Attention deficit hyperactivity disorder (hyperkinetic disorder). ADHD - what is it, symptoms in children and adults. diagnosis and treatment of ADHD

ADHD- This is a developmental disorder of a neurological-behavioral nature, in which the hyperactivity of babies is pronounced along with a lack of attention. Among the hallmarks of this disorder, the presence of which provides the basis for establishing the diagnosis of ADHD, there are symptoms such as difficulty concentrating, increased activity and impulsivity that cannot be controlled. Due to the fact that it is difficult for babies to focus their attention, they often cannot correctly complete educational tasks or solve problems, as they make mistakes due to their own inattention and restlessness (hyperactivity). Also, they may not listen to the explanations of teachers or simply do not pay attention to their explanations. Neurology considers this disorder as a stable chronic syndrome for which no cure has yet been found. Doctors believe that ADHD (attention deficit and hyperactivity disorder) goes away without a trace as kids grow up or adults adapt to live with it.

Causes of ADHD

Today, unfortunately, the exact causes of ADHD (Attention Deficit Hyperactivity Disorder) have not been established, but several theories can be distinguished. So, the causes of organic disorders can be: an unfavorable ecological situation, immunological incompatibility, infectious diseases of the female part of the population during pregnancy, anesthesia poisoning, the intake of certain medications, drugs or alcohol by women during the period of bearing a baby, some chronic diseases of the mother, threats of miscarriage, premature or prolonged labor, stimulation of labor activity, caesarean section, improper presentation of the fetus, any diseases of newborns that occur with high fever, taking strong drugs by babies.

Also, diseases such as asthmatic conditions, heart failure, pneumonia, diabetes can be factors that provoke a violation in the brain activity of babies.

Scientists have also found that there are genetic prerequisites for the formation of ADHD. However, they appear only when interacting with the outside world, which can either strengthen or weaken such prerequisites.

ADHD syndrome can also cause negative effects in the postnatal period on the child. Among these impacts, both social causes and biological factors can be distinguished. Methods of upbringing, the attitude towards the baby in the family, the socio-economic status of the cell of society are not the reasons that provoke ADHD, in and of themselves. However, often, these factors develop the adaptive capabilities of the crumbs to the outside world. Biological factors that provoke the development of ADHD include feeding the baby with artificial food additives, the presence of pesticides, lead, and neurotoxins in the child's food. Today, the degree of influence of these substances on the pathogenesis of ADHD is under study.

The ADHD syndrome, in summary, is a polyetiological disorder, the formation of which is due to the influence of several factors in combination.

Symptoms of ADHD

The main symptoms of ADHD include impaired attention function, increased activity of children and their impulsiveness.

Attention disorders are manifested in the baby by the inability to keep attention on the elements of the subject, the assumption of many mistakes, the difficulty of maintaining attention in the course of performing educational or other tasks. Such a child does not listen to speech addressed to him, does not know how to follow instructions and complete the work, is not able to plan or organize tasks on his own, tries to avoid things that require prolonged intellectual stress, tends to constantly lose his own things, shows forgetfulness, is easily distracted.
Hyperactivity is manifested by restless movements of the arms or legs, fidgeting in place, restlessness.

Children with ADHD often climb or run somewhere when it is inopportune, they cannot calmly and quietly play. This aimless hyperactivity is persistent and unaffected by the rules or conditions of the situation.

Impulsivity is manifested in situations where the kids, without listening to the question and without thinking, answer it, are not able to wait for their turn. Such children often interrupt others, interfere with them, are often talkative or unrestrained in speech.

Characteristics of a child with ADHD. The listed symptoms should be observed in babies for at least six months and apply to all areas of their life (disturbances in adaptation processes are noted in several types of environments). Disorders in learning, problems in social contacts and labor activity in such children are pronounced.

The diagnosis of ADHD is made with the exclusion of other pathologies of the psyche, since the manifestations of this syndrome should not be associated only with the presence of another disease.

The characteristics of a child with ADHD has its own characteristics depending on the age period in which he is.

In the preschool period (from three to 7 years), children often begin to show increased activity and impulsivity. Excessive activity is manifested by the constant movement in which the kids are. They are characterized by extreme restlessness in the classroom and talkativeness. The impulsiveness of babies is expressed in the commission of rash actions, in the frequent interruption of other people, interference in extraneous conversations that do not concern them. Usually such children are considered ill-mannered or overly temperamental. Often, impulsiveness can be accompanied by recklessness, as a result of which the baby can endanger himself or others.

Children with ADHD are rather sloppy, naughty, often throw or break things, toys, may show, sometimes lag behind their peers in speech development.

The problems of a child with ADHD after entering an educational institution are only exacerbated, due to school requirements, which he is not fully able to fulfill. Children's behavior does not meet the age norm, therefore, in an educational institution, he is not able to obtain results that correspond to his potential (the level of intellectual development corresponds to the age interval). Such children do not hear the teacher during classes, it is difficult for them to solve the proposed tasks, because they experience difficulties in organizing work and bringing it to completion, in the process of performing they forget the conditions of the tasks, they poorly learn the educational material and are not able to correctly apply it. Therefore, kids pretty quickly disconnect from the process of completing tasks.

Children with ADHD do not notice details, are prone to forgetfulness, poor switching and not following the instructions of the teacher. At home, such kids are unable to cope on their own with the implementation of tasks in the lessons. They are much more likely, in comparison with their peers, to have difficulties in the formation of logical thinking skills, the ability to read, write and count.

Schoolchildren suffering from ADHD syndrome are characterized by difficulties in interpersonal relationships, problems in establishing contacts. Their behavior is prone to unpredictability, due to significant mood swings. There is also ardor, cockiness, opposing and aggressive actions. As a result, such kids cannot devote a long time to the game, successfully interact and establish friendly contacts with their peers.

In the team, kids suffering from ADHD are sources of constant anxiety, as they make noise, interfere with others, take other people's things without asking. All of the above leads to the emergence of conflicts, as a result of which the baby becomes unwanted in the team. Encountering such an attitude, kids often consciously become "jesters" in the class, hoping thereby to establish relationships with their peers. As a result, not only the school performance of children with ADHD suffers, but also the work of the class as a whole, so they can disrupt the lessons. In general terms, their behavior gives the impression of inconsistency with their age period, so their peers are reluctant to communicate with them, which gradually forms an underestimated level in children with ADHD. In the family, such babies often suffer due to constant comparison with other children who are more obedient or learn better.

ADHD hyperactivity in adolescence is characterized by a significant decrease. It is replaced by a feeling of inner restlessness and fussiness.

Adolescents with ADHD are characterized by lack of independence, irresponsibility, difficulties in completing assignments, assignments and in organizing activities. In the pubertal period, pronounced manifestations of disorders in the function of attention and impulsivity are observed in approximately 80% of ADHD adolescents. Often, children with such a disorder have a deterioration in school performance, due to the fact that they are not able to effectively plan their own work and organize it in time.

Gradually, children develop difficulties in family and other relationships. Most teenagers with this syndrome are distinguished by the presence of problems in following the rules of behavior, reckless behavior associated with unreasonable risk, disobedience to the laws of society and disobedience to social norms. Along with this, they are characterized by a weak emotional stability of the psyche in case of failures, indecision,. Adolescents are overly sensitive to teasing and taunts from their peers. Educators and others characterize adolescent behavior as immature and out of proportion to their age. In everyday life, children ignore safety measures, which leads to an increased risk of accidents.

Children in puberty with a history of ADHD are much more likely than their peers to be drawn into various gangs that commit offenses. Adolescents may also develop a craving for the abuse of alcohol or drugs.

Work with children with ADHD can cover several areas: or, the key purpose of which is the development of social skills.

Diagnosis of ADHD

Based on international signs, containing lists of the most characteristic and clearly traced manifestations of this disorder, it is possible to diagnose ADHD.

The essential characteristics of this syndrome are:

- the duration of symptoms over time is not less than six months;

- prevalence in at least two types of environment, persistence of manifestations;

- the severity of symptoms (there are significant learning disorders, disorders of social contacts, professional sphere);

- exclusion of other mental disorders.

ADHD hyperactivity is defined as the primary disorder. However, there are several forms of ADHD, caused by the presence of predominant symptoms:

- combined form, which includes three groups of symptoms;

- ADHD with prevailing attention disorders;

- ADHD with dominance of impulsivity and increased activity.

In the childhood age period, the so-called states-imitators of this syndrome are relatively often observed. Approximately 20 percent of children periodically experience ADHD-like behaviors. Therefore, ADHD should be distinguished from a wide range of conditions that are similar to it only in external manifestations, but differ significantly in causes and methods of correction. These include:

- individual personal characteristics and characteristics (the behavior of overly active kids does not go beyond the age norm, the degree of formation of higher mental functions at the level);

- anxiety disorders (features of children's behavior are associated with the impact of psycho-traumatic causes);

- consequences of a brain injury, intoxication, neuroinfection;

- in case of somatic diseases, the presence of asthenic syndrome;

- characteristic violations of the formation of school skills, such as dyslexia or dysgraphia;

- diseases of the endocrine system (diabetes mellitus or thyroid pathology);

- sensorineural hearing loss;

- hereditary factors, for example, the presence of Tourette's syndrome, Smith-Magenis or a fragile X chromosome;

- epilepsy;

In addition, the diagnosis of ADHD should be made taking into account the specific age dynamics of this condition. Manifestations of ADHD have characteristic features in accordance with a certain age period.

ADHD in adults

According to current statistics, approximately 5% of adults are affected by ADHD. Along with this, such a diagnosis is noted in almost 10% of students at school. Approximately half of children with ADHD continue into adulthood with the condition. At the same time, the adult population is much less likely to go to the doctor because of ADHD, which significantly minimizes the detection of the syndrome in them.

The symptoms of ADHD are individual. However, in the behavior of patients, three core signs can be noted, namely, a violation of the function of attention, increased activity and impulsivity.

Attention disorder is expressed in the impossibility of concentrating attention on a certain object or things. An adult in the course of performing an uninteresting monotonous task becomes bored after a few minutes. It is difficult for such people to consciously focus on any subject. Patients with ADHD are considered by the environment to be optional and non-executive, as they can begin to do several things and not bring any to completion. Increased activity is found in the constant movement of individuals. They are characterized by restlessness, fussiness and excessive talkativeness.

Patients with ADHD suffer from restlessness, wander aimlessly around the room, grab everything in a row, tap on the table with a pen or pencil. Moreover, all such actions are accompanied by increased excitement.

Impulsivity is manifested in being ahead of the actions of thoughts. , suffering from ADHD, tends to voice the first thoughts that come to mind, constantly inserts his own remarks out of place into the conversation, and makes impulsive and often thoughtless actions.

In addition to these manifestations, individuals suffering from ADHD are characterized by forgetfulness, anxiety, lack of punctuality, low self-esteem, disorganization, poor resistance to stress factors, melancholy, depressive states, marked mood swings, and difficulty in reading. Such features complicate the social adaptation of individuals and form a fertile ground for the formation of any form of dependence. The inability to concentrate breaks careers and destroys personal relationships. If patients turn to a competent specialist in a timely manner and receive adequate treatment, then in most cases, all problems with adaptation will come to naught.

Treatment of ADHD in adults should be comprehensive. They are usually prescribed drugs that stimulate the nervous system, such as methylphenidate. These medications do not cure ADHD, but they do help control the symptoms.

Treatment of ADHD in adults leads to improvement in the condition of most patients, but it can be quite difficult for them. Psychological counseling helps to acquire self-organization skills, the ability to competently adjust the daily routine, restore broken relationships and improve communication skills.

Treatment for ADHD

Treatment of ADHD in children has certain methods aimed at reviving the frustrated functions of the nervous system and their adaptation in society. Therefore, therapy is multifactorial and includes diet, non-drug treatment and drug therapy.

In the first turn, you should deal with the normalization of the gastrointestinal tract. Therefore, preference in the daily diet should be given to natural products. Dairy products and eggs, pork, canned and dye-containing foods, refined sugar, citrus fruits and chocolate should be excluded from the diet.

Non-drug treatment of ADHD in children involves modification of behavior, psychotherapeutic practices, pedagogical and neuropsychological corrective impact. Toddlers are offered a facilitated learning mode, that is, the quantitative composition of the classroom is reduced and the duration of classes is reduced. Children are encouraged to sit at the first desks to be able to concentrate. It is also necessary to work with parents so that they learn to treat the behavior of their own children with patience. Parents need to explain the need for their control over the observance of the daily regimen of hyperactive children, providing kids with the opportunity to expend excess energy through exercise or long walks. In the process of children performing tasks, fatigue must be minimized. Since hyperactive kids are distinguished by increased excitability, it is recommended that they be partially isolated from interaction in large companies. Also, their partners in the game must have restraint and have a calm character.

Non-drug treatment also includes the use of some psychotherapeutic techniques, for example, correction of ADHD is possible with the help of role-playing games or art therapy.

Correction of ADHD with the help of drug therapy is prescribed if there is no result from other methods used. Psychostimulants, nootropics, tricyclic antidepressants and tranquilizers are widely used.

