Attention deficit disorder. What is ADHD: symptoms, treatment of attention deficit hyperactivity disorder in preschool and school-age children

The condition of a person with symptoms of impulsivity and persistent inattention is called attention deficit hyperactivity disorder. The disease is typical for children, who experience its symptoms more clearly, but it also manifests itself at an older age. It is useful to know how to deal with the disease, identify its causes and symptoms.

What is ADHD

When meeting the incomprehensible acronym ADHD, many people want to know what it is. Doctors and scientists explain that ADHD is attention deficit hyperactivity disorder. This is a mental illness, and it occurs several times more often in children than in adults. According to statistics, up to 7% of modern children show signs of hyperactivity, of which only a third are girls - the rest are boys.

Patients note different symptoms of ADHD, but in general the manifestations are as follows: they are all extremely active, have difficulty controlling themselves, and are unable to concentrate on one goal. If activity is normal, they only talk about attention deficit disorder. With age, the signs disappear, but increased impulsivity, hyperactivity, and the need to show attention in any way, including eccentric ones, remain.

Causes of ADHD

Until now, doctors cannot say for sure what the causes of ADHD are. Scientists believe that the symptoms are caused by a complex of factors that cause hyperactivity disorder at any age. These factors include:

• genetic predisposition - the disease can be transmitted from father and mother;
• prematurity, premature birth;
• abuse of alcoholic beverages and nicotine during pregnancy;
• head and brain injuries, infectious diseases in early childhood.

The mechanism for the development of mental abnormalities includes a deficiency of special chemicals. If dopamine and norepinephrine are not enough in certain areas of the brain, then the child becomes hyperactive, impulsive, and attracts attention to himself. Based on these data, it can be argued that a mental illness requires proper diagnosis and treatment based on the identified symptoms.

ADHD - symptoms in children

Before diagnosing the disease, it may be helpful to learn more about ADHD—the symptoms that will indicate that patients are experiencing problems. Attention deficit disorder manifests itself in children in the following 3 categories:

1. Inattention – Children are constantly distracted, forget responsibilities or information, and are unable or have difficulty focusing on one thing. They cannot complete tasks, collect themselves, organize work, or follow directions. Looking at them, you might think that they do not hear when you talk to them. They make mistakes due to lack of concentration, they are absent-minded, and they can lose their things.
2. Hyperactive qualities - schoolchildren are impatient, communicate a lot and excessively, fuss, cannot train themselves to sit in one place for a long time. In kindergarten or school, they are not in one place, they run away, ignoring the instructions of teachers.
3. Impulsiveness - always strives to be the first to answer, interrupts others, does not tolerate waiting in line. They cannot delay receiving pleasure; they need to realize their idea here and now. Preschoolers and schoolchildren do not give in to persuasion; they want to get everything at once.

Diagnosis of ADHD

It is not easy to identify a child with ADHD - the diagnosis is made only on the basis of comparing the behavior of their peers at the same level of development in the same social conditions. The analysis takes at least six months to accurately diagnose the disease, and not just identify an inattentive or hyperactive member of society. Symptoms of the disorder begin in preschool age and manifest later depending on social situations and family relationships.

With significantly pronounced symptoms, the child is often socially maladapted, which leads to mental problems and withdrawal. It is important to bring him to the doctor in time so that he can examine him and rule out other diseases that cause behavioral disorders. Based on the main symptoms, doctors make a diagnosis of attention deficit disorder with a predominance of inattention, hyperactivity, impulsivity, or a combination of these.

Some patients, in addition to the main characteristic, suffer from other diseases that accompany the disorder. This:

• poor development of learning skills, poor school performance;
• oppositional disorder – deliberate lack of obedience, violent behavior;
• emotional disorder – nervousness, tearfulness;
• tics - unintentional twitching of facial muscles, snoring, sudden screams.

ADHD - treatment

Hyperactivity in children is treated so that you do not have to suffer from its symptoms. Efficiency depends on complex therapy, the efforts of doctors, parents and teachers. Treatment for ADHD in children includes techniques such as:

More and more often, neurological problems in the behavior of children have recently begun to arise, and a diagnosis called hyperactivity syndrome is increasingly appearing. It is often accompanied by various learning disorders, which in the child are associated with a lack of attentiveness and concentration. This diagnosis is justified in some cases, but there are often errors in establishing the diagnosis. This attention deficit hyperactivity disorder or ADHD, unfortunately, has gone beyond just a medical problem, since such children study in schools along with ordinary children, disrupting academic performance and discipline. In addition, they require a special approach for proper upbringing and training, since such a child can slip into antisocial behavior and become an outcast.

Where do the diagnoses come from?
This syndrome occurs due to disturbances in coordinated work in one of the parts of the nervous system, which is responsible for attention and mobility - the reticular formation. This occurs due to functional disorders, but the structure of the nervous tissue itself is not disturbed. The syndrome is based on difficulties that arise when memorizing material, concentrating, restlessness, that is, the child simply cannot cope with the information flow, process information correctly and fully. Not long ago, the term ADHD was introduced into neurology; it is constantly being studied and supplemented, and over time it can be classified as a specific group of diseases, behavioral or neurosis-like. It is not even possible to say exactly how realistic this syndrome actually occurs, since the assessment of motor disinhibition and attention disorders is considered a rather subjective thing.

In addition, children can be completely different in temperament, which is normal for some children, but a pathology for others. It is believed that this condition is more typical for boys than for girls; you can always find several such children among students in primary school. This syndrome can have three variants, since it is heterogeneous, for example, when problems with hyperactivity and attention are combined, or only problems of attentiveness predominate, or there are only problems of excessive mobility.

The disease and its roots.
This condition usually occurs as the original characteristics of the body, which are laid down at the genetic level, although many researchers assume its occurrence after infections of the nervous system or injuries. Almost 90% of families with such children note that they already had similar children in their family, in older generations. But many are silent about this because of shyness and inconvenience. Often this syndrome is combined with the appearance of nervous tics, neuroses or obsessions. It is believed that a lack of dopamine, a special inhibitory substance, in brain tissue is partly to blame. It is considered an inhibitory transmitter at nerve synapses. The aggravating factor is the child’s unfavorable environment, manifestations of stress and bad habits in the family.

