Attention Syndrome. What is ADHD: symptoms, treatment of attention deficit hyperactivity disorder in preschool and school children

A detailed and accessible explanation of what Attention Deficit Disorder is, as well as what its features and symptoms are.

Today, in the parental environment and among child psychologists, terms such as “ attention deficit disorder”, “hyperactivity”, “impulsivity”, etc.

They still cause heated debate and discussion, have not yet been studied in detail, but it is doubtful that there are children (and often adults) with very specific symptoms that qualify as attention deficit hyperactivity disorder (ADHD). don't have to.

Does Attention Deficit Hyperactivity Disorder Really Exist?

As to whether attention deficit disorder actually exists, whether it can really be considered a disease, and how widespread it is, there are still fierce debates in scientific, educational, and other circles.

Often, teachers who hear that a child suffers from Attention Deficit Hyperactivity Disorder (ADHD) grimaces as if from a toothache and begin to stormily explain that these are all inventions of parents who do not want to properly raise their child.

Parents, outraged by the doubts of teachers about their parental abilities, begin to blame teachers in response: “They say that you don’t want to work and find an approach to different children.”

The truth, as always, lies somewhere in the middle.

Children with ADHD do exist.

And you really need to establish special contact with them - teachers will not get away from this.

But even some mothers and fathers go too far, believing that the behavior of their children at school is only a problem for teachers, without even trying to influence their own child on their part.

It is bad manners, which leads to the unwillingness of parents to take their kids seriously, is taken for attention deficit disorder.

“And he doesn’t have any Attention Deficit Disorder!”…

I remember once such a child turned a trip into a nightmare for all the passengers of the car for some time.

He ran down the aisle, opened all the compartments, tried to grab what he liked, yelled, banged on the walls.

The parents did not react to all this at all.

Attempts to attract their attention ended in nothing: the mother, after listening to the indignation of some passengers, calmly replied that she allows her son to behave as he wants, and if someone does not like it, then this is exclusively their problem.

This child, by the way, was about 10 years old, that is, he did not pull at all on an unintelligent peanut.

One older woman managed to rein in the little terrorist (later it turned out that the lady had raised three boys), my neighbor in the compartment.

When this ill-mannered child burst into our compartment, the woman, standing up, scolded the boy quite severely, forbidding him to take her things without asking and make noise next to her compartment, threatening to spank him properly if he did not calm down.

The boy, obviously not accustomed to such a tone and to the fact that he was told “No”, got hung up for a while, and then ran to complain to his mother.

She, having left the state of phlegm, came to understand: “How so, her child was offended?”.

To which I heard a calm answer from my neighbor: “I behave as I see fit, and if this does not suit someone, then this is exclusively their problem.”

Peace and silence finally reigned in the car, which were broken only by the angry sniffing of the little terrorist and his mother.

This child did not have any attention deficit hyperactivity disorder.

It was just a little boy, impudent from impunity.

Early research on attention deficit disorder

Studies of brain dysfunction have been conducted for a long time.

For example, at the beginning of the 20th century, E. Kan and his associates studied children who were distinguished by excessive activity and impulsiveness, inability to take a long time, distractibility, etc.

The very term "attention deficit disorder" is relatively new, because it was first used only in the early 1980s by American psychiatrists.

In the same country, they began to actively explore this most interesting phenomenon.

It was the American Psychiatric Association that first created the classification of children suffering from Attention Deficit Disorder.

According to their research, there are three types:

1. The so-called "pure" attention deficit disorder.
2. ADHD associated with hyperactivity.
3. Attention Deficit Hyperactivity Disorder.

Most often, it is the combined version of this disease that is observed, which is why the abbreviation ADHD has become so common in the scientific and popular science literature.

Domestic scientists, alas, are far behind them.

Features of Attention Deficit Disorder

Parents whose child does not behave too well and causes a lot of trouble for them, and teachers, and educators, and peers, will have to determine whether the child really suffers from attention deficit hyperactivity disorder or whether he simply has gaps in education.

Before talking about the symptoms, I would like you to learn about three features of this syndrome:

Its prevalence is not as high as it seems: only 5-7% of school-age children suffer from it.

If we take the average data, then in each class there may be a child with ADHD.

A lot, I agree, but these are not as frightening figures as popular literature tries to prove.

1. Boys are twice as likely to suffer from this syndrome than girls, so if you, being a parent of a boy, suspect ADHD in your baby, then you have much more cause for concern than the parents of girls.

Until the age of 5-6, attention deficit disorder is not worth worrying about.

Before the child goes to school or even to preparatory group and begins to systematically learn, it is quite difficult to determine if he has ADHD.

How to identify ADHD in a child

and what to do after confirmation of the diagnosis,

told in the video:

Symptoms of Attention Deficit Hyperactivity Disorder

To confirm your concerns, pay attention to whether your baby has the following symptoms:

1. Cannot focus his attention for a long time.
2. He constantly turns his head and is distracted by anything when you try to tell or show something, or play some kind of game with him that requires attention.
3. Difficult in correct sequence perform any task.
4. Difficulty switching from one activity to another.
5. He constantly loses his things, forgets where he left some toy.
6. It is impossible to organize it and instill in it some rules of behavior.
7. Suffering from frustration and forgetting important things.
8. He cannot control his urges, and does not try to do so.
9. If the baby wants something, then he should get it immediately, because waiting in line is unacceptable for him.
10. Unable to sit still even for a short time, is constantly in aimless movement, and does not walk, but runs.
11. He talks a lot, interrupts others, does not allow him to speak, does not know how to listen when something is told to him.
12. Easily falls into hysterics, shows his irritation and gets upset even when there is no reason for this.

Doesn't learn from his mistakes.

For example, if he gets burned, then after a while he will drink hot tea again, without waiting for it to cool down.

13. , can reproduce letters on paper, as if displayed in a mirror.

If he is distracted in the process of reading, then it is quite difficult for him to find the line on which he finished reading.

Forgets what he read.

14. You notice that the child often seems to turn off his feelings, that is, physically he is here, but in reality not with you, but with his thoughts somewhere very far away.

There are gaps in perception.

Often to your question “What did you do in class today?” you answer: "I do not remember."

Alone, these symptoms do not yet indicate that your child has attention deficit hyperactivity disorder, but if you find at least 5 of them in your baby, then you should consult a doctor to confirm or dispel your fears.

attention deficit disorder not amenable to treatment, but amenable to correction.

