Attention Deficit Hyperactivity Disorder (ADHD) is a fairly common disorder in childhood. Statistics indicate that in Spain it affects between 3 and 7% of children, but that figure rises to between 5 and 20% in the rest of the world. Basically, it is a neurobiological disorder that causes symptoms such as hyperactivity, impulsivity and difficulties concentrating, whose repercussions are reflected in children’s behavior.
ADHD does not have a single cause. It is a multicausal disorder, which means that it is determined by both genetic and hereditary factors as well as environmental ones. It is known that neurochemical alterations during the intrauterine period associated with the consumption of toxic substances and smoking in the mother increase the chances of developing ADHD in children. Likewise, a study carried out at the Mental Health Center of the CPB in Barcelona found that a diet rich in omega 6 and low in omega 3 during pregnancy increases the risk of suffering from the disorder in children.
In fact, diet also represents a risk factor in children themselves. An investigation carried out by experts from the Örebro University and revealed that an unhealthy diet with a predominance of sugars and fats can increase the risk of suffering from attention and concentration problems and, to a lesser extent, promote other alterations such as hyperactivity and impulsiveness that characterize to ADHD. In the same way, it is known that inadequate educational guidelines or a violent or stressful family environment can trigger or accentuate the symptoms of the disorder at an early age.
However, heredity plays a crucial role. Did you know that children whose parents have ADHD have a 57% increased risk of developing the disorder? This figure translates into a 20 times greater probability of suffering from ADHD in childhood, a risk that increases considerably among first-degree biological relatives. This means that children are more likely to develop ADHD when one of their parents or uncles has had the disorder.
And it can also be seen in the opposite direction, since the fact that children have ADHD increases the chances that one of their parents will have the disorder by 25% and that their siblings will develop it by 15%. In fact, a study carried out at the National Autonomous University of Mexico revealed that the risk of suffering from ADHD in twins can reach between 50% and 80%.
Like heredity, genes play an important role in the development of the disorder. Genetic analyzes point to an alteration of the GMR5 gene, related to glutamate receptors. According to statistics, about 10% of children with ADHD have a variation in the number of copies of this gene. However, it is not the only gene related to the disorder.
An investigation carried out by specialists from the Research Institute and the Department of Psychiatry of the Valle de Hebrón University Hospital found a new genetic variant related to the onset of the disorder in childhood and its subsequent permanence in adulthood. It is the LPHN3 gene, also known as Latrophilin 3, which appears to increase children’s susceptibility to ADHD.
In turn, it has been shown that some changes in the maturation of white matter fiber bundles and the density of gray matter in the brain can influence the onset of the disorder. This was confirmed by a study carried out at the University of California in which it was also found that structural changes due to incomplete maturation in the middle and superior temporal gyrus, as well as in the fronto-basal portions of the frontal lobe, are associated with greater chance of developing ADHD.
What are the most common symptoms of ADHD in children?
Identifying children with ADHD is not usually complicated since their inability to stay calm and their restless behavior give them away. They tend to be children who react in a rush, who find it difficult to wait their turn and stay focused on the same activity for long periods of time. In most cases, these signs begin to be noticed before they start school and are manifested the same when playing with friends, watching TV or sitting down to eat at the table. Among the most common symptoms are:
1. Intense motor arousal
Hyperactivity is usually the most frequent symptom of ADHD, often responsible for problems in the social sphere. It is a very intense feeling of restlessness that prevents children from staying calm and focused on an activity. Hence, they move their hands and feet too much, talk excessively and run, jump and move constantly, even if it is inappropriate. Many of the children with ADHD cannot even play quietly as they do not have much patience and, in most cases, it is difficult for them to stay still in one place.
2. Little attention
Lack of attention is another of the most typical symptoms of children with ADHD, being the main problem that leads to school failure in most cases. In fact, it’s common for kids with ADHD to have trouble processing information and following directions when spoken to, as well as trouble concentrating on a task, especially if they don’t like it. Often, they also find it difficult to organize their daily tasks and activities since they tend to be easily distracted by any external stimulus.
3. Marked impulsiveness
The impulsive behavior of children with ADHD is another symptom that distinguishes them. They often jump into answers even before questions are asked, make snap decisions without much thought, and have trouble waiting their turn, whether it’s in class, a game, or in line. Likewise, they tend to interfere in the activities of others, which usually leads to fights with their peers and it is common for them to be aggressive and violent when the rest do not do what they want.
