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Attention Deficit Hyperactive Disorder

What is Attention Deficit Hyperactivity Disorder (ADHD) ?

We believe, ADHD is not a disability but a different ability that need to be channelized towards productive goals. It is a psychiatric entity that is characterised by inability to remain attentive, extremely overactive and somewhat impulsive i.e they act first thinks later.

ADHD can occur in people of any intellectual ability, If not timely intervened, of course it can lead to poor IQ development due to failure in learning. People with ADHD may also have additional problems, such as sleep and anxiety disorders.
Symptoms of ADHD tend to be first noticed by parents by 3 to 5 years of age, but they often tend to ignore or underestimate it. Symptoms become more noticeable & problematic when a child's circumstances change, such as when they start school. Most cases are diagnosed at the ages of 6 and 12.
The symptoms of ADHD usually improve with age, especially hyperactivity, but many adults who are diagnosed with
the condition at a young age will continue to experience problems.

Based on prominent symptom profile of person, ADHD has been catogerized as1. Hyperactive / Impulsive type (Most Common Type)
1. Inattentive type
2. Combined type (both hyperactive & inattentive)

Symptoms in children and teenagers

The symptoms of ADHD in children and teenagers are well defined, and they are usually noticeable before the age of six. They occur in more than one situation, such as at home and at school.


The main signs of inattentiveness are: * Having a short attention span * Easy distraction * Making careless mistakes - for example, in schoolwork * Appearing forgetful or losing things * Being unable to stick at tasks that are tedious or time-consuming or requiring attention * Appearing to be unable to listen to or carry out instructions * Constantly changing activity or task * Having difficulty organizing tasks

The main signs of hyperactivity and impulsiveness are:
* Being unable to sit still, especially in calm or quiet surroundings
* Constantly fidgeting
* Being unable to concentrate on tasks
* Excessive physical movement
* Excessive talking
* Being unable to wait their turn
* Acting without thinking
* Interrupting conversations
* Little or no sense of danger

These symptoms can cause significant problems in a child's life, such as
1. Underachievement at school
2. Poor social interaction with other children and adults
3. Problems with discipline
4. Rejected by school authority as child frequently disrupt the class for normal children

Related conditions in children and teenagers

Although not always the case, some children may also have signs of other problems or conditions alongside ADHD, such as:

* Anxiety disorder - which causes your child to worry and be nervous much of the time; it may also cause physical symptoms, such as a rapid heartbeat, sweating and dizziness
* Oppositional defiant disorder (ODD) - this is defined by negative and disruptive behaviour, particularly towards authority figures, such as parents and teachers
* Conduct disorder - this often involves a tendency towards highly antisocial behaviour, such as stealing, fighting, vandalism and harming people or animals
* Depression
* Sleep problems - finding it difficult to get to sleep at night, and having irregular sleeping patterns
* Autistic spectrum disorder (ASD) - this affects social interaction, communication, interests and behaviour
* Epilepsy - a condition that affects the brain and causes repeated fits or seizures
* Tourette's syndrome - a condition of the nervous system, characterised by a combination of involuntary noises and movements called tics
* Learning difficulties - such as dyslexia

Symptoms in adults

In adults, the symptoms of ADHD are more difficult to define. This is largely due to a lack of research into adults with ADHD. ADHD is a developmental disorder; it is believed that it cannot develop in adults without it first appearing during childhood. However, it is known that symptoms of ADHD often persist from childhood into a person's teenage years, and then adulthood. Any additional problems or conditions experienced by children with ADHD, such as depression or dyslexia, may also continue into adulthood. By the age of 25, an estimated 15% of people diagnosed with ADHD as children still have a full range of symptoms, and 65% still have some symptoms that affect their daily lives. The symptoms in children and teenagers, which are listed above, is sometimes also applied to adults with possible ADHD. However, we strongly believe that the way in which inattentiveness, hyperactivity and impulsiveness affect adults can be very different from the way they affect children. For example, hyperactivity tends to decrease in adults, while inattentiveness tends to get worse as the pressure of adult life increases. Also, adult symptoms of ADHD tend to be far more subtle than childhood symptoms.Therefore, the following list of symptoms are particularly noticeable with ADHD in adults:

