity, impulsivity, or inattention. The questions addressed are -

• How severe are the symptoms?  The symptoms must have a negative impact on the child’s life.
• When did the symptoms start? How early the symptoms appeared?
• How long have the symptoms been bothering the child? Symptoms must have been going on for at least 6 months before ADD/ADHD can be diagnosed.
• When and where do the symptoms appear? The symptoms of ADD/ADHD must be present in multiple settings, such as at home and school. If the symptoms only appear in one environment, it is unlikely that ADD/ADHD is to blame.

Types and treatment of  ADHD