ADHD treatment. Medication treatment for ADHD

or ADHD is the most common cause of behavior disorders and learning problems in preschool and school children.

Attention deficit hyperactivity disorder in a child– a developmental disorder manifested in behavioral disturbances. A child with ADHD is restless, displays “stupid” activity, cannot sit through classes at school or kindergarten, and will not do anything that is not interesting to him. He interrupts his elders, plays in class, minds his own business, and can crawl under the desk. At the same time, the child correctly perceives his surroundings. He hears and understands all the instructions of his elders, but cannot follow their instructions due to impulsiveness. Despite the fact that the child understands the task, he cannot complete what he started and is unable to plan and foresee the consequences of his actions. This is associated with a high risk of getting injured at home and getting lost.

Neurologists consider attention deficit hyperactivity disorder in a child as a neurological disease. Its manifestations are not the result of improper upbringing, neglect or permissiveness, they are a consequence of the special functioning of the brain.

Prevalence. ADHD is found in 3-5% of children. Of these, 30% “outgrow” the disease after 14 years, another 40% adapt to it and learn to smooth out its manifestations. Among adults, this syndrome is found in only 1%.

Boys are diagnosed with attention deficit hyperactivity disorder 3-5 times more often than girls. Moreover, in boys the syndrome is more often manifested by destructive behavior (disobedience and aggression), and in girls by inattention. According to some studies, fair-haired and blue-eyed Europeans are more susceptible to the disease. Interestingly, the incidence rate varies significantly from country to country. Thus, studies conducted in London and Tennessee found ADHD in 17% of children.

Types of ADHD

• Attention deficit and hyperactivity are expressed equally;
• Attention deficit predominates, and impulsivity and hyperactivity are minor;
• Hyperactivity and impulsiveness predominate, attention is slightly impaired.

Treatment. The main methods are pedagogical measures and psychological correction. Drug treatment is used in cases where other methods have been ineffective because the drugs used have side effects.
If you leave your child with attention deficit hyperactivity disorder Without treatment, the risk of developing:

• dependence on alcohol, drugs, psychotropic drugs;
• difficulties with assimilation of information that disrupt the learning process;
• high anxiety, which replaces physical activity;
• Tics – repeated muscle twitching.
• headaches;
• antisocial changes - a tendency to hooliganism, theft.

Controversial points. A number of leading experts in the field of medicine and public organizations, including the Citizens Commission on Human Rights, deny the existence of attention deficit hyperactivity disorder in children. From their point of view, manifestations of ADHD are considered a feature of temperament and character, and therefore cannot be treated. They may be a manifestation of natural active child mobility and curiosity, or protest behavior that arises in response to a traumatic situation - abuse, loneliness, parental divorce.

Attention deficit hyperactivity disorder in a child, causes

The cause of attention deficit hyperactivity disorder in a child cannot be installed. Scientists are convinced that the disease is provoked by a combination of several factors that disrupt the functioning of the nervous system.

1. Factors that disrupt the formation of the nervous system in the fetus which can lead to oxygen starvation or hemorrhage in the brain tissue:

• environmental pollution, high content harmful substances in air, water, food;
• taking medications by a woman during pregnancy;
• exposure to alcohol, drugs, nicotine;
• infections suffered by the mother during pregnancy;
• Rh factor conflict – immunological incompatibility;
• risk of miscarriage ;
• fetal asphyxia;
• umbilical cord entanglement;
• complicated or rapid labor leading to injury to the head or spine of the fetus.

1. Factors that disrupt brain function in infancy

• diseases accompanied by a temperature above 39-40 degrees;
• taking certain medications that have a neurotoxic effect;
• bronchial asthma, pneumonia;
• severe kidney disease;
• heart failure, heart disease.

1. Genetic factors. According to this theory, 80% of cases of attention deficit hyperactivity disorder are associated with disorders in the gene that regulates the release of dopamine and the functioning of dopamine receptors. The result is a disruption in the transmission of bioelectrical impulses between brain cells. Moreover, the disease manifests itself if, in addition to genetic abnormalities, there are unfavorable environmental factors.

Neurologists believe that these factors can cause damage in limited areas of the brain. In this regard, some mental functions (for example, volitional control over impulses and emotions) develop inconsistently, with a delay, which causes manifestations of the disease. This confirms the fact that children with ADHD showed disturbances in metabolic processes and bioelectrical activity in the anterior parts of the frontal lobes of the brain.

Attention deficit hyperactivity disorder in a child, symptoms

A child with ADHD equally exhibits hyperactivity and inattention at home, in kindergarten, and when visiting strangers. There are no situations in which the baby would behave calmly. This differs him from an ordinary active child.

Signs of ADHD at an early age

Attention deficit hyperactivity disorder in a child, symptoms which most clearly manifests itself at 5-12 years of age, can be recognized at an earlier age.

• They begin to hold their heads up, sit, crawl, and walk early.
• They experience problems falling asleep and sleep less than normal.
• If they get tired, do not engage in a calm activity, do not fall asleep on their own, but become hysterical.
• Very sensitive to loud sounds, bright lights, strangers, and changes in environment. These factors cause them to cry loudly.
• They throw away toys before they even have time to look at them.

Such signs may indicate a tendency towards ADHD, but they are also present in many restless children under 3 years of age.
ADHD also affects the functioning of the body. The child often experiences digestive problems. Diarrhea is the result of excessive stimulation of the intestines by the autonomic nervous system. Allergic reactions and skin rashes appear more often than among peers.

Main symptoms

1. Attention disorder

• R The child has difficulty concentrating on one subject or activity. He does not pay attention to details, unable to distinguish the main from the secondary. The child tries to do all the things at the same time: he colors all the details without completing them, reads the text, skipping over a line. This happens because he does not know how to plan. When doing tasks together, explain: “First we’ll do one thing, then the other.”
• The child tries to avoid routine tasks under any pretext., lessons, creativity. This could be a quiet protest when the child runs away and hides, or a hysteria with screaming and tears.
• The cyclical nature of attention is pronounced. A preschooler can do one thing for 3-5 minutes, a child of primary school age for up to 10 minutes. Then, over the same period, the nervous system restores the resource. Often at this time it seems that the child does not hear the speech addressed to him. Then the cycle repeats.
• Attention can only be concentrated if you are left alone with the child. The child is more attentive and obedient if the room is quiet and there are no irritants, toys, or other people.

1. Hyperactivity

• The child makes a large number of inappropriate movements, most of which he doesn't notice. A distinctive feature of motor activity in ADHD is its aimlessness. This could be spinning the hands and feet, running, jumping, or tapping on the table or floor. The child runs, not walks. Climbing on furniture . Breaks toys.
• Talks too loudly and fast. He answers without listening to the question. Shouts out the answer, interrupting the person answering. He speaks in unfinished sentences, jumping from one thought to another. Swallows the endings of words and sentences. Constantly asks again. His statements are often thoughtless, they provoke and offend others.
• Facial expressions are very expressive. The face expresses emotions that quickly appear and disappear - anger, surprise, joy. Sometimes he grimaces for no apparent reason.

It has been found that in children with ADHD, physical activity stimulates the brain structures responsible for thinking and self-control. That is, while the child runs, knocks and takes things apart, his brain is improving. New neural connections are established in the cortex, which will further improve the functioning of the nervous system and relieve the child from the manifestations of the disease.

1. Impulsiveness

• Guided solely by his own desires and carries them out immediately. Acts on the first impulse, without thinking through the consequences and without planning. There are no situations for a child in which he must sit still. During classes in kindergarten or at school, he jumps up and runs to the window, into the corridor, makes noise, shouts from his seat. Takes the thing he likes from his peers.
• Cannot follow instructions, especially those consisting of several points. The child constantly has new desires (impulses), which prevent him from finishing the job he has started (doing homework, collecting toys).
• Unable to wait or endure. He must immediately get or do what he wants. If this does not happen, he makes a scandal, switches to other things, or performs aimless actions. This is clearly noticeable in class or while waiting for your turn.
• Mood swings happen every few minutes. The child goes from laughing to crying. Hot temper is especially common in children with ADHD. When angry, the child throws objects, can start a fight or ruin the offender’s things. He will do it right away, without thinking or hatching a plan for revenge.
• The child does not feel danger. He can do things that are dangerous to health and life: climb to a height, walk through abandoned buildings, go out on thin ice because he wanted to do it. This property leads to high rates of injury in children with ADHD.

Manifestations of the disease are due to the fact that the nervous system of a child with ADHD is too vulnerable. She is unable to cope with the large amount of information coming from the outside world. Excessive activity and lack of attention is an attempt to protect yourself from the unbearable load on the nervous system.

Additional symptoms

• Difficulties in learning with a normal level of intelligence. The child may have difficulty writing and reading. At the same time, he does not perceive individual letters and sounds or does not fully master this skill. The inability to learn arithmetic can be an independent disorder or accompany problems with reading and writing.
• Communication disorders. A child with ADHD may be obsessive towards peers and unfamiliar adults. He may be too emotional or even aggressive, which makes it difficult to communicate and establish friendly contacts.
• Lag in emotional development. The child behaves excessively capriciously and emotionally. He does not tolerate criticism, failures, and behaves unbalanced and “childish.” A pattern has been established that with ADHD there is a 30% lag in emotional development. For example, a 10-year-old child behaves like a 7-year-old, although he is intellectually developed no worse than his peers.
• Negative self-esteem. A child hears in a day great amount comments. If at the same time he is also compared with his peers: “Look how well Masha behaves!” this makes the situation worse. Criticism and complaints convince the child that he is worse than others, bad, stupid, restless. This makes the child unhappy, distant, aggressive, and instills hatred towards others.

Manifestations of attention deficit disorder are associated with the fact that the child’s nervous system is too vulnerable. She is unable to cope with the large amount of information coming from the outside world. Excessive activity and lack of attention is an attempt to protect yourself from the unbearable load on the nervous system.

Positive qualities of children with ADHD

• Active, active;
• Easily read the mood of the interlocutor;
• Willing to sacrifice themselves for the people they like;
• Not vindictive, unable to harbor a grudge;
• They are fearless and do not have most childhood fears.

Attention deficit hyperactivity disorder in a child, diagnosis

Diagnosis of attention deficit hyperactivity disorder may include several stages:

1. Collection of information - interview with the child, conversation with parents, diagnostic questionnaires.
2. Neuropsychological examination.
3. Pediatrician consultation.

As a rule, a neurologist or psychiatrist makes a diagnosis based on a conversation with the child, analyzing information from parents, caregivers and teachers.

1. Collection of information

The specialist receives most of the information during a conversation with the child and observing his behavior. The conversation with children takes place orally. When working with adolescents, the doctor may ask you to fill out a questionnaire that resembles a test. Information received from parents and teachers helps complete the picture.

Diagnostic questionnaire is a list of questions designed to collect as much information as possible about behavior and mental state child. It usually takes the form of a multiple-choice test. To identify ADHD, the following are used:

• Vanderbilt Adolescent ADHD Diagnostic Questionnaire. There are versions for parents and teachers.
• Parental Symptom Questionnaire for ADHD Manifestations;
• Conners Structured Questionnaire.

According to the international classification of diseases ICD-10 diagnosis of attention deficit hyperactivity disorder in a child diagnosed when the following symptoms are detected:

• Adaptation disorder. Expressed as non-compliance with characteristics that are normal for this age;
• Attention impairment, when the child cannot focus his attention on one object;
• Impulsivity and hyperactivity;
• Development of first symptoms before the age of 7 years;
• Adaptation disorder manifests itself in different situations(in kindergarten, school, at home), while the child’s intellectual development corresponds to his age;
• These symptoms persist for 6 months or more.

A doctor has the right to make a diagnosis of “attention deficit hyperactivity disorder” if at least 6 symptoms of inattention and at least 6 symptoms of impulsivity and hyperactivity are detected and followed for 6 months or more. These signs appear constantly, not from time to time. They are so pronounced that they interfere with the child’s learning and daily activities.