Only a specialist will tell you (after all, each case is unique) how to deal with your child so that he can adapt normally to society and his ADHD does not interfere with his life full life and did not create problems for others.

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In recent years, great progress has been made in the study of one of the most urgent problems of neuropediatrics - attention deficit hyperactivity disorder in children. The urgency of the problem is determined by the high frequency of this syndrome in the child population and its great social significance. Children with Attention Deficit Disorder have normal or high intelligence, but tend to do poorly in school. In addition to learning difficulties, attention deficit disorder is manifested by motor hyperactivity, attention defects, distractibility, impulsive behavior, and problems in relationships with others. It should be noted that attention deficit disorder is observed in both children and adults. In recent years, its genetic nature has been proven. It is quite obvious that the interests of various specialists - pediatricians, teachers, neuropsychologists, speech pathologists, neurologists - are concentrated in the focus of scientific problems of attention deficit hyperactivity disorder.

1. Attention Deficit Hyperactivity Disorder- dysfunction of the central nervous system(mainly the reticular formation of the brain and spinal cord. The reticular formation (lat. rete - network) is a collection of cells, cell clusters and nerve fibers located throughout the brainstem (medulla oblongata, bridge, midbrain and diencephalon) and in the central sections The reticular formation receives information from all sense organs, internal and other organs, evaluates it, filters and transmits it to the limbic system and cortex big brain. It regulates the level of excitability and tone of various parts of the central nervous system, including the cerebral cortex, plays an important role in consciousness, thinking, memory, perception, emotions, sleep, wakefulness, autonomic functions, purposeful movements, as well as in the mechanisms of formation of integral reactions of the body. The reticular formation primarily performs the function of a filter that allows sensory signals important for the body to activate the cerebral cortex, but does not allow habitual or repetitive signals to pass through.), Manifested by difficulties in concentrating and maintaining attention, learning and memory disorders, as well as difficulties in processing exogenous and endogenous information and incentives.

The term "attention deficit disorder" was isolated in the early 80s from the broader concept of "minimal brain dysfunction". The history of the study of minimal brain dysfunction is associated with the studies of E. Kahn, although some studies have been carried out earlier. Observing school-age children with such behavioral disorders as motor disinhibition, distractibility, impulsive behavior, the authors suggested that the cause of these changes is brain damage of unknown etiology, and proposed the term "minimal brain damage". Later, learning disorders (difficulties and specific impairments in learning writing, reading, counting skills; disorders of perception and speech) were included in the concept of "minimal brain damage". Subsequently, the static "minimal brain damage" model gave way to a more dynamic and more flexible "minimal brain dysfunction" model.

In 1980, the American Psychiatric Association developed a working classification - DSM-IV (the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition), - according to which cases previously described as minimal brain dysfunction were proposed to be considered as attention deficit hyperactivity disorder and hyperactivity disorder. . The underlying premise was that the most common and significant clinical symptoms of minimal brain dysfunction included impaired attention and hyperactivity. In the latest DSM-IV classification, these syndromes are grouped under one name "Attention Deficit Hyperactivity Disorder". In the ICD-10, the syndrome is covered under "Emotional and behavioral disorders with onset usually in childhood and adolescence" under "Activity and attention impairment" (F90.0) and "Hyperkinetic conduct disorder" (F90.1).

The frequency of attention deficit hyperactivity disorder, according to different authors, varies from 2.2 to 18% in school-age children. Such differences are explained by non-compliance with clear criteria for diagnosis. According to the American Psychiatric Association, about 5% of school-age children suffer from Attention Deficit Hyperactivity Disorder. Almost every school class has at least one child with this condition. In the study of N.N. Zavodenko, the frequency of attention deficit disorder in schoolchildren was 7.6%. Boys are affected twice as often as girls.

Classification. According to DSM-IV, there are 3 variants of the course of attention deficit hyperactivity disorder, depending on the prevailing clinical symptoms:

A syndrome that combines attention deficit hyperactivity disorder;

Attention deficit disorder without hyperactivity;

Attention Deficit Hyperactivity Disorder.

Some researchers question the association of attention deficit hyperactivity disorder and hyperactivity disorder, since up to 40% of all patients suffer only attention deficit without hyperactivity. Attention deficit without hyperactivity disorder is more common in girls.

Attention deficit disorder can be both primary and result from other diseases, that is, it can be secondary or symptomatic (genetically determined syndromes, mental illness, consequences of perinatal and infectious lesions of the central nervous system).

The etiology is not well understood. Most researchers suggest the genetic nature of the syndrome. Families of children with attention deficit hyperactivity disorder often have close relatives who had similar disorders at school age. To identify hereditary burden, a long and detailed questioning is necessary, since the difficulties of learning at school by adults are consciously or unconsciously "amnesiac". Pedigrees of children with attention deficit hyperactivity disorder also often show a burden of obsessive-compulsive disorder (obsessive thoughts and compulsive rituals), tics, and Gilles de la Tourette's syndrome. Probably, there is a genetically determined relationship of neurotransmitter disorders in the brain in these pathological conditions.

It is assumed that attention deficit/hyperactivity disorder is determined by mutations in 3 genes that regulate dopamine metabolism - the D4 receptor gene, the D2 receptor gene, and the gene responsible for dopamine transport (a neurotransmitter). S. Faraone, J. Biederman discussed the hypothesis that the carriers of the mutant gene are children with the most pronounced hyperactivity.

Along with genetic factors, family, pre- and perinatal risk factors for the development of attention deficit hyperactivity disorder are distinguished. Family factors include the low social status of the family, the presence of a criminal environment, severe disagreements between parents. Neuropsychiatric disorders, alcoholism and deviations in sexual behavior in the mother are considered especially significant. Pre- and perinatal risk factors for the development of attention deficit disorder include neonatal asphyxia, maternal alcohol consumption during pregnancy, certain drugs, and smoking.

