Attention deficit hyperactivity disorder 101
by Shruti arora

Introduction This is a type of mental disorder, which occurs primarily in school-aged children but can also be diagnosed for the first time in the late teens esp., if some of its symptoms are left unnoticed. It was once falsely thought that after puberty the children dont need treatment. These types of children are given special advantages under Section 54 of the Rehabilitation Act of 1973.

Diagnosis The disorder, as described in DSM IV-TR, is best characterized by three main symptoms of impulsivity, hyperactivity and inattention. For making a diagnosis in a child the disorder must start before age 7 and the symptoms must continue for 6 months. Children having signs of impulsivity and hyperactivity are restless, unpredictability, tendency to fail, difficult to stay seated and blurting answers without even giving thought. Feelings of inattention are getting distracted, making careless mistakes and trying to finish off things very fast. Although they start very fast but quickly jump to another job without completing the former one. Besides these other symptoms are vision problems such as double vision

Cause The cause is still not clear. Among the hypotheses are anatomical structural problems in frontal lobes and the basal ganglia of the brain. Some propose the theory of genetics. Others claim that certain environmental causes are smoking and having alcohol in pregnancy. Finally some hypothesize that taking artificial sweeteners and additives might be the cause.

Differential diagnosis Certain disorders such as autism, certain personality disorders, oppositional defiant disorder and learning disorders might at times mimic ADHD and mislead the doctors. Some disorders like bipolar disorder may accompany ADHD. Some children with ADHD may eventually develop some conduct disorder or anxiety or depression. Untreated the child is prone to both the social and family problems besides decreased self-esteem.

Management The first step in the diagnosis of the disorder is to interview the parents and then the teachers although psychologists, psychiatrists, pediatricians or the teachers of the child can diagnose the disorder. Generally the parents are not the first to notice. The best person to manage the child in this context is a psychiatrist. There are basically two sets of management and both are to be given simultaneously in order to manage the child. The disorder might run forever. Nutrition and child psychotherapy do not seem to help in the treatment.

Medical Although there are different medications available in the market but the most effective ones are adderal, Ritalin and strattera. Like all other CNS medicines, these are not without any side effects. For e.g. adderal has side effects of nervousness, irritability, dry mouth, sleeplessness and stomach upset. Similarly Ritalin causes above symptoms and decreased appetite. Strattera comes with the side effects of insomnia and anorexia. Counseling In a recent study long term combination therapy with both the medical and the counseling were far better than either of them alone.

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