Signs of inattention

• Doesn't pay attention to details. In his work he makes a large number of mistakes due to negligence and frivolity.
• Easily distracted.
• Has difficulty concentrating when playing and completing tasks.
• Does not listen to speech addressed to him.
• Unable to complete assignments or do homework. Cannot follow instructions.
• Has difficulty performing independent work. Needs guidance and supervision from an adult.
• Resists completing tasks that require prolonged mental effort: homework, tasks from a teacher or psychologist. Avoids such work for various reasons and shows dissatisfaction.
• Often loses things.
• In everyday activities, he shows forgetfulness and absent-mindedness.

Signs of impulsivity and hyperactivity

• Makes a large number of unnecessary movements. Cannot sit quietly in a chair. Spins, makes movements, feet, hands, head.
• Cannot sit or remain still in situations where this is necessary - in class, at a concert, in transport.
• Shows rash motor activity in situations where this is unacceptable. He gets up, runs, spins, takes things without asking, tries to climb somewhere.
• Can't play calmly.
• Excessively mobile.
• Too talkative.
• He answers without listening to the end of the question. Doesn't think before giving an answer.
• Impatient. Has difficulty waiting his turn.
• Disturbs others, pesters people. Interferes with play or conversation.

Strictly speaking, the diagnosis of ADHD is based on the subjective opinion of a specialist and his personal experience. Therefore, if the parents do not agree with the diagnosis, then it makes sense to contact another neurologist or psychiatrist who specializes in this problem.

1. Neuropsychological assessment for ADHD

In order to study the features of the brain, the child is given electroencephalographic examination (EEG). This is a measurement of the bioelectrical activity of the brain at rest or while performing tasks. To do this, the electrical activity of the brain is measured through the scalp. The procedure is painless and harmless.
For ADHD the beta rhythm is reduced and the theta rhythm is increased. The ratio of theta rhythm and beta rhythm several times higher than normal. This suggests that the bioelectrical activity of the brain is reduced, that is, a smaller number of electrical impulses are generated and transmitted through neurons compared to the norm.

1. Pediatrician consultation

Manifestations similar to ADHD can be caused by anemia, hyperthyroidism and other somatic diseases. A pediatrician can confirm or exclude them after a blood test for hormones and hemoglobin.
Note! As a rule, in addition to the diagnosis of ADHD, the neurologist indicates a number of diagnoses in the child’s medical record:

• Minimal brain dysfunction(MMD) – mild neurological disorders that cause disturbances in motor functions, speech, and behavior;
• Increased intracranial pressure(ICP) - increased pressure of the cerebrospinal fluid (CSF), which is located in the ventricles of the brain, around it and in the spinal canal.
• Perinatal CNS damage– damage to the nervous system that occurs during pregnancy, childbirth or in the first days of life.

All these disorders have similar manifestations, which is why they are often written together. Such an entry on the card does not mean that the child has a large number of neurological diseases. On the contrary, the changes are minimal and can be corrected.

Attention deficit hyperactivity disorder in a child, treatment

1. Medication treatment for ADHD

Medications are prescribed according to individual indications only if the child’s behavior cannot be improved without them.

Group of drugs	Representatives	The effect of taking medications
Psychostimulants	Levamphetamine, Dexamphetamine, Dexmethylphenidate	The production of neurotransmitters increases, due to which the bioelectrical activity of the brain is normalized. Improves behavior, reduces impulsivity, aggressiveness, and symptoms of depression.
Antidepressants, norepinephrine reuptake inhibitors	Atomoxetine. Desipramine, Bupropion	Reduce the reuptake of neurotransmitters (dopamine, serotonin). Their accumulation in synapses improves the transmission of signals between brain cells. Increase attention and reduce impulsiveness.
Nootropic drugs	Cerebrolysin, Piracetam, Instenon, Gamma-aminobutyric acid	They improve metabolic processes in brain tissue, its nutrition and oxygen supply, and the absorption of glucose by the brain. Increases the tone of the cerebral cortex. The effectiveness of these drugs has not been proven.
Sympathomimetics	Clonidine, Atomoxetine, Desipramine	Increases cerebral vascular tone, improving blood circulation. Promote normalization intracranial pressure.

Treatment is carried out with low doses of drugs to minimize the risk of side effects and addiction. It has been proven that improvement occurs only while taking the drugs. After their withdrawal, symptoms reappear.

1. Physiotherapy and massage for ADHD

This set of procedures is aimed at treating birth injuries to the head, cervical region spine, relieving neck muscle spasms. This is necessary to normalize cerebral circulation and intracranial pressure. For ADHD the following are used:

• Physiotherapy, aimed at strengthening the muscles of the neck and shoulder girdle. Must be performed daily.
• Neck massage courses of 10 procedures 2-3 times a year.
• Physiotherapy. Infrared irradiation (warming) of spasming muscles is used using infrared rays. Paraffin heating is also used. 15-20 procedures 2 times a year. These procedures go well with massage of the collar area.

Please note that these procedures can only be started after consultation with a neurologist and orthopedist.
You should not resort to the services of chiropractors. Treatment by an unqualified specialist, without prior x-raying of the spine, can cause serious injury.

Attention deficit hyperactivity disorder in a child, behavior correction

1. Biofeedback therapy (biofeedback method)

Biofeedback therapy– a modern treatment method that normalizes the bioelectrical activity of the brain, eliminating the cause of ADHD. It has been effectively used to treat the syndrome for more than 40 years.

The human brain generates electrical impulses. They are divided depending on the frequency of vibrations per second and the amplitude of vibrations. The main ones are: alpha, beta, gamma, delta and theta waves. In ADHD, the activity of beta waves (beta rhythm), which are associated with focusing attention, memory, and information processing, is reduced. At the same time, the activity of theta waves (theta rhythm) increases, which indicate emotional stress, fatigue, aggressiveness and imbalance. There is a version that the theta rhythm promotes the rapid assimilation of information and the development of creative potential.

The goal of biofeedback therapy is to normalize the bioelectrical oscillations of the brain - to stimulate the beta rhythm and reduce the theta rhythm to normal. For this purpose, a specially developed software and hardware complex “BOS-LAB” is used.
Sensors are attached to certain places on the child’s body. On the monitor, the child sees how his biorhythms behave and tries to change them at will. Also, biorhythms change during computer exercises. If the task is done correctly, a sound signal is heard or a picture appears, which are an element of feedback. The procedure is painless, interesting and well tolerated by the child.
The effect of the procedure is increased attention, decreased impulsivity and hyperactivity. Academic performance and relationships with others improve.

The course consists of 15-25 sessions. Progress is noticeable after 3-4 procedures. The effectiveness of treatment reaches 95%. The effect lasts for a long time, for 10 years or more. In some patients, biofeedback therapy completely eliminates the manifestations of the disease. Has no side effects.

1. Psychotherapeutic techniques

The effectiveness of psychotherapy is significant, but progress may take from 2 months to several years. The result can be improved by combining various psychotherapeutic techniques, pedagogical measures of parents and teachers, physiotherapeutic methods and adherence to a daily routine.

1. Cognitive-behavioral methods

The child, under the guidance of a psychologist, and then independently, forms various behavior patterns. In the future, the most constructive, “correct” ones are selected from them. At the same time, the psychologist helps the child understand his inner world, emotions and desires.
Classes are conducted in the form of a conversation or a game, where the child is offered various roles - a student, a buyer, a friend or an opponent in a dispute with peers. Children act out the situation. Then the child is asked to determine how each participant feels. Did he do the right thing?

• Skills in managing anger and expressing your emotions in an acceptable manner. What do you feel? What do you want? Now say it politely. What we can do?
• Constructive conflict resolution. The child is taught to negotiate, look for compromise, avoid quarrels or get out of them in a civilized manner. (If you don’t want to share, offer another toy. If you are not accepted into the game, come up with an interesting activity and offer it to others). It is important to teach a child to speak calmly, listen to the interlocutor, and clearly formulate what he wants.
• Adequate ways of communicating with the teacher and with peers. As a rule, the child knows the rules of behavior, but does not comply with them due to impulsiveness. Under the guidance of a psychologist, the child improves communication skills through play.
• Correct methods of behavior in public places - in kindergarten, in class, in a store, at a doctor’s appointment, etc. are mastered in the form of “theater”.

The effectiveness of the method is significant. The result appears after 2-4 months.

1. Play therapy

In the form of a game that is pleasant for the child, perseverance and attentiveness are formed, learning to control hyperactivity and increased emotionality.
The psychologist individually selects a set of games taking into account the symptoms of ADHD. At the same time, he can change their rules if it is too easy or difficult for the child.
At first, play therapy is carried out individually, then it can become group or family. Games can also be “homework”, or given by the teacher during a five-minute lesson.

• Games to develop attention. Find 5 differences in the picture. Identify the smell. Identify the object by touch with your eyes closed. Broken phone.
• Games to develop perseverance and combat disinhibition. Hide and seek. Silent. Sort items by color/size/shape.
• Games to control motor activity. Throwing the ball at a given pace, which gradually increases. Siamese twins, when children in a pair, hugging each other around the waist, must complete tasks - clap their hands, run.
• Games to relieve muscle tension and emotional tension. Aimed at the physical and emotional relaxation of the child. “Humpty Dumpty” for alternate relaxation of different muscle groups.
• Games to develop memory and overcome impulsiveness."Speak!" - the presenter asks simple questions. But he can answer them only after the command “Speak!”, before which he pauses for a few seconds.
• Computer games, which simultaneously develop perseverance, attention and restraint.

1. Art therapy

Practicing various types of art reduces fatigue and anxiety, relieves negative emotions, improves adaptation, allows you to realize talents and raise a child’s self-esteem. Helps develop internal control and perseverance, improves the relationship between the child and the parent or psychologist.

By interpreting the results of a child’s work, the psychologist gets an idea of ​​his inner world, mental conflicts and problems.

• Drawing colored pencils, finger paints or watercolors. Sheets of paper of different sizes are used. The child can choose the subject of the drawing himself or the psychologist can suggest a topic - “At school”, “My family”.
• Sand therapy. You need a sandbox with clean, moistened sand and a set of various molds, including human figures, vehicles, houses, etc. The child decides for himself what exactly he wants to reproduce. Often he plays out plots that unconsciously bother him, but he cannot convey this to adults.
• Modeling from clay or plasticine. The child makes figures from plasticine on a given topic - funny animals, my friend, my pet. Activities promote the development of fine motor skills and brain functions.
• Listening to music and playing musical instruments. Rhythmic dance music is recommended for girls, and marching music for boys. Music relieves emotional stress, increases perseverance and attention.

The effectiveness of art therapy is average. It is an auxiliary method. Can be used to establish contact with a child or for relaxation.

1. Family therapy and work with teachers.

A psychologist informs adults about the developmental characteristics of a child with ADHD. Talks about effective methods of work, forms of influence on a child, how to create a system of rewards and sanctions, how to convey to the child the need to fulfill responsibilities and observe prohibitions. This allows you to reduce the number of conflicts and make training and education easier for all participants.
When working with a child, a psychologist draws up a psychocorrection program designed for several months. In the first sessions, he establishes contact with the child and conducts diagnostics to determine the extent of inattention, impulsiveness and aggressiveness. Taking into account individual characteristics, he draws up a correction program, gradually introducing various psychotherapeutic techniques and complicating the tasks. Therefore, parents should not expect drastic changes after the first meetings.

1. Pedagogical measures

Parents and teachers need to consider the cyclical nature of the brain in children with ADHD. On average, a child takes 7-10 minutes to absorb information, then the brain needs 3-7 minutes to recover and rest. This feature must be used in the learning process, doing homework and in any other activity. For example, give your child tasks that he can complete in 5-7 minutes.

