Attention Deficit Hyperactivity Disorder (ADHD)

Attention Deficit Hyperactivity Disorder (ADHD)

Attention Deficit Hyperactivity Disorder (ADHD) is the most common behavioral disorder in children and adolescents. To varying degrees, ADHD can disrupt personal, academic, family and social functioning. If it is not identified and treated early, it can have consequences for the entire adult life.

What is ADHD?

Attention Deficit Hyperactivity Disorder (ADHD) is a neurological disorder that has two main characteristics: 1) inattention and 2) hyperactivity or impulsivity. Although these types of behaviors are found in all children, they are chronic and very pronounced in the case of those with ADHD. And they manifest themselves in all the circumstances of their life (not just at home or at school, for example).

Despite the academic difficulties caused by ADHD, there is no link between this disorder and intelligence.

It is estimated that 5% to 8% of the population suffers from ADHD. Boys have long been thought to be more affected than girls, but the most recent studies are not gender-specific.

This disorder is generally diagnosed around the age of 7, but children who have suffered from it have often had difficult behaviors as early as 2 years of age. In half of the cases, ADHD persists in adulthood, but symptoms may decrease in adolescence. Knowledge about ADHD has come a long way in recent years and care has improved a lot.

About half of children with ADHD also have other problems, such as learning disabilities, anxiety, opposition or emotional problems. These problems often lead to socialization difficulties and low self-esteem. For this reason, the evaluation of children may require the intervention of several professionals: psychologists, teachers, educators, remedial teachers, social workers, etc.

Symptoms

Your child may be suffering from ADHD if he has been present for 6 months or more:

At least 6 symptoms of inattention;

OR

At least 6 symptoms of hyperactivity or impulsivity;

OR

At least 6 symptoms of inattention and hyperactivity/impulsivity.

These symptoms must occur in a variety of circumstances (eg, home, daycare and school ) to a degree that does not correspond to the child’s level of development. Some of these symptoms must have been present before the age of 7 years.

Symptoms of inattention

Often, the child:

  • Symptoms of ADHD tend to increase in situations requiring some discipline or effort, and decrease when the child plays, experiences a new situation or is commended for good behavior.
  • is not able to pay attention to details or makes careless mistakes in homework or other activities;
    has trouble keeping his attention to the task or the games;
  • seems not to listen when we talk to him;
  • does not comply with instructions and fails to finish schoolwork or chores;
  • has difficulty organizing their activities or work;
  • avoid, dislike, or reluctantly do tasks that require sustained mental effort (such as schoolwork or homework);
  • loses objects necessary for his activities (eg toys, homework books, pencils)
  • is easily distracted by external sources of stimulation;
  • has forgotten things in everyday life.

Symptoms of hyperactivity or impulsivity

Often, the child:

  • stirs hands or feet, squirms in his seat or handles an object without stopping.
  • gets up in class or other situations where he has to sit.
  • short or climbing everywhere, in situations where this is inappropriate, without fear of danger.
  • has trouble keeping quiet in games or leisure activities.
  • is very active or acts as if he were “mounted on springs”.
  • talk too much.
  • responds hastily to a question that is not yet fully answered.
  • has trouble waiting for his turn.
  • interrupts others or imposes their presence (eg, bursting into conversations or games).
  • has difficulty controlling his actions and words in stressful moments, which can make him arrogant and sometimes aggressive in his words or actions.
  • does not tolerate the frustration imposed by certain instructions.
  • has mood swings.

Symptoms of mixed type ADHD

Children with mixed-type ADHD have, for 6 months or more, at least 6 symptoms of inattentive ADHD and at least 6 hyperactivity / impulsivity-related symptoms of ADHD.

Inattention does not always mean hyperactivity and impulsivity

A child can be very distracted and have no hyperactivity. Conversely, a child may be very agitated and impulsive, but be able to focus on certain tasks. Hyperactive children are more often boys. They are the ones that usually attract the attention of educators.

When to consult?

It is necessary to consult a doctor when the agitation of the child is present at all times, disrupts its exchanges and learning and makes family life impossible. Here are some clues to better assess the situation:

  • The duration of the behavior: more than 3 to 6 months.
  • Its frequency: several times a day or several seizures a week.
  • Consistency: It happens to him in many places, with several stakeholders.
  • Its intensity: this has consequences for the child and his environment.
  • The impact on his life: it affects his self-esteem, his school results.

Some situations may cause symptoms similar to those of ADHD. This is the case, for example, of a family conflict situation, a separation, an incompatibility of characters between the child and his teacher or conflicts with friends. Sometimes, hearing problems explain inattention. Finally, other health problems can cause this type of symptoms or amplify them. If in doubt, it is best to discuss it with the child’s doctor.

Causes of ADHD

This complex neurological disorder does not have a single cause. Probably related to certain chemicals in the brain, it is not caused by unmet emotional needs or psychosocial problems.

Although it may be an inherited disorder, there are some factors that can increase the risk, such as:

  • Exposure of the fetus to certain toxic substances ( alcohol, tobacco or drugs );
  • Meningitis bacterial;
  • Head trauma;
  • The prematurity ;
  • Any problems with childbirth that may have caused a lack of oxygen to the infant.

How to diagnose ADHD?

The diagnosis of ADHD is not easy to make and there is no test or medical examination for a clear diagnosis.

The specialist who makes the diagnosis makes a thorough assessment of the child and his environment. To help determine if a child has ADHD, this health professional also uses several tools, such as:

  • Behavioral criteria set by the book Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (primary tool);
  • Psychological tests;
  • Neuropsychological tests;
  • Some behavioral scales filled by parents and teachers (eg Conners scale).