In addition, work with children with ADHD should be focused on solving several problems: conducting a comprehensive diagnosis, normalizing the family environment, establishing contacts with teachers, increasing self-esteem in children, developing obedience in children, teaching them to respect the rights of other individuals, correct verbal communication, control over your own emotions.

In recent years, great progress has been made in the study of one of the most urgent problems of neuropediatrics - attention deficit hyperactivity disorder in children. The urgency of the problem is determined by the high frequency of this syndrome in the child population and its great social significance. Children with Attention Deficit Disorder have normal or high intelligence, but tend to do poorly in school. In addition to learning difficulties, attention deficit disorder is manifested by motor hyperactivity, attention defects, distractibility, impulsive behavior, and problems in relationships with others. It should be noted that attention deficit disorder is observed in both children and adults. In recent years, its genetic nature has been proven. It is quite obvious that the interests of various specialists - pediatricians, teachers, neuropsychologists, speech pathologists, neurologists - are concentrated in the focus of scientific problems of attention deficit hyperactivity disorder.

1. Attention Deficit Hyperactivity Disorder- dysfunction of the central nervous system (mainly the reticular formation of the brain and spinal cord. The reticular formation (lat. rete - network) is a collection of cells, cell clusters and nerve fibers located throughout the brainstem (medulla oblongata, bridge, middle and diencephalon ) and in the central parts of the spinal cord. The reticular formation receives information from all the senses, internal and other organs, evaluates it, filters it and transmits it to the limbic system and the cerebral cortex. It regulates the level of excitability and tone of various parts of the central nervous system, including the cortex large brain, plays an important role in consciousness, thinking, memory, perception, emotions, sleep, wakefulness, vegetative functions, purposeful movements, as well as in the mechanisms of formation of integral reactions of the body.The reticular formation primarily performs the function of a filter that allows important sensory signals to activate the cerebral cortex, but does not pass habitual or repetitive signals.), Manifested by difficulties in concentrating and maintaining attention, learning and memory disorders, as well as difficulties in processing exogenous and endogenous information and stimuli.

The term "attention deficit disorder" was isolated in the early 80s from the broader concept of "minimal brain dysfunction". The history of the study of minimal brain dysfunction is associated with the studies of E. Kahn, although some studies have been carried out earlier. Observing school-age children with such behavioral disorders as motor disinhibition, distractibility, impulsive behavior, the authors suggested that the cause of these changes is brain damage of unknown etiology, and proposed the term "minimal brain damage". Subsequently, learning disorders (difficulties and specific impairments in learning writing, reading, counting skills; disorders of perception and speech) were also included in the concept of "minimal brain damage". Subsequently, the static "minimal brain damage" model gave way to a more dynamic and more flexible "minimal brain dysfunction" model.

In 1980, the American Psychiatric Association developed a working classification - DSM-IV (the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition), - according to which cases previously described as minimal brain dysfunction were proposed to be considered as attention deficit hyperactivity disorder and hyperactivity disorder. . The underlying premise was that the most common and significant clinical symptoms of minimal brain dysfunction included impaired attention and hyperactivity. In the latest DSM-IV classification, these syndromes are grouped under one name "Attention Deficit Hyperactivity Disorder". In the ICD-10, the syndrome is covered under "Emotional and behavioral disorders with onset usually in childhood and adolescence" under "Impaired activity and attention" (F90.0) and "Hyperkinetic conduct disorder" (F90.1).

The frequency of attention deficit hyperactivity disorder, according to different authors, varies from 2.2 to 18% in school-age children. Such differences are explained by non-compliance with clear criteria for diagnosis. According to the American Psychiatric Association, about 5% of school-age children suffer from Attention Deficit Hyperactivity Disorder. Almost every school class has at least one child with this disease. In the study of N.N. Zavodenko, the frequency of attention deficit disorder in schoolchildren was 7.6%. Boys are affected twice as often as girls.

Classification. According to DSM-IV, there are 3 variants of the course of attention deficit hyperactivity disorder, depending on the prevailing clinical symptoms:

A syndrome that combines attention deficit hyperactivity disorder;

Attention deficit disorder without hyperactivity;

Attention Deficit Hyperactivity Disorder.

Some researchers question the association of attention deficit hyperactivity disorder and hyperactivity disorder, since up to 40% of all patients suffer only attention deficit without hyperactivity. Attention deficit without hyperactivity disorder is more common in girls.

Attention deficit disorder can be both primary and result from other diseases, that is, it can be secondary or symptomatic (genetically determined syndromes, mental illness, consequences of perinatal and infectious lesions of the central nervous system).

The etiology is not well understood. Most researchers suggest the genetic nature of the syndrome. Families of children with attention deficit hyperactivity disorder often have close relatives who had similar disorders at school age. To identify hereditary burden, a long and detailed questioning is necessary, since the difficulties of learning at school by adults are consciously or unconsciously "amnesiac". Pedigrees of children with attention deficit hyperactivity disorder also often show a burden of obsessive-compulsive disorder (obsessive thoughts and compulsive rituals), tics, and Gilles de la Tourette's syndrome. Probably, there is a genetically determined relationship of neurotransmitter disorders in the brain in these pathological conditions.

It is assumed that attention deficit/hyperactivity disorder is determined by mutations in 3 genes that regulate dopamine metabolism - the D4 receptor gene, the D2 receptor gene, and the gene responsible for dopamine transport (a neurotransmitter). S. Faraone, J. Biederman discussed the hypothesis that the carriers of the mutant gene are children with the most pronounced hyperactivity.

Along with genetic factors, family, pre- and perinatal risk factors for the development of attention deficit hyperactivity disorder are distinguished. Family factors include the low social status of the family, the presence of a criminal environment, severe disagreements between parents. Neuropsychiatric disorders, alcoholism and deviations in sexual behavior in the mother are considered especially significant. Pre- and perinatal risk factors for the development of attention deficit disorder include neonatal asphyxia, maternal alcohol consumption during pregnancy, certain drugs, and smoking.

It is assumed that the pathogenesis of the syndrome is based on disturbances in the activating system of the reticular formation, which contributes to the coordination of learning and memory, the processing of incoming information, and the spontaneous maintenance of attention. Violations of the activating function of the reticular formation, apparently, are associated with a lack of norepinephrine in it (in protein synthesis it follows dopamine). The impossibility of adequate processing of information leads to the fact that various visual, sound, emotional stimuli become redundant for the child, causing anxiety, irritation and aggressiveness. Violations in the functioning of the reticular formation predetermine secondary disorders of the neurotransmitter metabolism of the brain. The theory of the relationship of hyperactivity with dopamine metabolism disorders has numerous confirmations, in particular, the success of the treatment of attention deficit hyperactivity disorder with dopaminergic drugs. It is possible that disorders of neurotransmitter metabolism leading to hyperactivity are associated with mutations in genes that regulate the functions of dopamine receptors. Separate biochemical studies in children with attention deficit hyperactivity disorder indicate that the metabolism of not only dopamine, but also other neurotransmitters, serotonin and norepinephrine, is disturbed in the brain.

In addition to the reticular formation, dysfunction of the frontal lobes (prefrontal cortex), subcortical nuclei and the pathways connecting them are likely to be important in the pathogenesis of attention deficit hyperactivity disorder. One of the confirmations of this assumption is the similarity of neuropsychological disorders in children with attention deficit disorder and in adults with damage to the frontal lobes of the brain. Spectral tomography of the brain revealed a decrease in blood flow in the prefrontal cortex of the brain during intellectual loads in 65% of children with attention deficit hyperactivity disorder, while in the control group - only 5%.

Criteria for diagnosis and clinical manifestations. Adequate diagnosis of attention deficit hyperactivity disorder is impossible without strict adherence to the diagnostic criteria. These, according to DSM-IV, include:

The presence of attention deficit and / or hyperactivity in the child;

Early (up to 7 years) onset of symptoms and duration (more than 6 months) of their existence;

Some symptoms are observed both at home and at school;

The symptoms are not a manifestation of other diseases;

Violation of learning and social functions.

It should be noted that the presence of learning disorders and social functions is a necessary criterion for establishing the diagnosis of "attention deficit hyperactivity disorder". In addition, the diagnosis of attention deficit hyperactivity disorder can only be made when learning difficulties are evident (i.e. not earlier than 5-6 years of age).

According to the DSM-IV, a diagnosis of attention deficit disorder can be made if at least 6 of the symptoms described below are present. A child has an attention deficit if he:

Does not pay attention to details and makes mistakes in work;

With difficulty maintains attention in work and play;

Does not listen to what is said to him;

Unable to follow instructions;

Cannot arrange play or activity;

Has difficulty performing tasks that require prolonged concentration of attention;

Often loses things;

Frequently and easily distracted;

Be forgetful.

At least 5 of the following symptoms must be present to diagnose hyperactivity. A child is hyperactive if he:

Makes fussy movements with arms and legs;

Often jumps up from his seat;

Hypermobile in situations where hypermobility is unacceptable;

Cannot play "silent" games;

Always in motion;

He talks a lot.

A child is impulsive (i.e. unable to stop and think before speaking or acting) if they:

Answers a question without listening to it;

Can't wait for their turn;

Intervenes in the conversations and games of others.

In a significant percentage of cases, the clinical manifestations of the syndrome occur before the age of 5-6 years, and sometimes already in the 1st year of life. Children of the 1st year of life, who subsequently develop hyperactivity, often suffer from sleep disorders and hyperexcitability. In the future, they become extremely naughty and hyperactive, their behavior is hardly controlled by their parents. At the same time, children who later have attention deficit disorder without hyperactivity may moderately lag behind in motor (they begin to roll over, crawl, walk 1-2 months later) and speech development in infancy, they are inert, passive, not very emotional. As the child grows, attentional disturbances become apparent, which parents usually do not pay attention to at first.

Violation of attention and the phenomena of hyperactivity-impulsivity lead to the fact that a school-age child with normal or high intelligence has impaired reading and writing skills, does not cope with school assignments, makes many mistakes in work performed and is not inclined to listen to the advice of adults. The child is a source of constant anxiety for others (parents, teachers, peers), as he interferes in other people's conversations and activities, takes other people's things, often behaves completely unpredictably, overreacts to external stimuli (the reaction does not correspond to the situation). Such children hardly adapt in the team, their distinct desire for leadership has no actual reinforcement. Due to their impatience and impulsiveness, they often come into conflict with peers and teachers, which exacerbates existing learning disabilities. The child is also unable to foresee the consequences of his behavior, does not recognize authorities, which can lead to antisocial acts. Especially often antisocial behavior is observed in adolescence, when children with attention deficit hyperactivity disorder have an increased risk of developing persistent behavioral disorders and aggressiveness. Adolescents with this pathology are more likely to start smoking early and take narcotic drugs, they are more likely to experience traumatic brain injuries. Parents of a child with attention deficit hyperactivity disorder (ADHD) are sometimes moody and impulsive themselves. Outbursts of rage, aggressive actions, and a child's stubborn refusal to behave in accordance with parental rules can lead to an uncontrollable reaction from the parents and to physical abuse.

On neurological examination of a child with attention deficit disorder with or without hyperactivity, focal neurological symptoms are usually absent. There may be a lack of fine motor skills, impaired reciprocal coordination of movements and moderate ataxia. More often than in the general child population, speech disorders are observed.

Differential diagnosis of attention deficit hyperactivity disorder should be carried out with specific learning disorders (dyscalculia, dyslexia. dyscalculia is a specific learning disorder in counting, manifested at different ages of the preschool and school population. The term dyslexia comes from two Greek words "dis" - complexity and "lexis" -word, literally translated dyslexia means "difficulty with words". Dyslexia manifests itself in violations of the reading process, in constantly repeating mistakes. People suffering from dyslexia skip sounds, change letters in places or add unnecessary ones, distort the sound of words, sometimes "swallow" whole syllables.), asthenic syndromes (this condition is manifested by increased fatigue, weakening or loss of the ability for prolonged physical and mental stress. Patients have irritable weakness, expressed by increased excitability and exhaustion quickly following it, affective lability with a predominance of low mood with features of capriciousness and displeasure, as well as tearfulness.) against the background of intercurrent diseases (comorbidities), thyroid diseases, mild mental retardation and schizophrenia. Differential diagnosis is often difficult, since attention deficit disorder can be combined with a number of other diseases and conditions, most often with psychiatric pathology (depression, panic attacks, obsessive thoughts).

The system of treatment and observation of children with attention deficit is not developed enough, due to the ambiguity of the pathogenesis of the disease. There are non-drug and drug methods of correction.

Non-drug correction includes methods of behavior modification, psychotherapy, pedagogical and neuropsychological correction. The child is recommended a sparing mode of learning - the minimum number of children in the class (ideally no more than 12 people), a shorter duration of classes (up to 30 minutes), the child's stay in the first desk (eye contact between the teacher and the child improves concentration). From the point of view of social adaptation, it is also important to purposefully and long-term education of socially encouraged norms of behavior in a child, since the behavior of some children has antisocial features. Psychotherapeutic work is needed with parents so that they do not regard the child's behavior as "hooligan" and show more understanding and patience in their educational activities. Parents should monitor the observance of the day regimen of a "hyperactive" child (meal time, homework, sleep), provide him with the opportunity to expend excess energy in physical exercises, long walks, running. Fatigue while performing tasks should also be avoided, as this may increase hyperactivity. "Hyperactive" children are extremely excitable, so it is necessary to exclude or limit their participation in activities associated with the accumulation of a large number of people. Since the child has difficulty concentrating, you need to give him only one task for a certain period of time. The choice of partners for games is important - the child's friends should be balanced and calm.