Proper parenting is the main way to combat the symptoms of ADHD. Whether the child will “outgrow” this problem and how successful he or she will be in adulthood depends on the behavior of the parents.

• Be patient, maintain self-control. Avoid criticism. The peculiarities in the child’s behavior are not his fault and not yours. Insults and physical violence are unacceptable.
• Communicate expressively with your child. Showing emotions in facial expressions and voice will help keep his attention. For the same reason, it is important to look into the child's eyes.
• Use physical contact. Hold hands, stroke, hug, use elements of massage when communicating with your child. It has a calming effect and helps you concentrate.
• Ensure clear control over task completion. The child does not have sufficient willpower to complete what he started; he is very tempted to stop halfway. Knowing that an adult will supervise the completion of a task will help him complete the task. Will ensure discipline and self-control in the future.
• Set feasible tasks for your child. If he doesn't cope with the task you set for him, then next time make it easier. If yesterday he didn’t have the patience to put away all the toys, then today you just ask him to put the blocks in a box.
• Give your child a task in the form of short instructions.. Give one task at a time: “Brush your teeth.” When this is completed, ask to wash your face.
• Take breaks of a few minutes between each activity. I collected my toys, rested for 5 minutes, and went to wash myself.
• Do not forbid your child to be physically active during classes. If he waves his legs, twirls various objects in his hands, and shifts around the table, this improves his thought process. If you limit this small activity, the child’s brain will fall into a stupor and will not be able to perceive information.
• Praise for every success. Do this one on one and with your family. The child has low self-esteem. He often hears how bad he is. Therefore, praise is vital for him. It encourages the child to be disciplined, to put even more effort and perseverance in completing tasks. It's good if the praise is visual. These could be chips, tokens, stickers, cards that the child can count at the end of the day. Change the “rewards” from time to time. Withdrawal of a reward is an effective method of punishment. It must follow immediately after the offense.
• Be consistent in your demands. If you can’t watch TV for a long time, then don’t make an exception when you have guests or your mother is tired.
• Warn your child what will happen next. It is difficult for him to interrupt activities that are interesting. Therefore, 5-10 minutes before the end of the game, warn him that he will soon finish playing and will collect toys.
• Learn to plan. Together, make a list of things you need to do today, and then cross off what you do.
• Create a daily routine and stick to it. This will teach the child to plan, manage his time and anticipate what will happen in the near future. This develops the functioning of the frontal lobes and creates a feeling of security.
• Encourage your child to play sports. Martial arts, swimming, Athletics, cycling They will direct the child’s activity in the right useful direction. Team sports (soccer, volleyball) can be challenging. Traumatic sports (judo, boxing) can increase the level of aggressiveness.
• Try different types of activities. The more you offer your child, the higher the chance that he will find his own hobby, which will help him become more diligent and attentive. This will build his self-esteem and improve his relationships with peers.
• Protect from prolonged viewing TV and sitting at the computer. The approximate norm is 10 minutes for every year of life. So a 6-year-old child should not watch TV for more than an hour.

Remember, just because your child has been diagnosed with attention deficit hyperactivity disorder, this does not mean that he is behind his peers in intellectual development. The diagnosis only indicates a borderline state between normality and deviation. Parents will have to put in more effort, show a lot of patience in their upbringing, and in most cases, after 14 years of age, the child will “outgrow” this condition.

Children with ADHD often have high IQ levels and are called “indigo children.” If a child becomes interested in something specific during adolescence, he will direct all his energy to it and bring it to perfection. If this hobby develops into a profession, then success is guaranteed. This is proven by the fact that most major businessmen and prominent scientists suffered from attention deficit hyperactivity disorder in childhood.

Attention deficit disorder - how to cope with a hyperactive child?

Capricious, restless children are a real punishment for parents and teachers. It is difficult for them not only to behave quietly in class, but also to simply sit quietly in one place. They are talkative, unrestrained, change their mood and type of activity almost every minute. It is almost impossible to capture the attention of a restless person, as well as to direct his violent energy in the right direction. Whether this is ordinary bad manners or a mental disorder, only a specialist can determine. What is the manifestation of attention deficit in children and how to treat it this pathology? How can parents and teachers deal with this problem? We'll talk about everything related to ADHD below.

Signs of the disease

Attention deficit disorder is a behavioral disorder first described by a psychoneurologist from Germany back in the century before last. However, people started talking about the fact that this is a pathology associated with minor disorders of brain activity only in the mid-60s of the last century. Only in the mid-nineties did the disease take its place in the medical classification, and was called “Attention Deficit Disorder in Children.”

Pathology is considered by neurologists as a chronic condition, an effective treatment for which has not yet been found. An accurate diagnosis is made only in preschool age or when studying in the lower grades. To confirm it, it is necessary that the child prove himself not only in everyday life, but also in the learning process. Medical statistics show that hyperactivity occurs in 5-15% of schoolchildren.

Characteristic symptoms of child behavior with ADHD can be roughly divided into 3 categories.

• Inattention

The child is easily distracted from activities, forgetful, and unable to concentrate. It’s as if he doesn’t hear what his parents or teachers say. Such children constantly have problems completing tasks, following instructions, organizing free time and the educational process. They make too many mistakes, but not because they are not thinking well, but because of inattention or haste. They give the impression of being too absent-minded because they always lose something: personal belongings, toys, items of clothing.

• Hyperactivity

Children with this diagnosis are never calm. They constantly take off, run somewhere, climb poles and trees. In a sitting position, the limbs of such a child do not stop moving. He always swings his legs, moves objects on the table, or makes other unnecessary movements. Even at night, a baby or teenager too often turns around in bed, knocking down the bedding. In a group they give the impression of being overly sociable, talkative and fussy.

• Impulsiveness

They say about such children that their tongue gets ahead of their head. During a lesson, a child shouts out from his seat without even listening to the end of the question, and prevents others from answering, interrupting and getting forward. He does not know how to wait at all or delay getting what he wants for even a minute. Often such manifestations are considered by parents and teachers as character traits, although these are clear signs of the syndrome.

Psychologists and neurologists note that the manifestations of pathology vary among representatives of different age categories.

1. Kids are disobedient, overly capricious, and poorly controlled.
2. Schoolchildren are forgetful, absent-minded, talkative and active.
3. Teenagers tend to dramatize even minor events, constantly show anxiety, easily become depressed, and often behave demonstratively.

A child with such a diagnosis may show reluctance to communicate with peers, show rudeness towards peers and elders.

When does attention deficit disorder begin to appear in children?

Signs of pathology are indicated at an early age

Already in a 1-2 year old child, distinct symptoms of the disease are observed. But most parents accept this behavior as the norm or ordinary children's whims. No one goes to the doctor with such problems, missing out on important time. Children experience speech delay, excessive mobility with impaired coordination.

Three year old baby is worried age crisis associated with personal awareness. Whims and stubbornness are common accompaniments of such changes. But in a child with disabilities, such signs are more pronounced. He does not respond to comments and demonstrates hyperactivity; he simply does not sit still for a second. It is very difficult to put such a “live” to sleep. The formation of attention and memory in children with the syndrome noticeably lags behind their peers.

In children of primary preschool age, signs of ADHD include the inability to concentrate in class, listen to the teacher, or simply sit in one place. At the age of five or six years, children are already starting to prepare for school, the load, physical and psychological, increases. But since kids who have hyperactivity are slightly behind their peers in mastering new knowledge, they develop low self-esteem. Psychological stress leads to the development of phobias, and physiological reactions such as tics or bedwetting (enuresis) appear.

Students diagnosed with ADHD have poor academic performance, despite the fact that they are not stupid at all. Teenagers do not have good relationships with the staff and teachers. Teachers often classify such children as disadvantaged because they are harsh, rude, often conflict with classmates, and do not respond to comments or criticism. Among their peers, adolescents with ADHD also often remain outcasts because they are overly impulsive and prone to aggression and antisocial behavior.

Advice: Defiant behavior means that your child wants to attract attention, but does not yet know how to do it differently.

People started talking about attention deficit disorder as a neurological disease not too long ago in Russia and doctors still do not have enough experience in making a diagnosis. The pathology is sometimes confused with mental retardation, psychopathy, and even schizophrenic disorders. Diagnosis is also complicated by the fact that some of these signs are characteristic of ordinary children. Without careful analysis and long-term observation, it is difficult to determine why a child is inattentive during a lesson or is too active.

Causes of the disease

European and American doctors have been researching the syndrome for decades. Meanwhile, its reasons have not yet been reliably established. Among the main factors in the occurrence of pathology are usually called:

• genetic predisposition,
• birth injuries,
• nicotine and alcohol consumed by the expectant mother,
• unfavorable course of pregnancy,
• rapid or premature birth,
• stimulation of labor,
• head injuries at an early age,
• meningitis and other infections affecting the central nervous system.

The occurrence of the syndrome is facilitated by psychological problems in the family or neurological diseases. Pedagogical mistakes of parents and excessive strictness in upbringing can also leave some imprint. But the main cause of the disease is still considered to be a lack of the hormones norepinephrine and dopamine. The latter is considered a relative of serotonin. Dopamine levels increase during activities that a person finds enjoyable.

Interesting fact: since the human body is able to obtain dopamine and norepinephrine from certain foods, there are theories that the cause of ADHD in children is poor nutrition, for example, strict vegetarian diets.

It is customary to distinguish three types of disease.

1. The syndrome can be represented by hyperactive behavior, but without signs of attention deficit.
2. Attention deficit not associated with hyperactivity.
3. Hyperactivity combined with attention deficit .

Correction of hyperactive behavior is carried out comprehensively and includes various techniques, including both medicinal and psychological. Europeans and Americans, when attention deficit is detected in children, use psychostimulants for treatment. Such drugs are effective, but have unpredictable consequences. Russian experts recommend mainly methods that do not include pharmacological agents. They begin to treat the syndrome with tablets if all other methods have failed. In this case, nootropic drugs are used that stimulate cerebral circulation or natural sedatives.

What should parents do if their child has attention deficit disorder?

• Physical activity. But sports games that include competitive elements are not suitable for them. They only contribute to excessive overstimulation.
• Static loads: wrestling or weightlifting are also contraindicated. Aerobic exercise, but in moderation, has a good effect on the nervous system. Skiing, swimming, cycling will allow you to use up excess energy. But parents need to make sure that the child does not become overtired. This will lead to decreased self-control.
• Working with a psychologist.

Psychological correction in the treatment of the syndrome is aimed at reducing anxiety and increasing the sociability of a child or teenager. To do this, techniques are used to modulate all kinds of success situations, thanks to which the specialist has the opportunity to observe the child and select the most suitable areas of activity for him. The psychologist uses exercises that promote the development of attention, memory, and speech. Communication with such children is not easy for parents. Often mothers who have a child with the syndrome themselves have signs of a depressive disorder. Therefore, families are recommended to work together with a specialist.

• Behavioral correction of attention deficit hyperactivity disorder in children involves positive changes in their environment. As the child achieves success in classes with a psychologist, it is better to change the environment of peers.
• With a new team, children find a common language easier, forgetting old problems and grievances. Parents also need to change their behavior. If excessive strictness has been practiced in upbringing before, you need to loosen control. Permissiveness and freedom must be replaced by a clear schedule. Parents need to compensate for the lack of positive emotions by praising their child more often for his efforts.
• When raising such children, it is better to minimize prohibitions and refusals. Of course, you shouldn’t cross the borders of reason, but only impose “taboo” on what is truly dangerous or harmful. A positive parenting model involves frequent use of verbal praise and other rewards. You need to praise your child or teenager even for small achievements.
• It is necessary to normalize relations between family members. You should not quarrel in front of your child.
  Parents need to strive to gain the trust of their son or daughter, maintain mutual understanding, calm communication without shouting or commanding tone.
• Joint leisure time for families raising hyperactive children is also very important. It would be good if the games were educational in nature.
• Children with similar problems need a clear daily routine and an organized place to study.
• Daily household chores that children carry out independently are very disciplined. Therefore, be sure to find several such tasks and monitor their implementation.
• Set adequate expectations for your child that match his abilities. There is no need to underestimate its capabilities or, on the contrary, overestimate them. Speak in a calm voice, turn to him with a request, not an order. Do not try to create greenhouse conditions. He must be able to cope with loads appropriate to his age.
• Such children need to devote more time than ordinary children. Parents will also have to adapt to the lifestyle of the younger family member, adhering to the daily routine. You shouldn’t forbid a child anything if it doesn’t apply to everyone else. It is better for babies and middle-aged children not to visit crowded places, as this contributes to overstimulation.
• Hyperactive children are capable of disrupting the educational process, but at the same time it is impossible to influence them in proven ways. Such children are indifferent to shouts, remarks and bad grades. But you still need to find a common language with an overly active schoolchild. How should a teacher behave if there is a child with ADHD in the class?

