Diagnostic Deficit Hyperactivity Disorder (ADHD)

An important cause of poor school achievement in children is developmental dysfunction due to attention deficit. Approx. 10% children in early schooling years perform poorly in comparison to others and have difficulties in training and acquiring academic skills.

It would be unfair to label such children as mentally subnormal. Such children could be forced by circumstances to unfairly drop from school. These kids are not always mentally challenged or retarded and could demonstrate near-normal intelligence levels and potential for development with tests for intelligence.

Attention Deficit Hyperactivity Disorder or ADHD is a chronic condition in school-going children characterized by attention difficulty, hyperactivity and impulsiveness. It is one of the most common neuro-developmental disorders of childhood and is more in boys than in girls and often continues into adulthood.

Risk factors

Risk factors for ADHD could include:

• Premature births
• Blood relatives, such as a parent or sibling, with ADHD or another mental health disorder
• Exposure to environmental toxins
• Maternal drug use, drinking alcohol or smoking during pregnancy

Symptoms

In some children, ADHD symptoms begin as early as 3 years of age. An ADHD-affected person experiences impulsivity and distraction beyond a level that would be typical for a person’s age. ADHD is characterized by an age-inappropriate hyperactivity, impulsiveness and inattention and is divided into three classes:

• Class I: majorly having all three symptoms
• Class II: having first two symptoms
• Class III: mainly the third symptom

In ADHD, hyperactivity is usually the very first symptom to be noticed by parents. ADHD is the commonest psychiatric diagnosis made in school children.

Diagnosis

Different life events, psychological disorders, and medical conditions can lead to certain characteristics of ADHD. Some children with ADHD could have difficulty sitting still and others may display a combination of different symptoms. Diagnosis of ADHD is chiefly based on clinical symptoms.

The DSM criteria consists of presence of at least 6 symptoms of either inattention or hyperactivity and impulsivity and onset before 7 years of age, and the behaviour present for at least 6 months, functional impairment present in two or more settings, disturbance causing significant distress in learning and adaptability and impairment in academic behaviour pattern.

Following are the Diagnostic criteria for ADHD based on American Psychiatric Association:

Diagnostic criteria for ADHD based on American Psychiatric Association:

Inattention

Six symptoms or more of the following, to a degree that is maladaptive and inconsistent with developmental level, persisting for at least 6 months:

1. Often fails to give close attention to details or makes careless mistakes in school work, writing assignments or other activities.
2. Often having difficulties in sustaining attention in tasks or play activities.
3. Often does not seem to listen when directly spoken to.
4. Often does not follow through on instructions and fails to complete assigned schoolwork, chores, duties in workplace
5. Often has difficulty in organizing tasks and activities.
6. Often avoids, dislikes or is reluctant to engage in tasks requiring sustained mental effort (e. g. schoolwork or homework)
7. Often loses things necessary for tasks or activities (e. g. toys, school assignments, books copies, pencils, tools, etc.)
8. Is often distracted by extraneous stimuli.
9. Is often forgetful in daily activities.

Hyperactivity-Impulsivity

Six symptoms or more of the following, to a degree that is maladaptive and inconsistent with developmental level, persisting for at least 6 months:

1. Often fidgets with hands or squirms in seat.
2. Often leaves the seat in classroom or in other situations in which remaining seated is expected.
3. Often runs about or climbs excessively in situations in which it is inappropriate. (In adults, it could be limited to subjective feelings of restlessness.)
4. Often having difficulties in playing or engaging in leisure activities.
5. Is often “on the go” or often acts as if “driven by a motor”.
6. Often talks excessively.
7. Impulsivity.
8. Often blurts out answers before the questions have been completed.
9. Often has difficulty in awaiting turn.
10. Often interrupts or intrudes on others (e.g. bursts into conversations or games).

These above characteristics interfere with daily life, with relationships and success in school or work. More importantly, no specific diagnostic test can identify and diagnose ADHD. People over 17 years must demonstrate minimum five criteria to qualify for diagnosis of ADHD.

Management

It's typical for pre-schoolers to have short attention spans and be unable to stick with one activity for long and to get inattentive, hyperactive or impulsive at one time or another.

Sometimes parents or teachers have unrealistic expectations, especially about the behaviour of school boys. A growing child may need only a different environment, smaller than classrooms, firmer discipline or loving attention from parents, care-givers. He/ she may not necessarily have ADHD.

Conditions existing with ADHD are learning disabilities, depressive anxiety disorders and conduct disorders.

Such hyperactive children, often struggle in the classroom, which can lead to academic failure and judgment by other children and adults.

ADHD is diagnosed early in school years. The management of the ADHD affected child depends upon child’s age, severity of symptoms and nature and degree of associated problems. ADHD can make life difficult for children so getting children treated earlier is the necessity.