Attention-Deficit Hyperactivity Disorder (ADHD)

Ruwan M Jayatunge M.D. 

Attention-Deficit Hyperactivity Disorder (ADHD) is a neurobehavioral developmental disorder affecting about 3–5% of the world’s population. ADHD was first described by Dr. Heinrich Hoffman in 1845. He eloquently wrote about children with ADHD and their characteristics. Contemporary studies concur that the symptoms of ADHD are caused by a neurological dysfunction within the brain, mostly due to a deficiency in a specific neurotransmitter in the lower area of the brain. The principle characteristics of ADHD are inattention, hyperactivity, and impulsivity.

Attention-Deficit Hyperactivity Disorder is a condition that becomes apparent in some children in the preschool and early school years. Sometimes it may persist into adulthood. About 60 percent of children diagnosed with ADHD retain the condition as adults. These children need care and attention. When hyperactivity, distractibility, poor concentration, or impulsivity begin to affect performance in school, social relationships, or the ability to accomplish day-to-day activities, therefore, they need treatment.

According to the US-based statistics, an estimated three to five percent of school-age children suffer from ADHD. Although there are no statistics available in Sri Lanka, a considerable number of children are affected by ADHD, and many do not receive any treatment. In our school system, ADHD children are considered bad students who are disobedient. But the fact is, their behavior is caused by complex etiological factors, and they are not bad by nature.

They have a poor attention span. They have difficulty organizing tasks and activities. Furthermore, they act as if “driven by a motor” and cannot remain still. Difficulty remaining seated; Easily distracted; Gives answers to questions before they are completed; Difficulty following instructions from others. Difficulty sustaining attention in tasks or play activities shifts from one uncompleted task to another; Talks excessively; Interrupts others; does not seem to listen; Engages in physically dangerous activities without considering the possible consequences; is restless and does not follow the commands.

There are a number of risk factors associated with ADHD. Major etiologic contributors include adverse responses to food additives and intolerances to foods. Too much refined sugar, Chocolate and Genetically Modified Food can increase hyperativity in some children. Common food additives and colorings can increase hyperactive behavior; some artificial additives increase hyperactivity and decrease attention span in a wide range of children. Some have sensitivities to environmental chemicals, molds and fungi. Exposures to neurodevelopmental toxins, such as heavy metals and organohalide pollutants can precipitate the condition. 

General Strategies to combat ADHD are important. Parental Education is vital. The parents must be taught how to handle the children. Some parents use corporal punishment, which can lead to the damage the personality. Parent-coached social skill training gives insight and handiness to manage an ADHD child more effectively.  Medications are necessary since there is an imbalance in brain chemistry. The medications must be prescribed by a qualified medical professional. Ritalin (methylpenidate) is widely used to treat ADHD. Medications must be prescribed by a qualified Physician. 

Apart from drug therapy, special Psychotherapeutic approaches are essential. Behavior Modification Programs for Home and School can be used to minimize inattentiveness and improve concentration. Relaxation training advances emotional control and the child is able to face day-to-day activities without much tension. CBT, or Cognitive Behavioral Therapy is important to improve motivation, problem-solving skills, and self-esteem. Some experts recommend Fun Cognitive Rehabilitation Exercises (Brain Training) to improve attention span. 

Cybertherapy is another mode of treatment that can be used for ADHD. In cyber therapy especially designed computer animation programs are used to enhance attention, concentration, eye contact and fine motor movements.  The therapist should allow the child to change work sites frequently while completing homework or studying. Behavioral approaches can be attempted to help the child concentrate on sitting still, staying on task or thinking before acting. Many ADHD children can be managed via music therapy.  Music therapy reduces their excessive stress factors. In order to enhance their productivity, guidance must be given to the students to verbalize a plan before solving problems or undertaking a task. 

The therapist should provide opportunities for students to show divergent, creative, and imaginary thinking. On most occasions, ADHD children have a good IQ, and if their massive energy is used prolifically a good results can be expected. Art Benjamin, the famous Professor in Mathematics was an ADHD child and he was able to conquer the illness. Therefore, ADHD is not a paralyzing condition. If positive guidance is given to the child, he/she can be a productive person.