|According to the experts, attention deficit disorder with or without hyperactivity (ADHD) has probably always existed. It has however been described clinically at the beginning of the XX th century. He has had several denominations: hyperactive child syndrome (first appearance in the Diagnostic and Statistical Manual of Mental Disorders in 1968), attention deficit disorder with or without hyperactivity (1980), Attention Deficit Hyperactivity Disorder or ADHD (1987).
Today, we use the terms attention deficit hyperactivity disorder (ADHD), or attention deficit disorder with or without hyperactivity (ADHD), adopted in 2000 in Quebec, which we used for this record.
People with Attention Deficit Hyperactivity Disorder (ADHD) have difficulty concentrating, paying attention to, and completing complex tasks. They often have trouble staying in place, waiting their turn, and often acting impulsively.
Although these behaviors may be found in all humans, they are abnormally pronounced and prolonged in those with ADHD. They are also present in all the circumstances of life (not only at school or only at home, for example).
|ADHD in adolescents and adults
ADHD is often more noticeable in children than in adults. It has also been much more studied in children. However, it persists in adolescence in 40% to 70% and to adulthood in about half of children who are affected 8. It is estimated that about 4% of adults suffer from attention deficit with or without hyperactivity 1. Sometimes, ADHD is diagnosed only in adulthood.
Three symptoms characterize ADHD: inattention, hyperactivity and impulsivity. They may be present in varying degrees. For example, a child who is still “in the moon”, who does not complete his homework, who does not hold the instructions and who constantly loses his personal belongings, but who is not particularly agitated, could be suffering from ADHD. Another, especially hyperactive, impulsive and agitated, but who can concentrate relatively well when tasks are of interest to him could also be reached. In general, hyperactivity and impulsivity are more pronounced in boys than in girls.
The vast majority of people with ADHD have a neurological origin that may be dependent on heredity and environmental factors. Experts are emphatic about this: ADHD is not caused by unmet emotional needs or psychosocial problems, although it can be exacerbated by these factors.
ADHD is usually diagnosed around 7 years old. However, children with ADHD have difficult behaviorsbefore they return to school, often as young as 2 years old.
|ADHD and intelligence
There is no link between ADHD and the intelligence of the child. The academic difficulties most children experience with ADHD are most often related to behavioral or attention deficit disorders, but not to a lack of intelligence.
Prevalence of ADHD
It is the most common neurobehavioral disorder in children: 5% to 10% of them would be affected. It has long been argued that it is more prevalent among boys, probably because boys with ADHD have a more hyperactive behavior, which is more noticeable than that of girls (where inattention predominates). However, the most recent studies do not seem to reveal significant differences between the sexes.
Diagnostic of ADHD
It is not easy to diagnose ADHD because the same symptoms may result from other disorders more or less closely related to ADHD. Therefore, the diagnosis of ADHD will be based on a thorough assessment of the child and his / her environment.
The doctor is interested first of all in the psychomotor development of the child. Parents are invited to provide a history of the child’s development. Of psychological and neuropsychological testing may also be useful to assess its IQ and academic learning potential. Teachers can also contribute to the assessment of the child. The latter is finally questioned about his current difficulties.
There is no neurological or psychological test that can formally diagnose the disease. According to the criteria of the American Psychiatric Association, one must observe a number of symptoms of inattention or hyperactivity / impulsivity in a child that ADHD is diagnosed.
For the diagnosis to be confirmed, it is important to know that:
- some symptoms must be present before the age of 7;
- Symptoms should be as much at home as at nursery (day care) or at school, although their intensity may vary from place to place;
- the symptoms must have been present for at least 6 months.
Causes of ADHD
The ADHD is a complex condition that has no single cause. It is a disorder of neurological origin, related to abnormalities of development and functioning of the brain.
Thus, researchers have observed that in children or adults with ADHD, the brain areas responsible for attention, sense of organization and movement control become abnormally active or have a singular anatomy. They also noted an imbalance in the levels of certain chemical messengers (neurotransmitters) in the brain, such as dopamine and norepinephrine .
factors play a major role in the development of ADHD. Indeed, in studies conducted on identical twins, researchers have discovered that when a twin has ADHD, in 80% of cases, the other are also. In addition, most children with ADHD have at least one family member who suffers from it. Overall, a quarter of parents of ADHD children have a history with the disease turn. Several genes involved in ADHD have been identified, but genetic factors alone do not explain the disease.