These factors usually have an adverse effect on the area of ​​the reticular formation, which leads to disruptions in its smooth functioning. In the head, this area is responsible for the process of learning and memorizing new information, therefore it processes this information and distributes it according to the degree of importance, according to the need for its comprehension and processing. The reticular formation serves as a compartment in which the main tasks are highlighted from hundreds of tasks, so it is possible to concentrate on it and fully complete it until completion.

But this coherence and filtering are lost with the development of ADHD. A flow of information hits the child, so he cannot determine what he should take on first, and jumps from one task to another. As a result, none of them are fulfilled. Excess stimuli affect all the child’s analyzers - light, sounds, emotions, overstimulate the child, making him restless, nervous, irritable, and even aggressive.

How to clarify the diagnosis?
It is necessary to take into account when making a diagnosis that there are very active children who can run and jump for a long time on their own. It is for this reason that doctors have developed clear criteria by which this syndrome can be recognized and subsequently corrected. They should absolutely all be detected in children and all the time. This presence of excessive activity in a child should be present all the time, combined with or without distracted attention. Therefore, it is required that such phenomena appear no earlier than six or seven years of age and last at least six months. Such symptoms should be constantly observed in home, kindergarten, and school settings.

The child should also be observed by a neurologist, and the doctor should rule out all neurological, psychiatric and other diseases. Simply put, throughout life this condition prevents the child himself and his family from living normally and adapting socially. But such a diagnosis cannot be established before the age of five, and at the age of one or two years one cannot talk about any hyperactivity.

Attention deficit and criteria for its identification.
Leading experts who are closely involved in the problem of ADHD believe that several criteria can be identified that give the right to assert that attention deficit exists. If at least six or seven of the listed criteria are found, then we can talk about impaired attention. These are the criteria:
1.Children do not pay attention to details and make mistakes when working.
2.Children have difficulty maintaining attention in games or at work.
3. Kids cannot listen to what is said to them.
4.Children cannot follow exactly all the instructions given to them.
5.Children themselves cannot organize their own games or activities.
6. It is difficult for children to do things that require concentration and attention.
7.Children don’t remember what they put and where, and they often lose personal belongings.
8. Children are constantly and easily distracted.
9. Children constantly forget what you tell them.

Hyperactivity and its criteria.
Criteria have also been developed to identify excessive activity; this is done in parallel with attention disorders. The child must always have at least five of the above criteria.
1.Children perform fussy actions with their feet or hands.
2. Children very often jump out of their seats.
3.Children are overly active and move in places that are inappropriate or unacceptable.
4. Toddlers find it difficult or impossible to play calm games, such as chess.
5. It is impossible to seat children, as they are in constant motion.
6.Children have overly active speech and inappropriate talkativeness.

To these criteria, we must also add impulsiveness; this is a phenomenon when children cannot stop and think about their phrases or actions before speaking or doing them. There are criteria for this:
1. Without having yet heard the question in its entirety, the children begin to answer it.
2.Children cannot wait for their turn in games and work.
3. Children constantly interfere in other people's conversations.

Even at an early age, signs may appear, but only by the age of six will they become fully distinct. In addition to these manifestations, health problems in children include sleep disturbances, increased excitability and deterioration in well-being. Such children do not obey their parents, are not manageable and have little control.
The basis of treatment and correction includes classes with a psychologist and teacher with special training, training in special classes. Family psychotherapy courses are especially useful, as they will help the whole family learn to live with this particular problem.

On the site “Our inattentive hyperactive children”, when the most active parents from among the forum members decided to unite to help their own and other people’s children and other parents.

In fact, it has been operating since the fall of 2006, and was registered in the spring of 2007 with the organizational and financial support of the Attention Program of the Russian representative office of the British charity Charities Aid Foundation. Now Impulse includes parents living in Moscow and the Moscow region, and work is underway to open branches in St. Petersburg and Arkhangelsk. The organization includes about 40 families with children with attention deficit hyperactivity disorder and other learning and behavioral problems.

What does a child with ADHD need?

Families that are members of the organization and come to the site and forum are united not only by a common diagnosis (diagnoses may differ), but also by common problems. Inattentive, hyperactive, impulsive children urgently need adequate medical and educational assistance, proper upbringing at home and opportunities for self-realization - including in clubs and sections. However, children are often deprived of all this.

Typical problems of a family with a child with ADHD

• Lack of understanding of the child’s difficulties in society, family, school
• Frequent conflicts
• Social isolation of the child and family
• Violation of the child’s rights to receive education
• Uncoordinated work of specialists
• Unavailability of help
• Lack of information

Most often, the family is left alone with their problems. We are trying to solve them together.

Mom's troubles

It is especially difficult for mothers who single-handedly create and coordinate a treatment and correction plan for a child, without possessing the necessary knowledge and techniques. Mothers most often face the condemnation of others and bear a heavy burden of responsibility and guilt; Mothers of children with ADHD are significantly more likely than others to suffer from depression.

Helping a child is impossible without the help of the mother. Freeing her from despair, letting her believe in her strength and skills, equipping her with knowledge, helping her find joy in everyday life with a difficult child is one of our main goals.

The main directions of our work

• Information and moral support for families of children with ADHD and other learning and behavior problems
• Educational work
• Human rights activities
• Children's programs

What we can

• Publishing information materials and distributing them among parents
• Organization of events (including lectures, seminars, consultations, etc.)
• Collection and analysis of information in families, identification of the most important problems and key needs
• Exchange of experience with similar foreign organizations, analysis of their experience

What is being done now

• Lectures by specialists for parents
• Support groups with a psychologist
• Regular exchange of experience: online and offline meetings
• Online consultations with specialists (including a constantly consulting psychologist)
• Children's activities
• Legal training for parents is planned.