A few tips to help keep the situation under control:

• During the lesson, arrange short physical education breaks. This will benefit not only hyperactive, but also healthy children.
• Classrooms should be equipped functionally, but without distracting decor in the form of crafts, stands or paintings.
• To better control such a child, it is better to place him in the first or second desk.
• Keep active kids busy with errands. Ask them to wipe the board and hand out or collect notebooks.
• To better assimilate the material, present it in a playful way.
• A creative approach is effective in teaching all children without exception.
• Breaking tasks down into small chunks will make it easier for children with ADHD to navigate.
• Allow children with behavioral problems to express themselves in something necessary, to show their best side.
• Help such a student establish contact with classmates and take a place in the team.
• Exercises during the lesson can be done not only standing, but also sitting. Finger games are well suited for this purpose.
• Constant individual contact is required. It must be remembered that they respond better to praise; it is with the help of positive emotions that the necessary positive behavior patterns are reinforced.

Conclusion

To parents whose family is growing up hyperactive child, you should not brush aside the advice of doctors and psychologists. Even if the problem becomes less severe over time, the diagnosis of ADHD will have an impact in the future. IN mature age it will cause poor memory and inability to control your own life. In addition, patients with a similar diagnosis are prone to various types of addictions and depression. Parents should become an example for their child, help him find a place in life, and gain faith in his own strength.

N. Yu. Suvorinova, neurologist, candidate of medical sciences, Department of Neurology, Neurosurgery and Medical Genetics, Pension Fund, Russian National Research Medical University named after. N. I. Pirogova Ministry of Health of Russia, Moscow

Keywords: attention deficit hyperactivity disorder, comorbid disorders, anxiety, oppositional defiant disorder, Pantogam ®
Keywords: attention deficit disorder with hyperactivity, comorbid disorders, anxiety, oppositionaldefiant disorder, Pantogam ®

Attention deficit hyperactivity disorder (ADHD) is a disorder manifested by structural, metabolic, neurochemical, and neurophysiological changes that lead to disturbances in information processing in the central nervous system (CNS). ADHD is the most common clinical form of attention disorder in childhood; it can occur either in isolation or accompany other neurological syndromes and diseases. The prevalence of ADHD in school-age children is about 5%; the disorder is twice as common in boys as in girls.

The formation of ADHD is always based on neurobiological factors: genetic mechanisms and early organic damage to the central nervous system, as well as their combinations leading to dysfunction of the neurotransmitter systems of the brain. The genetic theory of the formation of ADHD assumes the presence of a structural defect in the structure and functioning of dopaminergic and noradrenergic receptors. Adriani W. et al. (2017) assessed and analyzed the epigenetic status of the 5′ untranslated region (UTR) in the SLC6A3 gene, encoding the human dopamine transporter (DAT), in 30 children with ADHD. Buccal swabs and sera from 30 children with ADHD whose clinical picture met DSM-IV-TR criteria were studied. Correlation was made between methylation level, clinical assessment of ADHD symptom severity on the CGAS, and parental ratings on the Conners Scale. Compared to healthy children in the control group, the level of DAT methylation in patients with ADHD was significantly reduced. The authors conclude that there is a correlation between DAT methylation levels and the severity of ADHD, as well as predicting the effectiveness of treatment.

According to modern ideas about the etiology of ADHD, leading importance is given to dysfunction of the prefrontal region and the parietal cortex, leading to disturbances in monoamine metabolism, insufficient functioning of frontostriatal systems, decreased metabolism in the prefrontal cortex, anterior cingulate cortex, and subcortical ganglia. Kim S.M. et al. (2017) performed neuroimaging of the brain in children with ADHD using a 3.0 Tesla MRI scanner to assess the functional connectivity between the cerebellar vermis and other areas of the central nervous system. For this purpose, functional tests were used to measure gait characteristics in 13 children with ADHD, who were then compared with 13 healthy peers. The difference in pressure on the center of the right and left foot while walking was measured. The study found higher functional connectivity between the cerebellum, right middle frontal gyrus (premotor cortex), and medial frontal gyrus (singular gyrus) in the control group compared to the ADHD group. Findings have been made about decreased connectivity between the cerebellum and the premotor cortex in children with ADHD.

Neurobiological factors are the main ones in the development of ADHD in children. When collecting anamnesis, abnormalities in the mother’s pregnancy and childbirth and/or the presence of ADHD symptoms in close relatives are revealed. However, socio-psychological factors, although not the main ones, can influence the course of ADHD and contribute to the strengthening or weakening of its symptoms. Social predictors of the development of ADHD in preschool children often include financial disadvantage of the family, low level of education among parents, antisocial behavior, use of alcohol and psychoactive substances, inconsistent methods of education, and indifferent attitude of the mother to pedagogical influence.

Zhou R.Y. et al. (2017) drew attention to the presence of a history of allergic rhinitis and bronchial asthma in children with ADHD. Also, these children, compared to healthy peers, more often suffer from upper respiratory tract infections. It has been suggested that repeated viral infections have a negative impact on the core features of ADHD, worsening behavior and worsening symptoms. In this regard, a version of the inflammatory or immune-associated etiology of the disease has been proposed, which may exist along with biological and genetic prerequisites. The role of the immune system in the etiology of ADHD has not been definitively established to date and requires further study.

The main manifestations of ADHD in childhood include impaired attention, hyperactivity and impulsivity. In the International Classification of Diseases, 10th Revision (ICD-10), ADHD is designated as a “hyperkinetic disorder” and is presented as a group of disorders characterized by early onset (usually in the first five years of life), lack of persistence in activities requiring mental concentration, and a tendency to frequently changing types of activities, when a child starts a new activity without finishing the previous one. Distinctive features of the child are low organization and unregulated, excessive activity. Children with hyperkinetic disorders are characterized as restless and impulsive, they are more prone to accidents and disciplinary sanctions, often make rash decisions, break rules, behave defiantly, and do not realize their mistakes. Their relationships with others are characterized by disinhibition, lack of distance, foresight and restraint. They are not loved by other children and may become isolated. Children with ADHD are characterized by insufficient development of cognitive functions. There is often a history of specific delays in motor and/or speech development. Secondary symptoms include antisocial behavior and low self-esteem.

In general, children with ADHD are characterized by restlessness, motor disinhibition, and restlessness. They are impulsive and often act without thinking, obeying a momentary impulse, making decisions according to their first impulse. Despite the fact that their rash actions often lead to negative consequences, children are not inclined to analyze and draw conclusions; they repeat the same mistakes again and again in different situations. In his actions, a child with ADHD often behaves childishly, his behavior is inconsistent and immature. It is characterized by avoiding unpleasant situations, avoiding responsibility for one’s misdeeds, and lying. Even when caught breaking the rules, the child does not confess or repent of what he has done, but stubbornly repeats again and again those actions for which he was previously punished. In the classroom, such children are a source of general anxiety; during the lesson they spin and twirl, chat, get distracted and distract others, and interfere with the work of the class. Relationships with peers are difficult; a child with ADHD experiences significant difficulties in forming friendships due to his inconsistency and instability. Often healthy peers avoid communicating with a child with ADHD; he is an outcast in class and has no friends. The most common symptom ADHD is a disorder of attention. Children cannot concentrate on any activity for a long time; they are distracted and scattered. The period of active concentration of attention is very short, the child is not able to consistently do one thing for a long time, often “jumps” from one thing to another, and abandons unfinished work. It is difficult for him to organize his own pastime; he requires constant supervision from adults. Students with ADHD have low academic motivation, are not interested in the results of their work, often get bad grades and do not try to achieve academically significant results. Due to high distractibility and low mental performance, children with ADHD spend a lot of time preparing lessons, they are slow, and their progress is significantly below their abilities. Independent work causes significant difficulties; the child is not able to do without the help of parents when doing homework.

According to the DSM-IV classification, the main symptoms of ADHD are identified.

Attention disorders.

1. Cannot concentrate on details, makes careless mistakes in the work performed and in other activities.
2. Cannot maintain attention for long periods of time, even when playing or engaged in something.
3. One gets the impression that the child does not listen to speech addressed to him.
4. Cannot complete assignments at school or at home.
5. Cannot organize his own classes.
6. Tries to avoid activities associated with prolonged mental stress.
7. Often loses various objects (toys, pencils, erasers).
8. Distracted from the task at hand.
9. Forgets to comply with regular requirements.

Manifestation of hyperactivity.

1. Cannot sit quietly, moves his arms and legs, fidgets while sitting in a chair.
2. Cannot sit for the required amount of time, for example, during a lesson or during lunch.
3. Runs around too much or climbs into places it shouldn't.
4. Has difficulty playing independently or doing quiet activities.
5. One gets the impression that the child is always on the move, like a wind-up.
6. Excessively sociable, talkative.

Manifestation of impulsiveness.

1. Answers a question without thinking, without listening to it to the end.
2. Has difficulty waiting his turn in various situations.
3. Disturbs others, pesters others, for example, interferes in conversations or games of other children.

To make a diagnosis, the patient must have at least 6 of the 9 symptoms of inattention and/or impulsivity-hyperactivity. Symptoms must occur most of the time and be observed in at least two types of environments, for example, at home and in a children's group. Depending on the predominance of inattention and/or hyperactivity-impulsivity, ADHD types with predominant disturbances of attention, with hyperactivity, and a combined form, in which inattention and motor disinhibition are equally present, are distinguished. The combined form of ADHD is the most severe, it is more common than others and accounts for up to 63% of all cases of ADHD. The form with a predominant disturbance of attention is observed in 22% of children, and the form with a predominance of hyperactivity is observed in 15%.

Not all children with ADHD have a clinical picture of the disease that includes all of the listed symptoms; they often vary and change over the course of life, even in one child. There are age dynamics in the manifestations of ADHD. The clinical picture in preschoolers with ADHD is dominated by hyperactivity and impulsivity, and attention impairment is less pronounced. When examining a preschool child, it should always be taken into account that in children under 5 years of age, increased motor activity may be a variant of normal development, so diagnosing it too early should be avoided. However, by the age of 5–6 years, children with ADHD are characterized by excessive motor and verbal activity, increased excitability, restlessness, lack of composure, and aggressiveness. They cannot maintain concentration for a long time when performing a task or during a game, they quickly get tired and switch to other activities. Often during activities that require perseverance, they get up and begin to pace around the room, refuse to further complete the task, prefer noisy games, and are often a source of conflicts and quarrels with peers. Often children show intemperance, they may call or hit another child, they are disobedient, and deliberately violate the rules of behavior in the family or in the children's group. Their clumsiness and clumsiness are noteworthy; they often fall and get injured. The formation of fine motor skills also occurs more slowly than in healthy peers; children experience difficulties when working with scissors, drawing, coloring pictures, and for a long time they cannot learn to tie shoelaces and fasten buttons. In general, a child with ADHD is characterized by lack of concentration, low learning motivation, distractibility and, as a result, a decrease in motivation for cognitive activity.