Drug therapy for attention deficit hyperactivity disorder is appropriate when non-drug methods of correction are ineffective. Psychostimulants, tricyclic antidepressants, tranquilizers and nootropic drugs are used. In international pediatric neurological practice, the effectiveness of two antidepressant drugs, amitriptyline and Ritalin, belonging to the amphetamine group, has been empirically established.

The drug of first choice in the treatment of attention deficit hyperactivity disorder is methylphenidate (Ritalin, Centedrin, Meredil). The positive effect of methylphenidate is observed in 70-80% of children. The drug is administered once in the morning at a dose of 10 mg (1 tablet), but the daily dose can reach 6 mg/kg. The therapeutic effect occurs quickly - during the first days of admission. Despite the high efficacy of methylphenidate, there are limitations and contraindications to its use associated with frequent side effects. The latter include growth retardation, irritability, sleep disturbance, loss of appetite and body weight, provocation of tics, dyspeptic disorders, dry mouth and dizziness. The drug may develop addiction. Contraindications to taking the drug are the child's age less than 6 years, pronounced states of anxiety and agitation, as well as the presence of a family history of tics and Tourette's syndrome. Unfortunately, methylphenidate is not available on the Russian pharmaceutical market. In domestic pediatric practice, the drug amitriptyline, which has fewer side effects, is more widely used. Amitriptyline is prescribed for children under 7 years old at a dose of 25 mg / day, for children over 7 years old - at a dose of 25-50 mg / day. The initial dose of the drug is 1/4 tablet and increases gradually over 7-10 days. The effectiveness of amitriptyline in the treatment of children with attention deficit disorder is 60%.

Single domestic studies also prove the effectiveness of the use of nootropic drugs (nootropil, piracetam and instenon) in the treatment of children with attention deficit hyperactivity disorder. N.N. Zavodenko and observed the positive effect of instenon in 59% of patients. Instenon was administered at a dose of 1.5 tablets per day to children aged 7-10 years for 1 month. There was an improvement in the characteristics of behavior, motor skills, attention and memory.

The greatest effect in the treatment of attention deficit hyperactivity disorder is achieved by combining various methods of psychological work (both with the child himself and with his parents) and drug therapy.

The prognosis is relatively good, as in a significant proportion of children, symptoms disappear during adolescence. Gradually, as the child grows, disturbances in the neurotransmitter system of the brain are compensated, and some of the symptoms regress. However, in 30-70% of cases, clinical manifestations of attention deficit hyperactivity disorder (excessive impulsivity, irascibility, absent-mindedness, forgetfulness, restlessness, impatience, unpredictable, rapid and frequent mood changes) can also be observed in adults. The factors of the unfavorable prognosis of the syndrome are its combination with mental illness, the presence of psychopathology in the mother, as well as the symptoms of impulsivity in the patient himself. Social adaptation of children with attention deficit hyperactivity disorder can be achieved only with the interest and cooperation of the family, school and society.

Someone thinks that this is just a character, someone considers it a wrong upbringing, but many doctors call it Attention Deficit Hyperactivity Disorder. Attention deficit hyperactivity disorder (ADHD) is a dysfunction of the central nervous system (mainly the reticular formation of the brain), manifested by difficulties in concentrating and maintaining attention, learning and memory disorders, as well as difficulties in processing exogenous and endogenous information and stimuli. This is one of the most common neuropsychiatric disorders in childhood, its prevalence ranges from 2 to 12% (average 3-7%), and is more common in boys than girls. ADHD can occur both in isolation and in combination with other emotional and behavioral disorders, having a negative impact on the child's learning and social adaptation.

The first manifestations of ADHD are usually observed from 3-4 years of age. But when a child gets older and enters school, he has additional difficulties, since the beginning of schooling makes new, higher demands on the child's personality and his intellectual abilities. It is during the school years that attention disorders become apparent, as well as difficulties in mastering the school curriculum and poor academic performance, self-doubt and low self-esteem.

Children with Attention Deficit Disorder have normal or high intelligence, but tend to do poorly in school. In addition to learning difficulties, attention deficit disorder is manifested by motor hyperactivity, attention defects, distractibility, impulsive behavior, and problems in relationships with others. In addition to the fact that children with ADHD misbehave and perform poorly at school, as they grow older, they may be at risk for the formation of deviant and antisocial forms of behavior, alcoholism, and drug addiction. Therefore, it is important to recognize the early manifestations of ADHD and be aware of the possibilities for their treatment. It should be noted that attention deficit disorder is observed in both children and adults.

Causes of ADHD

A reliable and unique cause of the syndrome has not yet been found. It is believed that the formation of ADHD is based on neurobiological factors: genetic mechanisms and early organic damage to the central nervous system, which can be combined with each other. They determine the changes in the central nervous system, violations of higher mental functions and behavior, corresponding to the picture of ADHD. The results of modern research indicate the involvement of the system "associative cortex-basal ganglia-thalamus-cerebellum-prefrontal cortex" in the pathogenetic mechanisms of ADHD, in which the coordinated functioning of all structures ensures control of attention and organization of behavior.

In many cases, an additional impact on children with ADHD is exerted by negative socio-psychological factors (primarily family factors), which in themselves do not cause the development of ADHD, but always contribute to an increase in the child's symptoms and adaptation difficulties.

genetic mechanisms. Among the genes that determine the predisposition to the development of ADHD (the role of some of them in the pathogenesis of ADHD is confirmed, while others are considered as candidates), include genes that regulate the metabolism of neurotransmitters in the brain, in particular dopamine and norepinephrine. Dysfunction of neurotransmitter systems of the brain plays an important role in the pathogenesis of ADHD. At the same time, disturbances in the processes of synaptic transmission are of primary importance, which entail dissociation, a break in connections between the frontal lobes and subcortical formations, and as a result of this, the development of ADHD symptoms. In favor of disorders of neurotransmitter transmission systems as the primary link in the development of ADHD is evidenced by the fact that the mechanisms of action of drugs that are most effective in the treatment of ADHD are to activate the release and inhibition of the reuptake of dopamine and norepinephrine in presynaptic nerve endings, which increases the bioavailability of neurotransmitters at the level of synapses. .

In modern concepts, attention deficit in children with ADHD is considered as a result of disturbances in the functioning of the posterior cerebral attention system regulated by norepinephrine, while disorders of behavioral inhibition and self-control characteristic of ADHD are considered as a lack of dopaminergic control over the flow of impulses to the forebrain attention system. The posterior cerebral system includes the superior parietal cortex, the superior colliculus, the thalamic cushion (the dominant role belongs to the right hemisphere); this system receives dense noradrenergic innervation from the locus coeruleus (blue spot). Norepinephrine suppresses spontaneous discharges of neurons, thereby preparing the posterior cerebral attention system, which is responsible for orienting to new stimuli, to work with them. This is followed by a switch in the mechanisms of attention to the anterior cerebral control system, which includes the prefrontal cortex and the anterior cingulate gyrus. The susceptibility of these structures to incoming signals is modulated by dopaminergic innervation from the ventral tegmental nucleus of the midbrain. Dopamine selectively regulates and limits excitatory impulses to the prefrontal cortex and cingulate gyrus, providing a reduction in excessive neuronal activity.

Attention deficit hyperactivity disorder (ADHD) is considered a polygenic disorder in which multiple disorders of dopamine and/or norepinephrine metabolism that exist simultaneously are due to the influence of several genes that override the protective effect of compensatory mechanisms. The effects of the genes that cause ADHD are complementary. Thus, ADHD is considered as a polygenic pathology with a complex and variable inheritance, and at the same time as a genetically heterogeneous condition.

Pre- and perinatal factors play an important role in the pathogenesis of ADHD. The formation of ADHD may be preceded by disturbances in the course of pregnancy and childbirth, in particular preeclampsia, eclampsia, the first pregnancy, the age of the mother is younger than 20 years or older than 40 years, prolonged labor, post-term pregnancy and prematurity, low birth weight, morphofunctional immaturity, hypoxic ischemic encephalopathy, a disease of a child in the first year of life. Other risk factors are the use of certain drugs by the mother during pregnancy, alcohol and smoking.

Apparently, a slight decrease in the size of the prefrontal areas of the brain (mainly in the right hemisphere), subcortical structures, corpus callosum, and cerebellum found in children with ADHD compared with healthy peers using magnetic resonance imaging (MRI) is apparently associated with early CNS damage. These data support the concept that the occurrence of ADHD symptoms is due to impaired connections between the prefrontal regions and subcortical ganglia, primarily the caudate nucleus. Subsequently, additional confirmation was obtained through the use of functional neuroimaging methods. Thus, when determining cerebral blood flow using single-photon emission computed tomography in children with ADHD, compared with healthy peers, a decrease in blood flow (and, consequently, metabolism) in the frontal lobes, subcortical nuclei and midbrain was demonstrated, and the changes were most pronounced at the level caudate nucleus. According to the researchers, changes in the caudate nucleus in children with ADHD were the result of its hypoxic-ischemic damage during the neonatal period. Having close connections with the thalamus opticus, the caudate nucleus performs an important function of modulation (mainly of an inhibitory nature) of polysensory impulsations, and the absence of inhibition of polysensory impulsations may be one of the pathogenetic mechanisms of ADHD.

With the help of positron emission tomography (PET), it was found that cerebral ischemia transferred at birth leads to persistent changes in dopamine receptors of the 2nd and 3rd types in the structures of the striatum. As a result, the ability of receptors to bind dopamine decreases and a functional insufficiency of the dopaminergic system is formed.

A recent comparative MRI study of children with ADHD, the purpose of which was to assess regional differences in the thickness of the cerebral cortex and compare their age dynamics with clinical outcomes, showed that children with ADHD showed a global decrease in cortical thickness, most pronounced in the prefrontal (medial and upper) and precentral regions. At the same time, in patients with worse clinical outcomes during the initial examination, the smallest thickness of the cortex was found in the left medial prefrontal region. Normalization of the thickness of the right parietal cortex was associated with the best outcomes in patients with ADHD and may reflect a compensatory mechanism associated with changes in the thickness of the cerebral cortex.

The neuropsychological mechanisms of ADHD are considered from the standpoint of disorders (immaturity) of the functions of the frontal lobes of the brain, primarily the prefrontal area. Manifestations of ADHD are analyzed from the standpoint of a deficit in the functions of the frontal and prefrontal parts of the brain and insufficient formation of executive functions (EF). Patients with ADHD present with "executive dysfunction". The development of UV and the maturation of the prefrontal region of the brain are long-term processes that continue not only in childhood but also in adolescence. EF is a rather broad concept referring to the range of abilities that serve the task of maintaining the necessary sequence of efforts to solve a problem, aimed at achieving a future goal. Significant components of the EF that are affected in ADHD are: impulse control, behavioral inhibition (restraint); organization, planning, management of mental processes; maintaining attention, keeping from distractions; inner speech; working (operative) memory; foresight, forecasting, a look into the future; retrospective assessment of past events, mistakes made; change, flexibility, ability to switch and revise plans; choice of priorities, the ability to allocate time; separating emotions from real facts. Some UF researchers emphasize the "hot" social aspect of self-regulation and the child's ability to control their behavior in society, while others emphasize the role of regulation of mental processes - the "cold" cognitive aspect of self-regulation.

Influence of adverse environmental factors. Anthropogenic pollution of the human environment, largely associated with microelements from the group of heavy metals, can have negative consequences for children's health. It is known that in the immediate vicinity of many industrial enterprises, zones with a high content of lead, arsenic, mercury, cadmium, nickel and other microelements are formed. The most common heavy metal neurotoxicant is lead, and its sources of environmental pollution are industrial emissions and vehicle exhaust gases. Lead exposure to children can cause cognitive and behavioral problems in children.

The role of nutritional factors and unbalanced nutrition. Nutritional imbalances (e.g., protein deficiency with an increase in easily digestible carbohydrates, especially in the morning), as well as micronutrient deficiencies, including vitamins, folates, omega-3 polyunsaturated fatty acids (PUFAs) can contribute to the onset or exacerbation of ADHD symptoms. , macro- and microelements. Micronutrients such as magnesium, pyridoxine and some others directly affect the synthesis and degradation of monoamine neurotransmitters. Therefore, micronutrient deficiencies can affect the neurotransmitter balance and hence the manifestation of ADHD symptoms.
Of particular interest among micronutrients is magnesium, which is a natural lead antagonist and promotes the rapid elimination of this toxic element. Therefore, magnesium deficiency, among other effects, can contribute to the accumulation of lead in the body.

Magnesium deficiency in ADHD can be associated not only with its insufficient intake with food, but also with an increased need for it during critical periods of growth and development, with severe physical and neuropsychic stress, and stress. Under conditions of environmental stress, nickel and cadmium, along with lead, act as magnesium displacing metals. In addition to a lack of magnesium in the body, the manifestation of ADHD symptoms can be influenced by zinc, iodine, and iron deficiencies.

