Attention Deficit and Hyperactivity Disorder in Children

– What is ADHD?

It is a disorder in children and adolescents characterised by 3 conditions. These are inattention, hyperactivity and impulsiveness. There are 3 types of ADHD: 1. the type with marked attention deficit, 2. the type with marked hyperactivity, and 3. a combination of the two.

– What are the symptoms?

Signs of inattention are a tendency to miss details, frequently making inadvertent mistakes in home work or other activities, difficulty in keeping focused on a task or games, tendency not to complete tasks, not seeming to listen during a conversation, difficulty in lining up and organising tasks, a dislike for situations which require mental effort and a tendency to avoid of such situations, often losing things, being easily distracted by external stimuli, forgetfulness. Signs of hyperactivity related to the condition are: difficulty in sitting still, tendency to dash around the classroom or run around excessively in inappropriate situations, inability to play quiet games, constantly in motion, excessive talking.. Signs of impulsiveness are: trying to quickly give an answer before the question has been asked in full, difficulties in waiting in line in any situation, tendency interrupt and talk when others are talking.

– How is it diagnosed?

Diagnosis is made entirely on the basis of the doctor’s assessment. It can be supported with the help of certain psychological tests and scales.

– Is ADHD treatable?

If the condition is diagnosed in early childhood it can be treated. The parents of the child who with the help of the information provided by the parents, teachers and other sources is diagnosed as with ADHD, should be given background information on the problems they experience at home. The aim is to inform the parents by discussing the problems and their reasons with them. After advice is given on what can be done at home and at school, it has to be decided whether drugs need to be used. In children who have low academic achievements in spite of having a normal intellect, who because of their hyper-activity often injure themselves or even find themselves in live-threatening situations, drug therapy is the primary choice. The family may have fears and concerns related to the drugs, therefore the reasons why they should be used have to be explained to the family in detail. Like with many other drugs, drugs used in ADHD also have side effects. Many of these side effects are reversible and can be controlled by adjusting the dosage. In children where the side effects are regarded as a risk (for instance if there are certain illnesses in the family history), certain tests are carried out before drug treatment is commenced, so that major problems can be prevented.

– Is attention deficit, that starts in adolescence, permanent? What are the causes? Does the condition require treatment?
Adolescence can be described as a period in which many changes happen, where childhood ends and the child tries to adjust to a life that resembles that of an adult. For children that enter adolescence, problems are no longer just limited to school tasks and family relationships. Changes occur in their body and in their hormones which result in feelings of interest in the opposite sex. The adolescent’s areas of interest become more varied, they try to get the attention of the opposite sex, to establish himself amongst other adolescents of similar age, and all this can cause confusion and inattention. Forgetting to take their belongings with them, wanting to sleep less, wanting to spend most of the time in front of the computer, opposing the parents, are some of the behaviour patterns that set in. During all these developments school work which in the past used to be their primary concern, starts playing a secondary role, and this affects their academic success. This last drop usually pushes parents into action. This period, which we can call adolescence, lasts approximately 2 years. In fact, latest research shows that it can last much longer and that in Turkey it can last up to the age of 20. Once the youth gets through this period in a healthy manner, we no longer need to talk about inattention. If the period comes to an end naturally, no intervention is required. However, in cases where the problem continues with increased severity or is prolonged, seeking the advice of an expert is beneficial. In some cases an intervention in the form of individual or family meetings is helpful, and in other cases intervention with drugs may be required.

– At the end of the 19th century there were efforts to explain Attention Deficit Hyperactivity Disorder as “Mad Follies”, “Impulsive Derangement”, “Inadequate Inhibition”. How is it defined today? What is its history?
At the end of the 19th century medical articles tried to explain the condition with words like “mad follies”, “impulsive derangement”, “inadequate inhibition”. In fact, in the same century, in 1863, a children’s book was published by Thomas Hoffman in Germany, on a hyperactive child called “Struwwelpeter”, and this was the first time the condition appeared in literature. In 1902 Sir George Frederic Still talked about a group of children whose condition resembled the diagnosis of today. These children were hyperactive, unable to focus, and displayed learning difficulties and conduct disorders. Still claimed that these children had a “defect in their moral control” for which he blamed both organic and environmental influences (Weiss, 1996). Following this there was more emphasize placed on organic origins of the condition. One of the reasons for this was the “encephalitis lethargica” which followed the flue epidemic after the I. World War. This condition showed similarities with the picture which Still had described. In 1937 Barclay announced that amphetamines had certain positive effects of on hyperactivity, which again placed emphasize on organic origins. After the 1950’s the condition was given names like “minimal brain damage, hyperkinetic syndrome, hyperactive syndrome”. Valid and reliable classification studies related to diagnosis started after the World Health Organisation and the American Psychiatry Association defined the disorder in their own classification systems as a “hyperkinetic childhood syndrome”. In later classifications it was defined as an attention deficit, with or without hyperactivity. However later on this definition was changed to ADHD listing 14 symptoms. The prerequisite for diagnosis was that the patient displayed at least 8 of these symptoms.

Lastly the disorder was named “Attention Deficit and Destructive Conduct Disorders”. It is regarded in two main subgroups, namely a Attention Deficit/Hyperactivity Disorder in which inattention comes to the forefront, and a Attention Deficit/Hyperactivity Disorder in which hyperactivity and impulsiveness come to the forefront. Other then these, there is the Combined type which presents symptoms from both groups.

– Is Attention Deficit Hyperactivity Disorder (ADHD) a genetic condition? How is the brain affected?
A single cause which would define ADHD has not been discovered. However, the role of biological and environmental factors has always been underlined. Interest in the causes of ADHD has risen in recent years. ADHD is undoubtedly a familial disorder with a genetic side to it. Experiments on mice demonstrated the role played by genetics. Clinical studies showed that in adopted children with ADHD there is a high likelihood of finding ADHD in the child’s biological parents. Abnormalities were detected in the brain particularly in the areas called prefrontal area and basal ganglia. Many studies established a decrease in blood flow or in the function of glucose (sugar) metabolism in the brain area called frontal lobe, particularly in the prefrontal cortex . Studies on imaging related to the brain are ongoing.

– Is the marital relationship of parents with a hyperactive child any different from that of parents whose children do not have this condition?
Some studies have demonstrated that when parents are in conflict, the child – regardless of whether it is a boy or a girl – displays a negative reaction, that however girls show more anger, sadness and fear compared to boys. Other studies however have concluded that such a difference between the reaction of girls and boys does not exist.