The beginning of schooling is characterized by an increase in the load on the attention function and the development of executive functions to a significant extent. Children with ADHD often develop learning skills with a significant delay. This is due to difficulties concentrating on educational material, low motivation to learn, lack of independent work skills, low concentration and increased distractibility. During lessons, such a child cannot keep up with the pace of the class, shows low interest in the results of his activities, and requires special control and additional assistance in completing tasks. Restlessness, motor disinhibition, lack of restraint, impulsive behavior, talkativeness and aggressiveness persist. Often children with ADHD serve as a source of conflict and violators of school discipline. Characteristic is the formation of a negative attitude towards learning, refusal to do homework, in some cases children show direct disobedience to the teacher’s instructions, violate the rules of behavior in class and during breaks, are noisy, restless, run around a lot during breaks, interfere with the lesson, argue with adults, quarrel and fight with children. In most cases, a child with ADHD has no friends, and the peculiarities of his behavior cause bewilderment and rejection among classmates. Often children “try on” the role of a jester, fool around and do ridiculous things, trying to attract the attention of their peers in this way. Trying to attract attention and win good attitude, children with ADHD steal money from their parents and use it to buy toys, chewing gum, and candy for their classmates.

Gradually, as the child grows up, his negative attitude towards school intensifies. In adolescents, manifestations of hyperactivity gradually decrease, and are replaced by a feeling of internal anxiety and self-doubt. Difficulties concentrating, increased distractibility, forgetfulness and absent-mindedness, low educational motivation, fatigue and negativism persist. Children try to avoid tasks that seem difficult or uninteresting to them, put off work from day to day and end up starting it at the last moment, rush and make ridiculous mistakes that could have been avoided under other circumstances. Often, schoolchildren with ADHD develop low self-esteem, when the child feels much worse than his more successful peers. Conflicts with classmates, teachers, and parents persist, friendships are not formed, and social connections are disrupted. Adolescents with ADHD are at risk of alcoholism, smoking, using psychoactive substances, and committing illegal acts, often under the negative influence of authoritarian persons. During adolescence, such negative manifestations, such as oppositional defiant disorder, conduct disorder, anxiety disorders, school maladjustment.

Comorbid disorders in children and adolescents with ADHD complicate the course and prognosis of the disease. They are represented by externalizing (oppositional defiant disorder (ODD), conduct disorder), internalizing (anxiety disorders, mood disorders), cognitive (language development disorders, dysgraphia, dyslexia, dyscalculia) and motor (developmental dyspraxia, tics) disorders. In only 30% of cases, ADHD occurs without complications, and in the rest it is accompanied by comorbid disorders. The most common comorbid disorders include sleep disorders (29.3%), school learning difficulties (24.4%), anxiety disorders (24.4%), ODD (22%), autism spectrum disorders (12%), speech delay development (14.6%), as well as enuresis, tension headaches, migraines and tics.

ODD and conduct disorder are both externalizing disorders. ODD occurs more often in younger children and is characterized by disobedience, expressed defiance of others, and outright disobedience to the rules of behavior. At the same time, the child does not commit criminal acts, he does not have destructive aggressiveness or dissocial behavior.

Conduct disorders are more common in adolescents and are characterized by repetitive, persistent aggressive or defiant behavior and unsociability. This behavior might be considered the highest manifestation of age-related social dysfunction, but it may nevertheless be more severe than ordinary childhood disobedience or adolescent indiscipline.

Diagnosis criteria include:

• excessive pugnacity and quarrelsomeness;
• cruelty towards other people and animals;
• severe damage to property;
• arson;
• theft;
• constant deceit;
• truancy from school;
• running away from home;
• frequent and severe outbursts of irritation;
• disobedience.

To make a diagnosis, it is necessary that the patient has at least one pronounced symptom for at least 6 months.

Anxiety disorders in childhood are represented by:

• separation anxiety disorder;
• phobic anxiety disorder;
• social anxiety disorder;
• generalized anxiety disorder.

Separation anxiety disorder occurs during the first years of a child's life. It manifests itself as increased anxiety, tearfulness, and the child’s experiences of separation from his mother or other significant family member. This disorder differs from normal separation anxiety in its significant degree of severity, duration, and associated impairments in social functioning.

Phobic anxiety disorder in childhood is characterized by excessive fears. Social anxiety disorder is manifested by fear of unfamiliar faces and anxiety that arises in a social setting (school, kindergarten), anxiety when receiving unexpected news, situations that are incomprehensible or threatening, in the child’s opinion. Fears with all phobias arise at an early age, have a significant degree of severity and are accompanied by problems in social functioning.

Generalized anxiety disorder (GAD) is characterized by persistent, persistent, and widespread anxiety. The feeling of anxiety in GAD is not associated with any permanent object or situation, as is the case with phobias. However, the unpleasant “internal” feeling of anxiety is noted in different conditions. The main symptoms include complaints of:

• persistent nervousness,
• feeling of fear,
• muscle tension,
• sweating,
• shiver,
• dizziness,
• feeling of discomfort in the epigastric region.

Patients fearfully expect bad news, an accident or illness of themselves or their relatives in the near future.

Often one child has not one, but several comorbid disorders, which significantly aggravates the clinical picture of ADHD. Such children are more disinhibited, adapt less well to the children's team, they are more likely to display aggressive manifestations and negativism, and are less susceptible to therapy. Danforth J.S. et al conducted a study of children with comorbid forms of ADHD using DSM-IV and the Schedule for Affective Disorders and Schizophrenia for School Age Children-Epidemiologic Version (K-SADS). Children with ADHD and comorbid anxiety disorders had a higher risk of developing oppositional defiant disorder and conduct disorder than children with ADHD without comorbidity. An analysis of the impact of ADHD and oppositional defiant disorder (ODD) symptoms on self-esteem and self-perception in early adolescence found that inattention symptoms significantly reduce self-esteem, which may indirectly contribute to the development of depression. The severity of the child’s comorbid disorders may overlap the main symptoms of ADHD, and without their timely correction, treatment of the main manifestations becomes ineffective.

Treatment

When choosing therapy for treating a child with ADHD, an interdisciplinary approach is preferable, in which drug therapy is combined with non-drug methods. The most effective is complex treatment, when doctors, psychologists, teachers, speech therapists and speech pathologists provide assistance to a child with ADHD and his family. The earlier the diagnosis is made and treatment started, the more optimistic the prognosis will be. When providing early adequate assistance to a child with ADHD, it is possible to significantly overcome difficulties in learning, behavior and communication. When deciding on the advisability of drug therapy for a child with ADHD, one should always take into account the individual characteristics of the patient, the form and severity of the disease, age and the presence of comorbid disorders.

The goal of modern drug therapy is to reduce the severity of both the core symptoms of ADHD and comorbid disorders. When prescribing drug therapy, one should take into account the etiological factors in the formation of ADHD, its pathogenesis, and clinical manifestations. In drug therapy for ADHD, preference is given to drugs that have a stimulating effect on insufficiently developed cognitive functions in children (attention, memory, speech, praxis, programming and control of mental activity). Traditionally, in our country, the drugs of choice are nootropic drugs. The advantage of this group is their moderate stimulating effect on the functions of the central nervous system, safety of use, good tolerability and lack of addiction.

Pantogam ® is a mixed-type nootropic drug with a wide range of clinical applications. In terms of its chemical structure, Pantogam ® is close to natural compounds, it is a calcium salt of D(+)-pantoyl-gamma-aminobutyric acid and is the highest homologue of D(+)pantothenic acid (vitamin B 5), in which beta-alanine is replaced by gamma-alanine aminobutyric acid (GABA). This homologue, named homopantothenic acid, is a natural metabolite of GABA in nervous tissue. Homopantothenic acid penetrates the blood-brain barrier, is practically not metabolized by the body, it pharmacological properties are caused by the action of the whole molecule, and not individual fragments. The nootropic effects of homopantothenic acid are associated with its stimulating effect on the processes of tissue metabolism in neurons, it enhances GABAergic inhibition through interaction with the ionotropic GABA-B receptor system, has an activating effect on the dopaminergic and acetylcholinergic systems of the brain, enhances the synthesis of acetylcholine and improves choline transport in structures that provide a memory mechanism. According to modern experimental data, Pantogam ® has an activating effect on the metabolism of acetylcholine, most significantly increasing its content in the cerebral hemispheres, and also helps to increase the content of dopamine, but not in the cerebral hemispheres, like acetylcholine, but in the basal ganglia. Thus, Pantogam ® has a positive effect on the brain structures responsible for the mechanisms of attention, memory, speech development, regulation and control, and executive functions.

Chutko L.S. et al. (2017) prescribed Pantogam ® to 60 children with mental development delays (MDD) aged 5–7 years; 30 children had a cerebrasthenic form of MDD, and 30 had a hyperdynamic form. Pantogam ® was used in the form of 10% syrup, 7.5 ml per day for 60 days. The effectiveness of treatment was assessed twice, before the start of therapy and after its completion. A technique for assessing fine motor skills, a test for memorizing 5 figures, the SNAP-IV scale to assess the degree of inattention, impulsivity, hyperactivity, 10-point scales to assess the severity of speech disorders, and a visual analogue scale (VAS) to objectify the severity of asthenic disorders were used. After treatment with Pantogam, positive dynamics were observed in 39 children, which amounted to 65%. Children showed improvement in memory and attention, speech activity in the form of expansion of active vocabulary, reduction in fatigue, emotional lability, exhaustion and increased perseverance. Fine motor assessment showed improved motor function and decreased dyspraxia. In 7 patients (11.7%) in the middle of the course of treatment there was an increase in hyperactivity, which completely ended after the end of treatment. No discontinuation of the drug or dose adjustment was required.

Sukhotina et al. (2010) examined the effectiveness of Pantogam compared to placebo on various clinical and psychopathological manifestations of hyperkinetic disorders. A total of 60 children aged 6 to 12 years who met the diagnostic criteria for hyperkinetic disorders according to ICD-10 took part in the study. Children were randomized 3:1 to 6 weeks of double-blind treatment with Pantogam (45 children) or placebo (15 children). Children aged 6 to 8 years took Pantogam ® or placebo in a daily dosage of 500–750 mg, and children aged 9 to 12 years – from 750 to 1250 mg. The dose was selected depending on the effectiveness of treatment. Efficiency assessment was carried out using a specially developed scale “ADHD criteria ICD-10”, a scale of general clinical impression, the Toulouse-Pieron test for assessing cognitive productivity, as well as tests for the study of short-term and delayed auditory memory by repeating 10 words, memory for numbers, visual memory to images. A study was also conducted of the child’s psycho-emotional state using the M. Kovac Children’s Depression Questionnaire and the level of anxiety using the Spielberg-Khanin technique. During the first 14 days, no significant differences were noted in the treatment and control groups, but starting from the 14th day in the group of children taking Pantogam ®, there was a statistically significant decrease in inattention, and from the 30th day – in hyperactivity and impulsivity. In addition to the main manifestations of ADHD, the authors point to a decrease in the severity of some comorbid disorders. Children became more sociable, their relationships with peers and teachers improved, their learning performance increased, as a result of which the stress associated with attending school decreased and family relationships improved. The authors also note the absence of side effects requiring discontinuation or dose adjustment of the drug.

Maslova O.I. et al. (2006) prescribed Pantogam ® in the form of 10% syrup to 59 children aged 7–9 years with memory and attention disorders. 53 children showed good tolerability of Pantogam. The positive effect of therapy was manifested by acceleration of complex sensorimotor reactions to sound, light, color and word, increased indicators of short-term visual memory, distribution and switching of attention. Side effects were noted in the form of abdominal pain in one case and allergic skin manifestations in 3 cases; they were temporary and transient and did not require discontinuation of the drug.