Thus, ADHD is a complex neuropsychiatric disorder, accompanied by structural, metabolic, neurochemical, neurophysiological changes in the CNS, as well as neuropsychological disorders in the processes of information processing and UV.

Symptoms of ADHD in children

Symptoms of ADHD in a child may be the reason for the primary appeal to pediatricians, speech therapists, defectologists, psychologists. Often it is teachers of preschool and school educational institutions who first pay attention to the symptoms of ADHD, and not parents. The detection of such symptoms is a reason to show the child to a neurologist and neuropsychologist.

Main manifestations of ADHD

1. Attention disorders
Does not pay attention to details, makes many mistakes.
It is difficult to maintain attention when performing school and other tasks.
He does not listen to what is said to him.
Cannot follow instructions and follow through.
Unable to independently plan, organize the execution of tasks.
Avoids things that require prolonged mental stress.
Often loses his things.
Easily distracted.
Shows forgetfulness.
2a. Hyperactivity
Often makes restless movements with arms and legs, fidgets in place.
Cannot sit still when necessary.
Often runs or climbs somewhere when it is inappropriate.
Can't play quietly.
Excessive aimless physical activity is persistent, it is not affected by the rules and conditions of the situation.
2b. Impulsiveness
Answers questions without listening to the end and without thinking.
Can't wait for their turn.
Interferes with other people, interrupts them.
Chatty, unrestrained in speech.

The essential characteristics of ADHD are:

Duration: symptoms persist for at least 6 months;
- constancy, distribution to all spheres of life: adaptation disorders are observed in two or more types of environment;
- severity of violations: significant violations in training, social contacts, professional activities;
- other mental disorders are excluded: the symptoms cannot be associated exclusively with the course of another disease.

Depending on the predominant symptoms, there are 3 forms of ADHD:
- combined (combined) form - there are all three groups of symptoms (50-75%);
- ADHD with predominant attention disorders (20-30%);
- ADHD with a predominance of hyperactivity and impulsivity (about 15%).

Symptoms of ADHD have their own characteristics in preschool, primary school and adolescence.

Preschool age. Between the ages of 3 and 7, hyperactivity and impulsivity usually begin to appear. Hyperactivity is characterized by the fact that the child is in constant motion, cannot sit still during classes for even a short time, is too talkative and asks an endless number of questions. Impulsivity is expressed in the fact that he acts without thinking, cannot wait for his turn, does not feel restrictions in interpersonal communication, intervening in conversations and often interrupting others. Such children are often characterized as misbehaving or too temperamental. They are extremely impatient, arguing, making noise, shouting, which often leads them to outbursts of strong irritation. Impulsivity can be accompanied by recklessness, as a result of which the child endangers himself (increased risk of injury) or others. During games, energy is overflowing, and therefore the games themselves become destructive. Children are sloppy, often throw, break things or toys, are naughty, poorly obey the demands of adults, and can be aggressive. Many hyperactive children lag behind their peers in language development.

School age. After entering school, the problems of children with ADHD increase significantly. The learning requirements are such that a child with ADHD is not able to fulfill them fully. Because his behavior does not correspond to the age norm, he fails to achieve results in school that correspond to his abilities (while the general level of intellectual development in children with ADHD corresponds to the age range). During the lessons, they do not hear the teacher, it is difficult for them to cope with the proposed tasks, as they experience difficulties in organizing work and bringing it to the end, they forget in the course of fulfilling the conditions of the task, they do not master the teaching materials well and cannot apply them correctly. They quite soon turn off the process of doing the work, even if they have everything necessary for this, do not pay attention to details, show forgetfulness, do not follow the instructions of the teacher, switch poorly when the conditions of the task change or a new one is given. They are unable to do their homework on their own. Compared with peers, difficulties in the formation of writing, reading, counting, and logical thinking skills are much more common.

Relationship problems with others, including peers, teachers, parents, and siblings, are common among children with ADHD. Since all manifestations of ADHD are characterized by significant mood swings at different times and in different situations, the child's behavior is unpredictable. Hot temper, cockiness, oppositional and aggressive behavior are often observed. As a result, he cannot play for a long time, successfully communicate and establish friendly relations with peers. In the team, he serves as a source of constant anxiety: he makes noise without hesitation, takes other people's things, interferes with others. All this leads to conflicts, and the child becomes unwanted and rejected in the team.

Faced with this attitude, children with ADHD often consciously choose to play the role of class jester, hoping to build relationships with their peers. A child with ADHD not only does not study well on his own, but often "breaks" the lessons, interferes with the work of the class, and therefore is often called to the director's office. In general, his behavior creates the impression of "immaturity", inconsistency with his age. Only younger children or peers with similar behavior problems are usually ready to communicate with him. Gradually, children with ADHD develop low self-esteem.

At home, children with ADHD usually suffer constant comparisons to siblings who are well-behaved and learn better. Parents are annoyed by the fact that they are restless, obsessive, emotionally labile, undisciplined, disobedient. At home, the child is unable to take responsibility for the implementation of daily tasks, does not help parents, is sloppy. At the same time, comments and punishments do not give the desired results. According to the parents, “Something always happens to him”, that is, there is an increased risk of injuries and accidents.

Adolescence. In adolescence, pronounced symptoms of impaired attention and impulsivity continue to be observed in at least 50-80% of children with ADHD. At the same time, hyperactivity in adolescents with ADHD is significantly reduced, replaced by fussiness, a sense of inner restlessness. They are characterized by lack of independence, irresponsibility, difficulties in organizing and completing the execution of assignments and especially long-term work, which they are often unable to cope with without outside help. School performance often worsens, as they cannot effectively plan their work and distribute it over time, they postpone the execution of necessary tasks from day to day.

Difficulties in relationships in the family and school, behavioral disorders are growing. Many adolescents with ADHD are distinguished by reckless behavior associated with unjustified risk, difficulties in following the rules of behavior, disobedience to social norms and laws, failure to comply with the requirements of adults - not only parents and teachers, but also officials, such as school administration representatives or police officers. At the same time, they are characterized by weak psycho-emotional stability in case of failures, self-doubt, low self-esteem. They are too sensitive to teasing and ridicule from peers who think they are stupid. Adolescents with ADHD continue to be characterized by peers as immature and inappropriate for their age. In everyday life, they neglect the necessary safety measures, which increases the risk of injury and accidents.

Adolescents with ADHD are prone to being involved in teen gangs that commit various offenses, they may develop cravings for alcohol and drugs. But in these cases, they, as a rule, turn out to be led, obeying the will of stronger peers or older people and not thinking about the possible consequences of their actions.

Disorders associated with ADHD (comorbid disorders). Additional difficulties in intra-family, school and social adaptation in children with ADHD may be associated with the formation of concomitant disorders that develop against the background of ADHD as the underlying disease in at least 70% of patients. The presence of comorbid disorders can lead to worsening of the clinical manifestations of ADHD, worsening of long-term prognosis, and reduced effectiveness of treatment for ADHD. Behavioral and emotional disturbances associated with ADHD are considered as unfavorable prognostic factors for the long-term, up to chronic, course of ADHD.

Comorbid disorders in ADHD are represented by the following groups: externalized (oppositional defiant disorder, conduct disorder), internalized (anxiety disorders, mood disorders), cognitive (speech development disorders, specific learning difficulties - dyslexia, dysgraphia, dyscalculia), motor (static-locomotor failure, developmental dyspraxia, tics). Other comorbid ADHD disorders can be sleep disturbances (parasomnias), enuresis, encopresis.

Thus, learning, behavioral, and emotional problems can be associated with both the direct influence of ADHD and comorbid disorders, which should be diagnosed in a timely manner and considered as indications for additional appropriate treatment.

Diagnosis of ADHD

In Russia, the diagnosis of "hyperkinetic disorder" is approximately equivalent to the combined form of ADHD. To make a diagnosis, all three groups of symptoms (table above) must be confirmed, including at least 6 manifestations of inattention, at least 3 - hyperactivity, at least 1 - impulsiveness.

To confirm ADHD, there are no special criteria or tests based on the use of modern psychological, neurophysiological, biochemical, molecular genetic, neuroradiological and other methods. The diagnosis of ADHD is made by a doctor, but educators and psychologists should also be familiar with the diagnostic criteria for ADHD, especially since it is important to obtain reliable information about the child's behavior not only at home, but also at school or preschool in order to confirm this diagnosis.

In childhood, ADHD “imitators” are quite common: in 15-20% of children, forms of behavior outwardly similar to ADHD are periodically observed. In this regard, ADHD must be distinguished from a wide range of conditions that are similar to it only in external manifestations, but differ significantly both in causes and methods of correction. These include:

Individual characteristics of personality and temperament: the characteristics of the behavior of active children do not go beyond the age norm, the level of development of higher mental functions is good;
- Anxiety disorders: the characteristics of the child's behavior are associated with the action of psychotraumatic factors;
- consequences of traumatic brain injury, neuroinfection, intoxication;
- asthenic syndrome in somatic diseases;
- specific disorders of the development of school skills: dyslexia, dysgraphia, dyscalculia;
- endocrine diseases (pathology of the thyroid gland, diabetes mellitus);
- sensorineural hearing loss;
- epilepsy (absence forms; symptomatic, locally conditioned forms; side effects of anti-epileptic therapy);
- hereditary syndromes: Tourette, Williams, Smith-Mazhenis, Beckwith-Wiedemann, fragile X-chromosome;
- mental disorders: autism, affective disorders (mood), mental retardation, schizophrenia.

In addition, the diagnosis of ADHD should be built taking into account the peculiar age dynamics of this condition.

Treatment for ADHD

At the present stage, it becomes obvious that the treatment of ADHD should be aimed not only at controlling and reducing the main manifestations of the disorder, but also at solving other important tasks: improving the functioning of the patient in various areas and his fullest realization as a person, the emergence of his own achievements, improving self-esteem , normalization of the situation around him, including within the family, the formation and strengthening of communication skills and contacts with people around him, recognition by others and increasing satisfaction with his life.

The study confirmed the significant negative impact of the difficulties experienced by children with ADHD on their emotional state, family life, friendships, schooling, and leisure activities. In this regard, the concept of an expanded therapeutic approach has been formulated, which implies the extension of the influence of treatment beyond the reduction of the main symptoms and taking into account functional outcomes and quality of life indicators. Thus, the concept of an expanded therapeutic approach involves addressing the social and emotional needs of a child with ADHD, which should be given special attention both at the stage of diagnosis and treatment planning, and in the process of dynamic monitoring of the child and evaluation of the results of therapy.

The most effective for ADHD is complex assistance, which combines the efforts of doctors, psychologists, teachers working with the child, and his family. It would be ideal if a good neuropsychologist takes care of the child. Treatment for ADHD should be timely and must include:

Helping the family of a child with ADHD - family and behavioral therapy techniques that provide better interaction in families of children with ADHD;
- development of parenting skills for children with ADHD, including parent training programs;
- educational work with teachers, correction of the school curriculum - through a special one - the presentation of educational material and the creation of such an atmosphere in the classroom that maximizes the chances of successful education of children;
- psychotherapy of children and adolescents with ADHD, overcoming difficulties, developing effective communication skills in children with ADHD during special remedial classes;
- drug therapy and diet, which should be long enough, since improvement extends not only to the main symptoms of ADHD, but also to the socio-psychological side of the patients' lives, including their self-esteem, relationships with family members and peers, usually starting from the third month of treatment . Therefore, it is advisable to plan drug therapy for several months up to the duration of the entire academic year.

Medications to treat ADHD

An effective drug specifically designed for the treatment of ADHD is atomoxetine hydrochloride. The main mechanism of its action is associated with the blockade of norepinephrine reuptake, which is accompanied by an increase in synaptic transmission involving norepinephrine in various brain structures. In addition, experimental studies have found an increase in the content of not only norepinephrine, but also dopamine selectively in the prefrontal cortex under the influence of atomoxetine, since in this area dopamine binds to the same transport protein as norepinephrine. Since the prefrontal cortex plays a leading role in providing executive functions of the brain, as well as attention and memory, an increase in the concentration of norepinephrine and dopamine in this area under the action of atomoxetine leads to a decrease in the manifestations of ADHD. Atomoxetine has a beneficial effect on the behavioral characteristics of children and adolescents with ADHD, its positive effect is usually manifested already at the beginning of treatment, but the effect continues to grow during the month of continuous use of the drug. In most patients with ADHD, clinical efficacy is achieved by prescribing the drug in the dose range of 1.0-1.5 mg/kg of body weight per day with a single dose in the morning. The advantage of atomoxetine is its effectiveness in cases of ADHD combined with destructive behavior, anxiety disorders, tics, enuresis. The drug has many side effects, so the reception is strictly under the supervision of a doctor.

Russian specialists in the treatment of ADHD traditionally use nootropic drugs. Their use in ADHD is justified, since nootropic drugs have a stimulating effect on cognitive functions that are not sufficiently formed in children of this group (attention, memory, organization, programming and control of mental activity, speech, praxis). Given this circumstance, the positive effect of drugs with a stimulating effect should not be taken as paradoxical (given the hyperactivity in children). On the contrary, the high efficiency of nootropics seems to be natural, especially since hyperactivity is only one of the manifestations of ADHD and is itself caused by violations of higher mental functions. In addition, these drugs have a positive effect on metabolic processes in the central nervous system and contribute to the maturation of the inhibitory and regulatory systems of the brain.

