What is a Disruption of Activity and Attention?
Previously called minimal brain dysfunction (MMD), hyperkinetic syndrome, minimal brain damage. This is one of the most common childhood behavioral disorders, many of which remain in adulthood.
The disorder is more common in boys. The relative prevalence among boys and girls from 3: 1 to 9: 1, depending on the criteria of diagnosis. Currently, the prevalence among schoolchildren is from 3 to 20%. In 30-70% of cases, the syndromes of the disorder turn into adulthood. Hyperactivity in adolescence in many decreases, even if other disorders remain, but the risk of asocial psychopathy, alcoholism and drug addiction is high.
Causes Disruption of Activity and Attention
Previously, the hyperkinetic disorder was associated with intrauterine or postnatal brain damage (“minimal brain damage”). Identified genetic predisposition to this disorder. For identical twins, concordance is higher than for dvuiaytsovyh. 20-30% of parents of patients suffered or suffer from impaired activity and attention. Congenital tendency to hyperactivity increases under the influence of certain social factors, since this behavior is more common in children living in adverse social conditions. Parents of patients are more likely to have alcoholism, asocial psychopathy, and affective disorders in the general population. The alleged causes of the disorder are associated with food allergies, prolonged lead intoxication and exposure to food additives, but these hypotheses are not supported by convincing evidence. A strong relationship was found between activity and attention disorders and insensitivity to thyroid hormones – a rare condition, based on a mutation of the thyroid hormone beta-receptor gene.
Symptoms Disruption of Activity and Attention
The diagnostic criteria for a disorder have changed somewhat over the years. Symptomatology almost always manifests itself to 5-7 years. The average age of a doctor is 8-10 years.
Major manifestations include:
- Violations of attention. Inability to maintain attention, decreased selective attention, inability to concentrate on the subject for a long time, frequent forgetting of what needs to be done; increased distractibility, irritability. Such children are fussy, restless. Even more attention is reduced in unusual situations when you need to act on your own. Some children cannot even watch their favorite TV shows to the end.
- Impulsivity. In the form of scruffy fulfillment of school tasks, despite the efforts to do them correctly; frequent shouts from a place, noisy tricks during classes; “Getting into” the conversation or work of others; impatience in line; inability to lose (as a result of this, frequent fights with children). With age, manifestations of impulsivity can change. At an early age, it is urinary and fecal incontinence; at school – excessive activity and extreme impatience; in adolescence – hooligan antics and antisocial behavior (theft, drug use, etc.). However, the older the child, the more impulsive is more pronounced and more noticeable to others.
- Hyperactivity. This is an optional feature. In some children, motor activity can be reduced. However, motor activity is qualitatively and quantitatively different from the age norm. In preschool and early school age, such children continuously and impulsively run, crawl, jump up, and are very fussy. To puberty, hyperactivity often decreases. Children without hyperactivity are less aggressive and hostile to others, but they are more likely to experience partial developmental delays, including school skills.
- Violations of coordination are noted in 50-60% in the form of the impossibility of subtle movements (tying shoelaces, using scissors, coloring, letters); imbalances, visual and spatial coordination (inability to play sports, cycling, ball games).
- Emotional disturbances in the form of imbalance, temper, intolerance to failure. There is a delay in emotional development.
- Relations with others. In mental development, children with impaired activity and attention lag behind peers, but strive to be leaders. It is difficult to be friends with them. These are extraverted children, they are looking for friends, but they quickly lose them. Therefore, they often communicate with more “complaisant” younger ones. Relationships with adults are difficult. They are not affected by punishment, affection, or praise. From the point of view of parents and educators, it is precisely “bad manners” and “bad behavior” that are the main reason for going to doctors.
- Partial developmental delays. Despite normal IQ, school performance in many children is low. The reasons are inattention, lack of perseverance, intolerance to failure. Partial delays in the development of writing, reading, and counting are characteristic. The main symptom is the mismatch of a high intellectual level and poor performance in school. The criterion of partial delay is considered to be a backlog of skills by at least 2 years. However, it is necessary to exclude other causes of failure: perceptual disorders, psychological and social causes, low intelligence and inadequate teaching.
- Behavioral disorders. Not always observed. Not all children with behavioral disorders may have impaired activity and attention.
- Bedwetting. Disorders of falling asleep and drowsiness in the morning.
Disorders of activity and attention can be divided into 3 types: with a predominance of inattention; with a predominance of hyperactivity; mixed.
Diagnostics Disorders of Activity and Attention
It is necessary to have inattention or hyperactivity and impulsivity (or all manifestations at the same time) that do not correspond to the age norm.
Features of behavior:
- appear up to 8 years;
- are found in at least two areas of activity – school, home, work, games, clinic;
- are not caused by anxious, psychotic, affective, dissociative disorders and psychopathies;
- cause significant psychological discomfort and maladaptation.