Areas of cooperation with professionals: where we need help

• Conducting lectures, seminars, information campaigns for parents
• Expert assistance in developing programs and materials
• Direct work with families

What we need volunteer help with:

• Organizational work on projects
• Legal assistance

Information about upcoming and past events of “Impulse” - lectures, seminars, consultations, meetings, joint trips - is posted on the forum in the “Events Calendar” section.

You can contact us by mail: [email protected]

Unfortunately, the organization does not yet have a permanent premises and a landline telephone. But we are always in touch via the Internet.

January 19

Attention deficit hyperactivity disorder (ADHD), similar to ICD-10 hyperkinetic disorder), is an emerging neuropsychiatric disorder in which there are significant problems with executive functions (eg, attentional control and inhibitory control) that cause attention deficit hyperactivity or impulsivity that is inappropriate for the person's age. These symptoms may begin between the ages of six and twelve years and last more than six months from diagnosis. In school-aged subjects, symptoms of inattention often lead to poor school performance. Although this is a disadvantage, particularly in modern society, many children with ADHD have good attention span for tasks that they find interesting. Although ADHD is the most widely studied and diagnosed psychiatric disorder in children and adolescents, the cause is unknown in most cases.

The syndrome affects 6-7% of children when diagnosed using the criteria of the manual for the diagnosis and statistical recording of mental illnesses, IV revision and 1-2% when diagnosed using the criteria. Whether the prevalence is similar among countries depends largely on how the syndrome is diagnosed. Boys are approximately three times more likely to be diagnosed with ADHD than girls. About 30-50% of people diagnosed in childhood have symptoms in adulthood, and approximately 2-5% of adults have the condition. The condition is difficult to distinguish from other disorders, as well as from the state of normal increased activity. Managing ADHD usually involves a combination of psychological counseling, lifestyle changes, and medications. Drugs are recommended exclusively as first-line treatment in children who exhibit severe symptoms and may be considered for children with mild symptoms who refuse or do not respond to psychological counseling.

Stimulant drug therapy is not recommended for preschool children. Treatment with stimulants is effective for up to 14 months; however, their long-term effectiveness is unclear. Adolescents and adults tend to develop coping skills that apply to some or all of their impairments. ADHD and its diagnosis and treatment have remained controversial since the 1970s. Controversies include medical practitioners, teachers, politicians, parents and the media. Topics include the cause of ADHD and the use of stimulant medications in its treatment. ADHD is recognized by most medical professionals as a congenital disorder, and debate within the medical community largely centers on how it should be diagnosed and treated.

Signs and symptoms

ADHD is characterized by inattention, hyperactivity (an agitated state in adults), aggressive behavior and impulsivity. Learning difficulties and relationship problems are common. Symptoms can be difficult to identify because it is difficult to draw the line between normal levels of inattention, hyperactivity, and impulsivity and significant levels that require intervention. DSM-5-diagnosed symptoms must have been present in a variety of environments for six months or more, and to a degree that is significantly greater than that observed in other subjects of the same age. They can also cause problems in a person's social, academic and professional life. Based on the symptoms present, ADHD can be divided into three subtypes: predominantly inattentive, predominantly hyperactive-impulsive, and mixed.

A subject with inattention may have some or all of the following symptoms:

Easily distracted, misses details, forgets things, and frequently switches from one activity to another

Finds it difficult to stay focused on a task

The task becomes boring after just a few minutes if the subject is not doing something enjoyable

Difficulty focusing on organizing and completing tasks or learning something new

Has trouble completing or turning in homework, often losing things (eg, pencils, toys, assignments) needed to complete a task or activity

Doesn't listen when talking

Has his head in the clouds, gets confused easily and moves slowly

Has difficulty processing information as quickly and accurately as others

Has difficulty following instructions

A subject with hyperactivity may have some or all of the following symptoms:

Restlessness or fidgeting in place

Talks nonstop

Rushes towards, touches and plays with everything in sight

Has difficulty sitting during lunch, in class, doing homework, and while reading

Constantly on the move

Has difficulty completing quiet tasks and tasks

These symptoms of hyperactivity tend to disappear with age and develop into “internal restlessness” in adolescents and adults with ADHD.

A subject with impulsivity may have all or more of the following symptoms:

Be quite impatient

Saying inappropriate comments, expressing emotions without restraint, and acting without thinking about the consequences

Has difficulty looking forward to things he wants or looking forward to returning to play

Frequently interrupts the communication or activities of others

People with ADHD are more likely to have difficulty with communication skills such as social interaction and education, as well as maintaining friendships. This is typical for all subtypes. About half of children and adolescents with ADHD exhibit social withdrawal, compared with 10-15% of non-ADHD children and adolescents. People with ADHD have an attention deficit that causes difficulty understanding verbal and nonverbal language, which negatively affects social interaction. They may also fall asleep during interactions and lose social stimulation. Difficulty managing anger is more common in children with ADHD, as are poor handwriting and delayed speech, language and motor development. Although this is a significant disadvantage, particularly in modern society, many children with ADHD have good attention span for tasks that they find interesting.

Related disorders

Children with ADHD have other disorders in about ⅔ of cases. Some commonly occurring disorders include:

1. Learning disabilities occur in approximately 20-30% of children with ADHD. Learning disabilities can include speech and language impairments, as well as learning disabilities. ADHD, however, is not considered a learning disability, but it often causes difficulties with learning.
2. Tourette syndrome is more common among ADHD sufferers.
3. Oppositional defiant disorder (ODD) and conduct disorder (CD), which are seen in ADHD in approximately 50% and 20% of cases, respectively. They are characterized by antisocial behavior such as stubbornness, aggression, frequent fits of anger, duplicity, lying and theft. About half of those with ADHD and ODD or CD will develop antisocial personality disorder in adulthood. Brain scans show that conduct disorder and ADHD are separate disorders.
4. Primary attention disorder, which is characterized by poor attention and concentration and difficulty staying awake. These children tend to fidget, yawn and stretch, and are forced to be hyperactive in order to remain alert and active.
5. Hypokalemic sensory overstimulation is present in less than 50% of people with ADHD and may be a molecular mechanism for many ADHD sufferers.
6. Mood disorders (especially bipolar disorder and major depressive disorder). Boys diagnosed with mixed subtype ADHD are more likely to have a mood disorder. Adults with ADHD also sometimes have bipolar disorder, which requires careful evaluation to accurately diagnose and treat both conditions.
7. Anxiety disorders are more common in those with ADHD.
8. Obsessive-compulsive disorder (OCD) can occur with ADHD and shares many of its characteristics.
9. Substance use disorders. Adolescents and adults with ADHD are at increased risk of developing a substance use disorder. Most of it is associated with alcohol and cannabis. The reason for this may be a change in the reward pathway in the brains of subjects with ADHD. This makes identifying and treating ADHD more challenging, with serious substance use problems typically treated first due to their higher risk.
10. Restless legs syndrome is more common in people with ADHD and is often associated with iron deficiency anemia. However, restless legs syndrome may be just a part of ADHD and requires accurate assessment to differentiate the two disorders.
11. Sleep disorders and ADHD usually coexist. They can also occur as a side effect of medications used to treat ADHD. In children with ADHD, insomnia is the most common sleep disorder, with behavioral therapy as the treatment of choice. Trouble falling asleep is common among ADHD sufferers, but they are more likely to be deep sleepers and have significant difficulty waking up in the morning. Melatonin is sometimes used to treat children who have difficulty falling asleep.

There is a link with persistent bedwetting, slow speech and dyspraxia (DCD), with around half of people with dyspraxia having ADHD. Slow speech in people with ADHD may include problems with auditory perception problems such as poor short-term auditory memory, difficulty following instructions, slow processing speed of written and spoken language, difficulty listening in distracting environments such as the classroom, and difficulty understanding read.

Causes

The cause of most cases of ADHD is unknown; however, environmental involvement is suspected. Certain cases are associated with a previous infection or brain injury.

Genetics

See also: The Hunter and Farmer Theory Twin studies indicate that the disorder is often inherited from one of the parents, with genetics accounting for about 75% of cases. Siblings of children with ADHD are three to four times more likely to develop the disorder than siblings of children without the syndrome. Genetic factors are thought to be relevant to whether ADHD persists into adulthood. Typically, multiple genes are involved, many of which directly affect dopamine neurotransmission. Genes implicated in dopamine neurotransmission include DAT, DRD4, DRD5, TAAR1, MAOA, COMT, and DBH. Other genes associated with ADHD include SERT, HTR1B, SNAP25, GRIN2A, ADRA2A, TPH2 and BDNF. A common gene variant called LPHN3 is estimated to be responsible for about 9% of cases and, when the gene is present, people respond partially to the stimulant drug. Because ADHD is widespread, natural selection is likely to favor traits, at least in isolation, that may provide a survival advantage. For example, some women may be more attractive to risk-taking men by increasing the frequency of genes that predispose to ADHD in the gene pool.

Because the syndrome is most common in children of anxious or stressed mothers, some theorize that ADHD is a coping mechanism that helps children cope with stressful or dangerous environments, such as increased impulsivity and exploratory behavior. Hyperactivity may be beneficial from an evolutionary perspective in situations involving risk, competition, or unpredictable behavior (such as exploring new places or searching for new food sources). In these situations, ADHD can be beneficial to society as a whole, even if it is harmful to the subject himself. Additionally, in certain environments, it can provide advantages to the subjects themselves, such as quick reactions to predators or outstanding hunting skills.

Environment

Environmental factors presumably play a lesser role. Drinking alcohol during pregnancy can cause fetal alcohol spectrum disorder, which may include symptoms similar to ADHD. Exposure to tobacco smoke during pregnancy can cause problems with the development of the central nervous system and increase the risk of ADHD. Many children exposed to tobacco smoke do not develop ADHD or have only mild symptoms that do not reach the threshold for diagnosis. A combination of genetic predisposition and exposure to tobacco smoke may explain why some children exposed during pregnancy may develop ADHD while others do not. Children exposed to lead, even at low levels, or PCBs may develop problems resembling ADHD and leading to the diagnosis. Exposure to the organophosphorus insecticides chlorpyrifos and dialkyl phosphate has been associated with increased risk; however, the evidence is not conclusive.

Very low birth weight, preterm birth and early exposure also increase risk, as do infections during pregnancy, birth and early childhood. These infections include, but are not limited to, various viruses (fenosis, varicella, rubella, enterovirus 71) and streptococcal bacterial infection. At least 30% of children with traumatic brain injury later develop ADHD, and about 5% of cases are associated with brain damage. Some children may react negatively to food colorings or preservatives. It is possible that certain colored foods may act as a trigger in those with a genetic predisposition, but the evidence is weak. The UK and the European Union have introduced regulation based on these problems; The FDA did not do this.

Society

A diagnosis of ADHD may indicate family dysfunction or a poor educational system rather than an individual problem. Some cases may be due to increased educational expectations, with the diagnosis in some cases representing a way for parents to obtain additional financial and educational support for their children. The youngest children in the class are more likely to be diagnosed with ADHD, which is believed to be due to the fact that they are developmentally behind their older classmates. Behaviors typical of ADHD are more often observed in children who have experienced cruelty and moral humiliation. According to social order theory, societies define the boundary between normal and unacceptable behavior. Members of society, including doctors, parents and teachers, determine which diagnostic criteria to use and thus the number of people affected by the syndrome. This has led to the present situation where the DSM-IV shows a level of ADHD that is three to four times higher than the ICD-10 level. Thomas Szasz, who supports this theory, argued that ADHD was “invented, not discovered.”

Pathophysiology

Current models of ADHD suggest that it is associated with functional impairments in several brain neurotransmitter systems, particularly those involving dopamine and norepinephrine. Dopamine and norepinephrine pathways, which originate in the ventral tegmental area and locus coeruleus, are directed to various regions of the brain and determine many cognitive processes. Dopamine and norepinephrine pathways, which are directed to the prefrontal cortex and striatum (particularly the reward center), are directly responsible for regulating executive function (cognitive control of behavior), motivation and perception of reward; These pathways play a major role in the pathophysiology of ADHD. Larger models of ADHD with additional pathways have been proposed.