Exposure to certain toxic substances (alcohol, tobacco, lead, pesticides, etc.) during fetal life would explain 10% to 15% of cases. Other environmental factors, not all identified, probably contribute to the onset of the disease in genetically predisposed children.
A brain injury or infection, a lack of oxygen at birth, or other birth-related complications can increase the risk of ADHD. See the sections at Risk and Risk Factors.
Many children with ADHD also have one or more of the following conditions.
- Oppositional disorder with provocation. Hostile, suspicious, and negative attitude to authority figures that tend to manifest more frequently in impulsive and hyperactive children.
- Conduct problems. Deep antisocial behavior that can result in the theft of property, the search for combat and generally destructive behavior towards humans and animals.
- Depression. Often present, depression results from the rejection that the child lives because he cannot control himself. He often suffers from poor self-esteem. Depression can occur in both children and adults with ADHD – especially if other family members have suffered.
- Anxiety disorders. Excessive anxiety and nervousness associated with various physical symptoms (tics, rapid heartbeat, sweating, dizziness, etc.) or obsessive compulsive disorder.
- Learning disabilities. About 20% of children with ADHD have delayed language development and fine motor skills (including writing) and require specialized education.
As adults, ADHD can cause serious behavioral and social problems. Nearly half of adults with ADHD suffer from anxiety disorders that disrupt their social integration and life balance. In addition, people with ADHD are more likely than others to be addicted to alcohol or drugs.
It is therefore very important to make every effort to detect and treat ADHD as best as possible from childhood.
Symptoms of ADHD
The 3 main features of ADHD are inattention, hyperactivity and impulsivity. They are manifested as follows, with varying intensity.
In the child
- Difficulty paying attention to a particular task or activity. However, the child can better control his attention if he has a great interest in an activity.
- Inattention errors in homework, work or other activities.
- A lack of attention to detail.
- Difficulty starting and completing homework or other tasks
- A tendency to avoid activities that require sustained mental effort.
- An impression that the child does not listen to us when talking to him.
- Difficulty remembering and applying instructions, although understood.
- A difficulty to organize.
- A tendency to be very easily distracted and forgetful in everyday life.
- Frequent loss of personal items (toys, pencils, books, etc.).
- A tendency to move your hands or feet often, squirming on your chair.
- Difficulty sitting in class or elsewhere
- A tendency to run and climb everywhere.
- A tendency to talk a lot.
- Difficulties to appreciate and to be interested in quiet games or activities.
- A tendency to interrupt others or answer questions that are not yet complete.
- A tendency to impose one’s presence, to burst into conversations or games. A difficulty to wait for his turn.
- An unpredictable and changing character.
- Frequent mood swings
- The child can be very noisy, antisocial, even aggressive, which can lead to rejection by others.
Warning. All children with “difficult” behavior do not have ADHD. Many situations can generate symptoms similar to those of ADHD. This is the case, for example, of a conflicting family situation, separation, incompatibility of character with a teacher or conflicts with friends. Sometimes undiagnosed deafness can explain a carelessness problem. Finally, other health problems can cause this type of symptoms or amplify them. Discuss with a doctor.
In the adult
The main symptoms of inattention, hyperactivity and impulsivity are expressed differently. The adult with ADHD leads a rather chaotic life.
- Less physical hyperactivity than during childhood.
- Immobility generates internal tension and anxiety.
- A search for thrills (for example, in extreme sports, speed, drugs or compulsive gambling).
- Low concentration capacity
- Difficult to organize daily and long term.
- Difficulty completing tasks
- Mood swings
- An angry and impulsive character (gets carried away easily, makes impulsive decisions).
- Low self-esteem
- Difficulty managing stress
- A difficulty to tolerate frustration.
- Little stability, both in the life of the couple and at work.
People at risk for ADHD
- People with a family history of ADHD.
