Source: specialedpost.org
Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood disorders and can continue through adolescence and adulthood. Symptoms include difficulty staying focused and paying attention, difficulty controlling behaviour, and hyperactivity (over-activity).
In the U.S.A, 9% of adolescents aged between 13-18 years have ADHD. The prevalence of ADHD in Malaysian children is not known but the NHMS 2011 (National Health & Morbidity Survey 2011) revealed that 1 in 5 Malaysian children has a psychiatric problem. Boys are 4 times more at risk than girls for ADHD.
A diagnosis of ADHD requires chronicity, i.e., the child needs to have had the symptoms for a period of at least six months but onset or appearance of symptoms can be up to 12 years of age. Although hyperactivity generally dates back to preschool years, referral to doctors is very often delayed until early school years. This is the period when the child’s inattentiveness, learning problems and disruptiveness become increasingly troublesome.
What are the Signs & Symptoms of ADHD?
Inattention, hyperactivity and impulsivity are the key behaviours of ADHD. It is normal for all children to be inattentive, hyperactive or impulsive sometimes, but for children with ADHD, these behaviours are extreme and they affect their daily functioning. To be diagnosed, a child must have symptoms for 6 months or more and to a degree that is greater than other children of the same age.
Features of Inattention: (Most difficult to detect and often missed)
Difficulty focusing attention or organising or completing tasks or learning something new, easily distracted, miss details, forget things and frequently switch from one activity to another, have difficulty focusing on one thing, unless they are doing something enjoyable. They become bored with a task after only a few minutes, have trouble completing or passing-up homework assignments, often losing things needed to complete tasks. An inattentive child may not seem to listen when spoken to, may daydream, become easily confused and move slowly even. They have difficulty processing information as quickly and accurately as others and they struggle to follow instructions.
Hyperactivity may manifest as:
Fidgeting and squirming in their seats, talking nonstop, dashing around, touching or playing with anything and everything in sight, have trouble sitting still during dinner, school and story time, being constantly in motion and having difficulty doing quiet tasks or activities.
Impulsivity may manifest as:
Being very impatient, blurting out answers, inappropriate comments, showing their emotions without restraint and acting without regard for consequences, having difficulty waiting for things they want or waiting their turn in games and these children often interrupt conversations or others’ activities.
What are the different types of ADHD?
ADHD has 3 main subtypes:
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:
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 are not paying attention to what they are doing. Therefore, this child often gets overlooked, and parents and teachers MAY NOT notice the he or she has ADHD.
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.
Treatment
In most cases, ADHD is best treated with a combination of medication and behaviour therapy. No single treatment is the answer for every child and good treatment plans will include close monitoring, follow-ups and making changes when the need arises.
Get Help!
If you or your child’s teachers have concerns about ADHD, you can take your child to a Child Psychiatrist/ Child Psychologist or a Developmental Paediatrician, or take him/ her to the nearby Primary Health Clinic for further assessment and referral if necessary.
Dr. Selvasingam is a child and adolescent psychiatrist working in Kuching, Sarawak.
[This article belongs to The Malaysian Medical Gazette. Any republication (online or offline) without written permission from The Malaysian Medical Gazette is prohibited.]
Reference:
- National Institute of Mental Health, U.S. (Retrieved in 2014). What is Attention Deficit Hyperactivity Disorder (ADHD, ADD)? Retrieved from: http://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml
- Division of Human Development, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention. (Aug 20, 2014). Facts About ADHD. Retrieved from: http://www.cdc.gov/ncbddd/adhd/facts.html
- Goodman & Scott. (2005). Hyperactivity. In Child Psychiatry-2nd (pp. 52-58). Oxford: Blackwell Publishing.