Brain structure

Children with ADHD show an overall decrease in the volume of certain brain structures, with a proportionately greater decrease in the volume of the left prefrontal cortex. The posterior parietal cortex also shows thinning in subjects with ADHD compared to controls. Other brain structures in the prefrontal-striatal-cerebellar and prefrontal-striatal-thalamic circuits also differ between people with and without ADHD.

Neurotransmitter pathways

It was previously thought that the increased number of dopamine transporters in people with ADHD was part of the pathophysiology, but the increased number has emerged as an adaptation to the effects of stimulants. Current models include the mesocorticolimbic dopamine pathway and the locus coeruleus-noradrenergic system. Psychostimulants for ADHD provide effective treatment because they increase the activity of neurotransmitters in these systems. Additionally, pathological abnormalities in serotonergic and cholinergic pathways may be observed. Also relevant is the neurotransmission of glutamate, a cotransmitter of dopamine in the mesolimbic pathway.

Executive function and motivation

ADHD symptoms include problems with executive function. Executive function refers to several mental processes that are required to regulate, control, and manage the tasks of daily life. Some of these impairments include problems with organization, time management, excessive procrastination, concentration, speed of execution, emotion regulation, and use of short-term memory. People usually have good long-term memory. 30-50% of children and adolescents with ADHD meet criteria for executive function deficits. One study found that 80% of subjects with ADHD were impaired on at least one executive function task, compared with 50% of subjects without ADHD. Due to the degree of brain maturation and increased demands on executive control as people get older, ADHD disorders may not fully manifest themselves until adolescence or even late teens. ADHD is also associated with motivational deficits in children. Children with ADHD have difficulty focusing on long-term versus short-term rewards and also exhibit impulsive behavior towards short-term rewards. In these subjects, a large amount of positive reinforcement effectively increases performance. ADHD stimulants may improve resilience in children with ADHD equally.

Diagnostics

ADHD is diagnosed by assessing a person's childhood behavior and mental development, including ruling out exposure to drugs, medications, and other medical or psychiatric problems as explanations for symptoms. Feedback from parents and teachers is often taken into account, with most diagnoses made after a teacher raises concerns about the issue. It may be seen as an extreme manifestation of one or more permanent human traits found in all humans. The fact that someone responds to medications does not confirm or rule out the diagnosis. Because brain imaging studies did not provide reliable results across subjects, they were used only for research purposes and not for diagnosis.

DSM-IV or DSM-5 criteria are often used for diagnosis in North America, while European countries usually use ICD-10. Moreover, the DSM-IV criteria are 3-4 times more likely to give a diagnosis of ADHD than the ICD-10 criteria. The syndrome is classified as a neurodevelopmental psychiatric disorder. It is also classified as a social conduct disorder along with oppositional defiant disorder, conduct disorder, and antisocial personality disorder. The diagnosis does not imply a neurological disorder. Associated conditions that should be assessed include anxiety, depression, oppositional defiant disorder, conduct disorder, and learning and speech disorders. Other conditions to consider are other neurodevelopmental disorders, tics, and sleep apnea. Diagnosis of ADHD using quantitative electroencephalography (QEEG) is an area of ​​ongoing research, although the value of QEEG in ADHD is unclear to date. In the United States, the Food and Drug Administration has approved the use of the QEEG to estimate the prevalence of ADHD.

Diagnostics and statistical guidance

As with other psychiatric disorders, a formal diagnosis is made by a qualified professional based on a set of several criteria. In the United States, these criteria are defined by the American Psychiatric Association in the Diagnostic and Statistical Manual of Mental Disorders. Based on these criteria, three subtypes of ADHD can be distinguished:

ADHD Predominantly Inattentive Type (ADHD-PI) presents with symptoms including being easily distractible, forgetfulness, daydreaming, disorganization, poor concentration, and difficulty completing tasks. Often people refer to ADHD-PI as “attention deficit disorder” (ADD), however, the latter has not been officially approved since the 1994 revision of the DSM.

ADHD, predominantly of the hyperactive-impulsive type, manifests itself as excessive restlessness and agitation, hyperactivity, difficulty waiting, difficulty staying still, and infantile behavior; Disruptive behavior may also occur.

Mixed ADHD is a combination of the first two subtypes.

This classification is based on the presence of at least six of nine long-term (lasting at least six months) symptoms of inattention, hyperactivity-impulsivity, or both. To be taken into account, symptoms must begin between the ages of six and twelve years and be observed in more than one surrounding location (for example, at home and at school or work). The symptoms must not be acceptable for children of this age, and there must be evidence that they are causing problems related to school or work. Most children with ADHD have a mixed type. Children with the inattentive subtype are less likely to pretend or have difficulty getting along with other children. They may sit quietly, but not paying attention, and as a result, difficulties may be overlooked.

International Classification of Diseases

In ICD-10, the symptoms of “hyperkinetic disorder” are similar to ADHD in DSM-5. When a conduct disorder (as defined by ICD-10) is presented, the condition is referred to as hyperkinetic conduct disorder. Otherwise, the disorder is classified as activity and attention disorder, other hyperkinetic disorder, or unspecified hyperkinetic disorder. The latter are sometimes referred to as hyperkinetic syndrome.

Adults

Adults with ADHD are diagnosed according to the same criteria, including symptoms that may be present between the ages of six and twelve. Interviewing parents or guardians about how the person behaved and developed as a child may form part of the assessment; a family history of ADHD also contributes to diagnosis. While the core symptoms of ADHD are the same in children and adults, they often present differently; for example, excessive physical activity seen in children may manifest as feelings of restlessness and constant mental alertness in adults.