The main types of ADHD in children
Most children with ADHD have very similar symptoms, although their intensity and the way they manifest can vary from one case to another. In addition to the emotional and educational particularities of each child, this is because there are different types of ADHD. According to the Diagnostic and Statistical Manual of Mental Disorders, DSM-V, these are the common variants of ADHD:
1. ADHD with predominant attention deficit
This type of ADHD is characterized by a marked attention deficit. Basically, children who suffer from it have great problems concentrating on tasks that require a lot of time and dedication since they are very easily distracted. It is common for them to have difficulties to organize themselves in their daily lives, at the same time that it is difficult for them to follow an organization to the letter because they lose concentration quickly. They often get low grades and may suffer school failure for this reason.
2. ADHD with predominance of hyperactivity and impulsivity
This variant of ADHD is distinguished by two main symptoms: extreme impulsivity and hyperactive behaviors. Children with this type of ADHD tend to have a lot of energy, which keeps them in constant motion and prevents them from being able to concentrate on an activity. For this reason, it is common for them not to follow the rules and it is difficult for them to follow orders since they are incapable of paying attention. In some cases, defiant and authoritarian behaviors tend to occur.
3. ADHD combined type
In this type of ADHD, children often show all the main symptoms of the disorder: they have a very restless behavior, they have a hard time concentrating on an activity and they show signs of impulsiveness. These are the typical children who cannot sit still for a moment and who often get into trouble due to their constant hyperactivity. In some cases, the presence of rebellious and defiant behavior is also common.
How is ADHD diagnosed in children?
The diagnosis of ADHD in children is the responsibility of the psychologist, although it can also be done by a child psychiatrist or a pediatric neurologist with training in this area. After an exhaustive psychological evaluation, the diagnosis is made based on the DSM-V criteria, also taking into account the psychopedagogical reports that are provided and the interviews with the parents. In some cases, neuropsychological evaluation and standardized evaluation scales can provide information of interest. However, the last word is held by the sessions with the children, which will be the ones that provide sufficient information on whether the symptoms are due to ADHD or another disorder.
When making the diagnosis, it is important to specify in each case the type of ADHD and the intensity of the symptoms. This is a fundamental step to identify the particular needs and implement the treatment guidelines that best respond to each case. Although it is worth noting that the diagnosis of ADHD is not static but dimensional, that is, it can vary as children mature and as the social circumstances around them change.
Is ADHD curable? Effective Treatments for Childhood ADHD
ADHD has no cure. Its treatment is aimed at mitigating symptoms and preventing short- and long-term consequences on child development. The choice usually varies taking into account the severity of the disorder and the time of evolution, as well as the psychosocial conditions of the children and their maturational level. However, most experts tend to opt for a multidisciplinary treatment that includes psychological therapy combined with the use of some medications and lifestyle changes.
1. Psychological therapy
Psychological therapy in children with ADHD is aimed at offering a balance between the behavioral, emotional, and social aspects that are at the root of the disorder, as well as providing small tools so that they are capable of regulating their behavior. treatment _includes a set of techniques, especially behavioral, that seek to teach children to monitor their own behavior and establish well-structured patterns to regulate their impulsiveness and hyperactivity. Sometimes cognitive therapy is also used to help children gain self-control and improve their attention span, as well as social skills training to teach them how to solve problems assertively. Relaxation techniques are often key for children to gain self-control and improve their attention.
2. Pharmacological treatment
The use of medication is usually quite common in the most severe cases of ADHD or in which psychological therapy does not work on its own. In fact, it is known that about 70% to 80% of children with ADHD who use medication respond positively to treatment. In these cases, it is usual to resort to both stimulant and non-stimulant drugs of the central nervous system which, although they tend to have different mechanisms of action, provide similar results that reduce impulsivity, hyperactivity and improve attention span. The drugs of choice are usually atomoxetine and methylphenidate ., although others such as clonidine, guanfacine and extended-release amphetamine are also used. In some cases, antidepressants are also used.
3. Socio-educational intervention
Socio-educational treatment is another of the fundamental pillars of specialized care for children with ADHD. In this sense, specialists recommend that parents define the limits at home well and establish clear rules, as well as plan the children’s daily activities in detail. It is also suggested to stimulate the practice of sports or bet on physical activities in nature to help them release excess energy, as a study foundconducted at the University of Vermont and Michigan State University. Likewise, it is known that there is a close relationship between ADHD and diet, so it is recommended to opt for a diet reduced in sugars, dyes and additives and rich in vitamins, minerals and essential fatty acids to reduce hyperactive symptoms and impulsivity in the little ones.