Attention Deficit Hyperactivity Disorder (ADHD) is the term used to describe a disorder which results in children being inattentive, impulsive and excessively active. Attention Deficit Disorder (ADD) is a commonly used term to refer to ADHD and was more prevalent earlier. In medical terms, ADD is one of the subtypes of ADHD.
What is ADHD?
There are currently three types of ADHD defined by the American Psyhchiatric Association in the fourth edition of the Diagnostic and Statistical Manual of Men-
tal Disorders (DSM-IV)1
What do these behaviours mean? How does this behaviour manifest itself in children?
- Often fails to give close attention to details
- Makes careless mistakes in school or other activities
- May not stick to a play activities for a sustained period and is easily distracted
- Often does not seem to listen when spoken to directly
- Often fails to finish any activity
- Appears disorganized
- Tries to avoid any activity that requires sustained mental effort
- Loses or misplaces things for tasks or activities
- Forgets things even in routine activities
- Constantly active and often in motion as if "driven by a motor"
- Cannot sit in one place, sometimes even in the classroom
- Often fidgets with hands or feet
- Often runs about or climbs excessively even when it is not right to do so
- Often has difficulty playing or engaging in leisure activities quietly
- Talks a lot
- Often answers before question is finished
- Often cannot wait for turn to speak or do things
- Often interrupts others in conversations or activities
As we look at this list, even our children exhibit a number of these behaviours often. In fact, virtually all children exhibit some of these behaviours. It is perfectly normal to do so.
ADHD is usually suspected only when there is an abnormal exhibitiion of such behaviour for a sustained period of time. Psychiatrics worldwide use the Diagnostic and Statistical Manual of Mental Disorders1 (DSM-IV) as their primary reference book. The DSM-IV suggests that atleast 6 of the characteristics of each behaviour should have been present for atleast 6 months for a possible diagnosis of ADHD. There are number of other criteria that must also be satisfied before determining that a child has ADHD.
How prevalent is ADHD?
Medical research in developed nations has shown a 3 - 5% occurrence in the student population1, 2 and boys can be three times more likely to be diagnosed3. Even though ADHD exists in India and is treated by psychiatrists, it is hard to find comprehensive studies that have measured the problem among the general population. We have only seen studies that measure ADHD prevalence among Indian children who have been brought for diagnosis to psychology departments. In one study 8.1% of Indian children brought for psycho-social evaluation to the psychology department exhibited ADHD. They had been referred to the department because of poor school performance, behavioural problems and hyperactivity4.
What causes ADHD?
We do not clearly know what causes ADHD, yet. A number of theories have been proposed, researched and rejected. Neurological and generic influences are still being researched worldwide to try and isolate the causes of ADHD.
Effects of ADHD
ADHD can result in learning disabilities, delayed language skills, delayed verbal development, diminished motor skills etc.,
ADHD can have significant impact on school performance. A collaboration and partnership between the parents, the school and the teacher are required to ensure we provide the right environments to mitigate the effects of ADHD.
Hyperactivity maybe perceived to be disruptive in social settings. Lack of attention maybe perceived as laziness. Some children also exhibit aggressive behaviour which may result in social isolation.
ADHD also commonly occurs with other conditions like learning disorders (eg., dyslexia), Tourette syndrome, Oppositional defiant disorder (angry and stubborn disobedience of adults), Anxiety and Depression5.
There is no known cure for ADHD. There are multiple treatments that can effective with children. One approach is a behavioral treatment. In this approach, all parties that are in the child's environment (family, teachers, therapists etc.,) work together to enable a modification in the child's behavior. Another approach is medication. In some cases, both are combined in a multimodal approach. The treatment method chosen depends on the child, the parent, the doctor(s) and the environment around the child.
1. American Psychiatric Association, "Diagnostic and Statistical Manual of Mental Disorders" Fourth Edition. Washington, DC, American Psychiatric Association, 1994.
2. "Identifying and Treating Attention Deficit Hyperactivity Disorder: A Resource for School and Home", U.S. Department of Education, Office of Special Education and Rehabilitative Services, Office of Special Education Programs, Washington, D.C., 2006
3. Gross-Tsur V, Shaley RS, Amir N., "Attention deficit disorder: association with familial-genetic factors" Pediatr Neurol. 1991;7 (4):258 –261 ()
4. Prahbhjot Malhi, Pratibha Singhi "Spectrum of Attention Deficit Hyperactivity Disorders in Children Among Referrals to Psychology Services", Indian Pediatrics 2000;37: 1256-1260
5. National Institute of Mental Health, "Attention Deficit Hyperactivity Disorder" Bethesda (MD): National Institute of Mental Health, National Institutes of Health, US Department of Health and Human Services