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Attention deficit hyperactivity disorder handbook : , Attention deficit hyperactivity disorder handbook : , کتابخانه دیجیتال جندی شاپور اهواز

Various alternative therapies for ADHD have been offered as substitutes or supplements to medication and behavioral treatments. Some merit a trial in children unresponsive or showing toxic reactions to medications, and others appear to show little advantage except as a placebo. The evaluation of claims for therapies in a disorder such as ADHD, without a single, well-defined cause, is a scientific challenge, requiring controls and appropriate measurement techniques.

ADHD, the abbreviation for Attention-Deficit/Hyperactivity Disorder, is the name coined to describe children, adolescents, and some adults, who are inattentive, easily distracted, abnormally overactive, and impulsive in their behavior. ADHD is a neurobiological “syndrome,” not a “disease,” with a specific known cause. Many different factors have been suggested as the cause of ADHD. The treatment requires several different approaches, involving medical, neuropsychological, educational, and parental disciplines. It is a “heterogeneous” disorder.

Neurological disorders that sometimes complicate the syndrome of attention deficit hyperactivity disorder include tics and Tourette syndrome, seizures and headaches. Causes underlying the ADHD may also be responsible for these disorders or, alternatively, drugs used in the treatment of ADHD may result in neurological side-effects. Special tests, including an EEG and CT or MRI, may be necessary to uncover the cause and determine the appropriate therapy. The recognition and diagnosis of associated neurological disorders is important for the optimal management of ADHD.

The diagnosis of ADHD is determined by an evaluation of reports from parents and teachers and by observation and examination of the child in the office of the physician or psychologist. The parents and teachers should provide completed questionnaires that rate attention, behavior, impulsivity, academic achievement, and social skills. Since the symptoms of ADHD are especially troublesome when the child enters school, the teacher is often the first to draw attention to the problem and advise the parents to consult their pediatrician.

What is the outcome for my child when he or she grows up? is a frequent question asked by parents of ADHD children. “Will he outgrow the ADHD?” “Will he need continued treatment with stimulant medication into adulthood?” “Is there an increased risk of drug abuse in adults with a history of childhood ADHD?” Some of the answers to these questions remain controversial, the outcome being influenced by complicating comorbid disorders and other factors.

Psychiatric disorders sometimes associated with ADHD include oppositional defiant disorder, conduct disorder, mood disorders, and anxiety disorders, including obsessive compulsive disorder. These are referred to as comorbid disorders. They complicate the management of ADHD and, if severe enough to impair school and social functioning, will require psychiatric or psychological intervention. For practical purposes, the following definitions are simplified from the DSM-IV diagnostic criteria.

The child with ADHD benefits from parental care and understanding, a teacher’s attention to special educational needs, the psychologist’s evaluation and behavior counseling, and a physician’s diagnostic skill and medical treatment. Each has an important role in the multimodal management of the problem (MTA, 1999) (see also Chap. 8).

Several methods and disciplines are involved in the management of the child with ADHD. These include participation of the parents, teachers, psychologist, and physicians. The parents, and especially the mother, may be the first to draw attention to the problem, even in the preschool years. The teacher generally reports concerns about a child’s inattention, hyperactivity, and impulsive behavior in kindergarten or first grade. The psychologist becomes involved either on referral from the teacher or after consultation with the physician. The pediatrician, pediatric neurologist, or child psychiatrist is usually consulted to confirm the diagnosis and to supervise the management of medical therapy.

The symptoms of ADHD are outlined in the DSM-IV diagnostic criteria in two main subtypes or groups: (1) symptoms of inattentiveness and (2) hyperactivity-impulsivity. Signs of brain dysfunction and associated perceptual and learning disabilities are omitted from the current definition, as outlined by the American Psychiatric Association. The recognition of both symptoms and signs of ADHD is important, however, particularly in terms of defining the cause and treatment.

Learning and language disorders frequently complicate attention deficit disorder, and their recognition and remediation are essential for the successful management of ADHD. Specific learning disorders that involve the “three Rs” are termed dyslexia, dysgraphia, and dyscalculia. Dyslexia or reading disability is the prototype of learning disabilities. Speech and language disorders include dysarthrias, or disorders of articulation, and aphasias or dysphasias, inabilities to comprehend and use language despite normal hearing and intellect.

Medications, especially central nervous system stimulants, are an important part of treatment of ADHD. The use of stimulants for the treatment of hyperactive behavior in children was first described in 1937, beginning with amphetamines. Controlled trials of methylphenidate (Ritalin®) in the 1960s demonstrated significant benefits without serious side effects. In addition to a lessening of motor activity, focus and attention were increased and schoolwork, grades, and social behavior were improved. In small to moderate doses, methylphenidate benefits learning without impairing creative or flexible thinking. The value of stimulant medication in the management of ADHD has withstood the test of time.