Recent study confirms good potential hopantenic acid preparation in the long-term treatment of ADHD. A positive effect on the main symptoms of ADHD is achieved after 2 months of treatment, but continues to increase after 4 and 6 months of its use. Along with this, the beneficial effect of long-term use of the hopantenic acid preparation on adaptation and functioning disorders characteristic of children with ADHD in various areas, including difficulties in behavior in the family and in society, schooling, reduced self-esteem, and lack of basic life skills, was confirmed. However, in contrast to the regression of the main symptoms of ADHD, longer periods of treatment were needed to overcome the disorders of adaptation and socio-psychological functioning: a significant improvement in self-esteem, communication with others and social activity was observed according to the results of parental questionnaires after 4 months, and a significant improvement in behavioral and schooling, basic life skills along with a significant regression of risk-taking behavior - after 6 months of using the drug hopantenic acid.

Another direction of ADHD treatment is to control negative nutritional and environmental factors that lead to the intake of neurotoxic xenobiotics (lead, pesticides, polyhaloalkyls, food colorings, preservatives) into the child's body. This should be accompanied by the inclusion in the diet of the necessary micronutrients that help reduce ADHD symptoms: vitamins and vitamin-like substances (omega-3 PUFAs, folates, carnitine) and essential macro- and microelements (magnesium, zinc, iron).
Among the micronutrients with a proven clinical effect in ADHD, magnesium preparations should be noted. Magnesium deficiency is determined in 70% of children with ADHD.

Magnesium is an important element involved in maintaining the balance of excitatory and inhibitory processes in the central nervous system. There are several molecular mechanisms through which magnesium deficiency affects neuronal activity and neurotransmitter metabolism: magnesium is required to stabilize excitatory (glutamate) receptors; magnesium is an essential cofactor of adenylate cyclases involved in signal transmission from neurotransmitter receptors to controlling intracellular cascades; magnesium is a cofactor for catechol-O-methyltransferase, which inactivates excess monoamine neurotransmitters. Therefore, magnesium deficiency contributes to the imbalance of the "excitation-inhibition" processes in the CNS towards excitation and can affect the manifestation of ADHD.

In the treatment of ADHD, only organic magnesium salts (lactate, pidolate, citrate) are used, which is associated with a high bioavailability of organic salts and the absence of side effects when they are used in children. The use of magnesium pidolate with pyridoxine in solution (ampoule form of Magne B6 (Sanofi-Aventis, France)) is allowed from the age of 1 year, lactate (Magne B6 in tablets) and magnesium citrate (Magne B6 forte in tablets) - from 6 years . The magnesium content in one ampoule is equivalent to 100 mg of ionized magnesium (Mg2+), in one tablet of Magne B6 - 48 mg of Mg2+, in one tablet of Magne B6 forte (618.43 mg of magnesium citrate) - 100 mg of Mg2+. The high concentration of Mg2+ in Magne B6 forte allows you to take 2 times fewer tablets than when taking Magne B6. The advantage of the drug Magne B6 in ampoules is also the possibility of more accurate dosing, the use of the Magne B6 ampoule form provides a rapid increase in the level of magnesium in the blood plasma (within 2-3 hours), which is important for the rapid elimination of magnesium deficiency. At the same time, taking Magne B6 tablets contributes to a longer (within 6-8 hours) retention of an increased concentration of magnesium in erythrocytes, that is, its deposition.

The emergence of combined preparations containing magnesium and vitamin B6 (pyridoxine) has significantly improved the pharmacological properties of magnesium salts. Pyridoxine is involved in the metabolism of proteins, carbohydrates, fatty acids, the synthesis of neurotransmitters and many enzymes, has a neuro-, cardio-, hepatotropic, and hematopoietic effect, contributes to the replenishment of energy resources. The high activity of the combined preparation is due to the synergistic action of the components: pyridoxine increases the concentration of magnesium in plasma and erythrocytes and reduces the amount of magnesium excreted from the body, improves magnesium absorption in the gastrointestinal tract, its penetration into cells, and fixation. Magnesium, in turn, activates the process of transformation of pyridoxine into its active metabolite pyridoxal-5-phosphate in the liver. Thus, magnesium and pyridoxine potentiate each other's action, which allows their combination to be successfully used to normalize magnesium balance and prevent magnesium deficiency.

The combined intake of magnesium and pyridoxine for 1-6 months reduces the symptoms of ADHD and restores normal values ​​of magnesium in red blood cells. Already after a month of treatment, anxiety, attention disorders and hyperactivity decrease, concentration of attention, accuracy and speed of task performance improve, and the number of errors decreases. There is an improvement in gross and fine motor skills, a positive dynamics of EEG characteristics in the form of the disappearance of signs of paroxysmal activity against the background of hyperventilation, as well as bilateral-synchronous and focal pathological activity in most patients. At the same time, taking Magne B6 is accompanied by the normalization of magnesium concentration in erythrocytes and blood plasma of patients.

Replenishment of magnesium deficiency should last at least two months. Considering that alimentary deficiency of magnesium occurs most often, when drawing up nutritional recommendations, one should take into account not only the quantitative content of magnesium in foods, but also its bioavailability. So, fresh vegetables, fruits, herbs (parsley, dill, green onions) and nuts have the maximum concentration and activity of magnesium. When preparing products for storage (drying, canning), the concentration of magnesium decreases slightly, but its bioavailability drops sharply. This is important for children with ADHD who have a deepening of magnesium deficiency that coincides with the period of school from September to May. Therefore, the use of combined preparations containing magnesium and pyridoxine is advisable during the school year. But, alas, the problem cannot be solved by drugs alone.

Home psychotherapy

Any classes are desirable to be carried out in a playful way. Any games where you need to hold and switch attention will do. For example, the game "find the pairs", where cards with images are opened and turned over in turn, and you need to remember and open them in pairs.

Or even take the game of hide and seek - there is a sequence, certain roles, you need to sit in the shelter for a certain time, and you also need to figure out where to hide and change these places. All this is a good training of programming and control functions, moreover, it takes place when the child is emotionally involved in the game, which helps to maintain the optimal tone of wakefulness at this moment. And it is needed for the emergence and consolidation of all cognitive neoplasms, for the development of cognitive processes.

Remember all the games that you played in the yard, they are all selected by human history and are very useful for the harmonious development of mental processes. Here, for example, is a game where you need to "do not say yes and no, do not buy black and white" - after all, this is a wonderful exercise for slowing down a direct answer, that is, for training programming and control.

Teaching Children with Attention Deficit Hyperactivity Disorder

With such children, a special approach to learning is needed. Often children with ADHD have problems maintaining optimal tone, which causes all other problems. Due to the weakness of the inhibitory control, the child is overexcited, restless, cannot concentrate on anything for a long time, or, conversely, the child is lethargic, he wants to lean against something, he quickly gets tired, and his attention can no longer be collected by any means until some upswing and then downswing again. The child cannot set tasks for himself, determine how and in what order he will solve them, do this work without being distracted and test himself. These children have difficulties in writing - omissions of letters, syllables, merging two words into one. They do not hear the teacher or are accepted for the task without listening to the end, hence, the problems in all school subjects.

We need to develop in the child the ability to program and control their own activities. While he himself does not know how to do this, these functions are taken over by the parents.

Preparation

Choose a day and address the child with these words: "You know, they taught me how to do homework quickly. Let's try to do them very quickly. It should work out!"

Ask the child to bring a portfolio, lay out everything you need to complete the lessons. Say: well, let's try to set a record - do all the lessons in an hour (let's say). Important: the time while you are preparing, clearing the table, laying out textbooks, figuring out the task, is not included in this hour. It is also very important that the child has all the tasks recorded. As a rule, children with ADHD do not have half of the tasks, and endless calls to classmates begin. Therefore, we can warn you in the morning: today we will try to set a record for completing tasks in the shortest possible time, only one thing is required of you: carefully write down all the tasks.

First item

Let's get started. Open the diary, see what is given. What will you do first? Russian or math? (It does not matter what he chooses - it is important that the child chooses himself).

Take a textbook, find an exercise, and I time it. Read the assignment aloud. So, I did not understand something: what needs to be done? Explain please.

You need to reformulate the task in your own words. Both - both the parent and the child - must understand what exactly needs to be done.

Read the first sentence and do what needs to be done.

It is better to first do the first trial action orally: what do you need to write? Speak aloud, then write.

Sometimes a child says something correctly, but immediately forgets what was said - and when it is necessary to write it down, he no longer remembers. Here the mother should work as a voice recorder: to remind the child what he said. The most important thing is to be successful from the very beginning.

It is necessary to work slowly, not to make mistakes: pronounce it as you write, Moscow - "a" or "o" next? Speak in letters, in syllables.

Check this out! Three and a half minutes - and we have already made the first offer! Now you can easily finish everything!

That is, the effort should be followed by encouragement, emotional reinforcement, it will allow maintaining the optimal energy tone of the child.

The second sentence takes a little less time than the first.

If you see that the child began to fidget, yawn, make mistakes - stop the clock. "Oh, I forgot, I have something left unfinished in my kitchen, wait for me." The child should be given a short break. In any case, you need to ensure that the first exercise is done as compactly as possible, in fifteen minutes, no more.

Turn

After that, you can already relax (the timer turns off). You are hero! You did the exercise in fifteen minutes! So, in half an hour we will do the whole Russian! Well, you already deserve compote. Instead of compote, of course, you can choose any other reward.

When you give a break, it is very important not to lose your mood, not to let the child be distracted during the rest. Well, are you ready? Let's do two more exercises the same way! And again - we read the condition aloud, we pronounce it, we write it.

When the Russian is finished, you need to rest more. Stop the timer, take a break of 10-15 minutes - like a school break. Agree: at this time you can’t turn on the computer and TV, you can’t start reading a book. You can do physical exercises: leave the ball, hang on the horizontal bar.

Second item

We do the same math. What is given? Open textbook. Let's start time again. Separately, we retell the conditions. We pose a separate question that needs to be answered.

What is asked in this problem? What is needed?

It often happens that the mathematical part is perceived and reproduced easily, but the question is forgotten, formulated with difficulty. The question should be given special attention.

Can we answer this question right away? What needs to be done for this? What do you need to know first?

Let the child tell in the simplest words: what needs to be done in what order. At first it is external speech, then it will be replaced by internal. Mom should insure the child: in time to hint to him that he went the wrong way, that it is necessary to change the course of reasoning, not to let him get confused.

The most unpleasant part of a mathematical task is the rules for solving problems. We ask the child: did you solve a similar problem in class? Let's see how to write so as not to make a mistake. Let's take a look?

You need to pay special attention to the recording form - after that it costs nothing to write down the solution to the problem.

Then check. Did you say you need to do this and that? Did it? And this? This? Checked, now you can write the answer? Well, how long did the task take us?

How did you do it in such a short amount of time? You deserve something delicious!

The task is done - we take up the examples. The child dictates and writes to himself, the mother checks the correctness. After each column we say: amazing! Are we taking on the next column or compote?

If you see that the child is tired - ask: well, will we work some more or will we go to drink compote?

Mom should be in good shape on this day herself. If she is tired, wants to get rid of it as soon as possible, if her head hurts, if she cooks something in the kitchen at the same time and runs there every minute - this will not work.

So you need to sit with the child once or twice. Then the mother should begin to systematically eliminate herself from this process. Let the child tell his mother the whole semantic part in his own words: what needs to be done, how to do it. And the mother can go away - go to another room, to the kitchen: but the door is open, and the mother imperceptibly controls whether the child is busy with work, whether he is distracted by extraneous matters.

It is not necessary to focus on mistakes: it is necessary to achieve the effect of effectiveness, it is necessary that the child has the feeling that he is succeeding.

Thus, early detection of ADHD in children will prevent future learning and behavioral problems. The development and application of complex correction should be carried out in a timely manner, be of an individual nature. Treatment for ADHD, including drug therapy, should be long enough.

Prognosis for ADHD

The prognosis is relatively favorable, and in a significant proportion of children, even without treatment, symptoms disappear during adolescence. Gradually, as the child grows, disturbances in the neurotransmitter system of the brain are compensated, and some of the symptoms regress. However, clinical manifestations of attention deficit hyperactivity disorder (excessive impulsivity, irascibility, absent-mindedness, forgetfulness, restlessness, impatience, unpredictable, rapid and frequent mood changes) can also be observed in adults.

The factors of the unfavorable prognosis of the syndrome are its combination with mental illness, the presence of mental pathology in the mother, as well as the symptoms of impulsivity in the patient himself. Social adaptation of children with attention deficit hyperactivity disorder can only be achieved with the interest and cooperation of the family and school.

In every little child
Both boy and girl
There are two hundred grams of explosives
Or even half a kilo!
He must run and jump
Grab everything, kick your feet,
Otherwise it will explode:
Fuck-bang! And there is none!
Every new baby
Coming out of diapers
And gets lost everywhere
And it's everywhere!
He's always running somewhere
He will be terribly upset
If anything in the world
Suddenly happen without it!

Song from m / f "Monkeys, forward!"

