How realistic is the diagnosis of ADHD?

Attention Deficit and Hyperactivity Disorders – “Fashion Concepts” in Neurology or Are They Serious Factors That Hinder the Child’s Adaptation? And the main question is how to treat this condition correctly? Or maybe not to heal, “it will pass by itself” and the child will “outgrow”? Let’s figure it out together with pediatric neurologists!

Is there an objective diagnosis of ADHD?

Unlike many imprecise neurological formulations (which are often included in the diagnosis only because you need to fill in the Diagnosis line) like “minimal brain dysfunction”, attention deficit hyperactivity disorder (ADHD) is a completely objective pathology that makes it difficult for the child to adapt and requires certain actions to improve the health of the child (rehabilitation, consultations of narrow specialists, as needed – drug therapy).

It is worth saying that in the Russian Federation there is overdiagnosis of this condition, that is, it is seen where it does not exist, and the existing features of behavior can be explained by personality traits. Therefore, in controversial cases, the child should be seen by not one competent specialist, but several – a pediatrician, neurologist, neuropsychologist , psychologist and psychotherapist.

Do impaired attention and increased activity always coexist?

As a rule, yes. But one of the violations will prevail.

According to the latest psychiatric classification of the DSM-V of 2013, there are three variants of attention deficit hyperactivity disorder :

  • Option with a predominance of hyperactivity ,
  • Attention deficit predominant variant
  • Mixed option, implying the presence of problems with both attention and motor activity.

How to tell a parent that something is really wrong with a child

The boundaries of nosological units are somewhat blurred even for practicing doctors, however, there are some reference points, based on which, a parent can bring a child to a pediatrician to confirm or refute their guesses and concerns.

If we are talking about a schoolchild, of course, first of all, the educational capabilities of the child are assessed: how does he perform school assignments, is he absent-minded or copes with home exercises himself, can he forget about them altogether? So you can roughly outline the circle of attention problems with which you need to go to the doctor. As for hyperactivity , you need to take a closer look at how impulsive the child is, how prone to expressing aggression and using force in a conflict situation. If there are obvious deviations that are noticed not only by the mother or close relatives, but also by teachers and even familiar families, you should definitely see a specialist.

If the child has not yet reached school age, other parameters are assessed, such as dyslexia (difficulties associated with mastering reading and writing skills), cognitive impairment. In this situation, for an objective assessment of the formation of the necessary nervous functions, it is necessary to involve a neuropsychologist . This is not only a “fashionable” doctor nowadays, but also a specialist who can really help a child no less than medicines . 

Control over your actions

ADHD is a dysfunction in which, among other things, control over one’s own actions is impaired. Recent evidence suggests that the areas of the cerebral cortex that are responsible for exercising control mature by the age of 22-27 years.

In addition, transient (transient) imbalance in neurotransmitters is genetically programmed in adolescence, which is expressed in somewhat oppositional (or quite specific, protest) behavior. With a pronounced imbalance, drug therapy can help, but this is not always possible. This is why, in particular, it is important to support the neuropsychologist and teach the child or adolescent certain behavioral skills.

Prescribing drugs – justified or not?

First of all, I would like to note that the treatment of neurological problems is by no means limited to the prescription of drugs. Without the necessary rehabilitation, involvement (as needed) of a child psychologist, psychotherapist or neuropsychologist , the treatment will be incomplete. According to the neurologist Aleksey Sergeev, “treatment with pills is just the tip of the iceberg.” It is impossible to cure anxiety-depressive disorder, for example, solely with anxiolytics ; you will need to talk with a psychologist, psychotherapy sessions, and work with your family. It is possible to erase the picture somewhat, but the problem will return soon, if it is not solved comprehensively.

Treatment of ADHD should be done in close consultation with a neuropsychologist , and antipsychotics and antidepressants are a last resort.

As children’s neurologists say, they often see children who come to see children after treatment with a psychotherapist and they feel uncomfortable, because if the diagnosis is far-fetched, and serious drugs are prescribed, “heavy artillery” of psychotropic drugs – this is not good.