- Inability to focus on details, errors of inattention.
- Inability to maintain attention.
- Inability to listen to the speech addressed.
- Inability to complete tasks.
- Low organizational skills.
- Negative attitude to tasks requiring mental stress.
- Loss of items needed to complete the task.
- Distractibility to extraneous irritants.
- Forgetfulness. (Of the listed symptoms, at least six should be stored for more than 6 months.)
Hyperactivity and impulsivity (of the following symptoms, at least four should last at least 6 months.):
- hyperactivity: the child is fussy, restless. Jumps up without permission. Running aimlessly, fidgeting, climbing. Cannot rest, play quiet games;
- impulsiveness: cries out the answer without listening to the question. Cannot wait in line.
For the diagnosis you need: a detailed history of life. Information must be found out with everyone who knows the child (parents, carers, teachers). Detailed family history (presence of alcoholism, hyperactivity disorder, ticks in parents or relatives). Data on the current behavior of the child.
Information is required on the child’s academic performance and behavior in the educational institution. There are currently no informative psychological tests to diagnose this disorder.
Disorders of activity and attention do not have clear pathognomonic signs. This disorder can be suspected on the basis of an anamnesis and psychological testing, taking into account diagnostic criteria. For a final diagnosis, a trial appointment of psychostimulants is shown.
The phenomena of hyperactivity and inattention can be symptoms of anxiety or depressive disorders, mood disorders. The diagnosis of these disorders is made in the presence of their diagnostic criteria. The presence of an acute onset of hyperkinetic disorder at school age can be a manifestation of a reactive (psychogenic or organic) disorder, manic state, schizophrenia, neurological disease.
Treatment Disorders of Activity and Attention
Drug treatment is effective in 75-80% of cases, with the correct diagnosis. Its effect is more symptomatic. Suppressing symptoms of hyperactivity disorder and impaired attention facilitates the child’s intellectual and social development. Drug treatment obeys several principles: only long-term therapy ending in adolescence is effective. The selection of the drug and dose proceed from the objective effect, and not the patient’s sensations. If the treatment is effective, then it is necessary to take trial breaks at certain intervals to determine whether the child can do without drugs. The first breaks are preferably arranged during the holidays, when the psychological load on the child is less.
Pharmacological agents used to treat this disorder are CNS stimulants. The mechanism of their action is not fully known. However, psychostimulants not only calm the baby, but also affect other symptoms. The ability to concentrate increases, emotional stability, sensitivity to parents and peers appear, and social relations are being established. Mental development can dramatically improve. Amphetamines (dexamphetamine (Dexedrine), methamphetamine), methylphenidate (Ritalin), pemoline (Ziller) are currently used. Individual sensitivity to them is different. If one of the drugs is ineffective, switch to another. The advantage of amphetamines is the long duration of action and the presence of prolonged forms. Methylphenidate is usually taken 2-3 times a day. It often has a sedative effect. The intervals between doses are usually 2.5-6 hours. Prolonged forms of amphetamines take 1 time per day. Doses of psychostimulants: methylphenidate – 10-60 mg / day .; methamphetamine – 5-40 mg / day .; pemoline – 56.25-75 mg / day. Treatment begins usually with low doses with a gradual increase. Physical dependence usually does not develop. In rare cases, the development of tolerance is transferred to another drug. Methylphenidate is not recommended for children under 6 years of age, dexamphetamine for children under 3 years of age. Pemoline is prescribed for the ineffectiveness of amphetamines and methylphenidate, but its effect may be delayed for 3-4 weeks. Side effects include decreased appetite, irritability, epigastric pain, headache, and insomnia. Pemoline – an increase in the activity of liver enzymes, possible jaundice. Psychostimulants increase heart rate, blood pressure. Some studies indicate a negative effect of drugs on growth and body weight, but these are temporary violations.
If psychostimulants are ineffective, imipramine hydrochloride (tofranil) is recommended in doses of 10 to 200 mg / day .; other antidepressants (desipramine, amfebutamon, phenelzine, fluoxetine) and some antipsychotics (chlorprotixen, thioridazine, sonapax). Antipsychotics do not contribute to the social adaptation of the child, therefore, indications for their appointment are limited. They should be used in the presence of severe aggressiveness, uncontrollability, or when other therapy and psychotherapy are ineffective.
A positive effect allows psychological assistance to children and their families. Rational psychotherapy is advisable with explaining to the child the reasons for his failures in life; behavioral therapy with teaching parents reward and punishment methods. Reducing psychological tension in the family and at school, creating a favorable environment for the child contribute to the effectiveness of treatment. However, as a method of radical treatment of disorders of activity and attention, psychotherapy is ineffective.
Monitoring the condition of the child should be established from the beginning of treatment and carried out in several directions – the study of behavior, school performance, social relationships.