- Children having a violent shock to the head.
- Children having bacterial meningitis.
- People born prematurely. Various factors, including birth weight, would influence the risk of developing ADHD. People born prematurely would also be more prone to learning disabilities.
- Those who lacked oxygen at the time of birth.
Risk factors for ADHD
- Alcohol or drug use during pregnancy Some studies suggest that alcohol abuse and maternal drug use during pregnancy can reduce the production of dopamine in children and increase the risk of ADHD.
- Smoking of the mother during pregnancy. Several studies suggest that pregnant women who smoke are from 2 to 4 times more likely to have a child with ADHD.
- Exposure to pesticides or other toxic substances (such as PCBs) during fetal life, but also during the childhood could contribute to the high prevalence of ADHD, as evidenced by several recent studies.
- Lead intoxication during childhood. Children are particularly sensitive to the neurotoxic effects of lead. This type of intoxication is however rare in Canada.
Prevention of ADHD
|Can we prevent?|
|It is difficult to prevent the onset of ADHD because its causes are still poorly understood and are largely genetic. However, ways must be found to reduce the risk of head shocks, meningitis, exposure to pollutants and heavy metal poisoning (including lead).
On the other hand, it is reasonable to think that pregnant women will give every chance to their future child by taking the following precautions:
|Measures to prevent the consequences|
|The ADHD affects the whole family, on learning and social integration. It is important to gather all the resources to help the child and his family (see below). This will prevent the occurrence of serious consequences in adolescence and adulthood (poor self-esteem, depression, dropping out of school, etc.).|
Medical treatments for ADHD
There does not seem to be any cure. The goal of management is to mitigate the consequences of ADHD in the child or adult, that is to say, his academic or professional difficulties, his suffering related to the rejection he often undergoes, his low self-esteem, etc.
Creating a context that allows the person with ADHD to live positive experiences is therefore part of the approach advocated by physicians, psychoeducators and remedial teachers. Parents also play a crucial role. Although many professionals accompany the child and the family, “parents remain the most important” therapists “for these children,”.
Here are the types of drugs used. They are not always necessary and they must always be associated with one or more psychosocial approaches (see below). Only a complete medical evaluation will determine if medication is required.
The methylphenidate (Ritalin, Rilatine, Biphentin, Concerta, and PMS-Méthylphénidate) is the drug by far the most used in ADHD. It does not cure the disorder or prevent its persistence in adulthood, but it reduces the symptoms as long as the person is in treatment.
|Ritalin and companion for adults
In adults, the treatment is similar, but the doses are higher. Some antidepressants are sometimes helpful. The treatment of ADHD in adults, however, has been less studied than in children, and recommendations vary from country to country.
It is a stimulant that increases the activity of dopamine in the brain. Paradoxically, it soothes the person, improves his concentration and allows him to live more positive experiences. In children, improvement of school results is often observed. Relationships are also more harmonious with parents and friends. The effects can be spectacular. With rare exceptions, methylphenidate is not prescribed before school age.
The dose varies from person to person. The doctor adjusts it according to the observed improvements and the undesirable effects (problems of sleep, loss of appetite, stomachaches or headaches, tics, etc.). The side effects tend to fade with time. If the dose is excessive, the person will be too quiet, or even idle. A readjustment of the dose is then necessary.
In the majority of cases, the drug is taken 2 or 3 times a day: one dose in the morning, another at noon, and if necessary, one last in the afternoon. Methylphenidate is also available as long-acting tablets, taken once a day, in the morning. It should be known that methylphenidate does not create any physiological or psychological addiction.
|The prescriptions of Ritalin
Doctors prescribe more and more Ritalin. In Canada, the number of prescriptions has increased five-fold from 1990 to 1997. It also doubled between 2001 and 2008.
Other drugs may be used as needed, such as amphetamine derivatives (Adderall, Dexedrine). Their effects (beneficial and undesirable) resemble those of methylphenidate. Some people respond better to one class of medication than another.