How is ADHD successfully treated in our country?

The main drug of world practice, Ritalin , is prohibited in Russia, since its property has been proven to enhance the existing propensity to addiction (nicotine, narcotic, etc.). Ritalin itself does not cause narcotic effects in therapeutic doses, but the name “baby cocaine” and a certain bad reputation stuck to it, although it shows good results with ADHD.

Another psychostimulant drug, Strattera, has been registered in our country and is being successfully used . And this most exciting action worries parents very much when they see the name of the drug group, psychostimulant , in the instructions. After all, if you look at a child, he is already excited. Wouldn’t it be more logical to give him something soothing? Practice has shown that there will be no point in this. 

If we take a simple look at the biochemical processes that occur in ADHD, there will be more excitatory substances in the child’s nervous system than inhibitory ones. There is a universal regulatory mechanism in the body of any person – a negative feedback mechanism. So, if, for some reason, the level of any hormone or neurotransmitter increases or decreases excessively, a signal about this goes to the brain , from where the command to lower or increase the level to normal comes from. A natural “rescue operation” is triggered. 

Thus, therapy with Strattera or another psychostimulant drug is aimed at spurring the natural regulation of the level of neurotransmitters through the mechanism of negative feedback, which leads to a clinical effect – a certain concentration, calmness, self-control.

Is it possible to turn on the braking system using non-drug methods?

Neurologist Pavel Brand cites the foreign practice of using non-drug methods: in some cases, parents give a cup of coffee in the morning (a natural psychostimulant ), and the child has the opportunity to study at school, and before doing homework they are allowed to play computer games for 15-20 minutes. , allowing you to do your home exercise in peace for the next hour. These measures are also explained by the negative feedback mechanism: non-drug methods that excite the nervous system trigger a cascade of biochemical reactions, which leads to the restoration of neurological status. However, psychotherapists warn that the extra time spent playing computer games increases the risks of developing gambling addiction , and this condition is a serious psychological dependence and in difficult cases requires long-term treatment by specialists.  

If left untreated, will the child “outgrow” the problem?

Behavioral therapy, like drug therapy, is extremely important in the treatment of ADHD. After all, if you look at the long-term prognosis, without treatment, after 10-15 years, the problems do not disappear, and in most cases they pass into adulthood , which is expressed in behavioral disturbances and obvious maladjustment of an adult.

Statistically, 3 to 10% of adults have mild or severe attention deficit problems. Since such a person is often fully aware of his problem, and also sees that he could achieve great success, but distraction and decreased concentration of attention, excessive excitability interfere with him – this understanding leads to a neurosis-like state, as well as the development of real depression.

Parents are also interested in the question of whether their child will be able to fully finish school and go to college. So, without treatment and non-drug correction of the syndrome, there are, of course, chances to enter, but often such students do not want to study under high stress. They drop out in the first year, they may be disturbed by psycho- emotional disorders, panic attacks.

Therefore, of course, attention deficit disorder cannot be ignored and treated. Only you need to do this with a competent specialist who will see the real problem and prescribe adequate therapy.

The use of nootropic drugs for ADHD: nonsense

Nootropics are a group of drugs that some neurologists like to prescribe, and which do not have a serious evidence base for ADHD. Neurologist Pavel Brand rightly notes that parents see a certain positive effect from the course intake of nootropil , cavinton , mixedol : students do their homework, their level of aggression is somewhat reduced. However, the improvement coincides with the treatment time and disappears after 1.5-2 months.

Reputable neurologists claim that this apparent effect is comparable to the placebo effect, which is even more pronounced in children than in adults: studies show an improvement on pill pills (placebo) in 30% of cases.

Therefore, this syndrome, of course, requires treatment – but only competently thought out, comprehensive, with the involvement of related specialists. Then the chances of a healthy future in children with ADHD are definitely high.

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