* Carelessness and lack of attention to detail
* Continually starting new tasks before finishing old ones
* Poor organisational skills
* Inability to focus or prioritise
* Continually losing or misplacing things
* Forgetfulness
* Restlessness and edginess
* Difficulty keeping quiet and speaking out of turn
* Blurting out responses and often interrupting others
* Mood swings, irritability and a quick temper
* Inability to deal with stress
* Extreme impatience
* Taking risks in activities, often with little or no regard for personal safety or the safety of others - for example, driving dangerously

Additional problems in adults with ADHD

As with ADHD in children and teenagers, ADHD in adults can occur alongside several related problems or conditions. One of the most common conditions is depression. Other conditions that adults may have alongside ADHD include:

* Personality disorders - Conditions in which an individual differs significantly from an average person, in terms of how they think, perceive, feel or relate to others
* Bipolar disorder - A condition that affects your moods, which can swing from one extreme to another
* Obsessive-compulsive disorder (OCD) - A condition that causes obsessive thoughts and compulsive behaviour


The behavioral problems associated with ADHD can also cause problems such as :


* Difficulties with relationships
* Social interaction
* Drugs
* Crime
* Frequent job change

Diagnosis of ADHD

Many children go through phases where they are restless or inattentive. This is often completely normal and does not necessarily mean they have ADHD. However, when the symptoms are quite disruptive, you should consider raising your concerns by consulting your psychiatrist at earliest.

WHEN PARENTS CONSULT A PSYCHIATRIST FOR POSSIBLE ADHD PROBLEM IN THEIR CHILD, BE READY TO ANSWER ABOUT DETAILS OF SYMPTOMS:

* About his/her symptoms
* When his/her symptoms started
* Where the symptoms occur - for example, at home or in school
* Whether the symptoms affect your or your child's day-to-day life - for example, if they make socialising difficult
* If there have been any recent significant events in your or your child's life, such as a death or divorce in the family
* If there is a family history of ADHD
* About any other problems or symptoms of different health conditions you or your child may have

For adults with possible ADHD, we will assess your symptoms if:


* You were not diagnosed with ADHD as a child, but your symptoms began during childhood and have been ongoing since then
* Your symptoms cannot be explained by a mental health condition
* Your symptoms have a significant impact on your day-to-day life - For example, if you are underachieving at work or find intimate relationships difficult

Diagnostic Criteria in children


Diagnosis in children's depends upon:
* Presence six or more symptoms of inattentiveness, or six or more symptoms of hyperactivity & impulsiveness (See Above)
* Been displaying symptoms continuously for at least six months
* Started to show symptoms before the age of 12
* Been showing symptoms in at least two different settings - For example, at home and at school, to rule out the possibility that the behavior is just a reaction to certain teachers or parental control
* Symptoms that make their lives considerably more difficult on a social, academic or occupational level
* Symptoms that are not just part of a developmental disorder or difficult phase, and are not better accounted for by another condition


Diagnostic Criteria in adults


Diagnosing ADHD in adults is more difficult because there is some disagreement about whether the list of symptoms used to diagnose children and teenagers also applies to adults. But the consensus among us to label an adult with ADHD include:


* Presence of at least five or more symptoms of inattentiveness, or five or more symptoms of hyperactivity and impulsiveness
* Underachieving at work or in education
* Driving dangerously
* Difficultly making or keeping friends
* Difficulty in relationships with partners

If your problems are recent and did not occur regularly in the past, you are not considered as having ADHD. This is because it is currently not thought that ADHD can develop for the first time in adults.


What causes ADHD ?


The exact cause of attention deficit hyperactivity disorder (ADHD) is not fully understood, although a combination of factors is thought to be responsible. Research has identified a number of possible differences in the brains of people with ADHD compared to those who don't have the condition.Genetics

ADHD tends to run in families and, in most cases, it is thought the genes you inherit from your parents are a significant factor in developing the condition. Research shows that both parents and siblings of a child with ADHD are four to five times more likely to have ADHD themselves. However, the way ADHD is inherited is likely to be complex and isn't thought to be related to a single genetic fault.