It is assumed that the pathogenesis of the syndrome is based on disturbances in the activating system of the reticular formation, which contributes to the coordination of learning and memory, the processing of incoming information, and the spontaneous maintenance of attention. Violations of the activating function of the reticular formation, apparently, are associated with a lack of norepinephrine in it (in protein synthesis it follows dopamine). The impossibility of adequate processing of information leads to the fact that various visual, sound, emotional stimuli become redundant for the child, causing anxiety, irritation and aggressiveness. Violations in the functioning of the reticular formation predetermine secondary disorders of the neurotransmitter metabolism of the brain. The theory of the relationship of hyperactivity with dopamine metabolism disorders has numerous confirmations, in particular, the success of the treatment of attention deficit hyperactivity disorder with dopaminergic drugs. It is possible that disorders of neurotransmitter metabolism leading to hyperactivity are associated with mutations in genes that regulate the functions of dopamine receptors. Separate biochemical studies in children with attention deficit hyperactivity disorder indicate that the metabolism of not only dopamine, but also other neurotransmitters, serotonin and norepinephrine, is disturbed in the brain.

In addition to the reticular formation, dysfunction of the frontal lobes (prefrontal cortex), subcortical nuclei and the pathways connecting them are likely to be important in the pathogenesis of attention deficit hyperactivity disorder. One of the confirmations of this assumption is the similarity of neuropsychological disorders in children with attention deficit disorder and in adults with damage to the frontal lobes of the brain. Spectral tomography of the brain revealed a decrease in blood flow in the prefrontal cortex of the brain during intellectual loads in 65% of children with attention deficit hyperactivity disorder, while in the control group - only 5%.

Criteria for diagnosis and clinical manifestations. Adequate diagnosis of attention deficit hyperactivity disorder is impossible without strict adherence to the diagnostic criteria. These, according to DSM-IV, include:

The presence of attention deficit and / or hyperactivity in the child;

Early (up to 7 years) onset of symptoms and duration (more than 6 months) of their existence;

Some symptoms are observed both at home and at school;

The symptoms are not a manifestation of other diseases;

Violation of learning and social functions.

It should be noted that the presence of learning disorders and social functions is a necessary criterion for establishing the diagnosis of "attention deficit hyperactivity disorder". In addition, the diagnosis of attention deficit hyperactivity disorder can only be made when learning difficulties are evident (i.e. not earlier than 5-6 years of age).

According to the DSM-IV, a diagnosis of attention deficit disorder can be made if at least 6 of the symptoms described below are present. A child has an attention deficit if he:

Does not pay attention to details and makes mistakes in work;

With difficulty maintains attention in work and play;

Does not listen to what is said to him;

Unable to follow instructions;

Cannot arrange play or activity;

Has difficulty performing tasks that require prolonged concentration of attention;

Often loses things;

Frequently and easily distracted;

Be forgetful.

At least 5 of the following symptoms must be present to diagnose hyperactivity. A child is hyperactive if he:

Makes fussy movements with arms and legs;

Often jumps up from his seat;

Hypermobile in situations where hypermobility is unacceptable;

Cannot play "silent" games;

Always in motion;

He talks a lot.

A child is impulsive (i.e. unable to stop and think before speaking or acting) if they:

Answers a question without listening to it;

Can't wait for their turn;

Intervenes in the conversations and games of others.

In a significant percentage of cases, the clinical manifestations of the syndrome occur before the age of 5-6 years, and sometimes already in the 1st year of life. Children of the 1st year of life, who subsequently develop hyperactivity, often suffer from sleep disorders and hyperexcitability. In the future, they become extremely naughty and hyperactive, their behavior is hardly controlled by their parents. At the same time, children who later have attention deficit disorder without hyperactivity may moderately lag behind in motor (they begin to roll over, crawl, walk 1-2 months later) and speech development in infancy, they are inert, passive, not very emotional. As the child grows, attentional disturbances become apparent, which parents usually do not pay attention to at first.

Violation of attention and the phenomena of hyperactivity-impulsivity lead to the fact that a school-age child with normal or high intelligence has impaired reading and writing skills, does not cope with school assignments, makes many mistakes in work performed and is not inclined to listen to the advice of adults. The child is a source of constant anxiety for others (parents, teachers, peers), as he interferes in other people's conversations and activities, takes other people's things, often behaves completely unpredictably, overreacts to external stimuli (the reaction does not correspond to the situation). Such children hardly adapt in the team, their distinct desire for leadership has no actual reinforcement. Due to their impatience and impulsiveness, they often come into conflict with peers and teachers, which exacerbates existing learning disabilities. The child is also unable to foresee the consequences of his behavior, does not recognize authorities, which can lead to antisocial acts. Especially often antisocial behavior is observed in adolescence, when children with attention deficit hyperactivity disorder have an increased risk of developing persistent behavioral disorders and aggressiveness. Adolescents with this pathology are more likely to start smoking early and take narcotic drugs, they are more likely to experience traumatic brain injuries. Parents of a child with attention deficit hyperactivity disorder (ADHD) are sometimes moody and impulsive themselves. Outbursts of rage, aggressive actions, and a child's stubborn refusal to behave in accordance with parental rules can lead to an uncontrollable reaction from the parents and to physical abuse.

On neurological examination of a child with attention deficit disorder with or without hyperactivity, focal neurological symptoms are usually absent. There may be a lack of fine motor skills, impaired reciprocal coordination of movements and moderate ataxia. More often than in the general child population, speech disorders are observed.

Differential diagnosis of attention deficit hyperactivity disorder should be carried out with specific learning disorders (dyscalculia, dyslexia. Dyscalculia is a specific learning disorder in counting, manifested at different ages of the preschool and school population. The term dyslexia comes from two Greek words"dis"-complexity and "lexis"-word, literally translated dyslexia means "difficulty with words". Dyslexia manifests itself in violations of the reading process, in constantly repeating mistakes. People suffering from dyslexia skip sounds, swap letters or add unnecessary ones, distort the sound of words, sometimes “swallow” whole syllables.), Asthenic syndromes (this condition is manifested by increased fatigue, weakening or loss of the ability to prolonged physical and mental stress. In patients irritable weakness is observed, expressed by increased excitability and exhaustion quickly following it, affective lability with a predominance of low mood with features of capriciousness and displeasure, as well as tearfulness.) against the background of intercurrent diseases (comorbidities), thyroid diseases, mild oligophrenia and schizophrenia . Differential diagnosis is often difficult, since attention deficit disorder can be combined with a number of other diseases and conditions, most often with psychiatric pathology (depression, panic attacks, obsessive thoughts).

