ƒÆ’-¡ƒ”š‚ Dr Ruwan M Jayatunge

Attention-Deficit Hyperactivity Disorder (ADHD) is a neurobehavioral developmental disorder affecting about 3-5% of the world’s population. ADHD was first described by Dr. Heinrich Hoffman in 1845. He eloquently wrote about the children with ADHD and their characteristics. Contemporary studies concur that the symptoms of ADHD are caused by a neurological dysfunction within the brain mostly due to a deficiency in a specific neurotransmitter in the lower area of the brain. The principle characteristics of ADHD are inattention, hyperactivity, and impulsivity

ƒÆ’-¡ƒ”š‚ Attention Deficit Hyperactivity Disorder is a condition that becomes apparent in some children in the preschool and early school years. Sometimes it may persist into adulthood. About 60% of children diagnosed with ADHD retain the condition as adults.ƒÆ’-¡ƒ”š‚  These children need care and attention. When hyperactivity, distractibility, poor concentration, or impulsivity begins to affect performance in school, social relationships, or ability to accomplish day-to-day activities diminish. Therefore they need treatment.

ƒÆ’-¡ƒ”š‚ According to the US based statisticsƒÆ’-¡ƒ”š‚ ƒÆ’-¡ƒ”š‚  an estimated 3 to 5 percent of school age children suffer from ADHD. Although there are no statistics available in Sri Lanka a considerable number of children are affected by ADHD and many do not receive any treatment.ƒÆ’-¡ƒ”š‚ ƒÆ’-¡ƒ”š‚  In our school system ADHD children are considered as bad students who are disobedient. But the fact is their behavior is caused by complex etiological factors and they are not bad by nature.

ƒÆ’-¡ƒ”š‚ Signs and symptoms

ƒÆ’-¡ƒ”š‚ They have a poor attention spanƒÆ’-¡ƒ”š‚ ƒÆ’-¡ƒ”š‚ 

They have a difficulty in organizing tasks and activities

Acts as if ƒÆ’‚¢ƒ¢-¡‚¬ƒ…-driven by a motorƒÆ’‚¢ƒ¢-¡‚¬ƒ”š‚ and cannot remain still

Difficulty remaining seated

Easily distracted

Gives answers to questions before they are completed

Difficulty following instructions from others

Difficulty sustaining attention in tasks or play activities

Shifts from one uncompleted task to another

Talks excessively

Interrupts others

Does not seem to listen

Engages in physically dangerous activities without considering the possible consequences

Restless and do not follow the commands

ƒÆ’-¡ƒ”š‚ Risk Factors

1) Major etiologic contributors include adverse responses to food additives, intolerances to foods. Too much refined sugar Chocolate andƒÆ’-¡ƒ”š‚ ƒÆ’-¡ƒ”š‚  Genetically Modified Food can increase hyperactivity in some children.ƒÆ’-¡ƒ”š‚ ƒÆ’-¡ƒ”š‚  Common food additives and colorings can increase hyperactive behavior some artificial additives increase hyperactivity and decrease attention span in a wide range of children

ƒÆ’-¡ƒ”š‚ 2) Sensitivities to environmental chemicals, molds, and fungi,

ƒÆ’-¡ƒ”š‚ 3) Exposures to neurodevelopmental toxins, such as heavy metals and organohalide pollutants

ƒÆ’-¡ƒ”š‚ Case Study

Master H who studies in the year 5 often distracts his peers in the classroom. According to his class teacher sometimes he goes out of the class without any permission. He has a poor concentration and inattentiveness. Frequently he becomes agitated and restless sometimes endangering himself to accidents. His academic skills are bellow average. In the exams master H makes careless mistakes may be due to inattentiveness.ƒÆ’-¡ƒ”š‚ ƒÆ’-¡ƒ”š‚  Master H has trouble organizing activities. He doesn’t want to do things that take a lot of mental effort for a long period of time and also forgetful in daily activities.

ƒÆ’-¡ƒ”š‚ General Strategies to Combat ADHD

ƒÆ’-¡ƒ”š‚ Parent Education is vital. The parents must be taught how to handle the children. Some parents use corporal punishment that can lead to the damage of the personality. Parent Coached Social Skill Training gives insight and handiness to manage an ADHD child more effectively.

ƒÆ’-¡ƒ”š‚ Medications are necessary since there is an imbalance in brain chemistry. The medications must be prescribed by a qualified medical professional. Ritalin (methylpenidate) is widely used to treat ADHD.ƒÆ’-¡ƒ”š‚  Medications must be prescribed by a qualified Physician.

ƒÆ’-¡ƒ”š‚ Apart from drug therapy special Psychotherapeutic approaches are essential. Behavior Modification Programs for Home and School can be used to minimize inattentiveness and to improve concentration. Relaxation Training advances emotional control and the child is able to face day today activities without a much tension.

ƒÆ’-¡ƒ”š‚ CBT or Cognitive Behavioral Therapy is important to improve motivation, problem solving skills and self-esteem. Some experts recommend Fun Cognitive Rehabilitation Exercises (Brain Training) to improve attention span.

ƒÆ’-¡ƒ”š‚ Cyber Therapy is another mode of treatment that can be used in ADHD.ƒÆ’-¡ƒ”š‚  In cyber therapy especially designed computer animation programs are used to enhance attention, concentration, eye contact and fine motor movements.

ƒÆ’-¡ƒ”š‚ The therapist should allow the child to change work sites frequently while completing homework or studying. Behavioral approaches can be attempted to help the child concentrate on sitting still, staying on task or thinking before acting.ƒÆ’-¡ƒ”š‚  Many ADHD children can be managed via music therapy. Music therapy reduces their excessive stress factors. In order to enhance their productivity guidance must be given to the students to verbalize a plan before solving problems or undertaking a task. The therapist should provide opportunities for student to show divergent, creative, imaginary thinking.

ƒÆ’-¡ƒ”š‚ On most occasions ADHD children have a good IQ and if their massive energy is used prolifically a good results can be expected. Art Benjamin the famous Professor in Mathematics was an ADHD child and he was able to conquer the illness. Therefore ADHD is not a paralyzing condition. If the positive guidance is given to the child he/she can be a productive person.