Management of ADD with Hyperactivity in Children PDF Print E-mail
Written by Dr. Niru Prasad   
      

The Management of Attention Deficit Disorder with Hyperactivity in Children

By: Dr. Niru Prasad, M.D., F.A.A.P., F.A.C.E.P. Department of Urgent Care Center St. Joseph Mercy Hospital, Pontiac Department of Emergency Medicine West Bloomfield Center Henry Ford Hospital, Detroit Royal Oak Pediatrics, Michigan
The term Attention Deficit Disorder with Hyperactivity is used to describe a group of children who have many problems in common. Most of them have learning disabilities or short attention spans which interfere with their school or social activities. These children are generally of average or above average intelligence and it is important for the family to know that they are not mentally retarded. The group of symptoms inattentiveness, impulsivity and hyperactivity were described in the past as minimal brain damage syndrome. Later on, the name was changed to minimal brain dysfunction hyperkinetic reaction of childhood until the present term Attention Deficit Disorder with hyperactivity. Approximately 3 to 5 percent of school age children have ADDH which affects children from all cultural, socioeconomic and racial background at all intelligence levels, more predominant in males with the ratio being 4 to 1, and the problem might continue after childhood in adolescents. A hereditary link has been suggested since this disorder is more common among the first degree relatives of individuals with ADDH. The exact cause of ADDH is still unknown. It is most likely caused by some type of genetic problem in the chemistry of the nervous system. There are certain factors during pregnancy and after birth which increases the susceptibility of developing ADDH in children. FACTORS DURING PREGNANCY: A. Alcohol and drug abuse. B. Poor maternal nutrition. C. Chemical poisons like lead. FACTORS AFTER BIRTH: A. Brain injuries during and after birth. B. Infections. C. Iron deficiency anemia. D. Lead poisoning. The following are precipitating factors that might make the symptoms worse in these children: 1. Eating too much or too little sugar. 2. Food sensitivities and allergies. 3. Food coloring and chocolates. 4. Aspartame - Artificial sugars. 5. Lack of vitamins. 6. Fluorescent lighting. 7. Video games and television. 8. Stress in families such as divorce and child abuse. The Diagnostic Steps: The diagnosis of these children are made by observing the child's behavior at home, school and a complete physical examination. Here are some of the facts about childhood behaviors that might be clues to the diagnosis: During Pre-school: Excess activity and increased talking. Resistance to routines and rules. Aggressive behavior and demanding personality. Accident prone. Inability to concentrate. Inattention, hyperactivity and impulsive symptoms. During Elementary School: Excess talking and erratic performance. Constant demand for attention. Inability to perform school work and organizing tasks. During Adolescence: Restlessness and too much talking. Destruction behaviors. Problems with friends, poor judgment and poor school performance. ADDH interferes with the ability to succeed at school and approximately 15 to 20 percent of these children develop specific learning disabilities. Some of the other difficulties that these children have include the following: 1. Anxiety and depressions. 2. Additional behavioral disorders. 3. Bed wetting and pants wetting/soiling. 4. Developmental delays in motor coordination skills. 5. Allergy, sleep disturbances and night terrors. 6. Speech and language disorders. 7. Hearing loss from earlier ear infections. 8. Underachievement, social problems and low self-esteem. While most children may, on occasion, exhibit inattention, impulsiveness and hyperactivity, the persistence pattern and increased frequency of symptoms in certain children leads to the diagnosis of this disorder. For the Diagnosis of ADDH: The inattention and hyperactivity symptoms appear before age 7, persist for 6 months or more and are present in at least two or more settings such as home, school or social situations. The term Specific Learning Disability with ADDH children is defined as a disorder in one or more of the basic psychological processes involved in understanding or using language, spoken or written, which may manifest itself in an imperfect ability to listen, think, speak, read, spell or do mathematic calculations. It is important to remember that children with ADDH may be a predominantly hyperactive and impulsive type or inattentive type such as make careless mistakes, unable to finish the task, forgetful or are easily distracted. The Ultimate goals of treatment are: A: Build the child's sense of competence. B: Minimize effects of ADDH symptoms without altering the nature of the child. C: Help child compensate for ADDH related difficulties. D: Prevent loss of self esteem. The Standard Therapies for ADDH: A: Managing the child at home. B: Educational approaches. C: Psychological and Behavioral approaches. D: Medications. Here are some tips for managing these children at home: A: When children do well, they should be rewarded. Be positive with your child and praise him frequently. B: It is helpful if children fully understand their conditions so they can improve themselves. C: Provide a good nutrition for them, make home poison and accident proof and discourage them from watching too much television. D: Be very consistent in the way you treat your ADDH child. They should know their limitations. The Educational Approaches: Special attention should be provided by school teachers for these children such as: A: Have the child sit in the front of class. B: Provide a structural learning environment. C: Give more time for tests and writing assignments. D: Write directions on the board and remind the child to turn in homework. E: Use simple textbooks, ignore the negative behavior as much as possible. F: Do not give bad marks for the child's work because of difficulties caused by attention disorders. G: Reward the child for positive behavior. Psychological and Behavioral Approaches: Since the successful management of ADDH takes a team effort, the team should include parents, school teacher, social service, psychologist and psychiatrist. The psychostimulant medication remains one of the most successful treatments for the child with ADDH. Some of the benefits of medication are: A: Improvement in attention span - at school and home. B: More control over conduct, social behavior, impulsiveness and aggressive behavior. C: Improvement in the quality and quantity of school work in general including handwriting, finishing tasks, the accomplishment of certain academic skills and classroom behavior. D: Better relationship with family members and friends. Psychostimulants are the medications used to control the hyperactive behaviors in ADDH children. These drugs stimulate the nervous system in the areas of the brain that control attention impulses and self regulation of behavior. They also increase the availability of certain chemicals that transmit neural impulses in the brain. The group of medications most often used are: Ritalin - Methylphenidate. Dexedrine - Dextroamphetamine. Cylent - Pemoline. Imipramine or Desipramine - Antidepressants. Bupropion - Antidepressant. The following are the side effects of these medications: A: Loss of appetite. B: Problems going to sleep when medication wears off. C: Headaches and stomach cramps. D: Drowsiness and irritability if medication dose is too high. E: Rebound effects as the medication wears off. It is important to remember that besides medications these children benefit more from educational and psychological therapy along with medicine. Other non-traditional therapies include giving these children extra vitamins and amino acid, vision therapy - using tinted lenses to help with reading problems and using antidepressant medications to improve mood and attention. There is currently no scientific proof that any of these therapies are very helpful. The long term prognosis for these ADDH children are: A: As these children grow up to adulthood they learn to compensate for some of their difficulties. B: The majority of these children will do well as adults. C: Since a short attention span is part of general developmental lag in children under 7 years of age, as they grow older, they are able to pay more attention. D: Children often learn to control their hyperactive behavior as they grow older due to peer pressure. Several of these signs and symptoms such as restlessness, impulsive behavior and disorganization persist during adulthood in certain individuals. Mood swings, inability to complete a task, hot temper with low stress tolerance, difficulties getting along with spouses and co-workers are other significant findings in adults who were hyperactive children. SUMMARY: Here are some of the guidelines to follow if you have a child with Attention Deficit Disorder with Hyperactivity: 1. Think positive and have patience with your child. 2. Work as a team with school teacher, pediatrician, psychologist and psychiatrist to get the most effective treatment. 3. Know your child and understand what situations make his symptoms worse. 4. Remember that with proper supervision and guidance, your child will grow up as a normal adult and will succeed in life.