The system of treatment and observation of children with attention deficit is not developed enough, due to the ambiguity of the pathogenesis of the disease. There are non-drug and drug methods of correction.

Non-drug correction includes methods of behavior modification, psychotherapy, pedagogical and neuropsychological correction. The child is recommended a sparing mode of learning - the minimum number of children in the class (ideally no more than 12 people), a shorter duration of classes (up to 30 minutes), the child's stay in the first desk (eye contact between the teacher and the child improves concentration). From the point of view of social adaptation, it is also important to purposefully and long-term education of socially encouraged norms of behavior in a child, since the behavior of some children has antisocial features. Psychotherapeutic work is needed with parents so that they do not regard the child's behavior as "hooligan" and show more understanding and patience in their educational activities. Parents should monitor the observance of the day regimen of a "hyperactive" child (meal time, homework, sleep), provide him with the opportunity to expend excess energy in physical exercises, long walks, running. Fatigue while performing tasks should also be avoided, as this may increase hyperactivity. "Hyperactive" children are extremely excitable, so it is necessary to exclude or limit their participation in activities associated with the accumulation of a large number of people. Since the child has difficulty concentrating, you need to give him only one task for a certain period of time. The choice of partners for games is important - the child's friends should be balanced and calm.

Drug therapy for attention deficit hyperactivity disorder is appropriate when non-drug methods of correction are ineffective. Psychostimulants, tricyclic antidepressants, tranquilizers and nootropic drugs are used. In international pediatric neurological practice, the effectiveness of two antidepressant drugs, amitriptyline and Ritalin, belonging to the amphetamine group, has been empirically established.

The drug of first choice in the treatment of attention deficit hyperactivity disorder is methylphenidate (Ritalin, Centedrin, Meredil). The positive effect of methylphenidate is observed in 70-80% of children. The drug is administered once in the morning at a dose of 10 mg (1 tablet), but the daily dose can reach 6 mg/kg. The therapeutic effect occurs quickly - during the first days of admission. Despite the high efficacy of methylphenidate, there are limitations and contraindications to its use associated with frequent side effects. The latter include growth retardation, irritability, sleep disturbance, loss of appetite and body weight, provocation of tics, dyspeptic disorders, dry mouth and dizziness. The drug may develop addiction. Contraindications to taking the drug are the child's age less than 6 years, pronounced states of anxiety and agitation, as well as the presence of a family history of tics and Tourette's syndrome. Unfortunately, methylphenidate is not available on the Russian pharmaceutical market. In domestic pediatric practice, the drug amitriptyline, which has fewer side effects, is more widely used. Amitriptyline is prescribed for children under 7 years old at a dose of 25 mg / day, for children over 7 years old - at a dose of 25-50 mg / day. The initial dose of the drug is 1/4 tablet and increases gradually over 7-10 days. The effectiveness of amitriptyline in the treatment of children with attention deficit disorder is 60%.

Single domestic studies also prove the effectiveness of the use of nootropic drugs (nootropil, piracetam and instenon) in the treatment of children with attention deficit hyperactivity disorder. N.N. Zavodenko and observed the positive effect of instenon in 59% of patients. Instenon was administered at a dose of 1.5 tablets per day to children aged 7-10 years for 1 month. There was an improvement in the characteristics of behavior, motor skills, attention and memory.

The greatest effect in the treatment of attention deficit hyperactivity disorder is achieved by combining various methods of psychological work (both with the child himself and with his parents) and drug therapy.

The prognosis is relatively good, as in a significant proportion of children, symptoms disappear during adolescence. Gradually, as the child grows, disturbances in the neurotransmitter system of the brain are compensated, and some of the symptoms regress. However, in 30-70% of cases, clinical manifestations of attention deficit hyperactivity disorder (excessive impulsivity, irascibility, absent-mindedness, forgetfulness, restlessness, impatience, unpredictable, rapid and frequent mood changes) can also be observed in adults. The factors of the unfavorable prognosis of the syndrome are its combination with mental illness, the presence of psychopathology in the mother, as well as the symptoms of impulsivity in the patient himself. Social adaptation of children with attention deficit hyperactivity disorder can be achieved only with the interest and cooperation of the family, school and society.

The occurrence of complications with concentration and concentration, as well as the appearance of a neurobehavioral disorder, indicate the disease "Attention Deficit Disorder" or ADD for short. Children are primarily affected by the disease, but the manifestation of the disease in adults is not excluded. The problems of the disease are characterized by varying degrees of severity, so ADD should not be underestimated. The disease affects the quality of life, its susceptibility, as well as relationships with other people. The disease wears enough complex nature therefore, patients have problems with learning, performing any work and mastering theoretical material.

It is the children who partly become hostages of this disease, therefore, in order to prevent such a deficiency, it is worth learning as much as possible about it, and this material will help in this.

Description and types

This disease is a deviation in a person that is caused by high intelligence. A person with such an indisposition has difficulties not only with mental development, but also with physical development, which is already referred to as Attention Deficit Hyperactivity Disorder.

Children are the main contingent that is prone to the manifestation of this disease, but in rare cases there are symptoms of malaise in adults. According to many years of research, it has been found that the occurrence of attention deficit hyperactivity disorder in adults is associated solely with the nature of genes.

In children, attention deficit hyperactivity disorder is quite common, and it can be detected both after birth and at a later age of the child. Mostly the syndrome occurs in boys, and only in rare cases in girls. If you look at the example, then in almost every classroom there is one child with attention deficit hyperactivity disorder.

The syndrome is divided into three types, which are called:

• Hyperactivity and impulsivity. This species is characterized by inherent signs of impulsivity, irascibility, nervousness and increased activity in a person.
• Carelessness. Only one sign of inattention appears exclusively, and the possibility of hyperactivity is excluded.
• Mixed look. The most common form, which manifests itself even in adults. It is characterized by the predominance of the first and second signs in humans.

In the language of biology, ADHD is a dysfunction of the central nervous system, characterized by the formation of the brain. Brain problems are the most dangerous and unpredictable diseases.

Causes

The development of attention deficit hyperactivity disorder is hidden in several reasons that have been established by scientists on the basis of facts. These reasons include:

• genetic predisposition;
• pathological influence.

genetic predisposition is the first factor by which the development of malaise in the patient's relatives is not excluded. Moreover, in this case, both distant heredity (i.e., the disease was diagnosed in ancestors) and near (parents, grandparents) play a huge role. The first signs of attention deficit hyperactivity disorder in a child lead caring parents to a medical institution, where it turns out that the predisposition to the disease in a child is associated precisely with genes. After examining the parents, it often becomes clear where this syndrome came from in the child, since in 50% of cases this is exactly the case.

