The attention deficit hyperactivity disorder (ADHD) is one of the most common developmental disorders in children and can continue into adolescence and adulthood. It is characteristic of people who move from one activity to another, who start several tasks without finishing any and who seem not to pay attention if others speak.
Its main symptoms are hyperactivity, inattention and impulsivity. Hyperactivity is shown by doing multiple activities, not stopping moving, going from one activity to another, inability to stay still, among others. Inattention due to difficulty paying attention to people who speak or to perform tasks. Difficulty controlling impulses, acting without thinking.
Hyperactivity and inattention of children at school can lead to academic deficiencies and problems in personal relationships. Brain imaging studies have found that in children with ADHD, the brain matures in a normal pattern, albeit with an average delay of about 3 years.
This delay occurs more in brain areas related to attention, planning or thinking. Other recent studies have found that there is a general delay in maturation in the cerebral cortex..
Although treatments can alleviate symptoms, there is currently no cure. With treatment, most children can be successful in school and lead productive lives..
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Typically adults with ADHD have had the disorder since childhood, although it has not been diagnosed until adulthood. The evaluation usually occurs from a colleague, friend or family member who has observed problems at work or in personal relationships.
The symptoms of adults may be somewhat different from those of children because there is a difference in maturity and physical differences.
Some children with this disorder are hyperactive, while others with attention problems are not. Children with ADHD who have attention problems but are not over-aroused may appear unmotivated.
Children with ADHD can focus on the activities they enjoy. However, they have trouble maintaining focus when homework is boring and repetitive..
Children with ADHD can do their best to be good, even though they are unable to sit up, stay still, or pay attention.
ADHD normally continues into adulthood, although treatment helps control and minimize symptoms.
Although medication is often prescribed, it may not be the best treatment for a child. Effective treatment also includes education, behavior therapy, exercise, proper nutrition, and school and family support..
Just because a child is inattentive, hyperactive, or impulsive, it doesn't mean they have ADHD. Other medical conditions, psychological disorders, and stressful events can cause similar symptoms..
Before a clear diagnosis of ADHD can be made, it is important for a healthcare professional to evaluate other possibilities:
In addition to the challenges they encounter, there are positive traits associated with people with ADHD:
Note: ADHD is not related to talent or intelligence. However, if there may be children in whom high intelligence and ADHD coincide.
Characteristic behaviors of people with ADHD are inattention, hyperactivity, and impulsivity. Although it is normal for children to display these behaviors, those with ADHD have more severe symptoms and they are frequent.
Although the cause of most cases of ADHD is unknown, it is believed to be related to interactions between genetic factors and environmental factors..
Some cases may be due to previous infections or brain trauma.
Twin studies indicate that the disorder is inherited from the parents, accounting for 75% of cases. Siblings of children with ADHD are estimated to be 3-4 times more likely to develop it.
Certain genetic factors are also believed to determine whether the disorder persists into adulthood..
Several genes are involved, many of which affect dopaminergic neurotransmission: DAT, DRD4, DRD5, TAAR1, MAOA, COMT, and DBH. Others are: SERT, HTR1B, SNAP25, GRIN2A, ADRA2A, TPH2, and BDNF. It is estimated that a variant of the gene called LPHN3 is responsible for 9% of cases, and that when this gene is present, the person responds to stimulant medication.
Because ADHD is common, it is likely that natural selection has favored these traits and that they have given a survival advantage. For example, some women may be attracted to men who take risk, increasing the frequency of gene transmission..
Because ADHD is more common in children with anxious or stressed mothers, it has been argued that it may be an adaptation that helps children cope with dangerous or stressful environments, with increased impulsivity and exploratory behavior.
Hyperactivity may have been beneficial from an evolutionary perspective in situations of risk, competitiveness or unpredictable behavior (for example to explore new areas or explore new resources).
In these situations, people with ADHD can be beneficial to society, although it may be harmful to the individual.
On the other hand, individually it may have offered advantages such as responding more quickly to predators or having better hunting skills..
Environmental factors are believed to play a less important role in the development of ADHD. Drinking alcohol during pregnancy can lead to fetal alcohol syndrome, which can include ADHD-like symptoms.
Exposure to tobacco during pregnancy can cause problems in the development of the fetal central nervous system and can increase the risk of ADHD. Many children exposed to tobacco do not develop ADHD or have only intermediate symptoms, which is not enough for a diagnosis.
A combination of genetic predisposition together with some factors such as negative exposures during pregnancy can explain why some children develop ADHD and others do not..
Children exposed to chlorine, even low levels, or polychlorinated biphenyls can develop ADHD-like problems. Exposure to organophosphate insecticides chlorpyrifos and dialkyl phosphate is associated with an increased risk, although there is no conclusive evidence.