Brain function and structure


Research has identified a number of possible differences in the brains of people with ADHD compared to those who don't have the condition, although the exact significance of these is not clear. For example, studies involving brain imaging scans have suggested that certain areas of the brain may be smaller in people with ADHD, whereas other areas may be larger. Research has also shown that the brain may take an average of two to three years longer to mature in children with ADHD, compared to children who don't have the condition. Other studies have suggested that people with ADHD may have an imbalance in the level of chemicals in the brain called neurotransmitters, or that these chemicals may not work properly.


Other possible causes


Various other causes have also been suggested as having a role in the development of ADHD, including:


* Being born prematurely (before the 37th week of pregnancy)
* Having a low birth weight
* Brain damage either in the womb or in the first few years of life
* Drinking alcohol, smoking or misusing drugs while pregnant
* Exposure to high levels of toxic lead at a young age
* However, the evidence for many of these factors is inconclusive, and more research is needed to determine if they do in fact contribute to ADHD.

How common is ADHD?

ADHD is the most common behavioral disorder in the age group of 3 to 10 years. It's unknown exactly how many people have the condition, but most estimates suggest if affects around 2-5% of school-aged children and young people. Childhood ADHD is more commonly diagnosed in boys than girls. Girls with ADHD often have a form of the condition where the main symptoms relate to problems with attention rather than hyperactivity, which can cause less noticeable symptoms. It is therefore possible that ADHD could be under diagnosed in girls, and could be more common than previously thought.

How ADHD is treated ?

There is no cure for attention deficit hyperactivity disorder (ADHD), but treatment can help relieve the symptoms and make the condition much less of a problem in day-to-day life. ADHD can be treated using medication or therapy, but a combination of both is often the best way to treat it. Treatment will usually be arranged by a specialist, such as psychiatrist.


Medication


There are four types of medication licensed for the treatment of ADHD:
* Methylphenidate
* Dexamfetamine
* Lisdexamfetamine
* Atomoxetine
These medications are not a permanent cure for ADHD, but they can help someone with the condition concentrate better, be less impulsive, feel calmer, and learn and practice new skills. Some medications need to be taken every day, but some can be taken just on school days. Treatment breaks are occasionally recommended, to assess whether the medication is still needed. Initially these medication are prescribed at low doses which may then be gradually increased. You or your child will need to see your psychiatrist for regular check-ups, to ensure the treatment is working effectively and to check for signs of any side effects or problems.Your specialist will discuss how long you should take your treatment but, in many cases, treatment is continued for as long as it is helping.


Methylphenidate


Methylphenidate is the most commonly used medication for ADHD. It belongs to a group of medicines called stimulants that work by increasing activity in the brain, particularly in areas that play a part in controlling attention and behavior. Methylphenidate is commonly used and quite effective in children with ADHD. Although methylphenidate is not licensed for use in adults due to abuse potential, it may be taken under close supervision from your specialist. The medication can be taken as either immediate-release tablets (small doses taken two to three times a day), or as modified-release tablets (taken once a day in the morning, and they release the dose throughout the day).

Common side effects of methylphenidate include:
* A small increase in blood pressure and heart rate
* Loss of appetite, which can lead to weight loss or poor weight gain
* Trouble sleeping
* Headaches
* Stomach aches
* Mood swings


Dexamfetamine


Dexamfetamine is also a stimulant medication that works in a similar way to methylphenidate, by stimulating areas of the brain that play a part in controlling attention and behaviour. Dexamfetamine can be used by teenagers and children with ADHD over the age of three. Although it is not licensed for use in adults, it may be taken under close supervision from your psychiatrist. Dexamfetamine is usually taken as a tablet once or twice a day, although an oral solution is also available.

Common side effects of dexamfetamine include:
* Decreased appetite
* Mood swings
* Agitation and aggression
* Dizziness
* Headaches
* Diarrhoea
* Nausea and vomiting


Lis-dexamfetamine


Lisdexamfetamine is a similar medication to dexamfetamine, and works in the same way. It can be used by children with ADHD over the age of six if treatment with methylphenidate hasn't helped. You may continue to take it into adulthood if your doctor thinks you are benefitting from treatment. Lisdexamfetamine comes in capsule form, which you or your child usually take once a day.


