By Ashok Shanishetti

ADHD: Attention deficit hyperactivity disorder Definition ADHD: Attention deficit hyperactivity disorder

Types Predominantly hyperactive-impulsive Predominantly inattentive ADHD has three subtypes: Predominantly hyperactive-impulsive Predominantly inattentive Combined hyperactive-impulsive and inattentive

Predominantly hyperactive-impulsive Types Predominantly hyperactive-impulsive Most symptoms (six or more) are in the hyperactivity-impulsivity categories. Fewer than six symptoms of inattention are present, although inattention may still be present to some degree.

Predominantly inattentive Types Predominantly inattentive The majority of symptoms (six or more) are in the inattention category and fewer than six symptoms of hyperactivity-impulsivity are present, although hyperactivity-impulsivity may still be present to some degree.   Children with this subtype are less likely to act out or have difficulties getting along with other children. They may sit quietly, but they are not paying attention to what they are doing. Therefore, the child may be overlooked, and parents and teachers may not notice that he or she has ADHD. .

Combined hyperactive-impulsive and inattentive Types Combined hyperactive-impulsive and inattentive Six or more symptoms of inattention and six or more symptoms of hyperactivity-impulsivity are present. Most children have the combined type of ADHD.

Symptoms Lack of attention (inattentiveness) Hyperactivity The symptoms of ADHD fall into three groups: Lack of attention (inattentiveness) Hyperactivity Impulsive behavior (impulsivity)

Symptoms Lack of attention (inattentiveness) Fails to give close attention to details or makes careless mistakes in schoolwork Has difficulty keeping attention during tasks or play Does not seem to listen when spoken to directly Does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace Has difficulty organizing tasks and activities Avoids or dislikes tasks that require sustained mental effort (such as schoolwork) Often loses toys, assignments, pencils, books, or tools needed for tasks or activities Is easily distracted Is often forgetful in daily activities

Symptoms Hyperactivity Fidgets with hands or feet or squirms in seat Leaves seat when remaining seated is expected Runs about or climbs in inappropriate situations Has difficulty playing quietly Is often "on the go," acts as if "driven by a motor," talks excessively

Symptoms Impulsive behavior (impulsivity) Blurts out answers before questions have been completed Has difficulty awaiting turn Interrupts or intrudes on others (butts into conversations or games)

Diagnosis The diagnosis is based on very specific symptoms, which must be present in more than one setting. Children should have at least 6 attention symptoms or 6 hyperactivity/impulsivity symptoms, with some symptoms present before age 7. The symptoms must be present for at least 6 months, seen in two or more settings, and not caused by another problem. The symptoms must be severe enough to cause significant difficulties in many settings, including home, school, and in relationships with peers.

Diagnosis In older children, ADHD is in partial remission when they still have symptoms but no longer meet the full definition of the disorder. The child should have an evaluation by a doctor if ADHD is suspected. Evaluation may include: Parent and teacher questionnaires (for example, Connors, Burks) Psychological evaluation of the child AND family, including IQ testing and psychological testing Complete developmental, mental, nutritional, physical, and psychosocial examination

Diagnosis For online diagnosis: http://psychcentral.com/addquiz.htm http://www.adhdawareness.com/adhd-assessment-checklist.html

Treatment Treating ADHD is a partnership between the health care provider, parents or caregivers, and the child. For therapy to succeed, it is important to: Set specific, appropriate target goals to guide therapy. Start medication and behavior therapy. Follow-up regularly with the doctor to check on goals, results, and any side effects of medications. During these check-ups, information should be gathered from parents, teachers, and the child.

Treatment If treatment does not appear to work, the health care provider should: Make sure the child indeed has ADHD Check for other, possible medical conditions that can cause similiar symptoms Make sure the treatment plan is being followed

Medication A combination of medication and behavioral treatment works best. There are several different types of ADHD medications that may be used alone or in combination. Psychostimulants (also known as stimulants) are the most commonly used ADHD drugs. Although these drugs are called stimulants, they actually have a calming effect on people with ADHD. These drugs include: Amphetamine-dextroamphetamine (Adderall) Dexmethylphenidate (Focalin) Dextroamphetamine (Dexedrine, Dextrostat) Lisdexamfetamine (Vyvanse) Methylphenidate (Ritalin, Concerta, Metadate, Daytrana)

Behavior Therapy Talk therapy for both the child and family can help everyone understand and gain control of the stressful feelings related to ADHD. Parents should use a system of rewards and consequences to help guide their child's behavior. It is important to learn to handle disruptive behaviors. Support groups can help you connect with others who have similar problems.

Some tips to a child with ADHD Communicate regularly with the child's teacher. Keep a consistent daily schedule, including regular times for homework, meals, and outdoor activities. Make changes to the schedule in advance and not at the last moment. Limit distractions in the child's environment. Make sure the child gets a healthy, varied diet, with plenty of fiber and basic nutrients. Make sure the child gets enough sleep. Praise and reward good behavior. Provide clear and consistent rules for the child.

ADHD student in classroom Seat the child with ADD/ADHD away from doors and windows. Put pets in another room or a corner while the student is working. Alternate seated activities with those that allow the child to move his or her body around the room. Whenever possible, incorporate physical movement into lessons. Write important information down where the child can easily read and reference it. Remind the student where the information can be found. Divide big assignments into smaller ones, and allow children frequent breaks.

ADHD student in classroom Make sure a written behavior plan is near the student. You can even tape it to the wall or the child’s desk. Give consequences immediately following misbehavior. Be specific in your explanation, making sure the child knows how they misbehaved. Recognize good behavior out loud. Be specific in your praise, making sure the child knows what they did right. Write the schedule for the day on the board or on a piece of paper and cross off each item as it is completed. Children with impulse problems may gain a sense of control and feel calmer when they know what to expect.

ADHD student in classroom Ask children with ADD/ADHD to run an errand or do a task for you, even if it just means walking across the room to sharpen pencils or put dishes away. Encourage the child to play a sport—or at least run around before and after school. Provide a stress ball, small toy, or other object for the child to squeeze or play with discreetly at his or her seat. Limit screen time in favor of time for movement. Make sure a child with ADD/ADHD never misses recess or P.E.  

Resources: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002518/ http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder/complete-index.shtml http://www.webmd.com/add-adhd/guide/types-of-adhd http://www.webmd.com/add-adhd/guide/adhd-symptoms http://psychcentral.com/addquiz.htm http://www.adhdawareness.com/adhd-assessment-checklist.html