Differential diagnosis

ADHD symptoms that may be associated with other disorders

Depression:

Feelings of guilt, hopelessness, low self-esteem, or unhappiness

Loss of interest in hobbies, routine activities, sex or work

Fatigue

Too little, poor or excessive sleep

Changes in appetite

Irritability

Low stress tolerance

Suicidal thoughts

Unexplained pain

Anxiety disorder:

Restlessness or persistent feeling of anxiety

Irritability

Inability to relax

Overexcitement

Easy fatigue

Low stress tolerance

Difficulty paying attention

Mania:

Excessive feeling of happiness

Hyperactivity

A race of ideas

Aggression

Excessive talkativeness

Grandiose delusional ideas

Decreased need for sleep

Inappropriate social behavior

Difficulty paying attention

ADHD symptoms such as low mood and low self-esteem, mood swings and irritability can be confused with dysthymia, cyclothymia or bipolar disorder, as well as borderline personality disorder. Some symptoms that are associated with anxiety disorders, antisocial personality disorder, developmental or intellectual disabilities, or chemical dependency effects such as intoxication and withdrawal may overlap with some symptoms of ADHD. These disorders sometimes occur along with ADHD. Medical conditions that can cause ADHD symptoms include: hypothyroidism, epilepsy, lead toxicity, hearing deficits, liver disease, sleep apnea, drug interactions, and traumatic brain injury. Primary sleep disorders can affect attention and behavior, and ADHD symptoms can affect sleep. Therefore, it is recommended that children with ADHD be screened regularly for sleep problems. Sleepiness in children can lead to symptoms ranging from classic yawning and eye rubbing to hyperactivity with inattention. Obstructive sleep apnea can also cause ADHD-type symptoms.

Control

Management of ADHD usually involves psychological counseling and medications, alone or in combination. While treatment may improve long-term outcomes, it does not eliminate negative outcomes overall. Drugs used include stimulants, atomoxetine, alpha-2 adrenergic agonists, and sometimes antidepressants. Dietary changes may also be beneficial, with evidence supporting free fatty acids and reduced exposure to food dyes. Removing other foods from the diet is not supported by evidence.

Behavioral therapy

There is good evidence for the use of behavioral therapy for ADHD, and it is recommended as first-line treatment for those with mild symptoms or for preschool-aged children. Physiological therapies used include: psychoeducational stimulation, behavioral therapy, cognitive behavioral therapy (CBT), interpersonal therapy, family therapy, school interventions, social skills training, parent training, and neural feedback. Parent training and education have short-term benefits. There is little high-quality research into the effectiveness of family therapy for ADHD, but evidence suggests that it is equivalent to social care and better than placebo. There are some ADHD-specific support groups as information resources that can help families cope with ADHD.

Social skills training, behavioral modification, and medications may have some limited benefit. The most important factor in alleviating later psychological problems such as major depression, delinquency, school failure, and substance use disorder is forming friendships with people who are not involved in delinquent activities. Regular physical activity, particularly aerobic exercise, is an effective adjunct to the treatment of ADHD, although the best type and intensity is currently unknown. In particular, physical activity causes better behavior and motor abilities without any side effects.

Medications

Stimulant medications are the pharmaceutical treatment of choice. They have at least short-term effects in about 80% of people. There are several non-stimulant medications, such as atomoxetine, bupropion, guanfacine, and clonidine, that can be used as alternatives. There are no good studies comparing different drugs; however, they are more or less equal in terms of side effects. Stimulants improve academic performance, while atomoxetine does not. There is little evidence regarding its effect on social behavior. Medicines are not recommended for preschool children, as long-term effects in this age group are not known. The long-term effects of stimulants are generally unclear, with only one study finding beneficial effects, another finding no benefit, and a third finding harmful effects. Magnetic resonance imaging studies suggest that long-term treatment with amphetamine or methylphenidate reduces the pathological abnormalities in brain structure and function found in subjects with ADHD.

Atomoxetine, due to its lack of addictive potential, may be preferable for those at risk of addiction to a stimulant drug. Recommendations about when to use drugs vary between countries, with the UK's National Institute for Health and Care Excellence recommending their use only in severe cases, while American guidelines recommend using drugs in almost all cases. While atomoxetine and stimulants are generally safe, there are side effects and contraindications for their use.

Stimulants can cause psychosis or mania; however, this is a relatively rare occurrence. For those undergoing long-term treatment, regular screening is recommended. Stimulant therapy should be discontinued temporarily to assess subsequent drug requirements. Stimulant drugs have the potential to develop addiction and dependence; Several studies suggest that untreated ADHD is associated with an increased risk of chemical dependency and conduct disorder. The use of stimulants either reduces this risk or has no effect on it. The safety of these drugs during pregnancy has not been determined.

Zinc deficiency has been linked to symptoms of inattention, and there is evidence that zinc supplementation is beneficial for children with ADHD who have low zinc levels. Iron, magnesium and iodine may also have an effect on ADHD symptoms.

Forecast

An 8-year study of children diagnosed with ADHD (mixed) found that difficulties with adolescents were common, regardless of treatment or lack thereof. In the United States, less than 5% of subjects with ADHD obtain a college degree, compared with 28% of the general population aged 25 or older. The proportion of children meeting criteria for ADHD drops to about half within three years of diagnosis, regardless of treatment. ADHD persists into adults in approximately 30-50% of cases. Those suffering from the syndrome are likely to develop coping mechanisms as they get older, thus compensating for previous symptoms.

Epidemiology

It is estimated that ADHD affects about 6-7% of people aged 18 years and older when diagnosed using DSM-IV criteria. When diagnosed using ICD-10 criteria, the prevalence in this age group is estimated to be 1-2%. North American children have a higher prevalence of ADHD than African and Middle Eastern children; this is presumably due to differing diagnostic methods rather than differences in the incidence of the syndrome. If the same diagnostic methods were used, the prevalence would be more or less the same in different countries. The diagnosis is made approximately three times more often in boys than girls. This difference between the sexes may reflect either a difference in susceptibility or that girls with ADHD are less likely to be diagnosed with ADHD than boys. The intensity of diagnosis and treatment has increased in both the UK and the US since the 1970s. This is thought to be due primarily to changes in the diagnosis of the disease and how willing people are to seek drug treatment, rather than to changes in the prevalence of the disease. Changes in diagnostic criteria in 2013 with the release of DSM-5 are thought to have increased the percentage of people diagnosed with ADHD, especially among adults.