Today it is known that scientists are working on isolating the genes that are responsible for this predisposition. Among these genes important role is given to DNA regions that control the regulation of dopamine levels. Dopamine is the main substance responsible for the correct functioning of the central nervous system. Dysregulation of dopamine due to genetic predisposition leads to the disease of attention deficit hyperactivity disorder.

Pathological influence plays an important role in answering the question about the causes of attention deficit hyperactivity disorder. Pathological factors can serve as:

• the negative impact of drugs;
• influence of tobacco and alcoholic products;
• premature or prolonged labor;
• interrupt threats.

If a woman allowed herself to use illegal substances during pregnancy, then the possibility of having a child with hyperactivity or this syndrome is not excluded. There is a high probability of the presence of attention deficit hyperactivity disorder in a child born at 7–8 months of pregnancy, i.e. premature. In 80% of such cases, pathology occurs in the form of ADHD.

The causes of the development of the disease in children are also distinguished, if a woman, being in a position, is fond of taking artificial food additives, pesticides, neurotoxins and more. It is also possible to provoke this syndrome in adults due to the passion for bioadditives, artificial hormones, etc.

Until the end, the unexplored causes of provoking attention deficit hyperactivity disorder are:

• the presence of infectious diseases in a pregnant woman;
• chronic diseases;
• incompatibility of Rh factors;
• environmental degradation.

It follows that attention deficit hyperactivity disorder is an unusual disorder that occurs due to the action of one or more of the above factors. The most basic and proven is the cause of genetic influence.

Symptoms of the disease

Symptoms of the disease have a pronounced manifestation in children, so consider the main signs of attention deficit hyperactivity disorder in childhood.

Most often, the impetus for contacting treatment centers become educators, teachers and educators who discover some deviations in children. Symptoms of the disease have the following signs:

Impaired focus and attention. The child cannot focus on one thing, he is constantly going somewhere, thinking about something of his own. The performance of any task ends with errors, which is caused by a disorder of attention. If the child is addressed, then there is a feeling of ignoring speech, he understands everything, but cannot assemble the heard speech into one whole. Children with attention disorder are completely unable to plan, organize and perform a variety of tasks.

Symptoms are also expressed in the form of absent-mindedness, while the child tends to lose his things, be distracted by any trifles. Forgetfulness appears, and the child categorically refuses to take on mental affairs. Relatives have a feeling of remoteness of the child from the whole world.

Hyperactivity. It manifests itself together with the syndrome, therefore, in addition, parents can track the following symptoms in the child:

Impulsiveness. Symptoms of impulsivity include the following manifestations:

1. A premature answer to a question that was not voiced to the end.
2. Wrong and quick answers to the questions asked.
3. Refusal to complete any task.
4. Does not listen to the answers of his peers, can interrupt them during the answer.
5. Constantly talking off-topic, perhaps a manifestation of talkativeness.

Symptoms of Attention Deficit Hypersensitivity Syndrome have their own characteristics of manifestation for various categories children according to age. Let's consider in more detail.

Symptoms in children of different ages

Consider what symptoms are inherent in children of the following ages:

• preschool;
• school;
• teenage.

AT preschool age from three to seven years, the symptoms are difficult to trace. ADHD in early age diagnosed by a doctor.

From the age of three, caring parents may notice the manifestation of hyperactivity in the form of a constant movement of the child. He cannot find something to do, constantly rushes from one corner to another, does not take on various mental tasks and constantly chats. Symptoms of impulsivity are due to the impossibility of restraining oneself in a given situation, the child constantly interrupts his parents, shouts over them, takes offense and even becomes irritable.

Games with such children lead to devastating consequences: they break toys, splashing out all their energy; it costs them nothing to harm their peers and even older children. Patients with ADHD are a kind of vandals for whom nothing is essential. Their brains have little to no control over their movements. There are also symptoms of developmental delays from their peers.

Reaching the age of seven When it's time to go to school, children with ADHD have more and more problems. Children with Attention Deficit Hyperactivity Disorder are unable to keep up with their peers in terms of mental development. In the classroom, they behave unrestrainedly, do not pay attention to the teacher's remarks, and do not listen to the material presented at all. They can be taken to complete the task, but after a while they actively switch to another one without finishing the first one.

At school age, ADHD in children manifests itself more clearly, as this is actively noticed by the teaching staff. Among all the children in the class, ADHD patients are visible even to the naked eye, for this it is enough to spend a couple of lessons, and it will not be difficult even for a person without a medical education to identify the presence of the syndrome in children.

Children not only lag behind in development, but also try in every way to incite their peers to this: they disrupt lessons, interfere with their classmates to perform any actions, and at a later age they can argue and even snap with the teacher. For a teacher in the classroom, such a child is a real test, because of which the lessons become unbearable.

Reaching adolescence , the symptoms of ADHD begin to subside a little, but in fact there is a certain change in the signs of the disease. Impulsivity is replaced by fussiness and a feeling of inner restlessness. Teenagers are taken to perform certain tasks, but everything also ends unsuccessfully, no matter how hard they try.

Irresponsibility and lack of independence are all signs of attention deficit hypersensitivity syndrome in adolescents. They are not able (even at this age) to do the lessons on their own, there is no organization, planning of the day and distribution of time.

Relationships with peers are deteriorating, as they do not communicate at the proper level: they are rude, do not restrain themselves in their statements, do not observe subordination with teachers, parents and classmates. Along with this, failures lead to the fact that adolescents have low self-esteem, they become less and less psycho-resistant and more and more irritable.

They feel negative attitudes towards themselves from parents and peers, which leads to the emergence of negative and even suicidal thoughts. Parents constantly set them as a bad example, thereby causing dislike and antipathy towards their sisters and brothers. In the family, children with attention deficit hypersensitivity become unloved, especially if more than one kid grows up in the house.

Symptoms of the disease in adults

Symptoms in adults compared to children are different, but this does not change end result. The same irritability is inherent, plus depressive disorders and the fear of trying oneself in a new field are added to this. In adults, the symptoms are more secretive, since at first glance the signs are due to calmness, but at the same time, imbalance.

