Attention Deficit Hyperactivity Disorder

ADHD is a real physical condition. The brains of children with ADHD are structurally different from those without it. Studies have shown that there are certain areas that are underdeveloped.
Due to these underdeveloped areas, the brain has a deficiency of messenger chemicals called neuro-transmitters, mainly Dopamine and Noradrenaline(NA).
Medication that elevates Dopamine are called stimulants and those that increases NA are called non-stimulants.
ADHD is a very diverse genetic condition. Researchers have found various genetic links to ADHD.
ADHD is more common in boys. Two out of three children with ADHD will have symptoms still as adults.
Symptoms:
•Inattentive behavior:
Some children will be mainly inattentive and it is then called ADD.
Doesn’t pay attention to details or makes careless mistakes in schoolwork.
Has problems focusing during tasks or play.
Doesn’t listen when spoken to directly.
Doesn’t follow through on instructions and doesn’t finish schoolwork or chores.
Has problems organizing tasks and activities
Avoids or doesn’t like tasks that require mental effort (such as schoolwork).
Often loses things, such as homework or toys.
Is easily distracted.
Is often forgetful.
•Hyperactive behavior:
Fidgets or squirms in seat.
Leaves their seat when they should stay in their seat.
Runs about or climbs when they shouldn’t be doing so.
Has problems playing or working quietly.
Is often “on the go,” acts as if “driven by a motor”.
Talks all the time.
•Impulsive behavior:
Blurts out answers before questions have been completed.
Has problems awaiting their turn.
Interrupts or intrudes on others (butts into conversations or games).
Many of the above findings are present in children as they grow. For these problems to be diagnosed as ADHD, they must be out of the normal range for a person’s age and development. Therefore, teachers are in the best position to compare your child with 30 others that may not have ADHD.
Co-morbid conditions:
Many children with ADHD will have one or more co-morbidity namely:
•Anxiety disorder.
•Movement disorder called tics.
•Mood disorders. Later in life they may turn out to have Bipolar disorder or suffer from depression.
•Learning problems.
•Risk of substance abuse later in life. This risk is reduced by 83% if treated effective early on in life.
Diagnosis:
There are no specific special investigations or tests or scans to diagnose this condition. It’s a clinical diagnosis that is made on the above criteria in collaboration with the teachers, caregivers and parents.
It is important however that the doctor should exclude medical conditions that could contribute to the symptoms of ADHD.
Sometimes it is necessary to do an EEG (Electro-encephalogram) to exclude certain forms of epilepsy.
Deficiencies of iron and vitamins can play a roll.
Severe allergies like asthma, hay fever and eczema can affect concentration.
Sleep deprivation can have a very negative effect on concentration and school performance.
Children 6-13 years should get 9-11 hours of sleep each night and according to the Sleep Foundation, preschoolers needs more.
It is important to have a child’s hearing and vision tested in the process of assessing a child with ADHD.
It is also helpful to have an Educational Psychologist assess a child with possible ADHD to exclude a specific learning disability and to evaluate the child’s intellectual potential.
Treatment:
Medicine combined with behavioral treatment often works best. Treatment is aimed at helping a child reach their full potential and alleviating co-morbid symptoms like stress ,anxiety and feelings of inadequacy and depression.
Treatment will also reduce the risk of substance abuse by 83% as mentioned before.
Treatment helps children perform better in sport where concentration is needed and improves social skills and relations with friends and family.
People with ADHD are more accident prone because of their lack of focus. They are also more likely to engage in risk taking behavior. Studies have shown that untreated ADHD sufferers have a 40% higher risk than average to end up at the Casualty department.
Untreated children have a higher rate of school failure and drop out than treated individuals.
Treating ADHD is a partnership between the health care provider, the child with ADHD as well as the parents and teachers.
For treatment to work, it is important to set specific goals that are right for the child.
Follow-up regularly with the doctor to check on goals, results, and any side effects of medicines.
If treatment does not seem to work, the doctor will reassess the diagnosis of ADHD and check for other health problems that can cause similar symptoms.
The doctor will also make sure that the treatment plan is being followed and that the child is on optimal dosages of the medicine or whether it is the correct medication for the specific individual.
MEDICINES:
Different ADHD medicines can be used alone or in combination. The doctor will decide which medicine is right, based on the child’s symptoms and needs.
Psychostimulants (also known as stimulants) are the most commonly used medicine. It helps to increase the available neurotransmitters which stimulates the right areas in the brain to focus better and reduces hyperactive and impulsive behavior. In this group of medicine there is only Methylphenidate available to us. The trade names are Ritalin and Concerta. Ritalin has an immediate release short acting tablet as well as an immediate release long acting tablet. They both start having an effect within 30 minutes but the short acting one works for 4 hours only and the Long acting(LA)one for up to 8 hours.
Concerta is only long acting and has an effect within 30 minutes that lasts for up to 12 hours.
Some children are fast metabolizers of these medicines hence the effect is shorter.
The non-stimulants increase the neurotransmitter Noradrenaline. Atomoxetine called Strattera is the one that’s available to us. Strattera is given in the evenings and takes up to 10 weeks to have maximal effect. Its drawback is its long introduction phase before optimal effect.
All the above medicines are safe when taken as prescribed by the doctor. It has hardly any interaction with other medicines.
Follow the health care provider’s instructions about how to take ADHD medicine. The provider needs to monitor if the medicine is working and if there are any problems with it. So, be sure to keep all appointments with the doctor.
Some ADHD medicines have side effects. If the person has side effects, contact the doctor. The dosage or medicine itself may need to be changed.
Side effects to be expected are head aches and tummy aches in the first month. Loss of appetite so make sure your child gets a good breakfast. Once the effect wears off after 8-12 hours the appetite comes back.
Children will also often feel moody once the effect starts wearing of but usually only in the first month of therapy.
THERAPY:
A common type of ADHD therapy is called behavioral therapy. It teaches children and parents healthy behaviors and how to manage disruptive behaviors. For mild ADHD, behavioral therapy alone (without medicine) may be effective.
Other tips to help a child with ADHD include:
Talk regularly with the child’s teacher.
Keep a daily schedule, including regular times for homework, meals, and activities. Make changes to the schedule ahead of time and not at the last moment.
Limit distractions in the child’s environment.
Make sure the child gets a healthy, varied diet, with plenty of fiber and basic nutrients.
Make sure the child gets enough sleep.
Praise and reward good behavior.
Provide clear and consistent rules for the child.
There is little proof that alternative treatments for ADHD such as herbs, supplements, and chiropractic are helpful.
Most important is to seek help early on. Refusing treatment to a child with ADHD is not in the child’s best interest. Medication is safe and life changing for children and adults with ADHD.
For appointments in this regard inform the person taking the booking that it will be an ADHD assessment because it takes more time than regular consultations.
It’s best if both parents attend the consultation because the one that does not come along is usually the one that refuses treatment for the child and is most often the farther.
ADHD IS REAL AND NEEDS TO BE TREATED.

Dr Willem Smit
Paediatrician

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