ADHD is a polymorphic clinical syndrome, the main manifestation of which is a violation of the child’s ability to control and regulate their behavior, which results in motor hyperactivity, attention disorders and impulsivity. I want to emphasize the word” polymorphic ” because in reality no two children with ADHD are the same, this syndrome has many faces and a wide range of possible manifestations.
This is a psychiatric disorder-its cause, contrary to popular myths, is the features of the structure and functioning of the brain, not bad parenting, allergies, etc.the Real reason is either genetic factors (in the majority of cases), or perinatal damage to the Central nervous system. This is why ADHD is a developmental disorder, not just an “innocent” feature of a child’s temperament, and its manifestations are present from early childhood, they are “embedded” in the temperament, and are not acquired over time and are not temporary. In this, ADHD differs from “episodic” psychiatric disorders, such as depression, post-traumatic stress disorder, and others. We speak about the disorder because such features as hyperactivity, impulsivity and attention disorders are expressed out of proportion to age, and these features lead to serious violations of the child’s functioning in the main areas of life.
This point needs further explanation, since such traits as motor activity, inattentiveness, and impulsivity are normal (especially in preschool and primary school age). In children with the so-called active temperament, these features are more pronounced. However, if they generally do not create big problems for children and their environment – neither in the family, nor in school, nor among peers, and do not lead to violations of behavior, learning, and social development, then there is no question of ADHD. ADHD is an extreme manifestation of the spectrum of “active” temperament, in which hyperactivity, impulsivity and attention disorders are expressed so strongly that they significantly hinder the child’s learning, social adaptation and overall psychological development. This is a specific characteristic of ADHD, because, unlike many other disorders that are accompanied by abnormal manifestations (for example, hallucinations in schizophrenia), ADHD is rather a spectral disorder, an excessive manifestation of features that are characteristic of normal behavior. This creates certain difficulties in diagnosis, especially in mild forms of ADHD, because the border between the norm and pathology is very conditional… In this case, ADHD can be compared with other spectral medical disorders, in particular, with obesity – the boundaries between normal weight, overweight, and obesity as a disease are quite conditional; however, the reality of obesity as a disease can not be underestimated or rejected.
This feature of ADHD also gives a certain opportunity to destigmatize such children, allows parents and children to present this problem not as a psychiatric diagnosis-a label indicating their “defectiveness” and “abnormality” (in Ukrainian society, as in the societies of most post-Soviet countries, the stigmatization of persons with psychiatric disorders, unfortunately, is very common), but rather as a disorder that is a continuation of the spectrum of active temperament, while, of course, not minimizing the reality of the violation and related problems, nor the importance of timely and effective intervention.
ADHD is a developmental disorder and can be compared to other developmental disorders, such as mental retardation. With mental retardation, the level of intellectual development of a child is lower than that of peers, and this leads to difficulties related to social adaptation, independence, etc.growing Up, such a child acquires new knowledge, his intellectual level increases, but still remains lower than that of peers. With ADHD, control, the brain’s ability to organize and self-control behavior is impaired. Accordingly, as children with ADHD age, this ability also improves, but remains lower than that of their peers. According to recent studies (detailed analysis is presented in the Chapter on the etiology of the disorder), children with ADHD have a delayed maturation of the functions of the frontal cortex. Studies have shown that their brains develop in accordance with the same features and patterns as those of their peers, but the maturation of the functions of the frontal cortex is slower. With milder forms of ADHD (and they are about 30-40 % of the total number), by adolescence, these children catch up with their peers, in other cases, children with ADHD will have signs of impaired self-control in adulthood.
The spectrum of ADHD has led to different views in child psychiatry about the spectrum boundaries that can be called a disorder proper. There are two most common diagnostic classifications – DSM-IV and ICD-10, which approach the diagnosis of ADHD somewhat differently. The boundaries of DSM-IV are broader and also include those milder forms of the disorder where only symptoms of attention disorders or only hyperactivity – impulsivity are present. Accordingly, there are three subtypes of ADHD in this system: a combined form, a form with a dominant attention disorder, and a form with a dominant hyperactivity-impulsivity.
The ICD-10 criteria are narrower, stricter (in this system, the term “hyperkinetic disorder” is used as a synonym for ADHD), and cover only those more severe forms of the disorder that correspond to the combined form of ADHD according to the DSM-IV.