At work, adults with ADHD are not smart, and therefore work as simple clerks is their maximum. Often they find it difficult to cope with mental types of work, so they do not have to choose.

Mental disorders and isolation lead to the fact that the ADHD patient finds painkillers for problems in alcohol, tobacco, psychotropic and narcotic substances. All this only aggravates the situation and causes complete degradation of a person.

Diagnostics

Diagnosis of the disease is not confirmed on any special equipment, but is carried out by observing the behavior of the child, his development and mental abilities. The diagnosis is established by a qualified doctor who takes into account all the information from parents, teachers and peers.

Diagnosis of ADHD is carried out using the following methods:

1. Collection of information about the child regarding the visit to the doctor.
2. Study of dopamine metabolism.
3. To identify the diagnosis, the doctor may prescribe the passage of Doppler ultrasound, EEG and video EEG.
4. A neurological examination is carried out, on which the use of the NESS technique is not excluded.
5. Genetic examination of parents to identify the causes of the disease.
6. MRI. A complete study of a person will show other deviations that may have influenced the provocation of the disease.
7. Conducting methods of neuropsychological testing for children of school and older ages is not excluded.

Based on all these methods, the preliminary diagnosis of ADD and hypersensitivity is either confirmed or refuted.

Treatment

The treatment of ADHD should include a complex impact, which should be due to the use of methods for correcting behavior, psychotherapy and neuropsychological correction. Treatment also implies the impact not only through various methods on the patient, but also the help of parents, teachers and relatives.

Initially, the doctor conducts a conversation with the people around the child and explains to them the features of the disease. The main feature is that such negative and reckless behavior of the child is not intentional. For a positive influence on the patient, contributing to his recovery, it is necessary that the people around him treat him positively. After all, first of all, it is with this that the treatment begins.

Parents have two main tasks that they must perform and monitor this:

Task #1: upbringing should not include a pitiful attitude towards the child and permissiveness. One should not feel sorry for him, address him with excessive love, this will only exacerbate the symptoms.

Task #2: do not impose increased requirements and tasks with which he cannot cope. This will contribute to the fact that his nervousness will increase and self-esteem will fall.

For children with ADHD, parental mood swings are much more negative impact than for normal children. Treatment must also come from the teachers with whom children spend most of their time. The teacher should control the situation and relations of children in the classroom and in every possible way instill love and integrity. In case of manifestations of aggression by a patient with ADHD, one should not scold and even more so call the parents, but it is worth trying to explain to him the correct attitude. After all, it is worth remembering that all manifestations of it are unintentional.

Note! It is also impossible for the child to feel from those around him that he is being treated as if he were sick. This will lower his self-esteem and will only lead to an exacerbation of symptoms.

Medication treatment

The complex uses treatment with the help of taking medications, which are formed according to individual indicators. To medications To overcome the disease ADHD include the following medications:

1. For CNS stimulation: Methylphenidate, Dextroamphetamine, Pemoline.
2. Tricyclic antidepressants: Imipramine, Amitriptyline, Thioridazine.
3. Substances of the nootropic series: Nootropil, Cerebrolysin, Semax, Phenibut.

It is stimulants that have a huge impact on the recovery of a person with ADHD. It was found that treatment with these drugs implies the influence of pathogenetic factors that have a targeted effect on the brain system.

The main advantage of such drugs is the speed of influence on the patient's recovery, that is, the effect of recovery is noticeable almost in the first week after taking the drugs. Among the signs of a cure, it is worth highlighting the manifestation of greater attentiveness, less distractibility, attempts to bring any matter to the end.

Concentration problems are a real scourge of modern society: everyone more people complain of fatigue, distractibility and inability to focus on an important task. This can be both a consequence of multitasking and information overload, and a manifestation of a specific mental disorder - attention deficit hyperactivity disorder. "Theory and Practice" tried to figure out what ADHD is and how to deal with it.

Attention deficit hyperactivity disorder reveals everything weak spots psychiatry as a science: it is hard to find a more controversial, vague and mysterious disorder. Firstly, there is a high risk of misdiagnosis, and secondly, scientists are still arguing whether this is a disease at all or a variant of the norm - and if it is still a disease, can ADHD be considered a full-fledged diagnosis or is it just a set of symptoms, perhaps not united by one reason.

The history of attention deficit disorder research (which did not get its current name until the second half of the 20th century) began in 1902, when pediatrician Georg Frederick Still described a group of impulsive, learning-poor children and hypothesized that such behavior was not due to developmental delays. The hypothesis was subsequently confirmed - although the doctor could not explain the reasons for this phenomenon. 25 years later, another physician, Charles Bradley, began prescribing hyperactive children with benzedrine, a psychostimulant derived from amphetamine. Stimulants proved to be very effective, although again, for a long time, doctors could not understand the mechanism of their effect on patients. In 1970, the American psychiatrist Conan Kornecki first hypothesized that the disease may be due to a reduced level of certain neurotransmitters in the brain and such drugs help to increase it. The American Psychiatric Association proposed the first methods for diagnosing the syndrome only in 1968, and in Russia they started talking about it only in the second half of the 1990s - and then without much enthusiasm.

The wary attitude towards this topic is understandable: the study of ADHD and the development of diagnostic criteria have been accompanied by scandals since the 1970s - the creators of the American DSM-4 handbook were accused of causing an epidemic of overdiagnosis in children and adolescents. Some doctors and parents chose medication as the path of least resistance: it was easier to stuff difficult kids with drugs than to deal with their features. pedagogical methods. In addition, amphetamine-type drugs prescribed to active and uncontrollable children sometimes migrated into the arsenal of their mothers-housewives: stimulants gave strength and helped to cope with housework (the most spectacular horror story on the topic of what domestic abuse of such drugs leads to is the story of a mother main character in "Requiem for a Dream"). In addition, the criteria for diagnosing the disorder changed several times, which also caused a flurry of criticism. As a result, attention deficit disorder turned out to be highly discredited and for some time fell into the tops of “non-existent diseases”.

