Attention-Deficit Hyperactivity Disorder (ADHD); is a neurobehavioral developmental disorder affecting about 3-5% of the world’s population under the age of 19. It typically presents itself during childhood, and is characterized by a persistent pattern of inattention and/or hyperactivity, as well as forgetfulness, poor impulse control or impulsivity, and distractibility. ADHD is currently considered to be a persistent and chronic condition for which no medical cure is available, although medication can be prescribed. ADHD is most commonly diagnosed in children and, over the past decade, has been increasingly diagnosed in adults. About 60% of children diagnosed with ADHD retain the condition as adults. It appears to be highly heritable, although one-fifth of all cases are estimated to be caused from trauma or toxic exposure.
Methods of treatment usually involve some combination of medications, behavior modifications, life style changes, and counseling.The scientific consensus in the field, and the consensus of the national health institutes of the world, is that ADHD is a disorder which impairs functioning, and that many adverse life outcomes are associated with ADHD.
Symptoms; The most common and core symptoms of ADHD poor attention span,hyperactivity and impulsive behaviour . The Diagnostic and Statistical Manual of Mental Disorders DSM IV categorises the symptoms of ADHD into two clusters: Inattention symptoms and Hyperactivity/Impulsivity symptoms.
According to an advanced high-precision imaging study by researchers at the United StatesNational Institutes of Health‘s National Institute of Mental Health, an actual delay in physical development in some brain structures, with a median value of three years, was observed in the brains of 223 ADHD patients beginning in elementary school, during the period when cortical thickening during childhood begins to change to thinning following puberty. The delay was most prominent in the frontal cortex and temporal cortex, which are believed responsible for the ability to control and focus thinking, attention and planning, suppress inappropriate actions and thoughts, remember things from moment to moment, and work for reward, all functions whose disturbance is associated with a diagnosis of ADHD; the region with the greatest average delay, the middle of the prefrontal cortex, lagged a full five years in development in the ADHD patients. In contrast, the motor cortex in the ADHD patients was seen to mature faster than normal, suggesting that both slower development of behavioral control and advanced motor development might both be required for the restlessness and fidgetiness that characterise an ADVariant of thedopamine D4 receptor gene, which accounts for about 30 percent of the genetic risk for ADHD, in unusual thinness of the cortex of the right side of the brain; however, in contrast to other variants of the gene found in ADHD patients, the region normalized in thickness during the teen years in these children, coinciding with clinical improvement. Hyperactivity is common among children with ADHD but tends to disappear during adulthood. However, over half of children with ADHD continue to have symptoms of inattention throughout their lives.Inattention and “hyperactive” behavior are not the only problems with children with ADHD. ADHD exists alone in only about 1/3 of the children diagnosed with it.
Many of these co-existing conditions( Comorbid conditions) require other courses of treatment and should be diagnosed separately instead of being grouped in the ADHD diagnosis.
Some of the associated comorbid conditions are: a. Oppositional-Defiance Disorder (35%) and Conduct Disorder(26%). These are both characterized by extreme anti-social behaviors. These disorders are frequently characterized by aggression, frequent temper tantrums, deceitfulness, lying, or stealing. b. Primary Disorder of Vigilance. Characterized by poor attention and concentration, as well as difficulties staying awake. These children tend to fidget, yawn and stretch, and appear to be hyperactive in order to remain alert and active. c. Bi-polar disorder. As many as 25% of children with ADHD may have bipolar disorder. Children with this combination may demonstrate more aggression and behavioral problems than those with ADHD alone. d. Anxiety Disorders. Commonly accompany ADHD, particularly Obsessive-Compulsive Disorder. OCD is believed to share a genetic component with ADHD, and shares many of its characteristics.f,Poor social and communication skill such Autism and Asperger Syndrome.g.Dyspraxia or motor coordination problem.
Multimodal method of treatment approach is most beneficial.Ideally in most of the mild to moderate cases where impairment in education or social life is not severe, behavioural therapy such as psychoeducation,cognitive behaviour therapy,social education, and empowering parents with parenting skill is the right kind of therapeutic approach.If above methods fail then this treatment is combined with medicinal treatment.
In severe cases medicinal treatment is the first choce of treatment.In cases when the other methods have failed medicinal treament is the most efficient and cost effective method of treating ADHD.
Over 200 controlled studies have shown that stimulant medication is an effective way to treat ADHD.But multimodal approach is most effective and benificial .There fore in majority of cases combined treatment with psychoeducation,improving social skills,behaviour modification and improving parenting skill along with treatment is the best choice.
To achieve the best possible benifit of treatment it is neccessary to also treat the child’s comorbid condition such as Autism ,Anxiety or Dyspraxia.
Not to forget early referral,early identification and diagnosis and timely intervention is golden rule in cases of ADHD.Autism and other Neurodevelopmental problems.