Syndrome of deficiency of attention and hyperactivity (Attention-Deficit/Hyperactivity Disorder (ADHD), abbr. SDVG) - the neurologic and behavioural disorder of development beginning at children's age. It is shown by such symptoms, as difficulties of concentration of attention, a hyperactivity and badly operated impulsiveness.
SDVG has been described for the first time by doctor Henry Hoffman (Heinrich Hoffman) in 1845. In 1902 sir George F. Still (George F. Still) has published a series of lectures for the Royal College of Physicians in England in which the group of impulsive children with the considerable bikhevioralny problems connected with genetic dysfunction, instead of with ill-breeding of the child was described
SDVG meets at boys more often. Relative prevalence among boys and girls fluctuates from 3:1 to 9:1, depending on criteria of the diagnosis, methods of research and groups of research (children whom have directed to the doctor; school students; population as a whole). From the same factors estimates of prevalence of SDVG (depend on 1-2 % till 25-30 %) also. According to some information, prevalence of a syndrome among younger school students makes about 10-15 %, at boys it met in 2,8-3 times more often than at girls.
The main symptoms of SDVG are deficiency of attention, a hyperactivity and impulsiveness. These signs appear at very early age. As many healthy children too have such symptoms, but expressed to a lesser extent, or caused by other frustration, for the child careful inspection and the corresponding diagnosis put by the highly skilled expert is important.
Symptoms of SDVG appear within many months, usually symptoms of impulsiveness and a hyperactivity precede symptoms of violation of attention which can not appear within a year and more. Different symptoms appear under different social conditions, depending on requirements to self-checking of the child in a concrete situation. The child who "cannot quietly sit" or which everything destroys, is appreciable at school, and the inattentive dreamer can and not notice. At the impulsive child who at first does, and then thinks, can assume "problems with discipline" whereas the passive or sluggish child can simply count not too motivated. Nevertheless, both can have SDVG different types. All children are sometimes uneasy, sometimes do something without thinking, sometimes departure somewhere in dreams. When the hyperactivity, an otvlekayemost, bad concentration of attention or impulsiveness start to influence progress at school, the relations with other children or behaviour of the house, at the child it is possible to suspect SDVG. As depending on social conditions symptoms very much vary, to diagnose SDVG very difficultly. It is especially true when primary symptom is deficiency of attention.
Hyper active children, apparently, constantly are in movement and standing. They destroy everything around, sufficing and playing with everything that catches sight to them or incessantly talk. For them there is difficult a task to sit quietly at the table during a dinner and a school lesson or quietly to communicate. They coil and fidget on chairs, or рыщут on a room. Or twirl ступнями, all touch, loudly knock a pencil. Hyper active teenagers or adults feel internal concern. They often tell that it is necessary to be it occupied, and can try to do some affairs at the same time.
Impulsive children cannot constrain the direct reaction or think before something to make. They often blurt out improper comments, impetuously show the emotions and operate, disregarding consequences of the behaviour. Their impulsiveness prevents them to wait something desirable or the turn in game. They can select a toy at other child or strike, if they are upset. Even teenagers or adults impulsively choose to themselves occupations which bring let small, but immediate return instead of being engaged in the business demanding big efforts, but also giving much bigger compensation - the truth, then.
Criteria of diagnostics
The main diagnostic criteria treat
- Inappropriate to age characteristics and testifying to insufficient adaptation
- attention violations
- hyperactivity and impulsiveness
2. The first symptoms develop aged till 7 years
3. Symptoms remain constantly for 6 months in such degree of expressiveness which testifies to bad adaptation of the child.
4. Insufficient adaptation is shown in various situations (at home, at school) despite compliance of level of intellectual development to normal age indicators
- During the period about one year - a syndrome of the increased neuroreflex excitability (concern, causeless shout, impellent activity it is raised, vegetative reactions, violations of a dream, food intake, ZhKT violation)
- Many children with SDVG differ from contemporaries high impellent activity already in the first year - two lives.
- Start to go with an advancing
- Superfluous motor activity always happens aimless and does not correspond to requirements of a concrete situation, can be combined with destructive behaviour
- the child cannot play quiet games,
- unable to concentrate on a task and to finish it
- gives up one occupation and begins another, without having finished which, passes to the following.
- Difficulty in observance of rules of behaviour
- Impetuosity, rashness of acts
- Enuresis, энкопрез
Development stages at SDVG
About one year - a syndrome of the increased neuroreflex excitability (concern, causeless shout, impellent activity it is raised, vegetative reactions, violations of a dream, food intake, ZhKT violation)
From a year to 3 years - hypererethism, impellent concern, motor awkwardness, violations of speech development, dream violation, enuresis, энкопрез
Preschool age - from 3 to 7 years. hyperactivity and impulsiveness symptoms are generally shown. Many lag behind contemporaries in development of skills of speech and a motility.
School age - from 8 to 13 years formation of a school dezadaptatsiya and difficulty in installation of relationship with contemporaries. Often there are simple social phobias, irascibility, aggressive behaviour. Weak psychoemotional stability and low self-image. The hyperactivity after 9 years weakens, but impulsiveness and violations of attention remain.
The teenage age - from 14 to the 18th poor progress at school, difficulty in end performance of long tasks, lack of independence, cannot work without assistance, the reckless behaviour interfaced to risk, bad relationship with contemporaries, difficulties in observance of rules of behaviour, submission to public norms and laws
The adult age - from 19 years - is not organised, does not possess sufficient skills of planning, is forgetful, diffused, often loses things. Experiences difficulties with an initiative and finishing till the end of work on various tasks, badly plans time for the activity, frequent changes of work, difficulty in family life, there are difficulties with long preservation of attention. Badly transfers negative emotions, disappointments.