Nevertheless, the experience of psychiatrists has shown that the problem, no matter how you classify it, still exists: a certain percentage of the population experiences difficulties associated with poor concentration, inability to self-organize, impulsivity and hyperactivity. Often these features persist into adulthood, and manifest themselves strongly enough to create serious problems for a person (especially an ambitious one) in school, at work and in his personal life. But usually the disorder is perceived by others and by the patient himself not as a serious illness, but as a manifestation of personal shortcomings. Therefore, the majority of adults with such a set of symptoms do not go to the doctors, preferring to fight their "weak character" by strong-willed efforts.

Attention deficit disorder causes difficulties for patients even at school: a teenager with such a diagnosis, even if he has a high IQ, finds it difficult to learn material, communicate with peers and teachers. A person with ADHD can immerse himself in a topic that is subjectively interesting to him (however, as a rule, not for long - such people are prone to frequent changes in priorities and hobbies) and show bright abilities, but it is difficult for him to perform even simple routine work. At the same time, he is bad at planning, and when high level impulsiveness - to anticipate even the immediate consequences of their actions. If all this is also combined with hyperactivity, such a teenager turns into nightmare a school teacher - he will get poor grades in "boring" subjects, surprise others with impulsive antics, disrupt order and sometimes ignore social conventions (because it will be difficult for him to focus on the expectations and requirements of others).

It used to be thought that the disorder “resolves” itself with age - but according to recent data, about 60% of children with ADHD continue to have symptoms of the disease into adulthood. An employee who is unable to sit through the end of the meeting and misses important instructions, a talented specialist who breaks important deadlines, is suddenly distracted by some personal project, an “irresponsible” partner who is unable to organize household life or suddenly spends a lot of money on some strange whim - all of them can be not just weak-willed slobs, but people suffering from a mental disorder.

Diagnostic problems

According to various estimates, 7-10% of children and 4-6% of adults suffer from this disease. At the same time, the popular idea of ​​​​an ADHD patient as exclusively an impulsive fidget is already outdated - modern science distinguishes three types of the disorder:

With an emphasis on attention deficit (when a person does not have signs of hyperactivity, but it is difficult for him to concentrate, work for a long time on the same task and organize his actions, he is forgetful and easily tired)

With an emphasis on hyperactivity (the person is excessively active and impulsive, but does not experience significant difficulties with concentration)

mixed option

According to the American classifier of mental disorders DSM-5, the diagnosis of attention deficit/hyperactivity disorder can be established no earlier than 12 years. In this case, the symptoms should be presented in different situations and settings and manifest themselves strongly enough to noticeably affect a person's life.

ADHD or bipolar disorder? One of the problems in diagnosing the syndrome is that, according to some signs, the syndrome overlaps with other mental illnesses - in particular, with cyclothymia and: hyperactivity can be confused with hypomania, and fatigue and problems with concentration can be confused with signs of dysthymia and depression. In addition, these disorders are comorbid - that is, the probability of getting both at the same time is quite high. In addition, suspicious symptoms may be associated with non-psychiatric illness (such as severe head trauma or poisoning). Therefore, experts often recommend that those who suspect that they have attention deficit disorder, before contacting psychiatrists, undergo a routine physical examination.

gender nuances. Last year, The Atlantic published an article stating that women experience ADHD differently than men. According to the studies described in the article, women with this disorder are less likely to show impulsivity and hyperactivity and more often - disorganization, forgetfulness, anxiety and introversion.

The T&P editors remind you that you should not completely rely on self-diagnosis - if you suspect that you have ADHD, it makes sense to consult a specialist.

Loss of control

The genetic factor plays a big role in the development of ADHD - if your close relative suffers from this syndrome, the likelihood that you will be diagnosed with the same diagnosis is 30%. Current theories link ADHD to functional disturbances in the neurotransmitter systems of the brain - in particular, to the balance of dopamine and norepinephrine. Dopamine and norepinephrine pathways are directly responsible for the executive functions of the brain - that is, for the ability to plan, to switch between different stimuli by volitional effort, to flexibly change one's behavior depending on changing environmental conditions and to suppress automatic reactions in favor of conscious decisions (this is what Nobel laureate Daniel Kahneman calls ). All this helps us to control our behavior. Another function of dopamine is to maintain a "reward system" that controls behavior by responding to "correct" (in terms of survival) actions with pleasant sensations. Violations in the work of this system affect motivation. In addition, people with attention deficit hyperactivity disorder may have abnormal serotonin balance. This can cause additional problems with organization, timing, concentration, and emotional control.

Disorder or personality trait?

Now gaining popularity is the concept of neurodiversity - an approach that considers different neurological features as a result of normal variations in the human genome. In the field of interest of adherents of neurodiversity - as sexual orientation and gender identity, as well as some genetically determined mental illnesses, including autism, bipolar disorder, and attention deficit disorder. Some scientists believe that many of the behaviors that are diagnosed with ADHD are natural personality traits that do not indicate the presence of unhealthy abnormalities. But since such traits make it difficult for a person to function in modern society, they are labeled "disorders".

Psychotherapist Tom Hartman developed the spectacular "hunter and farmer" theory that people with ADHD have retained the genes of primitive people that are responsible for the behavior that is optimal for hunters. Over time, humanity switched to agriculture, which required more patience, and "hunting" qualities - quick reaction, impulsiveness, susceptibility - began to be considered undesirable. According to this hypothesis, the problem lies only in the setting of tasks, and the ability of people with the syndrome to "hyperfocus" - a strong concentration on a subjectively interesting task to the detriment of everyone else - can also be seen as an evolutionary advantage. True, Hartman can hardly be considered an objective researcher - his son has been diagnosed with ADHD.

But in any case, there is a sound grain in this theory: since one of the most important criteria mental health- the ability to successfully cope with everyday tasks, you can smooth out many problems by choosing the right field of activity. That is, one where routine processes and patience play a lesser role and the "sprint" temperament, the ability to improvise, curiosity and the ability to easily switch between various kinds activities. For example, it is believed that with ADHD you can make a good career in sales or entertainment, in the arts and "adrenaline" professions (say, firefighter, doctor or military). You can also become an entrepreneur.

How to be treated

Medicines. Psychostimulants containing amphetamine (Aderol or Dexedrine) or methylphenidate (Ritalin) are still used to treat ADHD. Other groups of drugs are also prescribed, for example, norepinephrine reuptake inhibitors (atomoxetine), hypotension drugs (clonidine and guanfacine) and tricyclic antidepressants. The choice depends on the specific manifestations of ADHD, additional risks (tendency to drug addiction or related mental disorders) and the desire to avoid certain side effects (an approximate list of "side effects" from different drugs can be viewed)

Since in Russia psychostimulants have firmly settled in the list of dangerous drugs that are not even available by prescription, domestic psychiatrists use atomoxetine, guanfacine or tricyclics.