There are children who are born to immediately jump out of the cradle and rush off. They can't sit still even for five minutes, they scream the loudest and most often tear their pants. They always forget their notebooks and every day they write "homework" with new mistakes. They interrupt adults, they sit under the desk, they don't walk by the hand. These are kids with ADHD. Inattentive, restless and impulsive,” such words can be read on the main page of the website of the interregional organization of parents of children with ADHD “Impulse”.

Raising a child with Attention Deficit Hyperactivity Disorder (ADHD) is not easy. Parents of such children hear almost every day: “I have been working for so many years, but I have never seen such a disgrace”, “Yes, he has a bad manners syndrome!”, “You need to beat more! Completely spoiled the child!
Unfortunately, even today, many professionals working with children do not know anything about ADHD (or know only by hearsay and therefore are skeptical about this information). In fact, sometimes it is easier to refer to pedagogical neglect, bad manners and spoiledness than to try to find an approach to a non-standard child.
There is also a reverse side of the coin: sometimes the word "hyperactivity" is understood as susceptibility, normal curiosity and mobility, protest behavior, the child's reaction to a chronic psycho-traumatic situation. The issue of differential diagnosis is acute, because most of the children's neurological diseases can be accompanied by impaired attention and disinhibition. However, the presence of these symptoms does not always give grounds to say that a child has ADHD.
So what exactly is Attention Deficit Hyperactivity Disorder? What is an ADHD child? And how can you tell a healthy "shilopop" from a hyperactive child? Let's try to figure it out.

What is ADHD

Definition and statistics
Attention-Deficit/Hyperactivity Disorder (ADHD) is a developmental behavioral disorder that begins in childhood.
Manifested by symptoms such as difficulty concentrating, hyperactivity and poorly controlled impulsivity.
Synonyms: hyperdynamic syndrome, hyperkinetic disorder. Also in Russia, in the medical record, a neurologist can write to such a child: CNS PEP (perinatal damage to the central nervous system), MMD (minimal cerebral dysfunction), ICP (increased intracranial pressure).
First the description of the disease, characterized by motor disinhibition, attention deficit and impulsivity, appeared about 150 years ago, since then the terminology of the syndrome has changed many times.
According to statistics, ADHD is more common in boys than girls (almost 5 times). Some foreign studies indicate that this syndrome is more common among Europeans, fair-haired and blue-eyed children. American and Canadian specialists use the DSM (Diagnostic and Statistical Manual of Mental Disorders) classification in diagnosing ADHD, in Europe the International Classification of Diseases ICD (International Classification of Diseases) is adopted. ) with more stringent criteria. In Russia, the diagnosis is based on the criteria of the tenth revision of the International Classification of Diseases (ICD-10), also based on the DSM-IV classification (WHO, 1994, recommendations for practical use as criteria for the diagnosis of ADHD).

The controversy surrounding ADHD
Disputes of scientists about what ADHD is, how to diagnose it, what kind of therapy to carry out - drug therapy or manage with pedagogical and psychological measures - have been going on for more than a decade. The very fact of the presence of this syndrome is called into question: until now, no one can say for sure to what extent ADHD is the result of brain dysfunction, and to what extent it is the result of improper upbringing and incorrect psychological climate prevailing in the family.
The so-called ADHD controversy has been going on since at least the 1970s. In the West (particularly in the USA), where the medical treatment of ADHD with the help of potent drugs containing psychotropic substances (methylphenidate, dextroamphetamine) is accepted, the public is alarmed that a large number of "difficult" children are diagnosed with ADHD and unnecessarily often prescribed drugs that have a lot of side effects. In Russia and most countries of the former CIS, another problem is more common - many teachers and parents are unaware that some children have features that lead to impaired concentration and control. The lack of tolerance for the individual characteristics of children with ADHD leads to the fact that all the problems of the child are attributed to the lack of education, pedagogical neglect and parental laziness. The need to regularly make excuses for the actions of your child (≪yes, we explain to him all the time≫ —≪that means you explain poorly, since he doesn’t understand≫) often leads to the fact that moms and dads experience helplessness and guilt, starting to consider themselves worthless parents.

Sometimes the opposite happens - motor disinhibition and talkativeness, impulsiveness and inability to comply with discipline and the rules of the group are considered by adults (more often parents) as a sign of the child's outstanding abilities, and sometimes even encouraged in every possible way. “We have a wonderful child! He is not hyperactive at all, but simply alive and active. He is not interested in these classes of yours, so he rebels! At home, carried away, he can do the same thing for a long time. And irascibility is a character, what can you do with it, - other parents say not without pride. On the one hand, these mothers and fathers are not so wrong - a child with ADHD, carried away by an interesting activity (assembling puzzles, role-playing, watching an interesting cartoon - to each his own), can really do this for a long time. However, you should know that with ADHD, voluntary attention is the first to suffer - this is a more complex function that is peculiar only to a person and is formed in the learning process. Most seven-year-olds understand that during the lesson you need to sit quietly and listen to the teacher (even if they are not very interested). A child with ADHD understands all this too, but, unable to control himself, can get up and walk around the classroom, pull a neighbor's pigtail, interrupt the teacher.

It is important to know that ADHD children are not "spoiled", "ill-mannered" or "educational neglect" (although such children, of course, also occur). This should be remembered by those teachers and parents who recommend treating such children with vitamin P (or simply a belt). ADHD children disrupt classes, misbehave at breaks, be bold and disobey adults, even if they know how to behave, because of the objective personality traits inherent in ADHD. This must be understood by those adults who object to the fact that "a child is molded with diagnoses", arguing that these children "just have such a character."

How does ADHD manifest?
Main manifestations of ADHD
G.R. Lomakin in his book "Hyperactive child. How to find a common language with a fidget ≫ describes the main symptoms of ADHD: hyperactivity, impaired attention, impulsivity.
HYPERACTIVITY manifests itself in excessive and, most importantly, stupid motor activity, restlessness, fussiness, numerous movements that the child often does not notice. As a rule, such children speak a lot and often inconsistently, not finishing sentences and jumping from thought to thought. Lack of sleep often aggravates manifestations of hyperactivity - the already vulnerable nervous system of the child, without having time to rest, cannot cope with the flow of information coming from the outside world, and defends itself in a very peculiar way. In addition, such children often have violations of praxis - the ability to coordinate and control their actions.
ATTENTION DISORDERS manifested in the fact that it is difficult for a child to concentrate on the same thing for a long time. He has insufficiently formed abilities of selective concentration of attention - he cannot distinguish the main from the secondary. A child with ADHD constantly "jumps" from one to another: "loses" lines in the text, solves all the examples at the same time, drawing the tail of a rooster, paints all the feathers at once and all the colors at once. Such children are forgetful, unable to listen and concentrate. Instinctively, they try to avoid tasks that require prolonged mental effort (it is common for any person to subconsciously avoid activities, the failure of which he foresees in advance). However, the above does not mean that children with ADHD are not able to keep their attention on anything. They cannot focus only on what they are not interested in. If something fascinated them, they can do it for hours. The trouble is that our life is full of activities that still have to be done, despite the fact that it is far from always exciting.
IMPULSITY is expressed in the fact that often the child's action is ahead of thought. Before the teacher has time to ask a question, the ADHD child is already stretching his hand, the task is not yet fully formulated, and he is already doing it, and then without permission he gets up and runs to the window - simply because he became interested in watching how the wind blows off birch last foliage. Such children do not know how to regulate their actions, obey the rules, wait. Their mood changes faster than the direction of the wind in autumn.
It is known that no two people are exactly the same, and therefore the symptoms of ADHD in different children manifest themselves in different ways. Sometimes the main complaint of parents and teachers will be impulsivity and hyperactivity, the other child has the most pronounced attention deficit. Depending on the severity of symptoms, ADHD is divided into three main types: mixed, with a pronounced attention deficit, or with a predominance of hyperactivity and impulsivity. At the same time, G.R. Lomakina notes that each of the above criteria can be expressed in the same child at different times and to varying degrees: “That is, in Russian, the same child today can be distracted and inattentive, tomorrow - resemble an electric broom with battery Energizer, the day after tomorrow - all day to move from laughter to crying and vice versa, and in a couple of days - to fit in one day and inattention, and mood swings, and indefatigable and stupid energy.

Additional Symptoms Common to Children with ADHD
Coordination disorders found in about half of ADHD cases. These can be fine movement disorders (tying shoelaces, using scissors, coloring, writing), balance (difficulty for children to ride a skateboard and a two-wheeled bicycle), visual-spatial coordination (inability to play sports, especially with a ball).
Emotional disorders often seen in ADHD. The emotional development of the child, as a rule, is delayed, which is manifested by imbalance, irascibility, intolerance for failures. It is sometimes said that the emotional-volitional sphere of a child with ADHD is in the ratio of 0.3 to his biological age (for example, a 12-year-old child behaves like an eight-year-old).
Violations of social relations. A child with ADHD often has difficulties in relationships not only with peers, but also with adults. The behavior of such children is often characterized by impulsiveness, obsession, excessiveness, disorganization, aggressiveness, impressionability and emotionality. Thus, a child with ADHD is often a disruptor to the smooth flow of social relationships, interaction and cooperation.
Partial developmental delays, including school skills, are known as the discrepancy between actual performance and what can be expected based on the child's IQ. In particular, difficulties with reading, writing, counting (dyslexia, dysgraphia, dyscalculia) are not uncommon. Many preschool children with ADHD have specific difficulties in understanding certain sounds or words and/or difficulty in expressing their opinions in words.

Myths about ADHD
ADHD is not a perceptual disorder! Children with ADHD hear, see, perceive reality just like everyone else. This distinguishes ADHD from autism, in which motor disinhibition is also common. However, in autism, these phenomena are due to a violation of the perception of information. Therefore, the same child cannot be diagnosed with ADHD and autism at the same time. One excludes the other.
At the heart of ADHD is a violation of the ability to perform an understood task, the inability to plan, execute, and complete the work begun. Children with ADHD feel, understand, perceive the world in the same way as everyone else, but they react to it differently.
ADHD is not a disorder in understanding and processing the information received! A child with ADHD in most cases is able to analyze and draw the same conclusions as everyone else. These children perfectly know, understand and can even easily repeat all those rules that they are endlessly reminded day after day: “do not run”, “sit still”, “do not turn around”, “be silent during the lesson”, “lead yourself just like everyone else≫, "clean up your toys after you." However, children with ADHD cannot follow these rules.
It is worth remembering that ADHD is a syndrome, that is, a stable, single combination of certain symptoms. From this we can conclude that at the root of ADHD lies one unique feature that always forms a slightly different, but essentially similar behavior. Generally speaking, ADHD is a disorder of motor function, as well as planning and control, and not the function of perception and understanding.

Portrait of a hyperactive child
At what age can ADHD be suspected?
"Hurricane", "thump in the ass", "perpetual motion machine" - what kind of definitions parents of children with ADHD do not give their children! When teachers and educators talk about such a child, the main thing in their description will be the adverb “too much”. The author of the book about hyperactive children, G.R. Lomakina, notes with humor that “there are too many such children everywhere and always, they are too active, they can be heard too well and far away, they are too often seen absolutely everywhere. Not only do these kids always get into stories for some reason, but these kids always get into all the stories that happen within ten blocks of the school.”
Although today there is no clear understanding of when and at what age it is safe to say that a child has ADHD, most experts agree that that it is impossible to make this diagnosis before five years. Many researchers argue that the signs of ADHD are most pronounced at 5-12 years old and during puberty (from about 14 years old).
Although the diagnosis of ADHD is rarely made in early childhood, some experts believe that there are a number of signs that suggest the likelihood of a baby having this syndrome. According to some researchers, the first manifestations of ADHD coincide with the peaks of the child's psychoverbal development, that is, they are most pronounced at 1-2 years, 3 years and 6-7 years.
Children prone to ADHD often have increased muscle tone even in infancy, experience problems with sleep, especially with falling asleep, are extremely sensitive to any stimuli (light, noise, the presence of a large number of strangers, a new, unusual situation or environment), during wakefulness is often excessively mobile and excited.

What is important to know about a child with ADHD
1) Attention deficit hyperactivity disorder is considered to be one of the so-called borderline states of the psyche. That is, in a normal, calm state, this is one of the extreme variants of the norm, however, the slightest catalyst is enough to bring the psyche out of the normal state and the extreme version of the norm has already turned into some deviation. A catalyst for ADHD is any activity that requires the child to pay more attention, focus on the same type of work, as well as any hormonal changes that occur in the body.
2) Diagnosis of ADHD does not imply a lag in the intellectual development of the child. On the contrary, as a rule, children with ADHD are very smart and have fairly high intellectual abilities (sometimes above average).
3) The mental activity of a hyperactive child is characterized by cyclicity. Children can work productively for 5-10 minutes, then for 3-7 minutes the brain rests, accumulating energy for the next cycle. At this moment, the student is distracted, does not respond to the teacher. Then mental activity is restored, and the child is ready for work within the next 5-15 minutes. Psychologists say that children with ADHD have a so-called. flickering consciousness: that is, they can periodically “fall out” during activity, especially in the absence of motor activity.
4) Scientists have found that motor stimulation of the corpus callosum, cerebellum and vestibular apparatus of children with attention deficit hyperactivity disorder leads to the development of the function of consciousness, self-control and self-regulation. When a hyperactive child thinks, he needs to make some kind of movement - for example, swing in a chair, tap a pencil on the table, mumble something under his breath. If he stops moving, he "falls into a stupor" and loses the ability to think.
5) Hyperactive children are characterized superficiality of feelings and emotions. They they cannot hold a grudge for a long time and are unforgiving.
6) A hyperactive child is characterized by frequent mood swings- from stormy delight to unbridled anger.
7) A consequence of impulsivity in ADHD children is irascibility. In a fit of anger, such a child can tear up the notebook of the neighbor who offended him, throw all his things on the floor, shake out the contents of the briefcase on the floor.
8) Children with ADHD often develop negative self-esteem- the child begins to think that he is bad, not like everyone else. Therefore, it is very important that adults treat him kindly, understanding that his behavior is caused by objective control difficulties (that he does not want to, and cannot behave well).
9) Common in ADHD children lowered pain threshold. Also, they are practically devoid of a sense of fear. This can be dangerous to the health and life of the child, as it can lead to unpredictable fun.

