ADHD or attention deficit disorder / hyperactivity disorder (in English Attention-deficit hyperactivity disorder, ADHD or Attention-deficit disorder, ADD) is a neurological disorder characterized by impaired concentration (ADD) with or without hyperactivity / impulsivity . Its detection and caring are the subject of much controversy. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) ADHD is a behavioral disorder in the true sense of the term, although the risk of developing a disorder or conduct opposition is higher than average. The child who is taken with ADHD has behaviors that require greater coherence and greater consistency on the part of adults who revolve around him. The child is not provided a behavioral problem.
Neurological aspects
This mental state manifests itself, in terms of neurological deficit by dopamine, a neurotransmitter.
Chemical transmission of neuron A (transmitter) to neuron B (receiving)
1. Mitochondria
2. Synaptic vesicle with neurotransmitters
3. Auto receptor
4. Where the exchange is deficient (synapse)
5. Postsynaptic receptors activated by neurotransmitter (induction of a postsynaptic potential)
6. Calcium channel
7. Exocytosis of a vesicle
8. Recaptured neurotransmitter
It appears, however, that much controversy exists about whether ADHD is truly a neurological disorder as it is often claimed. Some research also aimed to highlight the inconsistency of some studies linking this issue to a neurological disorder.
Genetic factors
AD / HD has a hereditary aspect, involving in particular the role of dopamine transporters. The affected genes include dopamine D4 receptors, dopamine beta-hydroxylase, monoamine oxidase A, catecholamine-methyl transferase, the serotonin transporter (SLC6A4), 5-hydroxytryptamine receptor 2A (5-HT2A) receptor 5 - hydroxytryptamine 1B (5-HT1B), the 10-repeat allele of the DAT1 gene, the 7-repeat allele of the DRD4 gene, and dopamine beta hydroxylase gene (DBH TaqI).
However, this dimension is never inherited a genetic malfunction: it is a neurological condition naturally, which would have even promoted the survival of our ancestors, hunter-gatherers. It would have been gradually eliminated from the population once it sedentarised. The genetics of ADHD would be an original state of humankind and the non-ADHD the result of a recent adaptation, evolution still lower among populations (semi-) nomadic (it applies to the lactose intolerance, which is an original working of the human body, so that lactose tolerance is an adaptation related to the rearing of cattle, particularly in Europe and North and Central Africa).
In certain nomadic populations or recently settled, particularly in Africa and among Native Americans, the 7-repeat allele of the gene DRD4 is much more common and can reach more than half of the population.
Dietary factors
Some heavy metals such as lead or certain dyes or preservatives (sodium benzoate), absorbed as food, are suspected of contributing to hyperactivity and poor concentration in children:
* The dyes are widely used in children's diets. Some were able to exacerbate hyperactivity in children who had been diagnosed with ADHD. These studies have also highlighted the possible role of sodium benzoate, used as a preservative, may also be a factor in hyperactivity in children from the general population. The researchers have yet to verify if it is a synergy between sodium benzoate and certain colors, or whether the effect of sodium benzoate alone.
Epidemiology
The diagnosis is often at school age when symptoms interfere with the adaptation and reach about 3% to 5% of children in Western countries. It seems that ADHD is more common in North America and Europe, and in Northern Europe than in the south.
* In the West, about one fifth of cases of ADHD are hyperactive-dominant (H), while the attention deficit disorder (ADD) is dominant in four fifths of cases.
* The symptoms decrease with time, but it is estimated that two thirds of adults retain this status.
* This syndrome more readily reach girls (between 3 and 9 times more) but these figures may be skewed because that seems more normal hyperactivity in boys. There is a great disparity of prevalence figures of this syndrome in different countries or time studied, ranging from less than 1% (Hong Kong) to 25% (USA). The explanation for these differences is unclear: different assessment criteria, cultural factors? Swanson said in 1989 that the prevalence sometimes seems to be correlated to the marketing policy of primary treatment (methylphenidate).
Classification
One of the first descriptions of the syndrome dates back to 1902. The disease is recognized during the 1960s, where it appears in the BOMs.
* The International Classification of Diseases (ICD-10) conducted by the World Health Organization defines hyperkinetic disorders (code F90) as "disorders characterized by early onset (usually during the first five years of life) a lack of persistence in activities that require cognitive involvement and a tendency to move from one activity to another without finishing any, associated with an overall activity disorganized, uncoordinated and excessive. "
* U.S.: According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) prepared by the American Psychiatric Association, Disorder Attention Deficit / Hyperactivity Disorder (ADHD) is characterized by two sets of events: the attention deficit on one side, and hyperactivity-impulsivity on the other.
* France: In the French classification of mental disorders in children and adolescents (CFTMEA), hyperkinesia with attention deficit disorder (code 7.00), classified as conduct disorders and behavior, is characterized " the psychic side [with] difficulties to attract attention, a lack of consistency in activities that require cognitive involvement, a tendency for activity disorganized, uncoordinated and excessive, and a degree of impulsivity - the motor level [by] a motor restlessness or hyperactivity incessant."