Low birth weight, premature birth, or infections during pregnancy, birth, and early childhood also increase the risk. These infections include various viruses - measles, chickenpox, rubella, enterovirus 71 - and streptococcal bacterial infection..
At least 30% of children with brain injury develop ADHD and 5% are due to brain damage.
Some children may react negatively to food coloring or preservatives. It is possible that some dyes may act as triggers for ADHD in children who are genetically predisposed.
ADHD may represent family or educational system problems rather than an individual problem.
Younger children in classes have been found to be more likely to be diagnosed with ADHD, possibly due to developmental differences from their classmates.
ADHD behavior occurs more often in children who have experienced emotional or physical abuse. According to the theory of social construction, it is society that determines the boundaries between normal and abnormal behavior.
The members of a society - parents, teachers, doctors - determine what diagnosis and criteria are used, thus affecting the number of people affected.
This leads to situations like the current one, in which from the DSM-IV diagnosis, 3-4 times more cases of ADHD are diagnosed than with the ICE-10 criteria.
Some psychiatrists, like Thomas Szasz, have argued that ADHD was invented, not discovered.
Current models of ADHD suggest that it is related to functional alterations in some neurotransmitter systems of the brain, particularly dopamine and norepinephrine..
The dopamine and noreprinefin pathways originate in the ventral tegmental area and in the locus coeruleus they project to various brain regions of the brain, controlling various cognitive processes.
The dopamine and noreprinephrine pathways that project to the prefrontal and striatum cortex control executive function (cognitive control of behavior), perception of rewards and motivation.
Psychostimulants may be effective because they increase neurotransmitter activity in these systems. In addition, there may be abnormalities in the cholinergic and serotonergic pathways. Glutamate neurotransmission also appears to play a role.
There is a reduction in the volume of certain brain regions in children with ADHD, especially in the left prefrontal cortex.
The posterior parietal cortex also shows thinning in children with ADHD.
The symptoms of ADHD are related to difficulties in executive functions; mental processes that control and regulate daily tasks. The criterion for a deficit in executive functions occurs in 30-50% of children and adolescents with ADHD.
Some problems are with time control, organization, procrastination, concentration, information processing, emotion control or working memory..
One study found that 80% of people with ADHD had problems with at least one executive function, compared to 50% of people without ADHD.
ADHD has also been linked to motivational deficits in children, as well as difficulties focusing on long-term rewards. In these children, higher positive rewards improve task performance. In addition, stimulants can improve persistence..
Two out of three times another disorder occurs alongside ADHD in children. The most common are:
Current therapies focus on reducing ADHD symptoms and improving functioning in daily life. The most common treatments are medication, various types of psychotherapy, education, and a combination of various treatments.
Stimulants such as metalphenidate and amphetamines are the most used types of medication to treat ADHD.
It may seem counterintuitive to combat hyperactivity with a stimulant, although these drugs activate regions of the brain that improve attention, reducing hyperactivity. In addition, non-stimulant medications such as atomoxetine, guanfacine, and clonidine are used..
However, it is necessary to find the medication for each child. One child may have side effects with one drug, while another may benefit from it. Sometimes it is necessary to use several doses and types of drugs before finding one that works.
The most common side effects are sleep problems, anxiety, irritability, and decreased appetite. Other less common side effects are tics or personality changes.
Medication does not cure ADHD, but rather controls symptoms while taking it. Drugs can help your child focus or learn better.
Different types of psychotherapy are used to treat ADHD. Specifically, behavioral therapy changes behavior patterns by:
Here are some examples of behavioral strategies:
Children with ADHD need the guidance and understanding of parents and teachers to reach their potential and be successful in school. Frustration, blame, or hatred may build in the family before a child is diagnosed.
Health professionals can educate parents about ADHD, train skills, attitudes, and new ways of relating. Parents can be trained to use reward and consequence systems to modify the child's behavior.
Sometimes the whole family may need therapy to find new ways to cope with problem behaviors and encourage behavior changes..
Finally, support groups can help families connect with other parents with similar problems and concerns..
There is little research indicating that alternative therapies can reduce or control ADHD symptoms. Before using any of them, ask a mental health professional if they are safe for your child..
Some alternative therapies are:
Here are some tips for classes with kids with ADHD:
Because ADHD is unique to each child, it is difficult to make recommendations that work for everyone. However, some of the following recommendations may help to better control symptoms:
Complications in children's lives can be:
Risk factors can be:
To reduce the chance of a child developing ADHD:
ADHD and its diagnosis have been controversial since the 1970s. Positions range from viewing ADHD as normal behavior to the hypothesis that it is a genetic condition..
Other areas of controversy include the use of stimulant medications in children, the manner of diagnosis, and possible overdiagnosis..
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