How to recognize ADHD
Basic diagnostic methods
So, what to do if parents or educators suspect a child has ADHD? How to understand what determines the child's behavior: pedagogical neglect, lack of education or attention deficit hyperactivity disorder? Or maybe just character? In order to answer these questions, you need to contact a specialist.
It should be said right away that, unlike other neurological disorders, for which there are clear methods of laboratory or instrumental confirmation, there is no single objective diagnostic method for ADHD. According to modern recommendations of experts and diagnostic protocols, mandatory instrumental examinations for children with ADHD (in particular, electroencephalograms, computed tomography, etc.) are not indicated. There are many works that describe certain changes in the EEG (or the use of other methods of functional diagnostics) in children with ADHD, however, these changes are nonspecific - that is, they can be observed both in children with ADHD and in children without this disorder. On the other hand, it often happens that functional diagnostics do not reveal any abnormalities, but the child has ADHD. Therefore, from a clinical point of view the basic method for diagnosing ADHD is interviews with parents and the child and the use of diagnostic questionnaires.
Due to the fact that in this violation the boundary between normal behavior and disorder is very arbitrary, it is up to the specialist to establish it in each case at his own discretion.(unlike other disorders, where there are still landmarks). Thus, due to the need to make a subjective decision, the risk of error is quite high: both not detecting ADHD (this is especially true for milder, "borderline" forms), and detecting the syndrome where it actually does not exist. Moreover, the subjectivity doubles: after all, the specialist focuses on the data of the anamnesis, which reflect the subjective opinion of the parents. Meanwhile, parental ideas about what behavior is considered normal and what is not can be very different and are determined by many factors. Nevertheless, the timeliness of the diagnosis depends on how attentive and, if possible, objective people from the child’s immediate environment (teachers, parents or pediatricians) will be. After all, the sooner you understand the characteristics of the child, the more time for the correction of ADHD.

Stages of diagnosing ADHD
1) Clinical interview with a specialist (children's neurologist, pathopsychologist, psychiatrist).
2) Application of diagnostic questionnaires. It is advisable to obtain information about the child "from various sources": from parents, teachers, a psychologist of the educational institution that the child attends. The golden rule in diagnosing ADHD is to confirm the presence of the disorder from at least two independent sources.
3) In doubtful, “borderline” cases, when the opinions of parents and specialists about the presence of ADHD in a child differ, it makes sense video filming and its analysis ( recording the child's behavior in the lesson, etc.). However, help is also important in cases of behavioral problems without a diagnosis of ADHD - the point, after all, is not in the label.
4) If possible - neuropsychological examination a child whose goal is to establish the level of intellectual development, as well as to identify often associated violations of school skills (reading, writing, counting). The identification of these disorders is also important in terms of differential diagnosis, because, given the presence of reduced intellectual capabilities or specific learning difficulties, attention disorders in the classroom can be caused by a program that does not match the child's ability level, and not ADHD.
5) Additional examinations (if necessary)): consultation of a pediatrician, neurologist, other specialists, instrumental and laboratory studies for the purpose of differential diagnosis and identification of concomitant diseases. A basic pediatric and neurological examination is reasonable in connection with the need to exclude an "ADHD-like" syndrome caused by somatic and neurological disorders.
It is important to remember that behavioral and attentional disorders in children can be caused by any general somatic diseases (such as anemia, hyperthyroidism), as well as all disorders that cause chronic pain, itching, physical discomfort. The cause of "pseudo-ADHD" may be side effects of certain drugs(e.g. diphenyl, phenobarbital), as well as a number of neurological disorders(epilepsy with absences, chorea, tics and many others). The problems of the child may also be due to the presence sensory disorders, and here a basic pediatric examination is important to identify visual or hearing impairments that, if mild, may be misdiagnosed. A pediatric examination is also advisable in connection with the need to assess the general somatic condition of the child, to identify possible contraindications regarding the use of certain groups of medications that can be prescribed to children with ADHD.

Diagnostic questionnaires
DSM-IV criteria for ADHD
Attention disorder
a) often fails to pay attention to details or makes careless mistakes in schoolwork or other activities;
b) there are often problems keeping attention on the task or game;
c) often there are problems with the organization of activities and tasks;
d) is often reluctant or avoids engaging in activities that require sustained concentration (such as completing in-class assignments or homework);
e) often loses or forgets items needed for tasks or other activities (eg diary, books, pens, tools, toys);
f) is easily distracted by extraneous stimuli;
g) often does not listen when spoken to;
h) often does not follow instructions, does not complete or adequately complete assignments, homework or other work (but not out of protest, stubbornness or inability to understand instructions / assignments);
i) forgetful in daily activities.

Hyperactivity - impulsivity(at least six of the following symptoms must be present):
Hyperactivity:
a) cannot sit still, is constantly moving;
b) often leaves his seat in situations where he should be sitting (for example, in a lesson);
c) runs a lot and “turns everything upside down” where it should not be done (in adolescents and adults, the equivalent may be a feeling of inner tension and a constant need to move);
d) is unable to play quietly, calmly or rest;
e) acts "as if wound up" - like a toy with a motor running;
f) talks too much.

Impulsiveness:
g) often speaks prematurely, without listening to the end of the question;
h) impatient, often cannot wait for his turn;
i) frequently interrupts others and interferes with their activity/conversation. The above symptoms must have been present for at least six months, occur in at least two different environments (school, home, playground, etc.) and not be caused by another disorder.

Diagnostic criteria used by Russian specialists

Attention disorder(diagnosed when 4 out of 7 signs are present):
1) needs a calm, quiet environment, otherwise he is not able to work and concentrate;
2) often asks again;
3) easily distracted by external stimuli;
4) confuses details;
5) does not finish what he starts;
6) listens, but does not seem to hear;
7) has difficulty concentrating unless a one-on-one situation is created.

Impulsiveness
1) shouts out in the classroom, makes noise during the lesson;
2) extremely excitable;
3) it is difficult for him to wait for his turn;
4) overly talkative;
5) offends other children.

Hyperactivity(diagnosed when 3 out of 5 signs are present):
1) climbs on cabinets and furniture;
2) always ready to go; runs more often than walks;
3) fussy, writhing and writhing;
4) if he does something, then with noise;
5) must always do something.

Characteristic behavioral problems should be of early onset (before six years) and persistence over time (manifest for at least six months). However, prior to school entry, hyperactivity is difficult to recognize due to the wide range of normal variations.

And what will grow out of it?
What will grow out of it? This question worries all parents, and if fate decreed that you became a mom or dad of ADHD, then you are especially worried. What is the prognosis for children with Attention Deficit Hyperactivity Disorder? Scholars answer this question in different ways. Today they talk about the three most possible options for the development of ADHD.
1. Over time symptoms disappear, and children become teenagers, adults without deviations from the norm. Analysis of the results of most studies indicates that 25 to 50 percent of children "outgrow" this syndrome.
2. Symptoms to varying degrees continue to be present, but without evidence of psychopathology. Such people are the majority (from 50% or more). They have some problems in daily life. According to surveys, they are constantly accompanied by a feeling of "impatient and restless", impulsiveness, social inadequacy, low self-esteem throughout their lives. There are reports of a higher frequency of accidents, divorces, job changes among this group of people.
3. Develop severe complications in adults in the form of personality or antisocial changes, alcoholism and even psychotic states.

What is the path for these children? A lot of it depends on us adults. Psychologist Margarita Zhamkochyan characterizes hyperactive children as follows: ≪Everyone knows that restless children grow up as explorers, adventurers, travelers and founders of companies. And this is not just a coincidence. There are quite extensive observations: children who in elementary school tormented teachers with their hyperactivity, becoming older, are already addicted to something specific - and by the age of fifteen they become real docks in this matter. They have attention, concentration, and perseverance. Such a child can learn everything else without much diligence, and the subject of his passion - thoroughly. Therefore, when they say that the syndrome usually disappears by the senior school age, this is not true. It is not compensated, but results in some kind of talent, in a unique skill.
The creator of the famous airline "JetBlue" David Niliman tells with pleasure that in his childhood they not only found such a syndrome, but also described it as "luxuriantly blossoming" (flamboyant). And the presentation of his work biography and management methods suggests that this syndrome did not leave him in his adult years, moreover, that he owes his dizzying career to him.
And this is not the only example. If you analyze the biographies of some famous people, it becomes clear that in childhood they had all the symptoms characteristic of hyperactive children: explosive temper, problems with learning at school, a tendency to risky and adventurous enterprises. It is enough to take a closer look around, recall two or three good friends who have succeeded in life, their childhood years, in order to conclude: a gold medal and a red diploma very rarely turn into a successful career and a well-paid job.
Of course, a hyperactive child is difficult in everyday hostel life. But understanding the reasons for his behavior can make it easier for adults to accept the "difficult child." Psychologists say that children are especially in dire need of love and understanding when they least deserve it. This is especially true of a child with ADHD who wears down parents and educators with his constant "antics". The love and attention of parents, the patience and professionalism of teachers, and the timely help of specialists can become a springboard for a child with ADHD into a successful adult life.

Oksana Berkovskaya | editor of the magazine "Seventh petal"

Portrait of a hyperdynamic child
The first thing that catches the eye when meeting a hyperdynamic child is his excessive in relation to the calendar age and some kind of "stupid" mobility.
Being a baby, such a child in the most incredible way gets out of the diaper. ... It is impossible to leave such a baby on the changing table or on the couch even for a minute from the very first days and weeks of his life. One has only to gape a little, as he will somehow dodge and fall to the floor with a dull thud. However, as a rule, all the consequences will be limited to a loud, but short scream.
Not always, but quite often, hyperdynamic children have some kind of sleep disturbance. ...Sometimes the presence of hyperdynamic syndrome can be assumed in an infant by observing its activity in relation to toys and other objects (although this can only be done by a specialist who knows well how ordinary children of this age manipulate objects). The study of objects in a hyperdynamic infant is intense, but extremely undirected. That is, the child discards the toy before exploring its properties, immediately grabs another (or several at once) only to discard it a few seconds later.
... As a rule, motor skills in hyperdynamic children develop in accordance with age, often even ahead of age. Hyperdynamic children earlier than others begin to hold their heads, roll over on their stomachs, sit, stand up, walk, etc. ... It is these children who stick their heads between the bars of the crib, get stuck in the playpen, get tangled in duvet covers and quickly and dexterously learn to shoot everything that caring parents put on them.
As soon as a hyperdynamic child is on the floor, a new, extremely important stage begins in the life of the family, the purpose and meaning of which is to protect the life and health of the child, as well as family property from possible damage. The activity of the hyperdynamic infant is unstoppable and crushing. Sometimes relatives get the impression that he acts around the clock, almost without a break. Hyperdynamic children from the very beginning do not walk, but run.
... It is these children, aged from one to two - two and a half years old, who drag tablecloths with tableware to the floor, drop TV sets and New Year trees, fall asleep on the shelves of empty wardrobes, endlessly, despite prohibitions, turn on gas and water, and also overturn pots with contents of different temperatures and consistency.
As a rule, no attempts at admonition work on hyperdynamic children. They are fine with memory and understanding of speech. They just can't resist. Having committed another trick or a destructive act, the hyperdynamic child himself is sincerely upset and does not understand at all how it happened: “She fell herself!”, “I walked, walked, climbed, and then I don’t know”, “I didn’t touch it at all !"
...Quite often, hyperdynamic children have various speech development disorders. Some begin to speak later than their peers, some - on time or even earlier, but the trouble is that no one understands them, because they do not pronounce two-thirds of the sounds of the Russian language. ... When they speak, they wave their arms a lot and stupidly, shift from foot to foot or jump on the spot.
Another feature of hyperdynamic children is that they do not learn not only from others, but even from their own mistakes. Yesterday, a child was walking with his grandmother on the playground, climbed a high ladder, could not get down. I had to ask the teenage guys to take him out of there. The child was clearly frightened, to the question: “Well, are you going to climb this ladder now?” - earnestly replies: "I will not!" The next day, on the same playground, he first of all runs to the same ladder ...