Psychotherapy. It is believed that cognitive behavioral therapy helps with ADHD, which, unlike many other psychotherapeutic schools, focuses on working with the conscious mind, and not the subconscious mind. For a long time this method has been successfully used in the fight against depression and anxiety disorder - and now there are special programs for the treatment of attention deficit disorder. The essence of such therapy is to develop awareness and not allow irrational patterns of behavior to take over a person's life. Classes help control impulses and emotions, fight stress, plan and systematize your actions and bring things to an end.

Nutrition and supplements. You can try to adjust your diet in accordance with the advice of foreign medicine. The most common advice is to take fish fat and avoid spikes in blood glucose levels (i.e. say no to simple carbs). There is also evidence showing a relationship between iron, iodine, magnesium, and zinc deficiencies in the body and increased symptoms. Some studies have shown that small doses of caffeine can help you concentrate, but most experts still don't recommend binge drinking. In any case, adjusting the diet is more of a "maintenance" measure than a full-fledged way to deal with the disorder.

Schedule. People with ADHD, more than anyone else, require planning and a clear daily routine. compensate internal problems external “backbone” helps with systematization and time management: timers, organizers and to-do-lists. Any large projects should be broken down into small tasks and planned in advance for periods of rest and possible deviations from the schedule.

Attention deficit hyperactivity disorder (ADHD) is a disorder of neurological and behavioral development in children, the course of this disease is chronic. As a rule, the first symptoms of this disease appear in late preschool and school age. Many of the symptoms of ADHD are not "specific" for the disease and can be present to some extent in absolutely all children. Children with ADHD primarily have difficulty concentrating, increased motor activity (hyperactivity), and impulsive behavior (virtually uncontrollable).

Reasons for development

ADHD is a persistent and chronic syndrome for which there is no cure in modern medicine. It is believed that children can "outgrow" this syndrome, or adapt to its manifestations in adulthood.

In the 1970s, there was a lot of controversy about ADHD among medical professionals, educators, parents, and politicians. Some said that this disease does not exist at all, others argued that ADHD is genetically transmitted, and there are physiological grounds for the manifestation of this condition. A number of scientists prove the influence of climate conditions on the development of ADHD.

There is reason to believe that acute or chronic intoxication (alcohol, smoking, drugs) during pregnancy and breastfeeding may further affect the manifestation of ADHD in children. Preeclampsia, toxicosis, eclampsia in childbirth, premature birth, intrauterine growth retardation, C-section, protracted labor, late attachment to the breast, artificial feeding from birth and prematurity are also risk factors for the development of this syndrome.

Traumatic brain injury and past infectious diseases may influence the development of hyperactivity in children. With hyperactivity, the neurophysiology of the brain is disturbed; in such children, a deficiency of dopamine and norepinephrine is found.

signs

It is customary to distinguish three types of ADHD: a case of attention deficit, a case of child hyperactivity and impulsivity, and a mixed type.

According to the statistics of American scientists, this disorder is observed on average in 3-5% of American children, most often the signs of this disease appear in boys. Many of the signs of ADHD in children are not always detected. The first symptoms of hyperactivity manifest in kindergarten and in primary school. Psychologists should observe children in the classroom and how they behave at home and on the street.

Children with ADHD are not only not attentive, they are also very impulsive. They have no control over behavior in response to any demands. Such children quickly and independently react to any situation that has arisen, without waiting for instructions and recommendations from parents and other adults. Such children do not correctly evaluate the requirements of teachers and assignments. Children with hyperactivity cannot properly assess the results of their actions, and what a destructive or negative impact they can have. Such children are very capricious, they do not have a sense of fear, they expose themselves to unnecessary risks in order to show themselves to their peers. Children with hyperactivity very often get injured, poisoned, spoil other people's property.

Diagnostics

According to international criteria, children can be diagnosed with ADHD if they have the corresponding symptoms no earlier than at the age of 12 (according to foreign publications, this diagnosis is also valid at the age of six). The signs of ADHD should show up in a variety of settings and situations. To make a diagnosis of ADHD, you need to have six main symptoms (from the list below), and if the signs of the disease persist and are older than 17 years, 5 symptoms are enough. Signs of the disease should appear stably for six months or more. There is a certain gradation of symptoms. Inattention syndrome and hyperactivity syndrome have their own symptoms, and they are considered separately.

inattention

Increased activity in children with ADHD

Hyperactivity in children with ADHD is always and everywhere.

Behavior with ADHD can be "unbearable" for parents, teachers, and other family members. Most often, it is the parents who are blamed for the poor upbringing of their child. It is very difficult for parents themselves with such children, and they constantly experience a sense of shame for the behavior of their son or daughter. Constant remarks at school about the hyperactivity of a daughter or son, on the street - from neighbors and friends.

The fact that a child has a diagnosis of ADHD does not mean that his parents did not raise him well and did not teach him how to behave correctly. Parents of these children should understand that ADHD is a disease that requires proper treatment. Parents and the internal situation in the family will help the boy or girl get rid of increased hyperactivity, become more attentive, study better at school, and later adapt to adulthood. Each small man must discover their inner potential.

Children are in great need of parental attention and care. In the world modern technologies and if there is money, parents can buy any toy for their child, the most modern phone, tablet and computer. But, no modern "toys" will give your baby warmth. Parents must not only feed and clothe their children, they must devote all their free time to them.

Very often, parents get tired of their children with hyperactivity and try to shift all the worries about upbringing to grandparents, but this is not a way out of the current situation. difficult situation. Parents of such "special" children should contact a psychologist and solve this problem together with teachers and medical workers. The sooner parents realize the seriousness of ADHD, and the sooner they turn to specialists, the better the prognosis for curing this disease.

Parents should arm themselves with knowledge about this disease. There is a lot of literature on this subject. Only in close cooperation with a doctor and a teacher can one achieve good results in the treatment of this disease. ADHD is not a "label" and should not be afraid of this word. You need to talk to the teachers at school about the behavior of your beloved child, discuss any problems with them, and make sure that the teachers understand what is happening with their boy or girl.