Attention Deficit Hyperactivity Disorder

From the author: For the first time, attention deficit hyperactivity disorder was talked about at the beginning of the 20th century (more precisely, in 1902) in connection with the observation of hyperactive children in the psychiatric department of the hospital. A lot of material has been written and researched about childhood ADHD. The spread of symptoms to adults, or the isolation of the adult variant of ADHD, has been talked about recently, in the last 10 years. We will consider in more detail in the article. 

Since the description of symptoms, the disorder has gone by various names before being referred to as ADHD. The following names can be found in the literature: minimal cerebral dysfunction, hyperkenetic reaction of childhood, post-encephalic disorder, and some others .Throughout the research, data was collected and classified, the structure of the disorder was identified – the pathology of memory and attention functions. It was also important to observe that symptoms can occur not only in childhood, but also not be accompanied by hyperactivity.Thus, by 1980, three forms of violation were presented in the DSM-III classification :  ADHD;ADD without hyperactivity;Residual ADHD (when symptoms persist into adulthood).With the adoption of DSM-IV, the classification of ADHD changed somewhat:  Primarily hyperactive type (with a predominance of hyperactivity); Primarily inattentive type (with a predominance of attention disorders); Mixed (combined) type.Prevalence. According to current data, ADHD in adults is diagnosed in 4% of the population (according to Kessler , 2006). Despite the fact that in adults the symptoms “last” from childhood, there are cases when they initially appear immediately in adulthood. The main, most common manifestations of ADHD in adults are a psychological portrait Attention deficit;Restlessness;Additional movements of the arms and legs in a sitting position (agitation, agility);Difficulties with self-control, composure;Initially, symptoms of attention deficit can be perceived as versatility , preoccupation;Failure to comply with physical and communicative boundaries (difficulties in negotiations, communication, telephone conversations, loss of the logic of dialogue);Impulsiveness;Tendency to adrenal addiction;Cataplexy;Formalization and superficiality of contacts, social “dryness” (due to the difficulties of immersion in the depth of contact due to switching);The more deep communication begins to be, the more avoidance behavior grows;In situations of stress, life dramas, etc., negative traits, usually hidden during normal communication, are exacerbated;Difficulty learning, spending time.The basic triad of symptoms , distinguished by both the ICD and the DSM:Impaired attention;Hyperactivity;Impulsiveness.

The clinical picture. The hyperactivity in the ADHD structure is designed to compensate for the internal feeling of emptiness through impulsivity and kaleidoscopic switching, since they do not require activation of internal resources to overcome external stress factors. One of the important characteristics of ADHD is subjectively “fast” perception of time. For them, time flows faster, therefore, the world around them is perceived as somewhat slower.Low frustration tolerance, which is masked by the choice to solve many small problems instead of serious and important ones. Inclination to delegate affairs to others.The peculiarity of countertransference when working with ADHD: a feeling of exhaustion after prolonged contact, a feeling of irritation (anger), emptiness, loss of creativity and energy potential.Specific diagnostic criteria for adult ADHD can be found here. Etiopathogenesis Many authors classify ADHD as the body’s response to hyperstimulation of the surrounding reality – as a variant of psychological defense, overcoming psychological discomfort to difficulties in adequately responding to environmental influences. Switching attention and impulsivity is the psyche’s response to short-term and superficial perception of stimuli and information.Diagnostics. When diagnosing ADHD, information from all family members (parents, spouses, relatives), self-reports of clients (in view of criticality), pathopsychological diagnostics are used. The main guidelines for the experimental psychological diagnosis of ADHD:Analysis of cognitive activity;Level of intellectual development;The structure of intellectual activity;Characteristics of the general prerequisites for cognitive activity (memory, attention, performance).Wechsler tests, proofreading tests ( Landolt , Bourdon), Schulte tables , Kraepelin counting , Toulouse- Pieron test , memorization of 10 words, pictograms, memorization of stories are usedStudy of the emotional-volitional sphere ( Dembo- Rubinstein, SAN, TAT, Rosenzweig, Wagner, drawing tests);The study of individual psychological characteristics of personality (SMIL, 16-factor test of Cattell and others.);Pathopsychological differential diagnosis with hyperkinetic disorders.The psychological conclusion should reflect the integral structure of mental activity and personal characteristics, as well as the degree of expression.In addition to experimental psychological research, it will be useful to additionally conduct neuropsychological research.Differential diagnosis. Differential diagnosis in a situation with ADHD must be carried out with: 1. Individual character traits;2. Anxiety disorders;3. Consequences of exogenous-organic and exogenous disorders (craniocerebral trauma, CNS infections, intoxication, asthenia after somatic disorders);4. Endocrine disorders;5. Hearing impairment;6. Socio-pedagogical neglect and disorders of school skills (dyslexia, dysgraphia , etc. );7. Epilepsy;8. Hereditary diseases (Martin-Bell, Beckwith- Wiedemann, Williams, Smith- Mazhenis syndrome );9. Some disorders of the cognitive spectrum, for example – the schizophrenic spectrum;10. Certain autism spectrum disorders;11. Tikami and Tourette’s syndrome ;12. Certain autoimmune spectrum disorders affecting the nervous system;13. BAR;14. Neurological disorders;Conclusion : Differential diagnosis is a difficult task. To solve it, it is important to use an integrated multilateral approach, including both psychological research and medical, clinical laboratory, etc.================================================== ===============Psychocorrection tasks.1. Awareness of the presence of a disorder and the mechanisms of its action (informational familiarization); 2. Awareness of the prevalence of the disorder and diagnosis of its impact on all areas of life;3. Compensation for maladaptive manifestations, the use of the positive side of the disorder (if we consider ADHD as a “cognitive style”, then it is possible to redistribute the symptoms to “helping”);4. Formation of a positive attitude towards symptoms, the ability to look at them from the perspective of a resource (for example, inattention – not as a defect, but as insufficient interest;5. Work with self-esteem (as a resource for increasing personal and social functioning; impulsivity – as a way to break out of patterns and stereotypes, as the realization of creative potential; hyperactivity – as the presence of strength, a charge for achievements and actions);6. Work with a sense of guilt for what was lost (lost opportunities), for parents for upbringing, etc .;7. Recognition of their imperfection, acceptance of responsibility for what is happening;8. Pharmacotherapy is actively used with psychotherapy. According to statistics, 75% of people with ADHD respond positively to it (although the response to one drug varies from person to person).Comorbidity ADHD is often overlaid with anxiety (25-43% have Generalized Anxiety Disorder), addictive disorders and depression. According to Barkley (1996), 25–35% of adults with ADHD were diagnosed with Behavioral Disorder or Oppositional Defiant Disorder in childhood.

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