How to treat?

There is no cure for ADHD. The objective of the intervention is to reduce the effects of this disorder on the child, ie, his or her academic difficulties, the suffering related to the rejection he often suffers, his low self-esteem, etc. When an ADHD is well treated, its evolution is generally good.

Are there more children with ADHD than before?

“We do not have studies to that effect. I just think this disorder is better understood than before. That said, the current lifestyle can make this disorder more disturbing than it was before. As families are smaller, the pressure of success for each child increases. In addition, society demands to be more productive. Families feel more forced to treat these children. – Dr. Ann Graillon, pediatrician

Once the diagnosis of ADHD is made, the child must be part of the discussion and decisions. The treatment of ADHD is individualized and requires the collaboration of various specialists, the family, and the school environment.

The stigma associated with ADHD is stubborn. For this reason, medical treatment is always combined with a psychosocial intervention (eg social skills assistance program, behavioral psychotherapy, family therapy, educational support or participation in sports or community activities). In schools, interventions that promote the organization of work by a suitable framework are recommended.

Pharmaceuticals

In addition to psychological and social interventions, medication is often needed to reduce the symptoms of ADHD. The doctor usually does not prescribe these medications just because a child is turbulent unless that behavior is strong enough to disrupt his or her social skills or self-esteem.

In general, it is the school difficulties that justify the start of treatment. This is why the use of medication should be exceptional before school entry.

No tranquilizers

Most of the drugs used in the treatment of ADHD are stimulants. Their effect can be compared to that obtained when you take a coffee. By stimulating the center of awakening, psychostimulants help to maintain some attention and have the effect of reducing agitation.

Some children respond better to one particular class of drugs than to another. It is sometimes necessary that the child tries different drugs before finding the one that brings the desired effects. Here are the main medications prescribed for ADHD:

  • Methylphenidate: the psychostimulant most often used (eg Ritalin®, Biphentin® and Concerta®). It does not cure ADHD and does not prevent it from persisting into adulthood, but it reduces the symptoms as long as it is taken. It does not entail any dependence.
  • Amphetamine derivatives: another class of psychostimulants (eg Adderall®, Dexedrine® and Vyvanse®).
  • Atomoxetine is not a stimulant (eg Strattera®). This medicine may be useful in children who also have an anxiety problem.

Methylphenidate, like amphetamine derivatives, improves the child’s mental focus and allows him to experience more positive experiences. Often, her academic performance improves and her relationships with her parents and friends become more harmonious.

Side effects of psychostimulants

The most common side effects of psychostimulants are loss of appetite and falling asleep. They can also give headaches, stomach pains and mood swings (sadness, irritability). The tics may appear or be exacerbated if they were already present. These effects tend to disappear over time.

A child who is taking psychostimulants may lose some weight or gain weight slightly less quickly than before. These medications do not affect the growth of the child.

Drugs, only one aspect of treatment

In addition to taking his medication, the child must also develop strategies that will help him organize, focus, reduce the excitants present in his environment, etc. It is also essential to work on your behavior and your self-esteem. Here’s how to help him.

  • Tell the child that ADHD is a neurological disorder that has nothing to do with intelligence.
  • To clear the child by insisting that he is not responsible for his condition.
  • Empower him by telling him that he has the most power over reducing his symptoms. Stakeholders and medications are there only to help.
  • Emphasize her strengths and explain to her that the treatment will give her tools to better control herself and have better results in school.
  • Avoid multiplying the family arrangements to supervise the hyperactive child. This may exaggerate his sense of omnipotence and heighten his sense of isolation.

Drug holiday on weekends and summer?

It is possible that the health professional following your child recommends stopping the medication on weekends or in the summer, especially if your child has significant side effects or if the medication is not necessary to be functional in your child. current activities outside the school.

One exception: atomoxetine (Strattera®). Your child should not stop taking this medication, especially at the beginning of treatment. Atomoxetine should be taken continuously for several weeks before reaching its maximum effect.

Complementary approaches

There are many complementary approaches to treating ADHD. Whether it is food restrictions (eg avoiding food additives or concentrated sugars) or taking supplements (vitamins, minerals), there is no scientific evidence to prove their effectiveness. The only exception is the high omega-3 diet, which could have a favorable effect on concentration.

Care and practical advice

  • Give your child one task at a time, and make sure he has done it well before giving him another one. If necessary, break down the instructions into steps that are easy to understand and do.
  • Avoid as much as possible to leave him in a turbulent group, or put him in the presence of a restless or impatient person.
  • Find a quiet place to do homework and other tasks that require attention.
  • To help focus, reduce the sources of stimulation and distraction in your environment, such as television, video games, tablet, and computer. Promote quiet activities.
  • If he has difficulty sleeping, encourage him to physically exercise during the day and do quiet activities before going to bed. Create a relaxing atmosphere before bedtime (sift the light, put on soft music, use essential oils with soothing properties, etc.).
  • Always keep an eye on him: a hyperactive child is more likely than others to get hurt while playing because he does not have the notion of danger.
  • Force, cries and corporal punishment are usually of no use. When your hyperactive child goes overboard, ask them to go to their room for a few minutes. This solution allows everyone to regain his composure.
  • Avoid falling into the “agitation – punishment – supervision” circle. You would then be more likely to control a child who needs to move more than others. So privilege explanations rather than punishments.
  • Avoid pointing out mistakes: motivation and encouragement lead to better results. Cultivate self-esteem by congratulating and thanking when he behaves well.
  • Recognize your limits before losing patience and ask for help as needed.

How to prevent?

We can not prevent the onset of ADHD.

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