For the purpose of evaluation therapeutic action We examined 32 children with ADHD, 23 boys and 9 girls aged 6 to 12 years, in monotherapy mode with long-term administration of the drug. The effect of Pantogam was assessed not only on the main clinical manifestations of ADHD, but also on adaptation disorders and socio-psychological functioning. Pantogam ® was prescribed in the form of tablets, in daily doses of 500–1000 mg (20–30 mg/kg) in 2 doses, morning and afternoon, after meals; At the beginning of treatment, the dose was titrated. The duration of therapy was determined individually depending on the clinical dynamics and ranged from 4 to 8 months. Treatment effectiveness was assessed at intervals of 2 months. For this purpose, parents were tested. The ADHD Core Symptom Rating Scale–DSM-IV Parent Version was used and completed by the investigator. The ADHD–DSM-IV scale consists of 18 items corresponding to the core symptoms of ADHD according to DSM-IV. The severity of each symptom is assessed using a 4-point system: 0 – never or rarely; 1 – sometimes; 2 – often; 3 – very often. When patients were included in the study, the total score on the DSM-IV ADHD scale was 27–55 for boys and 26–38 for girls. An improvement in the patient's condition was defined as a decrease in the total score on the ADHD-DSM-IV scale by more than 25%. The total score and results were calculated for two sections: attention disorders and signs of hyperactivity-impulsivity. As an additional method for assessing the dynamics of the condition of children with ADHD, the M. Weiss scale for assessing functional impairments, a form for filling out by parents, was used. This scale allows you to assess not only the symptoms of ADHD, but also the severity of disturbances in the emotional sphere and behavior. The scale contains assessment of symptoms in 6 groups: family; study and school; basic life skills; child's self-esteem; communication and social activity; risky behavior. The degree of impairment is determined as follows: 0 – no impairment, 1 – mild, 2 – moderate, 3 – significant impairment. Violations are considered confirmed if there is a score of “2” for at least 2 indicators or a score of “3” for at least one indicator. In 22 patients, the duration of treatment was 6 months, in 6 children – 4 months, in 4 – 8 months. Improvement was achieved in 21 patients clinical picture in the form of a decrease in the total score on the ADHD-DSM-IV scale by more than 25%. However, improvements in reducing ADHD symptoms in children were achieved in different terms. Thus, 14 patients showed positive dynamics after 2 months, in 5 children the effect of treatment appeared after 4 months, in another 2 – after 6 months of Pantogam therapy. Thus, the effectiveness of Pantogam in children with ADHD manifested itself at different times, and despite the fact that in most patients improvement occurred already at the beginning of treatment, a fairly large group that did not give a positive response in the first months still achieved it with continued therapy. It should be especially noted that in children who responded to treatment already in the first 2 months, the effect with further use of Pantogam not only did not weaken, but even intensified. The score for inattention in the first 2 months decreased from 19.0 to 14.8 (p< 0,001), гиперактивности и импульсивности – с 18,3 до 15,4 (p < 0,001). Через 6 месяцев средние балльные оценки симптомов нарушений внимания и гиперактивности–импульсивности составили соответственно 13,0 и 12,6 (p < 0,001).

Side effects in patients with a positive effect of treatment were noted in 4 cases: in 3 children it was increased excitability and emotional lability during the daytime, in 1 - restless night sleep. All adverse events were mild and did not require drug discontinuation or dose adjustment.

In 11 patients there was no effect from Pantogam. In this subgroup, 5 children had side effects in the form of sleep disturbances - in 2, tics - in 1, headaches and excitability - in 1, excitability and emotional lability - in 1. In children who did not respond to treatment, the side effects were more pronounced, and they required additional prescription of other drugs (teraligen, stugeron).

Thus, Pantogam ® has shown its effectiveness and safety when prescribed to children with ADHD. The recommended dosage is 30 mg/kg body weight per day. The duration of treatment should be determined individually, but the course of treatment should last at least 2 months. It should be remembered that even the absence of a clear effect in the first weeks of treatment in no way allows us to draw conclusions about the ineffectiveness of the drug, since the effect in many cases is delayed and manifests itself at different times, from 2 weeks to 4-6 months from the start of therapy . Side effects that occur when prescribing Pantogam are rare, manifest mainly as excitability and, for the most part, do not require discontinuation of the drug or dose adjustment.

Bibliography:

1. Voronina T.A. Pantogam and pantogam-active. Pharmacological effects and mechanism of action. On Sat. Pantogam and pantogam-active. Clinical Application and basic research. M., 2009, p. 11-30.

Attention deficit hyperactivity disorder (ADHD), similar to ICD-10 hyperkinetic disorder), is an emerging neuropsychiatric disorder in which there are significant problems with executive functions (eg, attentional control and inhibitory control) that cause attention deficit hyperactivity or impulsivity that is inappropriate for the person's age. These symptoms may begin between the ages of six and twelve years and last more than six months from diagnosis. In school-aged subjects, symptoms of inattention often lead to poor school performance. Although this is a disadvantage, particularly in modern society, many children with ADHD have good attention span for tasks that they find interesting. Although ADHD is the most widely studied and diagnosed psychiatric disorder in children and adolescents, the cause is unknown in most cases. The syndrome affects 6–7% of children when diagnosed using the criteria of the manual for the diagnosis and statistical recording of mental illnesses, IV revision and 1–2% when diagnosed using the ICD-10 criteria. Whether the prevalence is similar among countries depends largely on how the syndrome is diagnosed. Boys are approximately three times more likely to be diagnosed with ADHD than girls. About 30–50% of people diagnosed in childhood have symptoms in adulthood, and approximately 2–5% of adults have the condition. The condition is difficult to distinguish from other disorders, as well as from the state of normal increased activity. Managing ADHD usually involves a combination of psychological counseling, lifestyle changes, and medications. Drugs are recommended exclusively as first-line treatment in children who exhibit severe symptoms and may be considered for children with mild symptoms who refuse or do not respond to psychological counseling. Stimulant drug therapy is not recommended for preschool children. Treatment with stimulants is effective for up to 14 months; however, their long-term effectiveness is unclear. Adolescents and adults tend to develop coping skills that apply to some or all of their impairments. ADHD and its diagnosis and treatment have remained controversial since the 1970s. Controversies include medical practitioners, teachers, politicians, parents and the media. Topics include the cause of ADHD and the use of stimulant medications in its treatment. Most of medical workers ADHD is recognized as a congenital disorder, and debate in the medical community largely centers on how it should be diagnosed and treated.

Signs and symptoms

ADHD is characterized by inattention, hyperactivity (an agitated state in adults), aggressive behavior and impulsivity. Learning difficulties and relationship problems are common. Symptoms can be difficult to identify because it is difficult to draw the line between normal levels of inattention, hyperactivity, and impulsivity and significant levels that require intervention. DSM-5-diagnosed symptoms must have been present in a variety of environments for six months or more, and to a degree that is significantly greater than that observed in other subjects of the same age. They can also cause problems in a person's social, academic and professional life. Based on the symptoms present, ADHD can be divided into three subtypes: predominantly inattentive, predominantly hyperactive-impulsive, and mixed.

A subject with inattention may have some or all of the following symptoms:

Easily distracted, misses details, forgets things, and frequently switches from one activity to another

Finds it difficult to stay focused on a task

The task becomes boring after just a few minutes if the subject is not doing something enjoyable

Difficulty focusing on organizing and completing tasks or learning something new

Has trouble completing or turning in homework, often losing things (eg, pencils, toys, assignments) needed to complete a task or activity

Doesn't listen when talking

Has his head in the clouds, gets confused easily and moves slowly

Has difficulty processing information as quickly and accurately as others

Has difficulty following instructions

A subject with hyperactivity may have some or all of the following symptoms:

Restlessness or fidgeting in place

Talks nonstop

Rushes towards, touches and plays with everything in sight

Has difficulty sitting during lunch, in class, doing homework, and while reading

Constantly on the move

Has difficulty completing quiet tasks and tasks

These symptoms of hyperactivity tend to disappear with age and develop into “internal restlessness” in adolescents and adults with ADHD.

A subject with impulsivity may have all or more of the following symptoms:

Be quite impatient

Saying inappropriate comments, expressing emotions without restraint, and acting without thinking about the consequences

Has difficulty looking forward to things he wants or looking forward to returning to play

Frequently interrupts the communication or activities of others

People with ADHD are more likely to have difficulty with communication skills such as social interaction and education, as well as maintaining friendships. This is typical for all subtypes. About half of children and adolescents with ADHD exhibit social withdrawal, compared with 10–15% of non-ADHD children and adolescents. People with ADHD have an attention deficit that causes difficulty understanding verbal and nonverbal language, which negatively affects social interaction. They may also fall asleep during interactions and lose social stimulation. Difficulty managing anger is more common in children with ADHD, as are poor handwriting and delayed speech, language and motor development. Although this is a significant disadvantage, particularly in modern society, many children with ADHD have good attention span for tasks that they find interesting.

Related disorders

Children with ADHD have other disorders in about ⅔ of cases. Some commonly occurring disorders include:

Learning disabilities affect approximately 20–30% of children with ADHD. Learning disabilities can include speech and language impairments, as well as learning disabilities. ADHD, however, is not considered a learning disability, but it often causes difficulties with learning.

Oppositional defiant disorder (ODD) and conduct disorder (CD), which are seen in ADHD in approximately 50% and 20% of cases, respectively. They are characterized by antisocial behavior such as stubbornness, aggression, frequent fits of anger, duplicity, lying and theft. About half of those with ADHD and ODD or CD will develop antisocial personality disorder in adulthood. Brain scans show that conduct disorder and ADHD are separate disorders.

Primary attention disorder, which is characterized by poor attention and concentration and difficulty staying awake. These children tend to fidget, yawn and stretch, and are forced to be hyperactive in order to remain alert and active.

Hypokalemic sensory overstimulation is present in less than 50% of people with ADHD and may be a molecular mechanism for many ADHD sufferers.

Mood disorders (especially bipolar disorder and major depressive disorder). Boys diagnosed with mixed subtype ADHD are more likely to have a mood disorder. Adults with ADHD also sometimes have bipolar disorder, which requires careful evaluation to accurately diagnose and treat both conditions.

Anxiety disorders are more common in those with ADHD.

Substance use disorders. Teens and adults with ADHD are in a group increased risk development of a substance use disorder. For the most part it is associated with and. The reason for this may be a change in the reward pathway in the brains of subjects with ADHD. This makes identifying and treating ADHD more difficult, while serious problems substance use disorders are usually treated first due to their higher risk.

There is a link with persistent bedwetting, slow speech and dyspraxia (DCD), with around half of people with dyspraxia having ADHD. Slow speech in people with ADHD may include problems with auditory perception problems such as poor short-term auditory memory, difficulty following instructions, slow processing speed of written and spoken language, difficulty listening in distracting environments such as the classroom, and difficulty understanding read.

Causes

The cause of most cases of ADHD is unknown; however, environmental involvement is suspected. Certain cases are associated with a previous infection or brain injury.

Genetics

See also: The Hunter and Farmer Theory Twin studies indicate that the disorder is often inherited from one of the parents, with genetics accounting for about 75% of cases. Siblings of children with ADHD are three to four times more likely to develop the disorder than siblings of children without the syndrome. Genetic factors are thought to be relevant to whether ADHD persists into adulthood. Typically, multiple genes are involved, many of which directly affect dopamine neurotransmission. Genes implicated in dopamine neurotransmission include DAT, DRD4, DRD5, TAAR1, MAOA, COMT, and DBH. Other genes associated with ADHD include SERT, HTR1B, SNAP25, GRIN2A, ADRA2A, TPH2 and BDNF. A common gene variant called LPHN3 is estimated to be responsible for about 9% of cases and, when the gene is present, people respond partially to the stimulant drug. Because ADHD is widespread, natural selection likely favors characteristic features, at least in isolation, and they may provide a survival advantage. For example, some women may be more attractive to risk-taking men by increasing the frequency of genes that predispose to ADHD in the gene pool. Because the syndrome is most common in children of anxious or stressed mothers, some theorize that ADHD is a coping mechanism that helps children cope with stressful or dangerous environments, such as increased impulsivity and exploratory behavior. Hyperactivity may be beneficial from an evolutionary perspective in situations involving risk, competition, or unpredictable behavior (such as exploring new places or searching for new food sources). In these situations, ADHD can be beneficial to society as a whole, even if it is harmful to the subject himself. Additionally, in certain environments, it can provide advantages to the subjects themselves, such as quick reactions to predators or outstanding hunting skills.