A non-stimulant drug, atomoxetine (Strattera), would also reduce the main symptoms of hyperactivity and inattention caused by ADHD. One of his interests is that he would not influence the quality of sleep. It would allow children to fall asleep faster and be less irritable compared to children taking methylphenidate. It would also reduce anxiety in children who suffer from it. Finally, atomoxetine may be an alternative for children in whom methyphenidate causes tics.
The child should be seen again 2 to 4 weeks after the start of treatment, then at regular intervals of a few months.
|In an advisory issued in May 2006, Health Canada states that drugs to treat ADHD should not be given to children or adults with heart conditions. hypertension (even moderate), atherosclerosis, hyperthyroidism or structural cardiac malformation. This warning is also for people who engage in intense cardiovascular activities or exercise. Indeed, medications to treat ADHD have a stimulating effect on the heart and blood vessels that can be dangerous in people with a heart condition. The doctor may, however, decide to prescribe them with the patient’s consent, after having carried out a thorough medical examination and an assessment of the risks and benefits.|
Various interventions can help the child, adolescent or adult to control their symptoms. There are multiple forms of support that help, for example, to improve attention and reduce anxiety related to ADHD.
These interventions include:
- consultations with a psychoeducator, an orthopedagogue or a psychologist;
- family therapy
- a support group;
- training to help parents take care of their hyperactive child.
The best results are achieved when parents, teachers, doctors and psychotherapists work together.
Live better with a hyperactive child
Since the hyperactive child has attention problems, he needs clear structures to promote his learning. For example, it’s better to give him one task at a time. If the task – or the game – is complex, it is best to break it down into steps that are easy to understand and do.
The hyperactive child is particularly sensitive to external stimuli. Being in a group or in a distracting environment (TV, radio, outdoor agitation, etc.) can act as a trigger or aggravating factor. For schoolworkor other tasks requiring concentration, it is therefore recommended to settle in a quiet place where there will be no stimulus likely to divert his attention.
For kids who have trouble falling asleep, some tips can help. Children can be encouraged to exercise physically during the day, but enjoy soothing activities such as reading before going to bed. You can also create a relaxing atmosphere (subdued lighting, soft music, essential oils with soothing properties, etc.). It is advisable to avoid television and video games in the hour or two hours before bedtime. It is also desirable to adopt a sleep routine that is as constant as possible.
Taking Ritalin often changes the eating habits of the child. In general, he has less appetite for lunch and more for dinner. If so, give the child the main meal when the child is hungry. For lunch, favor small portions of varied foods. If necessary, nutritious snacks can be offered. If the child is taking a long-acting medication (a single dose in the morning), hunger may only occur in the evening.
Living with a hyperactive child requires a lot of energy and patience from parents and educators. It is therefore important that they recognize their limitations and ask for help as needed. In particular, it is advisable to provide “respite” times, including for siblings.
The hyperactive child does not have the notion of danger. This is why he usually asks for more supervision than a normal child. When keeping such a child, it is important to choose a reliable and experienced person to avoid accidents.
Force, cries and corporal punishment are usually of no use. When the child “goes overboard” or the behavioral problems get bigger, it is better to ask him to isolate himself for a few minutes (in his room, for example). This solution allows everyone to find a little calm and regain control.
As a result of being reprimanded for their behavioral problems and gaffes, hyperactive children may suffer from a lack of self-confidence. It is important to highlight their progress rather than their mistakes and to value them. The motivation and incentives work better than punishment.
Finally, we often talk about the “unmanageable” side of children with ADHD, but we must not forget to highlight their qualities. They are usually very affectionate, creative and sporty children. It is crucial that these children feel loved by the family, especially as they are very sensitive to the marks of affection.
|In 1999, a major study funded by the National Institute of Mental Health of the United States, having covered 579 children, stressed the usefulness of approach overall. The researchers compared four types of approaches, used for 14 months: drugs; a behavioral approach to parents, the child and the school; a combination of drugs and behavioral approach; or no particular intervention. The combined treatmentis the one who offered the best overall effectiveness (social skills, academic performance, relations with parents). However, 10 months after cessation of treatment, the group of children who had received only drugs (a higher dose than in the group receiving the combination of the two treatments) is the one who presented the fewer symptoms. Hence the importance of persevering when we choose a global approach.|