DEFINITION AND SYMTOMS

 WHAT IS ADHD?

• A complex and heterogeneous behavioral disorder, with a neurobiological basis, which appears in childhood and is identified when the child is around seven years old, whose causes are mainly genetic and environmental.

• It has a chronic character and follows a persistent behavioral pattern of a lack of attention skills and/or hyperactivity and impulsivity.

• It appears with an intensity and frequency greater than normal, interfering significantly not only in the child’s performance but in other daily activities too (López-Ibor A. et al, 2002)

• Low self-esteem, depression and/or anxiety can appear associated with ADHD in children.

• On some occasions it also appears associated with learning difficulties: dyslexia, dysgraphia, dysorthographia and dyscalculia, as well as other comorbidities such us: Defiant disorder, antisocial behavior, tics, etc.
  In people with ADHD there have been found anomalies in the chemical functioning of the brain (neurotransmitter activity: dopamine and adrenalin) and in the structural level ( volumetric anomalies in brain, cerebellum and caudate nucleus) of some brain areas (prefrontal lobe and the areas related to it)

• There is a general agreement that ADHD is a dysexecutive disorder characterized by:

1. Difficulties in the pre-attention system.
2. Difficulties in sustained attention.
3. Difficulties in verbal fluency.
4. Difficulties in inhibition and self-regulation processes.
5. Difficulties in working memory
6. Difficulties in cognitive flexibility.
7. Difficulties in social and emotional skills.

WHAT ARE EXECUTIVE FUNCTIONS?

• Executive functions have been described as cognitive processes that allow us to control and regulate our behavior in order to achieve a given aim.

Goldberg, Luria,s disciple, uses in his book «The executive brain» the metaphor or the «orquestra conductor» to explain how the frontal lobe is the anatomic structure that coordinates the information and other functions that receives from other brain structures in order to achieve an aim.

 

 

• ADHD is a failure in the activation or not of executive functions in the brain, mainly in RESPONSE INHIBITION. This failure affects four main executive capacities:

1. Non-verbal working memory: to be able to look back and see or recuperate visual information of previous actions and its consequences. Implies self-awareness, sense and use of time and space.

2. Verbal working memory: it is the voice of our brain that allows us to reflect and apply self-instructions that help us regulate our action.

3. Emotional self-regulation: to be able to control, adjust and moderate our emotions. It includes regulation of motivation.

4. Planning and problem solving directed to action: innovation capacity directed to an aim, planning our response and choosing the best one, facing problem solving, planning our life and thinking about future.

• We could say that in terms of brain functioning is as if the child/young person with ADHD had a «Ferrari» with «bicycle breaks»

 

 

WHAT DO WE “SEE” IN CHILD WITH ADHD?

 

Illustration 1 ATTENTION DEFICIT

Illustration 2 HIPERACTIVITY

Illustration 3 IMPULSIVITY

• These symptoms are variable in intensity but NOT necessarily simultaneous

• CLASSIFICATION SYSTEMS OF ADHD

Currently there are two international classification systems for diagnosis of ADHD in children and adolescents:

DSM V

CIE 10

• Following DSM-V, ADHD characterizes are:

1. Persistent pattern of inattention and/or hyperactivity-impulsivity that interferes in the functioning or the development, characterized by (1) Inattention and/or (2) Hyperactivity and Impulsivity :

Note: Symptoms are not only a manifestation of oppositional behavior, defying, hostility behavior or failure in the understanding of tasks and instructions. For adolescents and adults (above 17 years old) five symptoms or more are required for diagnosis.

CRITERIA 1: ATTENTION DEFICIT

Doesn’t pay attention to details	Doesn’t listen	Doesn’t follow instructions
Loses important/ necessary things things tasks	Distracted by external	Dislikes concentration

 

CRITERIA 2: HYPERACTIVITY & IMPULSIVITY

 

Plays/moves when he shouldn’t	Inappropriate behavior	Doesn’t play/ sit quietly
Can’t wait for his turn	Talks without control	Interferes with others’ work

• DSM V: ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD)

- These symptoms are variable in intensity but NOT necessarily simultaneous

 

ASSESMENT OF ADHD

We need to remember in the degree of the difficulty to adapt that the child with ADHD shows, the importance of:

 

ASSESMENT OF ADHD: COMORBIDITY

- Comorbidity occurs in more than half of the cases.

- We need to get information about the following aspects:
. Specific learning difficulties
. Oppositional defiant disorder or conduct disorder
. Emotional symptoms

- Up to a 60% of the children suffer a neuropsychiatric condition associated with ADHD, the most common are:

- Learning difficulties - Speech/language difficulties - Oppositional defiant disorder - Tics/ Tourette Syndrome - Anxiety disorder

- Motor coordination difficulties - Autistic spectrum - Conduct disorder - Depression/bipolar disorder - Sleep disorder

- Comorbidity in ADHD is understood as a severity indicator.

- In many cases it explains the lack of response to treatment.

- Multidisciplinary treatment should have specific intervention areas to treat ADHD and to treat the comorbid difficulties.

- Early and thorough treatment of ADHD could prevent the appearance of comorbidities.

 

HOW DO CHILDREN FEEL AT SCHOOL?

I’m stupid! I can´t do anything right! Nobody loves me! Everybody laughs at me!

I’m going to be punished today! All for homework today! Mum is going to get angry at me! I hate you!

 

WHAT DO WE KNOW ABOUT SPECIFIC DIFFICULTIES OF ADHD KIDS AT SCHOOL?

1. They work slower

2. They are very disorganized

3. They are unable to keep their concentration during long periods -normal to their peers

4. They get easily frustrated and tend to abandon quickly when they have to solve difficult tasks

5. They express their emotions inadequately and/or ignore others’ emotions

6. Their behavior is «childish» for their age

 

WHAT DO WE KNOW ABOUT THE POSITIVE FEATURES OF CHILDREN WITH ADHD?

1. Frequently they are creative and stand out in skills that are not appreciated or used in the classroom.

2. They are often very affectionate.

3. They often enjoy collaborating with teachers to do things.

4. They respond well to affection and to positive expectations.