ADHD is defined as difficulty paying and maintaining attention, hyperactivity, and lack of impulse control, compared to children at similar developmental levels. It is seen in approximately 5-7% of school-age children. It is 3-4 times more common in boys than in girls. Generally, hyperactivity is more prominent in boys, while attention deficit complaints are more common in girls. Although it is usually diagnosed after starting primary school, symptoms are also noticed before school in the majority of cases.
What are the symptoms of Attention Deficit and Hyperactivity Disorder?
As can be understood from the definition, the symptoms are grouped into three main groups: attention deficit, hyperactivity and impulsivity. Although the majority of ADHD cases involve both attention deficit and hyperactivity, in some cases there may be only attention deficit or only hyperactivity. Even though it is only one of the symptom groups, in any case the diagnosis is called Attention Deficit Hyperactivity Disorder. The complaints must have been present for at least 6 months and must have started before the age of 12 at the latest, and some symptoms must have been present before the age of 7.
Attention Deficit Symptoms:
Activities During lessons or games, their attention span is shorter than their peers. This situation is especially noticeable when they start school. Children with attention deficits cannot listen to their teachers for long periods of time, and when they do study without breaks, it is usually very brief.
In class, their attention gets distracted by a voice they hear easily, a movement of their friends, or an event that comes to their mind, and they lose track of the lesson. They generally seem absent-minded, as if their body is in the classroom but their mind is not in the classroom. They make frequent mistakes while reading and writing. Because they cannot pay attention to details, it is common for them to read questions incompletely or incorrectly and to answer questions they know incorrectly. They especially surprise their teachers by answering difficult questions and answering easy ones incorrectly.
Tasks that require attention, such as doing homework, are tasks that children with attention deficit find very difficult and dislike. Parents, their attention is immediately focused on something else. They complain that they are slipping, that homework that could be completed in half an hour takes hours, and that they spend all their evenings struggling to get homework done.
Forgetfulness in ordinary daily tasks is very common, and due to this forgetfulness, they lose their lesson equipment and personal belongings. Although such problems can be seen in all children from time to time, it is not normal for a child to forget his coat at school on a winter day. Another problem expressed about forgetfulness is as follows: "If we ask for three or four types of ingredients from the market, he will definitely forget to buy at least one of them."
Symptoms of Hyperactivity
Hyperactive children are more active than their peers. They are in a constant rush. Families describe this situation as "It's as if an engine has been installed" or, as one father put it, "I think our child has a nuclear power plant installed." They have difficulty following the rules in their games. That's why they have problems with their friends and are labeled as "naughty, disruptive".
Children with hyperactivity problems are exposed to more accidents at home, at school, and in games. Falling, bumping into things, and injuring themselves happen a lot. They exhibit risky behaviors such as not looking left or right while crossing the street, suddenly running out into the street, and climbing on garden walls and poles. For example, falling off the bike, hitting objects while running around the house, not being able to adjust the dose while joking and hurting your friend are common.
They have difficulty sitting still during class at school. They often leave their seats with excuses such as throwing garbage, sharpening their pencils, or going to the toilet. Apart from this, dropping and picking up your pencil and eraser, poking your friend, disturbing your friend and talking too much are the most frequently complained problems. His teachers said, "I see him everywhere except where he is supposed to sit in class." They express their complaints. Another symptom of hyperactivity is talking too much. For this reason, "If his hand stops, his feet will not stop, and if his feet stop, his mouth will not stop." They are described as: He/she is complained about trying to answer and comment on everyone who speaks in the classroom, and that he/she spoils the lesson with unnecessary conversations.
Symptoms of Impulsivity
The main problem with impulsivity is with this child. It is their inability to postpone their wishes. In class, the teacher pastes the answer before the question is completed. For this reason, the teacher said, "I could not teach speaking by raising my hand and speaking." he complains. They have difficulty waiting their turn, and this causes them to spoil the game, as mentioned above. When others are talking, they interrupt before they finish their words, they want to be heard immediately, and for this reason they often interrupt their parents and friends.
Causes of Attention Deficit and Hyperactivity Disorder
Genetic Causes
The first place among the causes of ADHD is It is genetic, that is, it is inherited. Evidence supporting this is that the rate of occurrence in both identical twins is as high as 80%, in fraternal twins it is 40-50%, and in non-twin siblings it is around 30%. Having ADHD in a first-degree relative increases the risk 4-5 times.
