Attention Deficit Disorder with or without Hyperactivity (ADD/ADHD)

What is attention deficit disorder with or without hyperactivity? Attention deficit disorder with or without hyperactivity (ADD/ADHD) is characterised by inattention,impulsivity ("action before thought"), andhyperactivity or uncontrolled motor agitation. It develops in an intelligent child, but is not exclusively due to a neurological or psychiatric illness. There are often other disorders associated with or integral to ADD/ADHD, including learning disabilities. ADD/ADHD very often leads to difficulties at school. Why is this? There are certain genetic predisposing factors (family history), biological factors (in particular a deficit in certain neurotransmitters - molecules that enable information to circulate between neurons), psychosocial factors.... These factors seem to be able to alter the functioning of certain brain circuits (striatum, frontal lobe, etc.) involved in controlling attention and inhibiting spontaneous responses. What are the symptoms and consequences? Attention deficit, impulsivity and motor agitation are the main symptoms of ADD/ADHD. These signs are obviously not specific to this diagnosis and can be observed, for example, in unruly children, children who are failing at school or children who lack education. However, if these symptoms are particularly intense and long-lasting (with an early onset and prolonged course), and if they are expressed in different situations (at school, at home, in leisure activities, etc.) with disturbing consequences for the child's social, school and family life, they are suggestive of ADHD. Diagnosis requires a variety of elements to be gathered, based on interviews with the parents and the child, a clinical examination of the child, assessment questionnaires for parents and teachers (such as the Conners scales: see linked document), a psychological and neuropsychological assessment and possibly various paramedical assessments (speech therapy, psychomotor therapy, etc.) depending on the disorders identified. The diagnostic criteria are those of the DMS-IV classification shown in the appendix; six of the nine symptoms of inattention or six of the nine symptoms of hyperactivity and impulsivity must have been present for 6 months.Inattention is the most constant symptom, sometimes masked by agitation and impulsivity, or sometimes in the foreground. It is reflected in frequent difficulties in remaining focused on an activity in class or at play (the child is distracted by the slightest noise), but also by difficulties in following all instructions and getting organised (loss of equipment, etc.). Hyperactivity is often evident. Children are constantly on the move; in class, they fidget in their seats, trample on things, move around all the time or knock things over. Their restlessness may also be expressed by excessive chatter, constant handling of objects or involuntary finger movements during the oath-taking manoeuvre (Prechtl's chorea), which explains the often irregular handwriting of these children. Impulsivity is manifested by a child who reacts too quickly, without thinking or considering the consequences of his or her actions, who does not wait for questions to be finished before answering them, and who has difficulty letting his or her classmates speak or do what they want. In cognitive activities, they tend to "jump ahead" in their reasoning. Given the non-specific nature of the symptoms, the initial examination should look for certain disorders likely to cause secondary attention deficits (visual or auditory sensory deficits, sleep disorders, sleep apnoea, fatigue linked to a chronic illness, etc.) and rule out a general intellectual disability. It must also provide objective data on the extent and profile of the disorders: - Quantify the attentional deficit and specify its profile (assessment of sustained attention, selective or divided attention, visual and auditory attention, executive functions). - Analyse specific cognitive disorders using psychometric tests and check-ups depending on the disorders identified (speech therapy, psychomotor therapy, orthoptics, occupational therapy, etc.) to determine whether there are any learning disorders (particularly in written language, but also in graphics or arithmetic), which are frequently found. - Assesspsycho-affective disorders: emotional disorders, including the particularly common anxiety disorders, oppositional disorders (provocation, disobedience, defiance, anger, etc.), and sometimes conduct disorders (behaviour that violates the rights of others and social rules). Loss of self-esteem is common. A rigorous initial assessment, if possible by a multidisciplinary team (neuropaediatrician, child psychiatrist, psychologist, speech therapist, etc.) is therefore necessary to confirm the diagnosis of ADD/ADHD, assess the impact of the disorder, specify the child's needs in class and in everyday life, and then later enable the development of the disorder to be assessed. A few figures ADD/ADHD is thought to affect between 3% and 6% of school-age children, i.e. almost 200,000 children aged between 4 and 19, across all social classes. It is a predominantly male disorder, with four boys affected for every girl. A learning disability is present in 60 to 80% of cases, i.e. 15 to 20 times more often than in the general population. Treatment The treatment of ADHD is always multifaceted and must be adapted on a case-by-case basis. It combines drug treatment if the problem warrants it, psychotherapeutic follow-up if necessary, and treatment of specific learning disorders if they exist; parental guidance is essential. Drug treatment is based on methylphenidate (Ritalin®, RitalinLP® or Concerta®). It is indicated for children over the age of 6, in the context of confirmed ADHD, present in several situations and leading to significant failure to integrate (failure at school and/or repercussions on family equilibrium). When the indication meets the diagnostic criteria, its beneficial effects affect around 90% of children treated, and are spectacular within a few days, in all areas. The first prescription must come from a hospital doctor or a doctor working in a health facility (such as a CMP or CAMSP). Most often, with the new delayed-release forms, the treatment is administered once a day. This treatment is sometimes interrupted during school holidays. The necessary treatment for learning disorders includes speech therapy and/or psychomotor therapy, occupational therapy, depending on the case.... An indication for psychotherapy depends on the associated symptoms (low self-esteem, depressive syndrome, etc.). Parental guidance, and in particular parents' groups, are a remarkable help in framing and supporting the young person and reducing the day-to-day consequences of the disorder. Consequences for school life Children with ADHD often have difficulties at school, even though their overall cognitive level is fine. Schooling in an ordinary environment may require specific adjustments to promote learning, whether in terms of human assistance (AESH), technical assistance (computer) or teaching adjustments. These must be specified in a Personalised Support Plan (PAP), sometimes a Personalised Schooling Plan (PPS) with the MDPH. At other times, schooling with a ULIS-type structure will be necessary. Specialised establishments do not seem to be the best way to deal with these children's difficulties. When to be careful - Children with ADD/ADHD may suffer from a degree of isolation in their relationships. Because of their difficulty in following instructions, taking turns and concentrating on an activity, they are likely to be rejected by their peers. They may also suffer from repeated remarks about their behaviour and any difficulties they may have at school. A loss of self-esteem, a lack of self-confidence and anxiety are therefore common and need to be monitored. These feelings can sometimes be accompanied by a genuine depressive syndrome. As far as possible, sources that reinforce inattention and hyperactivity should be avoided: noise, agitation, distressing circumstances. Creating a calm and serene working atmosphere encourages learning and helps to break the vicious circle of hyperactivity, remorse, anxiety and increased hyperactivity. How can school life be improved for sick children? There are a number of points that can help children adapt to the demands of school activities in class and at home: - Create a calm, structured working environment, with a regular timetable; - Make it easier for the child to fit in and concentrate by placing him or her in the right place in the classroom; - Allow socially acceptable expressions of the need to move around; - Offer alternative solutions to avoid noisy interruptions from the teacher when instructions are forgotten (raise your hand, ask your classmate discreetly, etc.); - Shorten the time spent in class; - Make it easier for the child to concentrate on his or her work.Help the child to organise himself, to acquire strategies; - Talk to the child, establish a system of encouragement when he achieves something positive... The future Early diagnosis and medical and educational treatment, in close collaboration with teachers and parents, give children with ADHD the best long-term chances of academic, professional, social and family success. Teachers have a key role to play in assessing, together with the various health professionals and parents, changes in the child's behaviour and progress in learning, which are very important indicators of the child's development.