Treatment
Drug treatment of ADHD is generally based on psychostimulants that stimulate the central nervous system. Methylphenidate hydrochloride (Ritalin ® in France, Belgium Rilatine ®), which is also in the list of drugs, is one of the most widely used drugs in this indication, the latter existing as sustained release or not. It does not appear to induce dependence in the topic, since the beaches to stop treatment are observed. Mention was made of cases of stunting, but recent surveys have revealed their character in some idiopathic overactive, unrelated to the treatment.
Another type of treatment has been recently developed: the Strattera. The molecule is atomoxetine. It is a specific inhibitor of the reuptake of norepinephrine (not psycho). But now, it is not yet on sale in France. The only way to get it, is to ask his doctor to make a request for ATU (temporary use).
In Europe, the evaluation is done by a child psychiatrist who has sole authority to issue methylphenidate. In North America, contrary to the ethical rules of European psychologists, psychologists and / or psycho can do a job evaluation, but not diagnostic. This portion is reserved for a doctor. In France, they are neurologists who can diagnose ADHD, with or without H.
Symptoms
* Impulsivity
* Hyperactivity
* Forward
* Easily angered, frustrated
* Mood swings, especially when disturbed during activities
* Inattention, difficulty concentrating for an extended period
* Lack of time, dreams
* Difficult to get to work
* Memory Problem
* Too many things in mind both
* Starts too many things at once without finishing
* Low tolerance for boredom
* Difficult to follow established procedures
* Anti-conformism
* Frequent changes in hobbies, center of interest, work, etc..
* Agitation, excitement
* Cyclothymia
* Lack of organization
* Feeling of insecurity
* Feeling of lack of self-realization
ADHD is often associated with other disorders, and if untreated, can cause many psychological complications. The most common disorders are:
* Disabilities oppositions in 30-50% of cases
* Conduct disorders in 25% of cases
* Anxiety disorders in 25% of cases
* Of the motor disorders are very common
* Persistent developmental stuttering
* Learning difficulties sizeable
* Of dyslexia, 50% of dyslexics also have ADD
These characteristics are certainly in no specific cases of the disease and are found in varying degrees, in children not meeting the criteria of ADHD As such, a number of people deny the relevance of the designation of such criteria as constituting a syndrome, dedicated to a specific medical treatment. For the diagnosis of ADHD can be clearly established, it must be complied with criteria defined by internationally recognized classifications (such as DSM-IV and ICD-10), the main manifestations of the disorder (inattention, impulsivity, hyperactivity) are a real gene for the subject, they are present before the age of 7, occur in two distinct environments permanently for at least six months and lead to school difficulties, social and / or professional.
In addition to the diagnostic criteria, we must eliminate any problems that might cause a disturbance in attention, such as: neglect, family problems, trouble with vision or hearing, petit mal epilepsy, anemia...
Hyperactive children and gifted
It is sometimes difficult to see the difference between gifted children and children with attention deficit hyperactivity disorder because it is common for gifted children also suffer from hyperactivity. This also poses the question of adapting teaching general education or prevention through the difficulty of evaluating the factors and events. Indeed in both cases the child:
* Demonstrates little attention in class, bored
* Tends to oppose the authority of Professor
* Suffers from a lack of self esteem
* A few friends
* Puts in doubt the rules and regulations
* Perfectionist
* Has an uneven development
* Demonstrated an excessive self-criticism
* A depressive tendencies
* Avoid taking risks
* Is afraid of failure
* Is impatient with others
* Do not like routine
* Raises many more questions than normal
* Is excessive in its interests
* Has a strong character
* Resists the guidance
* Questions the learning procedures
* Do not clear or areas not illogical
* Is concerned with humanitarian issues
* Built complicated rules
* Would be the chief
* Uses language to manipulate others
* Is intolerant
* Neglects his duties
* Can be seen as disruptive, next to the plate
* Can be perceived as stubborn, narrow-minded
* Is frustrated by the inactivity
* Can be seen as hyperactive
* May seem disorganized and dispersed
* Is frustrated by the lack of time
* Sometimes has a funny sense of humor, others do not understand his and vice versa
* Is independent
* Prefers individual work
* Research to organize things and people
* Has an extensive vocabulary
* Has varied and extensive knowledge
* Has high aspirations for himself and others
* Is terribly demanding of himself and other
* Is creative
* Is inventive
* Is intuitive
* Demonstrated hypersensitivity
* A lot of energy and liveliness
ADHD in adulthood
The ADHD child often persists into adulthood. Symptoms also remain the most often and do not disappear in 30% of cases. There is also a significant overlap with addictive disorders, abuse and dependence of legal substances (alcohol, tobacco, sedatives, benzodiazepines) or illegal (cocaine, cannabis, heroin and opiates). Some studies show that the risk of abuse or substance dependence is two times higher and that the same risk of combining drugs and alcohol is 4 times higher.
See also Autism
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