Story

Hyperactivity has long been part of human nature. Sir Alexander Crichton describes "mental agitation" in his book An Inquiry into the Nature and Origin of Mental Disorder, written in 1798. ADHD was first clearly described by George Still in 1902. The terminology used to describe the condition has changed over time and includes: in the DSM -I (1952) "minimal brain dysfunction", in DSM-II (1968) "hyperkinetic childhood reaction", in DSM-III (1980) "attention deficit disorder (ADD) with or without hyperactivity" . It was renamed ADHD in DSM-III-R in 1987, and DSM-IV in 1994 reduced the diagnosis to three subtypes, ADHD inattentive type, ADHD hyperactive-impulsive type, and ADHD mixed type. These concepts were retained in the DSM-5 in 2013. Other concepts included “minimal brain injury,” which was used in the 1930s. The use of stimulants to treat ADHD was first described in 1937. In 1934, Benzedrine became the first amphetamine drug approved for use in the United States. Methylphenidate was discovered in the 1950s and enantiopure dextroamphetamine in the 1970s.

Society and culture

Controversy

ADHD and its diagnosis and treatment have been subject to debate since the 1970s. The controversy involves doctors, teachers, politicians, parents and the media. Opinions regarding ADHD range from the fact that it merely represents the extreme limit of normal behavior to the fact that it is the result of a genetic condition. Other areas of controversy include the use of stimulant medications and especially their use in children, as well as the method of diagnosis and the potential for overdiagnosis. In 2012, the UK's National Institute for Health and Care Excellence, while acknowledging the controversy, stated that current treatments and diagnostic methods are based on the prevailing view of the academic literature.

In 2014, Keith Conners, one of the first advocates for disease confirmation, spoke out against overdiagnosis in an op-ed in the NY Times. On the contrary, in 2014, a peer-reviewed review of the medical literature found that ADHD is rarely diagnosed in adults. Due to widely varying diagnostic rates among countries, states within countries, and races and ethnic groups, several questionable factors other than the presence of ADHD symptoms play a role in diagnosis. Some sociologists believe that ADHD represents an example of the medicalization of “deviant behavior” or, in other words, the transformation of a previously unrelated problem of school performance into one. Most health care providers recognize ADHD as a congenital disorder in at least a small number of people with severe symptoms. The debate among medical professionals largely focuses on diagnosing and treating the larger population of people with less severe symptoms.

In 2009, 8% of all US Major League Baseball players were diagnosed with ADHD, making the syndrome widespread among this population. The increase coincides with the League's 2006 ban on stimulants, raising concerns that some players were faking or falsifying symptoms of ADHD to circumvent the sport's ban on stimulants.

ADHD is a developmental disorder of a neurological-behavioral nature, in which the hyperactivity of children is pronounced along with attention deficit. Among the hallmarks of this disorder, the presence of which provides the basis for a diagnosis of ADHD, include symptoms such as difficulty concentrating, increased activity and impulsivity that cannot be controlled. Due to the fact that it is difficult for children to concentrate, they often cannot complete educational tasks or solve problems correctly, as they make mistakes due to their own inattention and restlessness (hyperactivity). They may also not listen to teachers’ explanations or simply not pay attention to their explanations. Neurology considers this disorder as a stable chronic syndrome, for which no cure has been found to this day. Doctors believe that ADHD (attention deficit hyperactivity disorder) disappears without a trace as children grow older or adults adapt to living 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 identified. So, the causes of organic disorders can be: an unfavorable environmental situation, immunological incompatibility, infectious diseases of the female population during pregnancy, poisoning by anesthesia, taking certain medications, drugs or alcohol by women during pregnancy, some chronic diseases of the mother, threats of miscarriage, premature or protracted labor, stimulation of labor, cesarean section, malpresentation of the fetus, any diseases of newborns that occur with high fever, or babies taking potent drugs.

Also, diseases such as asthmatic conditions, heart failure, pneumonia, diabetes can act as factors that provoke disturbances in the brain activity of children.

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 preconditions.

ADHD syndrome can also cause negative effects in the postnatal period on the child. Among such influences, one can distinguish both social reasons and biological factors. Methods of upbringing, attitude towards the child in the family, socio-economic status of the social unit are not the causes of ADHD in themselves. However, often the listed factors develop the baby’s adaptive capabilities to the surrounding world. Biological factors that provoke the development of ADHD include feeding the baby 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.

ADHD syndrome, summarizing the above, is a polyetiological disorder, the formation of which is caused by the influence of several factors in combination.

ADHD symptoms

The main symptoms of ADHD include impaired attention, increased activity in children and their impulsivity.

Attention disorders are manifested in the child by the inability to maintain attention on the elements of the subject, making many mistakes, and the difficulty of maintaining attention during the performance of educational or other tasks. Such a child does not listen to speech addressed to him, does not know how to follow instructions and complete work, is unable to independently plan or organize the completion of tasks, tries to avoid activities that require prolonged intellectual stress, tends to constantly lose his own things, is forgetful, and is easily distracted.
Hyperactivity is manifested by restless movements of the arms or legs, fidgeting in place, and restlessness.

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

Impulsivity manifests itself in situations when children, without listening to the question and without thinking, answer it, unable to wait for their turn. Such children often interrupt others, disturb them, and are often talkative or unrestrained in speech.

Characteristics of a child with ADHD. The listed symptoms should be observed in children for at least six months and extend to all areas of their life (disorders of adaptation processes are observed in several types of environments). Disturbances in learning, problems in social contacts and work activities in such children are pronounced.

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

The characteristics of a child with ADHD have their 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 impulsiveness. Excessive activity is manifested by the constant movement in which babies are located. They are characterized by extreme restlessness in class and talkativeness. The impulsiveness of children is expressed in committing rash actions, frequently interrupting other people, and interfering in extraneous conversations that do not concern them. Typically, 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, disobedient, often throw or break things and toys, they can exhibit mental illness, and sometimes lag behind their peers in speech development.