Environment

Environmental factors presumably play a lesser role. Drinking alcohol during pregnancy can cause fetal alcohol spectrum disorder, which may include symptoms similar to ADHD. Exposure to tobacco smoke during pregnancy can cause problems with the development of the central nervous system and increase the risk of ADHD. Many children exposed to tobacco smoke do not develop ADHD or have only mild symptoms that do not reach the threshold for diagnosis. A combination of genetic predisposition and exposure to tobacco smoke may explain why some children exposed during pregnancy may develop ADHD while others do not. Children exposed to lead, even at low levels, or PCBs may develop problems resembling ADHD and leading to the diagnosis. Exposure to the organophosphorus insecticides chlorpyrifos and dialkyl phosphate has been associated with increased risk; however, the evidence is not conclusive. Very low birth weight, preterm birth and early exposure also increase risk, as do infections during pregnancy, birth and early childhood. These infections include, but are not limited to, various viruses (fenosis, varicella, rubella, enterovirus 71) and streptococcal bacterial infection. At least 30% of children with traumatic brain injury later develop ADHD, and about 5% of cases are associated with brain damage. Some children may react negatively to food colorings or preservatives. It is possible that certain colored foods may act as a trigger in those with a genetic predisposition, but the evidence is weak. The UK and the European Union have introduced regulation based on these problems; The FDA did not do this.

Society

A diagnosis of ADHD may indicate family dysfunction or a poor educational system rather than an individual problem. Some cases may be due to increased educational expectations, with the diagnosis in some cases representing a way for parents to obtain additional financial and educational support for their children. The youngest children in the class are more likely to be diagnosed with ADHD, which is believed to be due to the fact that they are developmentally behind their older classmates. Behaviors typical of ADHD are more often observed in children who have experienced cruelty and moral humiliation. According to social order theory, societies define the boundary between normal and unacceptable behavior. Members of society, including doctors, parents and teachers, determine which diagnostic criteria to use and thus the number of people affected by the syndrome. This has led to the present situation where the DSM-IV shows a level of ADHD that is three to four times higher than the ICD-10 level. Thomas Szasz, who supports this theory, argued that ADHD was "invented, not discovered."

Pathophysiology

Current models of ADHD suggest that it is associated with functional disorders in certain neurotransmitter systems of the brain, particularly those involving dopamine and norepinephrine. Dopamine and norepinephrine pathways, which originate in the ventral tegmental area and locus coeruleus, are directed to various regions of the brain and determine many cognitive processes. Dopamine and norepinephrine pathways, which are directed to the prefrontal cortex and striatum (particularly the reward center), are directly responsible for regulating executive function (cognitive control of behavior), motivation and perception of reward; These pathways play a major role in the pathophysiology of ADHD. Larger models of ADHD with additional pathways have been proposed.

Brain structure

Children with ADHD show an overall decrease in the volume of certain brain structures, with a proportionately greater decrease in the volume of the left prefrontal cortex. The posterior parietal cortex also shows thinning in subjects with ADHD compared to controls. Other brain structures in the prefrontal-striatal-cerebellar and prefrontal-striatal-thalamic circuits also differ between people with and without ADHD.

Neurotransmitter pathways

It was previously thought that the increased number of dopamine transporters in people with ADHD was part of the pathophysiology, but the increased number has emerged as an adaptation to the effects of stimulants. Current models include the mesocorticolimbic dopamine pathway and the locus coeruleus-noradrenergic system. Psychostimulants for ADHD have effective treatment, since they increase the activity of neurotransmitters in these systems. Additionally, pathological abnormalities in serotonergic and cholinergic pathways may be observed. Also relevant is the neurotransmission of glutamate, a cotransmitter of dopamine in the mesolimbic pathway.

Executive function and motivation

ADHD symptoms include problems with executive function. Executive function refers to several mental processes that are required to regulate, control, and manage the tasks of daily life. Some of these impairments include problems with organization, time management, excessive procrastination, concentration, speed of execution, emotion regulation, and use of short-term memory. People usually have good long-term memory. 30–50% of children and adolescents with ADHD meet criteria for executive function deficits. One study found that 80% of subjects with ADHD were impaired on at least one executive function task, compared with 50% of subjects without ADHD. Due to the degree of brain maturation and increased demands on executive control as people get older, ADHD disorders may not fully manifest themselves until adolescence or even late teens. ADHD is also associated with motivational deficits in children. Children with ADHD have difficulty focusing on long-term versus short-term rewards and also exhibit impulsive behavior towards short-term rewards. In these subjects, a large amount of positive reinforcement effectively increases performance. ADHD stimulants may increase resilience in children with ADHD equally.

Diagnostics

ADHD is diagnosed by assessing a person's childhood behavior and mental development, including ruling out exposure to drugs, medications, and other medical or psychiatric problems as explanations for symptoms. Feedback from parents and teachers is often taken into account, with most diagnoses made after a teacher raises concerns about the issue. It may be seen as an extreme manifestation of one or more permanent human traits found in all humans. The fact that someone responds to medications does not confirm or rule out the diagnosis. Because brain imaging studies did not provide reliable results across subjects, they were used only for research purposes and not for diagnosis. DSM-IV or DSM-5 criteria are often used for diagnosis in North America, while European countries ICD-10 is usually used. However, DSM-IV criteria are 3–4 times more likely to diagnose ADHD than ICD-10 criteria. The syndrome is classified as a neurodevelopmental psychiatric disorder. It is also classified as a social conduct disorder along with oppositional defiant disorder, conduct disorder, and antisocial personality disorder. The diagnosis does not imply a neurological disorder. Associated conditions that should be assessed include anxiety, depression, oppositional defiant disorder, conduct disorder, and learning and speech disorders. Other conditions to consider are other neurodevelopmental disorders, tics, and sleep apnea. Diagnosis of ADHD using quantitative electroencephalography (QEEG) is an area of ​​ongoing research, although the value of QEEG in ADHD is unclear to date. In the United States, the Food and Drug Administration has approved the use of QEEG to estimate the prevalence of ADHD.

Diagnostics and statistical guidance

As with other psychiatric disorders, a formal diagnosis is made by a qualified professional based on a set of several criteria. In the United States, these criteria are defined by the American Psychiatric Association in the Diagnostic and Statistical Manual of Mental Disorders. Based on these criteria, three subtypes of ADHD can be distinguished:

ADHD Predominantly Inattentive Type (ADHD-PI) presents with symptoms including being easily distractible, forgetfulness, daydreaming, disorganization, poor concentration, and difficulty completing tasks. Often people refer to ADHD-PI as “attention deficit disorder” (ADD), however, the latter has not been officially approved since the 1994 revision of the DSM.

ADHD, predominantly of the hyperactive-impulsive type, manifests itself as excessive restlessness and agitation, hyperactivity, difficulty waiting, difficulty staying still, and infantile behavior; Disruptive behavior may also occur.

Mixed ADHD is a combination of the first two subtypes.

This classification is based on the presence of at least six of nine long-term (lasting at least six months) symptoms of inattention, hyperactivity-impulsivity, or both. To be taken into account, symptoms must begin between the ages of six and twelve years and be observed in more than one surrounding location (for example, at home and at school or work). The symptoms must not be acceptable for children of this age, and there must be evidence that they are causing problems related to school or work. Most children with ADHD have a mixed type. Children with the inattentive subtype are less likely to pretend or have difficulty getting along with other children. They may sit quietly, but not paying attention, and as a result, difficulties may be overlooked.

International Classification of Diseases

In ICD-10, the symptoms of “hyperkinetic disorder” are similar to ADHD in DSM-5. When a conduct disorder (as defined by ICD-10) is presented, the condition is referred to as hyperkinetic conduct disorder. Otherwise, the disorder is classified as activity and attention disorder, other hyperkinetic disorders or unspecified hyperkinetic disorders. The latter are sometimes referred to as hyperkinetic syndrome.

Adults

Adults with ADHD are diagnosed according to the same criteria, including symptoms that may be present between the ages of six and twelve. Interviewing parents or guardians about how the person behaved and developed as a child may form part of the assessment; a family history of ADHD also contributes to diagnosis. While the core symptoms of ADHD are the same in children and adults, they often present differently, for example, the excess physical activity seen in children may manifest as feelings of restlessness and constant mental activity in adults.

Differential diagnosis

ADHD symptoms that may be associated with other disorders

Depression:

Feelings of guilt, hopelessness, low self-esteem, or unhappiness

Loss of interest in hobbies, routine activities, sex or work

Fatigue

Too little, poor or excessive sleep

Changes in appetite

Irritability

Low stress tolerance

Suicidal thoughts

Unexplained pain

Anxiety disorder:

Restlessness or persistent feeling of anxiety

Irritability

Inability to relax

Overexcitement

Easy fatigue

Low stress tolerance

Difficulty paying attention

Excessive feeling of happiness

Hyperactivity

A race of ideas

Aggression

Excessive talkativeness

Grandiose delusional ideas

Decreased need for sleep

Inappropriate social behavior

Difficulty paying attention

ADHD symptoms such as low mood and low self-esteem, mood swings and irritability can be confused with dysthymia, cyclothymia or borderline personality disorder. Some symptoms that are associated with anxiety disorders, antisocial personality disorder, developmental or intellectual disabilities, or chemical dependency effects such as intoxication and withdrawal may overlap with some symptoms of ADHD. These disorders sometimes occur along with ADHD. Medical conditions that can cause ADHD symptoms include: hypothyroidism, epilepsy, lead toxicity, hearing deficits, liver disease, sleep apnea, drug interactions, and traumatic brain injury. Primary sleep disorders can affect attention and behavior, and ADHD symptoms can affect sleep. Therefore, it is recommended that children with ADHD be screened regularly for sleep problems. Sleepiness in children can lead to symptoms ranging from classic yawning and eye rubbing to hyperactivity with inattention. Obstructive sleep apnea can also cause ADHD-type symptoms.

Control

Management of ADHD usually involves psychological counseling and medications, alone or in combination. While treatment may improve long-term outcomes, it does not eliminate negative outcomes overall. Drugs used include stimulants, atomoxetine, alpha-2 adrenergic agonists, and sometimes antidepressants. Dietary changes may also be beneficial, with evidence supporting free fatty acids and reduced exposure to food dyes. Removing other foods from the diet is not supported by evidence.

Behavioral therapy

There is good evidence for the use of behavioral therapy for ADHD, and it is recommended as first-line treatment for those with mild symptoms or for preschool-age children. Physiological therapies used include: psychoeducational stimulation, behavioral therapy, cognitive behavioral therapy (CBT), interpersonal therapy, family therapy, school interventions, social skills training, parent training, and neural feedback. Parent training and education have short-term benefits. There is little high-quality research into the effectiveness of family therapy for ADHD, but evidence suggests that it is equivalent to social care and better than placebo. There are some ADHD-specific support groups as information resources that can help families cope with ADHD. Social skills training, behavioral modification, and medications may have some limited benefit. The most important factor in alleviating late psychological problems such as deep depression, crime, school failure, and substance use disorder, is the formation of friendships with people who are not involved in delinquent activities. Regular physical activity, particularly aerobic exercise, is an effective adjunct to the treatment of ADHD, although the best type and intensity is currently unknown. In particular, physical activity causes better behavior and motor abilities without any side effects.