Common side effects of lisdexamfetamine include:
* Decreased appetite, which can lead to weight loss or poor weight gain
* Aggression
* Drowsiness
* Dizziness
* Headaches
* Diarrhea
* Nausea and vomiting


Atomoxetine


Atomoxetine works differently to other ADHD medications. It is known as a selective noradrenaline uptake inhibitor (SNRI), which means it increases the amount of a chemical in the brain called noradrenaline. This chemical passes messages between brain cells, and increasing the amount can aid concentration and help control impulses. Atomoxetine can be used by teenagers and children over the age of six. It is also licensed for use in adults who are continuing treatment after taking the medication as a teenager. It is not licensed for use in adults newly diagnosed with ADHD, but your psychiatrist may prescribe it under their supervision. Atomoxetine comes in capsule form, which you or your child usually take once or twice a day.Common side effects of atomoxetine include:


*A small increase in blood pressure and heart rate
* Nausea and vomiting
* Stomach aches
* Trouble sleeping
* Dizziness
* Headaches
* Irritability
* Atomoxetine has also been linked to some more serious side effects that it's important to look out for, including suicidal thoughts and liver damage. If either you or your child begin to feel depressed or suicidal while taking this medication, speak to your doctor.


Psychotherapy


Along with medication, different types of psychotherapies can be useful in treating ADHD in children, teenagers and adults. Such behavioural therapies are particularly useful in dealing other comorbid psychiatric illnesses, such as conduct or anxiety disorders, that may appear with ADHD. Some of the therapies that may be used are outlined below.Psychoeducation

Psychoeducation means you or your child will be encouraged to discuss ADHD and how it affects you. It can help children, teenagers and adults make sense of being diagnosed with ADHD, and can help you to cope and live with the condition.


Behaviour therapy


Behaviour therapy provides support for carers of children with ADHD, and may involve teachers as well as parents. Behaviour therapy usually involves behaviour management, which uses a system of rewards to encourage your child to try to control their ADHD. If your child has ADHD, you can identify types of behaviour you want to encourage, such as sitting at the table to eat. Your child is then given some sort of small reward for good behaviour, and removal of a privilege for poor behaviour. For teachers, behaviour management involves learning how to plan and structure activities, and to praise and encourage children for even very small amounts of progress.


Parent training and education programmes


If your child has ADHD, specially tailored parent training and education programmes can help you learn specific ways of talking to your child, and playing and working with them to improve their attention and behaviour.

You may also be offered parent training before your child is formally diagnosed with ADHD.

These programmes are usually arranged in groups and can last several weeks.

They aim to teach parents and carers about behaviour management, while increasing your confidence in your ability to help your child, as well as improving your relationship.


Social skills training


Social skills training involves your child taking part in role play situations, and aims to teach them how to behave in social situations by learning how their behaviour affects others.

Cognitive behavioural therapy (CBT)

Cognitive behavioural therapy (CBT) is a talking therapy that can help you manage your problems by changing the way you think and behave. Although very useful in adult with ADHD, a CBT therapist would try and change how your child feels about a situation, which would in turn potentially change their behaviour. CBT can be carried out with a therapist individually or in a group.


Other possible treatments


There are other ways of treating ADHD that some people with the condition find helpful, such as cutting out certain foods and taking supplements. However, there is no strong evidence these work, and they should not be attempted without medical advice.


Diet


People with ADHD should eat a healthy, balanced diet. Do not cut out foods without medical advice. Some people may notice a link between types of food and worsening ADHD symptoms. For example, sugar, food colourings and additives, and caffeine are often blamed for aggravating hyperactivity, and some people believe they have intolerance to wheat or dairy products, which may add to their symptoms. If this is the case, keep a diary of what you eat and drink, and what behavior this causes. Discuss this with your psychiatrist, who may refer you to a dietitian (a healthcare professional who specializes in nutrition). Do not change your (or your child's) diet without medical advice.


Supplements


Some studies have suggested that supplements of omega-3 and omega-6 fatty acids may be beneficial in people with ADHD, although the evidence supporting this is very limited. It's advisable to talk to your psychiatrist before using any supplements, because some can react unpredictably with medication or make it less effective. You should also remember that some supplements should not be taken long term, as they can reach dangerous levels in your body.

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