The problems of a child with ADHD after entering an educational institution only get worse due to school requirements that 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, since they experience difficulties in organizing work and bringing it to completion, in the process of completing it they forget the conditions of the tasks, they do not assimilate the educational material well and are not able to apply it competently. Therefore, kids quickly disconnect from the process of completing tasks.

Children with ADHD do not notice details, are prone to forgetfulness, poor switching ability, and failure to follow teacher instructions. At home, these kids are unable to cope with homework assignments on their own. They are much more likely, compared to their peers, to have difficulties in developing logical thinking skills, the ability to read, write and count.

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

In a group, children suffering from ADHD are sources of constant anxiety, as they make noise, disturb others, and 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. When faced with such an attitude, children often consciously become “jesters” in the class, thereby hoping to improve 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 lessons. In general terms, their behavior gives the impression of being inappropriate for their age, so their peers are reluctant to communicate with them, which gradually develops an understated attitude in children with ADHD. In the family, such children often suffer due to constant comparison with other children who are more obedient or study 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, and difficulty completing tasks, assignments, and organizing activities. During puberty, pronounced manifestations of disorders in the function of attention and impulsivity are observed in approximately 80% of adolescents with ADHD. Often, children with such a disorder experience a deterioration in school performance due to the fact that they are unable to effectively plan their own work and organize it in time.

Gradually, children experience increasing difficulties in family and other relationships. Most adolescents with this syndrome are characterized by problems in following the rules of behavior, reckless behavior associated with unreasonable risks, disobedience to the laws of society and disobedience to social norms. Along with this, they are characterized by weak emotional stability of the psyche in the event of failures, indecision, etc. Teenagers are extremely sensitive to teasing and barbs from their peers. Educators and others characterize adolescent behavior as immature and inappropriate for their age. In everyday life, children ignore safety measures, which leads to an increased risk of accidents.

Pubertal children with a history of ADHD are much more likely than their peers to be drawn into various groups that commit crimes. Teenagers may also develop a craving for abusing alcoholic beverages or drugs.

Working with children with ADHD can cover several areas: or, the key purpose of which is to develop social skills.

Diagnosis of ADHD

Based on international criteria containing lists of the most characteristic and clearly traceable manifestations of this disorder, a diagnosis of ADHD can be made.

The essential characteristics of this syndrome are:

- the duration of symptoms over time is at least six months;

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

— severity of symptoms (significant learning disabilities, disorders of social contacts, and professional sphere are observed);

- exclusion of other mental disorders.

ADHD hyperactivity is defined as the primary disorder. At the same time, there are several forms of ADHD, determined by the presence of predominant symptoms:

- combined form, which includes three groups of symptoms;

— ADHD with prevalent attention disorders;

— ADHD with dominance of impulsivity and increased activity.

In childhood, so-called condition imitators of this syndrome are relatively often observed. Approximately twenty percent of children periodically exhibit behaviors that appear similar to ADHD. Therefore, ADHD should be distinguished from a wide range of conditions that are similar to it solely in external manifestations, but differ significantly in causes and methods of correction. These include:

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

— anxiety disorders (features of children's behavior are associated with the influence of traumatic causes);

— consequences of brain injury, intoxication, neuroinfection;

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

— characteristic disorders 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 syndrome, Smith-Magenis syndrome or fragile X chromosome;

- epilepsy;

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

ADHD in adults

According to current statistics, ADHD affects approximately 5% of adults. Along with this, such a diagnosis is observed in almost 10% of students at school. Approximately half of children with ADHD continue into adulthood with this condition. At the same time, the adult population consults a doctor much less often due to ADHD, which significantly minimizes the detection of the syndrome in them.

ADHD symptoms vary from person to person. However, three core signs can be noted in the behavior of patients, namely a disturbance in the function of attention, increased activity and impulsivity.

Attention disorder is expressed in the inability to concentrate attention on a specific object or things. An adult becomes bored after just a few minutes while performing an uninteresting, monotonous task. It is difficult for such people to consciously concentrate attention on any subject. People with ADHD are considered by their environment to be dispensable and non-executive, since they can begin to do several things and not complete any of them. Increased activity is found in the constant movement of individuals. They are characterized by restlessness, fussiness and excessive talkativeness.

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

Impulsivity manifests itself in actions ahead of thoughts. A person suffering from ADHD tends to voice the first thoughts that come to his mind, constantly inserts his own out-of-place remarks into the conversation, and commits impulsive and often rash actions.

In addition to the listed manifestations, individuals suffering from ADHD are characterized by forgetfulness, anxiety, unpunctuality, low self-esteem, disorganization, poor resistance to stress factors, melancholy, depressive states, severe mood swings, and difficulty reading. Such features complicate the social adaptation of individuals and form fertile ground for the formation of any form of addiction. The inability to concentrate ruins careers and ruins 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 disappear.

Treatment of ADHD in adults should be comprehensive. They are usually prescribed a nervous system stimulant such as Methylphenidate. Such medications do not cure ADHD syndrome, but help achieve control over 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 establish a daily routine, restore broken relationships and improve communication skills.

ADHD Treatment

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

The first step is to normalize the functioning of the gastrointestinal tract. Therefore, preference in the daily diet should be given to natural products. You should exclude dairy products and eggs, pork, canned foods and foods containing dyes, refined sugar, citrus fruits and chocolate from your diet.

Non-drug treatment of ADHD in children involves behavioral modification, psychotherapeutic practices, pedagogical and neuropsychological correction. Children are offered a lighter training regime, that is, the size of the classroom is reduced and the duration of classes is reduced. Children are recommended 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 children with patience. Parents need to explain the need for control on their part over the daily routine of hyperactive children, providing children with the opportunity to expend excess energy through physical exercise or long walks. As children complete tasks, it is important to minimize fatigue. Since hyperactive children are characterized by increased excitability, it is recommended to partially isolate them from interaction in large companies. Also, their playing partners must have self-control and 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 using 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.