It is not surprising that in clinical practice, the DSM-IV system is used more often, because it allows you to identify lighter forms of ADHD and correctly choose methods of correction, since these conditionally “light” forms can nevertheless be accompanied by serious secondary problems and lead to significant violations of the child’s functioning in the main areas of life.
However, the question of the existence of subtypes of ADHD, their etiopathogenetic and prognostic differences is currently in the focus of scientific research, and in the near future this may lead to a new understanding of the nature of the disorder and its polymorphism, as well as changes in the classification system.
Now it is important to realize that the essence of diagnostic labels is not to “hang” them on children, while ceasing to see the individuality in its uniqueness, but to be able to understand the characteristics of a particular child and know how to help him overcome difficulties.
Diagnostic criteria for ADHD / hyperkinetic disorders in the international classification of diseases (ICD-10, who, 1999)
/F90/ Hyperkinetic disorders
Disorders belonging to this group are characterized by an early onset; a combination of overly active, poorly regulated behavior with pronounced inattention and lack of persistence in the child’s performance of tasks, and these characteristics of behavior are consistent in various situations and over time.
It is believed that constitutional abnormalities play a key role in the Genesis of these disorders, but their specific etiology remains unknown to date. In recent years, it has been suggested to use the diagnostic term “attention deficit disorder”to refer to these syndromes. It was never implemented, because it implied knowledge of psychological processes that we do not yet possess. This term also implied the inclusion in its scope of anxious, preoccupied,” dreamy ” or apathetic children, also characterized by reduced attention, which arose in connection with completely different problems (violations). Nevertheless, it is clear that from a behavioral perspective, attention problems are a Central feature of hyperkinetic disorders.
Hyperkinetic disorders always begin at an early stage of development (usually within the first five years of life). Their main characteristics are a lack of perseverance in activities that require the use of cognitive functions, and a tendency to move from one activity to another without completing the tasks that have been started. Along with this, disorganized, almost uncontrolled, excessive activity is typical. These problems usually continue throughout the school years, and sometimes into adulthood, but many individuals with these disorders experience improvements in both behavior and attention.
These violations can be combined with many other deviations. Hyperactive children are often reckless and impulsive, prone to accidents and injuries. They often get themselves into trouble and get punished, more for thoughtlessly breaking the rules than for deliberately ignoring them or deliberately disobeying them. In relationships with adults, these children are often characterized by social disinhibition, excessive swagger in communication, they lack natural caution and restraint. They are usually not popular with their peers, and they are disliked, which can eventually lead to social isolation. Among these children, cognitive disorders are common, and specific delays in motor and speech development are disproportionately common.
The frequency of hyperkinetic disorders in boys is several times higher than their frequency in girls. These disorders are often accompanied by reading difficulties (and/or other learning difficulties).
The main symptoms are impaired attention and excessive activity. Both symptoms must be present to make a diagnosis, and they must appear in more than one situation (for example, at home, in the classroom, or in a clinic).
Attention disorder is expressed in the fact that the child interrupts tasks in the middle and does not complete the tasks started, constantly moves from one class to another, and it looks as if he loses interest in the previous case, being distracted by the next (although the results of laboratory studies do not always show a significant degree of sensory or perceptual distraction). This lack of perseverance and attention should be taken into account when diagnosing, only if it is excessive for a child of a given age and with an appropriate IQ.
Excessive activity implies excessive mobility and restlessness, especially in situations that require relative rest. Depending on the situation, the child may run and jump, jump up from his seat when he should be sitting, talk too much and make too much noise, or move his hands and feet restlessly, turn and fidget in the chair. The standard for diagnosis should be the child’s hyperactivity in comparison with what is expected in the situation and with other children of the same age and level of intellectual development. This feature of behavior becomes very noticeable in structured, organized situations that require a high level of self-control behavior.
• The main manifestations of ADHD are hyperactivity, attention disorders, and impulsivity.
- In ADHD, these symptoms are not age-appropriate and lead to significant disorders of the child’s functioning in the main areas of life.
- ADHD is a spectrum disorder and represents the extremes of a continuum of “active” temperament and normal behavior in children.
- Diagnostic systems with clearly defined criteria are used to accurately diagnose and differentiate ADHD and normal behavior.
- The two main diagnostic systems, DSM-IV and ICD-10, cover the spectrum of this disorder somewhat differently: the first is broader, while the second includes only more severe forms of this disorder.