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     Volume 5 Issue 107 | August 11, 2006 |

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Attention-deficit/hyperactivity disorder (ADHD) is a group of chronic disorders that begin in childhood and sometimes last into adult life.

Problems generally associated with ADHD include inattention, hyperactivity and impulsive behaviour. They can affect nearly every aspect of life. Children and adults with ADHD often struggle with low self-esteem, troubled personal relationships and poor performance in school or at work.

The best treatment for ADHD is a matter of debate. Currently, psychostimulant drugs are the most common treatment. But although these drugs can relieve many symptoms, they don't cure ADHD. Counselling, special accommodations in the classroom, and family and community support are other key parts of treatment.

Signs and symptoms
For some time, experts disagreed on how ADHD should be diagnosed and even on whether it was a real disorder. But in 1998, the National Institute of Mental Health decided that ADHD is a legitimate condition. In addition, most doctors believe that a child shouldn't receive a diagnosis of ADHD unless the core symptoms of ADHD appear early in life before age 7 and create significant problems at home and at school on an ongoing basis.

The symptoms of ADHD fall into two broad categories:
* Inattention
* Hyperactivity-impulsive behaviour

In general, children are said to have ADHD if they show six or more symptoms from each category for at least six months. These symptoms must significantly affect a child's ability to function in at least two areas of life typically at home and at school.

In most children diagnosed with ADHD, signs and symptoms appear between 4 and 6 years of age, although they sometimes may occur even earlier. They include the following:

* Often fails to pay close attention to details or makes careless mistakes in schoolwork or other activities
* Often has trouble sustaining attention during tasks or play
* Often doesn't seem to listen when spoken to directly
* Often doesn't follow through on instructions and fails to finish schoolwork, chores or other tasks
* Often has difficulty organising tasks or activities
* Often avoids or dislikes tasks that require sustained mental effort, such as schoolwork or homework
* Often loses things needed for tasks or activities, such as books, pencils, toys or tools
* Is often easily distracted
* Is often forgetful

Hyperactivity-impulsive behavior
* Often fidgets with hands or feet or squirms in seat
* Often leaves seat in the classroom or in other situations where remaining seated is expected
* Often runs or climbs excessively when it's not appropriate, or, if an adolescent might constantly feel restless
* Often has difficulty playing quietly
* Is often "on the go" or acts as if "driven by a motor"
* Often talks excessively
* Often blurts out the answers before questions have been completely asked
* Often has difficulty waiting his or her turn
* Often interrupts or intrudes on others by butting into conversations or games

Parents often blame themselves when a child has been diagnosed with ADHD, but scientists increasingly believe that structural changes in the brain, not parenting, may be a leading cause of the disorder. At the same time, certain environmental factors may contribute to or worsen a child's symptoms. Although much still isn't understood about ADHD, researchers have identified several factors that may play a role:
* Altered brain function. Scientists once thought that a chemical imbalance was involved in many cases of ADHD because adults and children diagnosed with ADHD appear to have low levels of dopamine (dopa decarboxylase), a chemical that sends messages to the part of the brain involved in attention, movement and motivation. But brain scans of children with ADHD also show changes in the neural pathways along which these messages move. It's possible that this may interfere with communication between the parts of the brain that regulate attention, planning, impulsive behavior and motor control all areas of difficulty for people with ADHD.

* Heredity. ADHD tends to run in families. About one in four children with ADHD have at least one relative with the disorder, and when one identical twin has ADHD, the other twin almost always has it as well.

* Maternal smoking, drug use and exposure to toxins. Pregnant women who smoke are at increased risk of having children with ADHD. And alcohol or drug abuse during pregnancy may reduce activity of the nerve cells (neurons) that produce dopamine. Pregnant women who are exposed to environmental poisons such as polychlorinated biphenyls (PCBs), also may be more likely to have children with symptoms of ADHD. PCBs are industrial chemicals that were widely used until they were finally banned in 1976. But PCBs are slow to degrade and high levels remain in the environment, in animal and human tissue and in breast milk, which tends to attract contaminants because of its high fat content.

* Childhood exposure to environmental toxins. Preschool children exposed to certain environmental toxins, particularly lead and PCBs, are at increased risk of developmental and behavioral problems, many of which are similar to those found in children diagnosed with ADHD. Exposure to lead, which is found mainly in paint and pipes in older buildings, has been linked to disruptive and even violent behavior and to a short attention span. And high levels of PCBs are known to interfere with many aspects of a child's development, in addition to being human carcinogens. Children may be exposed to PCBs in the womb as well as after birth both breast milk and certain fish are high in these toxins.

Because ADHD is a complex disorder and each person with ADHD is unique, it's hard to make recommendations that are right for every child or adult. But some of the following suggestions may help:

Children at home
* Show your child lots of affection. Children need to hear that they're loved and appreciated. Focusing only on the negative aspects of your child's behavior can harm your relationship with him or her and affect self-confidence and self-esteem. If your child has a hard time accepting verbal signs of affection, a smile, a pat on the shoulder or a hug can show you care.

* Be patient. Try to remain patient and calm when dealing with your child, even when your child is out of control. If you're calm, your child is more likely to calm down too.

* Keep things in perspective. Be realistic in your expectations for improvement both your own and your child's.

* Take time to enjoy your child. Make an effort to accept and appreciate the parts of your child's personality that aren't so difficult. One of the best ways to do this is simply to spend time together. This should be a private time when no other children or adults interfere. Try to give your child more positive than negative attention every day.

* Try to keep a regular schedule for meals, naps and bedtime. Use a big calendar to mark special activities that will be coming up. Children with ADHD have a hard time accepting and adjusting to change.

* Make sure your child is rested. Try to keep your child from becoming overtired, because fatigue often makes symptoms of ADHD worse.

* Identify difficult situations. Try to avoid situations that are difficult for your child, such as sitting through long presentations or shopping in malls and supermarkets where the array of merchandise can be overwhelming.

* Use timeouts or the loss of a privilege to discipline your child. For children with ADHD, a timeout from social stimulation can be very effective. Timeouts should be relatively brief, but long enough for your child to regain control. The idea is to interrupt and defuse out-of-control behavior. A timeout doesn't work for everything, but many parents have found that it's one of the best tools for managing the behavior of an overactive or impulsive child.

* Work on organization. Help your child organize and maintain a daily assignment notebook and be sure your child has a quiet place to study.

* Find ways to enhance your child's self-esteem and sense of discipline. Children with ADHD often do very well with art projects, music or dance lessons, or martial arts classes, especially karate or tae kwon do. But don't force children into activities that are beyond their abilities.

* Use simple words and demonstrate when giving your child directions. Speak slowly and quietly and be very specific and concrete. Give one direction at a time.

* Take a break yourself. If you're exhausted and stressed, you're a much less effective parent.

Children in school
* Ask about school programs. Take advantage of any special programs your school may have for children with ADHD.

* Talk to your child's teachers. Stay in close communication with your child's teachers, and support their efforts to help your child in the classroom. Be sure teachers closely monitor your child's work, provide positive feedback and are flexible and patient. They should also be very clear about their instructions and expectations.
* Ask about having your child use a computer in the classroom. Children with ADHD often have trouble with handwriting and can greatly benefit from using a computer or a typewriter.



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