Medications

Stimulant medications are the pharmaceutical treatment of choice. They have at least short-term effects in about 80% of people. There are several non-stimulant medications, such as atomoxetine, bupropion, guanfacine, and clonidine, that can be used as alternatives. There are no good studies comparing different drugs; however, they are more or less equal in terms of side effects. Stimulants improve academic performance, while atomoxetine does not. There is little evidence regarding its effect on social behavior. Medicines are not recommended for preschool children, as long-term effects in this age group are not known. The long-term effects of stimulants are generally unclear, with only one study finding beneficial effects, another finding no benefit, and a third finding harmful effects. Magnetic resonance imaging studies suggest that long-term treatment with amphetamine or methylphenidate reduces pathological disorders in brain structure and function found in subjects with ADHD. Atomoxetine, due to its lack of addictive potential, may be preferable for those at risk of addiction to a stimulant drug. Recommendations about when to use drugs vary between countries, with the UK's National Institute for Health and Care Excellence recommending their use only in severe cases, while American guidelines recommend using drugs in almost all cases. While stimulants are generally safe, there are side effects and contraindications for their use. Stimulants can cause psychosis or mania; however, this is a relatively rare occurrence. For those undergoing long-term treatment, regular screening is recommended. Stimulant therapy should be discontinued temporarily to assess subsequent drug requirements. Stimulant drugs have the potential to develop addiction and dependence; Several studies suggest that untreated ADHD is associated with an increased risk of chemical dependency and conduct disorder. The use of stimulants either reduces this risk or has no effect on it. The safety of these drugs during pregnancy has not been determined. The deficiency has been linked to symptoms of inattention, and there is evidence that zinc supplementation is beneficial for children with ADHD who have low zinc levels. , and may also have an effect on ADHD symptoms. There is evidence of modest benefits from taking omega-3 fatty acids, but they are not recommended in place of traditional medications.

Forecast

An 8-year study of children diagnosed with ADHD (mixed) found that difficulties with adolescents were common, regardless of treatment or lack thereof. In the United States, less than 5% of subjects with ADHD obtain a college degree, compared with 28% of the general population aged 25 or older. The proportion of children meeting criteria for ADHD drops to about half within three years of diagnosis, regardless of treatment. ADHD persists into adults in approximately 30–50% of cases. Those suffering from the syndrome are likely to develop coping mechanisms as they get older, thus compensating for previous symptoms.

Epidemiology

It is estimated that ADHD affects about 6–7% of people aged 18 years and older when diagnosed using DSM-IV criteria. When diagnosed using ICD-10 criteria, the prevalence in this age group is estimated to be 1–2%. North American children have a higher prevalence of ADHD than African and Middle Eastern children; this is presumably due to differing diagnostic methods rather than differences in the incidence of the syndrome. If the same diagnostic methods were used, the prevalence would be more or less the same in different countries. The diagnosis is made approximately three times more often in boys than girls. This difference between the sexes may reflect either a difference in susceptibility or that girls with ADHD are less likely to be diagnosed with ADHD than boys. The intensity of diagnosis and treatment has increased in both the UK and the US since the 1970s. This is thought to be due primarily to changes in the diagnosis of the disease and how willing people are to seek drug treatment, rather than to changes in the prevalence of the disease. Changes in diagnostic criteria in 2013 with the release of DSM-5 are thought to have increased the percentage of people diagnosed with ADHD, especially among adults.

Story

Hyperactivity has long been part of human nature. Sir Alexander Crichton describes "mental agitation" in his book An Inquiry into the Nature and Origin of Mental Disorder, written in 1798. ADHD was first clearly described by George Still in 1902. The terminology used to describe the condition has changed over time and includes: in the DSM -I (1952) "minimal brain dysfunction", in DSM-II (1968) "hyperkinetic childhood reaction", in DSM-III (1980) "attention deficit disorder (ADD) with or without hyperactivity" . It was renamed ADHD in DSM-III-R in 1987, and DSM-IV in 1994 reduced the diagnosis to three subtypes, ADHD inattentive type, ADHD hyperactive-impulsive type, and ADHD mixed type. These concepts were retained in the DSM-5 in 2013. Other concepts included “minimal brain injury,” which was used in the 1930s. The use of stimulants to treat ADHD was first described in 1937. In 1934, Benzedrine became the first amphetamine drug approved for use in the United States. was discovered in the 1950s, and enantiopure dextroamphetamine in the 1970s.

Society and culture

Controversy

ADHD and its diagnosis and treatment have been subject to debate since the 1970s. The controversy involves doctors, teachers, politicians, parents and the media. Opinions regarding ADHD range from the fact that it merely represents the extreme limit of normal behavior to the fact that it is the result of a genetic condition. Other areas of controversy include the use of stimulant medications and especially their use in children, as well as the method of diagnosis and the potential for overdiagnosis. In 2012, the UK's National Institute for Health and Care Excellence, while acknowledging the controversy, stated that current treatments and diagnostic methods are based on the prevailing view of the academic literature. In 2014, Keith Conners, one of the first advocates for disease confirmation, spoke out against overdiagnosis in an op-ed in the NY Times. On the contrary, in 2014, a peer-reviewed review of the medical literature found that ADHD is rarely diagnosed in adults. Due to widely varying diagnostic rates among countries, states within countries, and races and ethnic groups, several questionable factors other than the presence of ADHD symptoms play a role in diagnosis. Some sociologists believe that ADHD represents an example of the medicalization of “deviant behavior” or, in other words, the transformation of a previously unrelated problem of school performance into one. Most health care providers recognize ADHD as a congenital disorder in at least a small number of people with severe symptoms. The debate among medical professionals largely focuses on diagnosing and treating the larger population of people with less severe symptoms. In 2009, 8% of all US Major League Baseball players were diagnosed with ADHD, making the syndrome widespread among this population. The increase coincides with the League's 2006 ban on stimulants, raising concerns that some players were faking or falsifying symptoms of ADHD to circumvent the sport's ban on stimulants.

Media comments

Several famous people have made conflicting statements regarding ADHD. Tom Cruise has referred to the drugs Ritalin and Aderal as "street drugs." Ushma S. Neil has criticized this view, stating that the doses of stimulants used in the treatment of ADHD are not addictive and that there is some evidence of a relatively low risk of subsequent chemical dependence in children treated with stimulants. In the UK, Susan Greenfield spoke publicly in 2007 at the House of Lords about the need for large-scale research into the dramatic increase in ADHD diagnosis in the UK and the possible reasons for this. She later spoke on the BBC Panorama program about eye-catching research that suggests drugs are no better than other forms of therapy in the long term. In 2010 The BBC Trust criticized the 2007 BBC Panorama program for summing up the study as "no apparent improvement in children's behavior after taking ADHD medication over three years" when in fact "the study found that the drug did not provide significant improvement over the long term ", although the long-term benefit of the drugs was determined to be "no better than that of children exposed to behavioral therapy."

Specific populations

Adults

It has been estimated that 2–5% of adults have ADHD. About half of children with ADHD continue to have the disorder into adulthood. Approximately 25% of children continue to exhibit ADHD symptoms during puberty, while the remaining 75% show fewer or no symptoms. Most adults remain untreated. Many lead disorganized lives and use non-prescribed medications or alcohol as coping mechanisms. Other problems may include difficulties with relationships and work, and an increased risk of criminal activity. Associated mental health problems include: depression, anxiety disorders and learning disabilities. Some symptoms of ADHD in adults differ from those in children. While children with ADHD may run and climb excessively, adults may experience an inability to relax or talk excessively in social situations. Adults with ADHD may enter relationships impulsively, exhibit sensation seeking, and be short-tempered. Abuse behavior is common psychoactive substances and passion for gambling. The DSM-IV criteria have been criticized for being inappropriate for adults; subjects demonstrating differing symptoms may lead to a claim that they have outgrown the diagnosis.

Children with high IQ

The diagnosis of ADHD and its implications for children with high intelligence quotient (IQ) are controversial. Most studies have found similar violations regardless of IQ, with a high degree of repetitive stages and social difficulties. Additionally, more than half of people with high IQs and ADHD experience major depressive disorder or oppositional defiant disorder at some point in their lives. Generalized anxiety disorder, separation anxiety disorder, and social phobia are common. There is some evidence that subjects with high IQ and ADHD have a low risk of developing chemical dependency and antisocial behavior compared to children with low and average IQ and ADHD. Children and adolescents with high IQs may have their IQ measured incorrectly by standard assessments and may require more in-depth testing.

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List of used literature:

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Parker J, Wales G, Chalhoub N, Harpin V (September 2013). "The long-term outcomes of interventions for the management of attention-deficit hyperactivity disorder in children and adolescents: a systematic review of randomized controlled trials." Psychol. Res. Behav. Manag. 6:87–99. doi:10.2147/PRBM.S49114. PMC 3785407. PMID 24082796. “Results suggest there is moderate-to-high-level evidence that combined pharmacological and behavioral interventions, and pharmacological interventions alone can be effective in managing the core ADHD symptoms and academic performance at 14 months.” However, the effect size may decrease beyond this period. …Only one paper53 examining outcomes beyond 36 months met the review criteria. … There is high level evidence suggesting that pharmacological treatment can have a major beneficial effect on the core symptoms of ADHD (hyperactivity, inattention, and impulsivity) in approximately 80% of cases compared with placebo controls, in the short term.22"

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Franke B, Faraone SV, Asherson P, Buitelaar J, Bau CH, Ramos-Quiroga JA, Mick E, Grevet EH, Johansson S, Haavik J, Lesch KP, Cormand B, Reif A (October 2012). “The genetics of attention deficit/hyperactivity disorder in adults, a review.” Mol. Psychiatry 17(10):960–987. doi:10.1038/mp.2011.138. PMC 3449233. PMID 22105624.

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De Cock M, Maas YG, van de Bor M (August 2012). “Does perinatal exposure to endocrine disruptors induce autism spectrum and attention deficit hyperactivity disorders? Review". Acta Paediatr. 101(8):811–818. doi:10.1111/j.1651-2227.2012.02693.x. PMID 22458970.

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Sonuga-Barke EJ, Brandeis D, Cortese S, Daley D, Ferrin M, Holtmann M, Stevenson J, Danckaerts M, van der Oord S, Döpfner M, Dittmann RW, Simonoff E, Zuddas A, Banaschewski T, Buitelaar J, Coghill D, Hollis C, Konofal E, Lecendreux M, Wong IC, Sergeant J (March 2013). "Nonpharmacological interventions for ADHD: systematic review and meta-analyses of randomized controlled trials of dietary and psychological treatments." Am J Psychiatry 170(3):275–289. doi:10.1176/appi.ajp.2012.12070991. PMID 23360949.

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Rommel AS, Halperin JM, Mill J, Asherson P, Kuntsi J (September 2013). “Protection from genetic diathesis in attention-deficit/hyperactivity disorder: possible complementary roles of exercise.” J Am Acad Child Adolesc Psychiatry 52(9):900–10. doi:10.1016/j.jaac.2013.05.018. PMID 23972692. “As exercise has been found to enhance neural growth and development, and improve cognitive and behavioral functioning in individuals and animal studies, we reviewed the literature on the effects of exercise in children and adolescents with ADHD and animal models of ADHD behaviors. A limited number of undersized non-randomized, retrospective and cross-sectional studies have investigated the impact of exercise on ADHD and the emotional, behavioral and neuropsychological problems associated with the disorder. The findings from these studies provide some support for the notion that exercise has the potential to act as a protective factor for ADHD. …Although it remains unclear which role, if any, BDNF plays in the pathophysiology of ADHD, enhanced neural functioning has been suggested to be associated with the reduction of remission of ADHD symptoms.49,50,72 As exercise can identify gene expression changes mediated by alterations in DNA methylation38, the possibility emerges that some of the positive effects of exercise could be caused by epigenetic mechanisms, which may set off a cascade of processes instigated by altered gene expression that could ultimately link to a change in brain function.”

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