It is the hyperdynamic children who are the children who get lost. And there is absolutely no strength to scold the found child, and he himself does not really understand what happened. “You left!”, “I just went to look!”, “And you were looking for me ?!” - all this discourages, angers, makes you doubt the mental and emotional capabilities of the child.
...Hyperdynamic children are usually not evil. They are not able to harbor resentment or plans for revenge for a long time, they are not prone to targeted aggression. They quickly forget all grievances, yesterday's offender or offended today is their best friend. But in the heat of a fight, when the already weak inhibitory mechanisms fail, these children can be aggressive.

The real problems of the hyperdynamic child (and his family) begin with schooling. “Yes, he can do anything if he wants to! He only has to concentrate - and all these tasks are for him in one tooth! nine out of ten parents say this or something like this. The whole trouble is that a hyperdynamic child categorically cannot concentrate. Seated for lessons, in five minutes he draws in a notebook, rolls a typewriter on the table, or simply looks out the window, behind which the older guys play football or clean the feathers of a crow. Ten minutes later, he will be very thirsty, then eat, then, of course, go to the toilet.
The same thing happens in the classroom. A hyperdynamic child for a teacher is like a mote to the eye. He spins endlessly in place, gets distracted and chats with his desk mate. ... In the work at the lesson, he is either absent and then, when asked, answers inappropriately, or takes an active part, jumps on the desk with his hand raised to the sky, runs out into the aisle, shouts: “I! I! Ask me!” - or simply, unable to resist, shouts out an answer from a place.
The notebooks of a hyperdynamic child (especially in primary school) are a pitiful sight. The amount of bugs in them rivals the amount of dirt and fixes. The notebooks themselves are almost always wrinkled, with bent and soiled corners, with torn covers, with spots of some unintelligible dirt, as if someone had recently eaten pies on them. The lines in the notebooks are uneven, the letters crawl up and down, letters are omitted or replaced in words, words in sentences. The punctuation marks seem to be in a completely arbitrary order - the author's punctuation in the worst sense of the word. It is the hyperdynamic child who can make four mistakes in the word "more".
Reading problems also occur. Some hyperdynamic children read very slowly, stuttering over every word, but they read the words correctly. Others read quickly, but change endings and "swallow" words and whole sentences. In the third case, the child reads normally in terms of pace and quality of pronunciation, but does not understand what he read at all and cannot remember or retell anything.
Problems with mathematics are even rarer and are associated, as a rule, with the total inattention of the child. He can correctly solve a complex problem, and then write down the wrong answer. He easily confuses meters with kilograms, apples with boxes, and the resulting two diggers and two-thirds do not bother him at all. If there is a “+” sign in the example, the hyperdynamic child will easily and correctly perform subtraction, if the division sign will perform multiplication, and so on. and so on.

The hyperdynamic child constantly loses everything. He forgets his hat and mittens in the locker room, his briefcase in the square near the school, sneakers in the gym, a pen and textbook in the classroom, and a diary with grades somewhere in the garbage heap. Books, notebooks, boots, apple cores and half-eaten candies coexist calmly and closely in his satchel.
At recess, a hyperdynamic child is a "hostile whirlwind." The accumulated energy urgently demands an exit and finds it. There is no such brawl in which our child would not get involved, there is no prank that he will refuse. Clueless, crazy running around at recess or at the "extension", ending somewhere in the solar plexus area of ​​​​one of the members of the teaching staff, and suggestion and repression appropriate to the occasion - the inevitable end of almost every school day of our child.

Ekaterina Murashova | From the book: "Children are "mattresses" and children are" disasters ""

Hyperactivity of children is clearly manifested in their behavior and in violent emotional expression. All the actions and experiences of children with ADHD go with the prefix "super" - they are impulsive, stubborn, absent-minded, capricious, aroused much more strongly than is typical of ordinary children. The constancy of such behavior alarms parents and pediatricians. Revealing that this is attention deficit hyperactivity disorder or parenting errors is a difficult task, there is no unambiguous solution for it. What is left for parents? Let us analyze in more detail the concept of attention deficit disorder, taking into account all the assumptions.

What can cause ADHD?

• Unfavorable factors that influenced the course of pregnancy. Maternal smoking, stressful situations, various diseases, taking medications - all this negatively affects the body of the fetus.
• Neuralgia disorders that occurred at birth or in fetal development. Often attention deficit hyperactivity disorder manifests itself after hypoxia (lack of oxygen) or asphyxia (suffocation) is observed during childbirth or fetal development in the womb.
• The cause may be premature or very rapid birth. Affects the diagnosis of ADHD and stimulation of the birth process.
• Social factors when the baby grows up in an unfavorable environment. Frequent conflicts of adults, malnutrition, too soft or hard methods of education, lifestyle and temperament of the child himself.

The combination of several dangerous factors at once increases the risk of ADHD in children. The child suffered asphyxia during childbirth, his upbringing is carried out within strict limits, he faces frequent conflicts in the family - the result will be a pronounced hyperactivity of the baby.

How to spot the signs of ADHD?

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Self-diagnosing ADHD in a child is not always easy. It is possible that attention deficit is the result of other neurological problems. Manifestations of symptoms characteristic of ADHD:

• The first symptoms of hyperactivity are noticeable even in infancy. Hyperactive children are characterized by violent reactions to loud sounds and noise, they do not sleep well, lag behind in the development of motor skills, are excited in games and when bathing.
• A child is 3 years old - the age when the moment comes, called the three-year-old crisis. Many children at this age are prone to whims, stubbornness, mood swings. Kids with hyperactivity make everything several times brighter. Their behavior is characterized by a belated development of speech skills, awkward movements, interspersed with fussiness and randomness. There are frequent complaints of headaches, fatigue, the presence of enuresis,.
• Prominent restlessness. It is revealed in kindergarten in classes that require concentration. In addition, in a kindergarten environment, the baby hardly falls asleep, does not want to sit on the potty, does not want to eat, it is impossible to calm him down.
• Problems of preschool age. A child with hyperactivity does not learn well the materials that prepare him for school, but this does not indicate a delay in the development of the child, but rather a decrease in concentration. The kid cannot sit in one place and does not listen to the teacher.
• Poor school performance. Children with hyperactivity do not get poor grades because of low mental inclinations. This is due to disciplinary requirements. Children are not able to sit quietly for 45 minutes of the lesson, listen carefully, write and do the tasks proposed by the teacher.
• Mental problems. From an early age, hyperactive children develop various phobias. Symptoms such as tearfulness, irascibility, resentment, irritability, distrust, anxiety, suspicion are clearly manifested.

Usually such children do not study well at school, they cannot calmly sit out until the end of the lesson or do their homework in full.

Parents are especially concerned about the fact that the symptoms of ADHD can be complex - they appear in children regularly and vividly.

How is the problem diagnosed?

Doctors do not diagnose a seven-year-old child with a neurological diagnosis, even with severe hyperactivity, and do not use drugs. The solution is connected with the psychology of the growing organism. Preschoolers are experiencing two serious psychological crises at 3 years and 7 years (we recommend reading:). So by what criteria does a doctor make a verdict about ADHD? Consider two lists of criteria by which the diagnosis of the disease is carried out.

Eight signs of hyperactivity

1. Children's movements are fussy and chaotic.
2. They sleep restlessly: they spin a lot, often talk, laugh or cry in their sleep, throw off the covers, walk at night.
3. It is difficult to sit on a chair, constantly spinning from side to side.
4. The state of rest is almost absent, all the time running, jumping, spinning, jumping.
5. They do not stand in line well, they can get up and leave.
6. They talk too much.
7. When talking with someone, they do not listen to the interlocutor, they try to interrupt, they are distracted from the conversation, they do not answer the questions asked.
8. When asked to wait, they respond with pronounced impatience.

Eight Signs of Attention Deficit

1. There is no desire to do well the task given to them. Any work (cleaning, homework) is done quickly and carelessly, often not completed.
2. It is difficult to concentrate on the details, the child does not remember them well and cannot reproduce them.
3. Frequent immersion in one's own world, absent gaze, difficulties with communication.
4. The conditions of the games are poorly assimilated, they are constantly violated.
5. Great absent-mindedness, expressed in the loss of personal things that are not put in their place, and then cannot find them.
6. There is no personal self-discipline. We have to constantly monitor and organize.
7. Rapid switching of attention from one subject or object to another.
8. The control mechanism is the "spirit of destruction". They break toys and other things, but do not admit to their deeds.

If you find 5-6 matches in the child's behavior for the diagnosis of ADHD, show it to specialists (psychotherapist, neurologist, psychologist). The doctor will thoroughly study the problem and find a competent solution.

Treatment Methods

Methods for correcting ADHD in children are selected individually. The doctor, choosing a method of treatment, proceeds from the degree of development of the problem. After talking with the parents and observing the child, the specialist decides what is necessary in a particular case. Treatment of hyperactive children can be carried out in two directions: medication, with the help of ADHD drugs, or through psychotherapeutic correction.

Medical method

Physicians in the United States and in the West treat hyperactivity in children with psychostimulants. Such drugs improve concentration and quickly give visible positive changes, but they are also characterized by side effects: children have headaches, sleep disturbances, appetite, nervousness and excessive irritability appear, they are reluctant to communicate.

Russian specialists do not resort to psychostimulants in the treatment of ADHD, based on the protocol for the treatment of ADHD, according to which the use of such drugs is prohibited. They are replaced by nootropic drugs - a group of psychotropic drugs designed for a specific effect on the higher functions of the brain, which increase its resistance to the influence of negative factors, thereby improving memory and cognitive activity in general. There is no shortage of ADHD drugs on the market. Strattera pill-capsules are recognized as an effective representative of ADHD drugs. Depressants are given to a child under the strict supervision of a physician.

Strattera tablets should not be self-administered as they directly affect nervous activity and should only be taken under strict medical supervision.

Psychological and psychotherapeutic methods

The methods of psychologists and psychotherapists are aimed at correcting behavior. Designed to help improve memory, develop speech skills, thinking. Specialists seek to increase the child's self-esteem, give him creative tasks. To reduce the syndrome, modeling of communicative situations that can facilitate the communication of hyperactive children with peers and adults. To correct ADHD, a relaxation method is used, which helps to relax the child and normalize brain and nervous activity. A speech therapist deals with speech defects. Difficult cases require a combination of medical and psychological methods of correcting the situation.

What do parents need to know?

If the problem is identified and there is no doubt about it, parents should know how to properly raise a hyperactive child. Proceed like this:

• Increase your child's self-esteem. The incomprehensible hyperactivity of the child pushes adults to constant remarks and pulling. They do not ask him, but order him to "shut up", "sit down", "calm down". A little man hears such words in the garden, at home, and at school - he develops a feeling of his own inferiority, while he is in dire need of encouragement and praise. Do it more often.
• When building a relationship with a son or daughter, respect personal qualities. Put aside your emotional perception of their behavior, act strictly but fairly. When punishing the baby, coordinate your decision with other family members. Understanding that it is difficult for a child to restrain himself and he indulges in all serious things, do not do it yourself. Your rallies with the "brakes" may be perceived by him as the norm.
• While keeping your child busy with household chores, give him simple and short-term tasks for which he will have enough patience. Be sure to reward if he did them.
• Obtaining informative knowledge should be dosed. Take no more than 15 minutes for reading and preparing lessons per lesson. Let the child rest by inviting him to play, then return to the lessons.
• If the kid is used to being forgiven for all the pranks at home, then he will certainly face a negative attitude towards his tricks at school or kindergarten. Your help consists in an intelligible explanation to the kid of his wrong behavior. Discuss the conflict with him, find a solution to the situation.
• A good solution is to invite the child to keep a diary in which all his small victories will be reflected. Such a visual illustration of achievements will be a constructive help.

It is very important for parents to speak with the child on an equal footing, to explain their position, to increase his self-esteem. Thus, you can direct excess energy in a positive direction and gently correct the behavior of the baby.

Difficulties of social adaptation

Coming to a kindergarten or school, children with ADHD immediately fall into the list of "difficult" pupils. Hyperactive behavior is perceived by others as inadequate. Sometimes the situation develops in such a way that parents are forced to change schools or kindergartens. You have to teach your child to be tolerant, flexible, polite, friendly - only such qualities will help him in social adaptation.

Tips for teachers and educators:

• keep a hyperactive student in sight at all times;
• put him in the first or second desk;
• try not to put emphasis on the behavior of such a child;
• often praise for success, but do not do it without a reason;
• involve in the life of the team, make simple requests: wipe the blackboard, bring a cool magazine, put notebooks on desks, water flowers.

Turning to the advice of Dr. Komarovsky, we note that he offers complex tasks for such children to turn into a kind of mosaic. Break the cleaning of the room into separate tasks: put away the toys and relax, spread out the books and relax.

Tips for parents:

• protect the interests of your son or daughter, but do not allow open confrontation with teachers;
• listen and take into account the opinions of teachers about your child, an objective view from the outside will help you better understand him;
• never punish the baby in front of strangers, especially with peers and teachers;
• help with adaptation actions, invite his friends to visit, take part in school holidays and competitions with him.

Dr. Komarovsky recommends getting any pet for a child with attention deficit. Caring for a friend will help him become more collected and attentive. Only with complex forms of incorrect behavior, doctors resort to medical methods of correcting the disease. Most children are shown psychological correction, which is carried out in close cooperation with their parents.