The frustration sometimes accompanying SDVG
Difficulties in training. Many children with SDVG, about 20-30 percent, also have concrete difficulties with training. At preschool age these problems consist in misunderstanding of certain sounds or words, and/or it is difficult to them to put the opinion into words. At school age there can be problems with reading, spelling, a written statement and arith
metics. Such type of disorder of reading as a dyslexia is widespread. Nearly 8 % of children of elementary school have problems with reading.
Syndrome Giles de la Turetta. Very small percent of people with SDVG has a neurologic disease - a syndrome Giles de la Turetta. People with this syndrome suffer various nervous tics and the repeating actions including a blinking, tics of the person or grimacing. Others can repeatedly cough, sniff, snuffle or cry out swear words. Such behaviour can be supervised by means of drugs. Though very few children suffer from a syndrome Giles de la Turetta, at many children, to it suffering, it is connected with SDVG. In such cases medicines are necessary for treatment of both diseases.
Oppositional defiant frustration. From one third to a half of all children from SDVG - generally boys - have other frustration known as oppositional defiant frustration (OVR). Such children are usually impudent, stubborn, pig-headed, for them fits of anger or aggressions are characteristic. They argue with adults and refuse to obey.
Konduktivnoye frustration. Approximately at 20-40 % of children with SDVG konduktivny frustration - more serious antisocial behaviour eventually develops. Such children often lie or steal, fight with others or lift up them, they have problems at school or with police more often. They break the fundamental rights of other people, show aggression to other people or animals, destroy a private property, break into houses of people, make thefts, carry or use the weapon or are engaged in vandalism. Such children or teenagers with a high probability can try drugs, and then get under their dependence. The help is urgently necessary for them.
Uneasiness and depression. Some children with SDVG often have accompanying uneasiness or a depression. If uneasiness or a depression are diagnosed and them have started to treat, the child can supervise better the problems connected with SDVG. And on the contrary, effective treatment of SDVG can render a positive effect on uneasiness as the child is capable to carry out better than a task at school.
Bipolar frustration. There are no exact statistical data on how many children with SDVG have bipolar frustration. In the childhood it is very difficult to differentiate SDVG and bipolar frustration. In the classical option bipolar frustration is characterised by change of the periods of bad and good mood. But it seems that children with bipolar frustration have chronic violation of regulation of mood in a combination to euphoria, a depression and annoyance rather. Besides there are some symptoms which are characteristic both for SDVG, and for bipolar frustration, such as hyperactivity and decrease in requirement for a dream. The symptoms differentiating SDVG from bipolar frustration, is a high spirits and pomposity of the child with bipolar frustration.
In the different countries approaches to treatment and correction of SDVG and available methods can differ. However, despite of these distinctions, the majority of experts consider as the most effective a comprehensive approach which combines some methods which have been individually picked up in each case. Methods are used: updatings of behaviour, psychotherapy, pedagogical and neuropsychological correction.
Medicinal therapy is appointed according to individual indications when violations from cognitive functions and a behaviour problem at the child with SDVG cannot be overcome only by means of non-drug methods.
Neuropsychological method. When by means of various exercises we come back to the previous stages онтогенеза and anew prostraivay those functions which were created archaically incorrectly and were already fixed. For this purpose them it is necessary, as any other inefficient pathological skill, purposefully to open, растормозить, to destroy and create new skill which more corresponds to effective work. And it is carried out on all three floors of cogitative activity. It is laborious many months work. The child is born 9 months. And neuropsychological correction is calculated on this term. And then the brain starts to work more effectively, with smaller power expenses. Old archaic communications, the relations between hemispheres are normalised. Power, management, active attention простраиваются.
The Sindromalny method is that the child is given interesting activity (any). But in this activity there is post-any attention (when we have become interested in something and have penetrated, we already strain without additional expenses). Therefore, when say that children with SDVG to stay in a condition behind the computer very long, it absolutely other attention.
There are outdoor games which demand only tension of attention. The child moves on game conditions, it can be взрывчат, is impulsive. It can help to win to it. But game is calculated on attention. This function trains. Then restraint function trains. Thus it can distract. Each task is solved in process of receipt. Each function separately so improves.
The Bikhevioralny or behavioural psychotherapy is accented on these or those behavioural templates, either forming, or extinguishing them by means of encouragement, punishment, coercion and a vdokhnovleniye.
Work on the personality. Family psychotherapy which forms the personality and which defines where to direct these qualities (a rastormozhennost, aggression, hyperactivity).
At SDVG treatment as an auxiliary method medicines are applied. Most known of them are psychostimulators, such as метилфенидат, декстроамфетамин with amfetaminy and декстроамфетамин. One of shortcomings of these preparations - need to accept them several times a day (action time about 4 hours). Now have appeared метилфенидат and декстроамфетамин with amfetaminy long action (till 12 o'clock). Also use preparations of other groups, for example - атомоксетин.
The approach widespread in Russia and the countries of the CIS-nootropnye preparations, the substances improving work of a brain, exchange, the power increasing a tone of a bark. Also the preparations consisting of amino acids which improve a brain metabolism are appointed. Nevertheless, now convincing proofs of efficiency of such treatment are not present.