Structural and Functional Abnormalities in the Brain
In fact, abnormalities are detected in many regions of the brain in ADHD cases. However, the areas that stand out the most are the front outer region of the brain and the nerve cell clusters in the inner parts of the brain. Apart from these, the cerebellum is also one of the areas held responsible.
Functional abnormality is the insufficient activation of the mentioned areas in the brain. Brain imaging studies have shown that the brain regions mentioned above work less than their healthy peers.
Neurotransmitter Abnormalities
Neurotransmitters are mediators such as dopamine and noradrenaline that provide signal transmission between brain cells. In ADHD, there is a disorder in the release of dopamine and noradrenaline and in the receptor sensitivity that responds to them. While noradrenaline is effective in transmitting the desired signal, dopamine is responsible for suppressing noise, that is, suppressing distracting stimuli that come from outside or in our own mind.
Other causes
Causes such as lead, maternal alcohol and especially cigarette use during pregnancy, birth trauma, and low birth weight may play a role in the development of ADHD. lyre. Inadequate parenting skills and inappropriate discipline methods do not cause ADHD, but this situation worsens the symptoms in children with ADHD. There is no evidence that nutrition has an effect. However, some families whose children have ADHD state that their child's mobility increases, especially when they eat sweets and chocolate.
Diagnosis
ADHDis diagnosed through clinical observation, examination, and information received from teachers and families. In addition, tests such as Moxo, CAS, Bender, GISD are methods used to support the diagnosis
What is Attention Deficit Hyperactivity Disorder Confused with, What are the Differences?
Symptoms of ADHD are first and foremost. It can also be seen in other psychiatric disorders such as learning disorder, mental retardation, depression and anxiety disorder.
In learning disorders, especially dyslexia, as the name suggests, problems such as inability to learn letters, numbers, reading, and confusion are observed starting from the beginning of school. Children with learning disorders generally become bored and uninterested in the lesson, just like those with attention deficit disorder. There is no problem of not being able to learn in attention deficit.
Since attention is one of the important parts of intelligence, the attention span of children with mental retardation is naturally insufficient. However, in addition to mental retardation, there is a general learning and comprehension retardation.
The sluggish, absent-minded appearance of depressed children can be confused with attention deficit or sometimes with hyperactivity when they exhibit a picture of restlessness. Likewise, restlessness in anxiety disorders can create a clinical picture similar to hyperactivity symptoms. In ADHD, the symptoms last for at least 6 months, and symptoms are seen from a very young age, while the time between the onset of depression and anxiety disorders and the application is shorter.
Apart from psychiatric disorders, moving, school change, parents' divorce. A deterioration in the child's attention and academic success may also occur in situations such as the loss of a relative or a serious illness of a family member.
Treatment
Drug Treatment
Stimulants (Methylphenidate)
Abroad� Although there are other stimulants, only methylphenidate is available in our country. Methylphenidate has 3 forms:
Ritalin 10 mg tablet, Medikinet 10 mg tablet. Its effect begins in 30 minutes and ends in 4 hours.
Medikinet retard capsule. Duration of effect-6-8 hours.
Concerta tablet. Its effect starts in 45 minutes and ends in 10-12 hours.
While the short-acting form is used in the morning and at noon, the long-acting forms are used once in the morning. The effect of methylphenidate begins immediately, between 30 and 60 minutes, and continues for the period specified above, after which its effect ends. One of these forms is chosen according to the child's response to the medication, side effects, and school status. The most common side effect of methylphenidate is loss of appetite. In addition, side effects such as headache, abdominal pain, nausea and insomnia may occur, especially in the beginning.
Non-Stimulant Drugs
Atomoxetine
Atomoxetine is not a stimulant. It can also be used in the evening as it does not cause insomnia. Its effect begins to be seen after approximately three weeks and its effect lasts for 24 hours. It can be taken in the morning or evening depending on side effects.
Misbeliefs about drugs
Drugs numb children
Stimulant As its name suggests, it means warning. In other words, the belief that "drugs numb the child", which is settled in society, has the opposite mechanism of action. Families may describe their hyperactive children's return to normal as lethargy. However, in a very small number of cases, such as 5%, actual stagnation can be observed, contrary to the mechanism of action of the drug.
Those who use these drugs get used to drugs
The rate of drug use in ADHD cases using treatment is much lower than in ADHD patients who do not use medication and do not receive treatment. So, in fact, drug treatment has a protective effect against drug use.
Drugs prevent height growth and bone development
Methylphenidate is a drug that has been used for at least 50 years. In long-term follow-up studies, no clear finding was found that those using methylphenidate were shorter than their expected height.
Non-drug treatments
Psychoeğ
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