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ATTENTION DEFICIT/HYPERACTIVITY DISORDER
When examining the DSM-5 criteria, it is seen that the diagnostic criteria are clustered around inattention, hyperactivity, and impulsivity. Emphasis is placed on careless mistakes made during school, work, or activities, difficulties sustaining attention and focusing, difficulties persisting in and completing tasks, and difficulties organizing life. Even if the person wants to, they experience significant difficulty performing in the situations mentioned. In the hyperactivity and impulsivity cluster, the emphasis is on the excessive motor activity observed in the person as hyperactivity. Behaviors such as constantly being on the move, fidgeting, inability to stay still, excessive talking, difficulty waiting, inability to remain silent, and talkativeness are observed, and these behaviors are to an extent that they consume and wear down the person's immediate environment. In social settings, this may manifest as being overly intrusive (interrupting others) or making important decisions without considering the long-term consequences.
It is now generally accepted that genetic factors may play a role in the etiology of ADHD, and it has been suggested that environmental factors may also play a role in 10-40% of cases. Twin studies have shown that ADHD is a genetic disorder in 70% of cases.
Banerjee and colleagues (2007), in their study examining which environmental factors, in addition to genetic and biological factors, could be risk factors for ADHD, did not find any studies showing that nutrition and television viewing were risk factors, but concluded that maternal exposure to toxic substances such as lead, manganese, tobacco, alcohol, and polychlorinated biphenyls during pregnancy increases the risk of developing ADHD.
ADHD is the most common neurodevelopmental disorder in children and adolescents. It is more common in males, occurring at rates 2 to 4 times higher than in females. In clinical samples, hyperactivity and impulsivity are more common in males than in females. While hyperactivity and impulsivity symptoms are more prominent in males, in females, problems related to inattention tend to be more prominent.
The most common comorbidity in children diagnosed with this disorder is oppositional defiant disorder, occurring in 54% of cases. In addition, psychological problems such as anxiety, depression, and learning difficulties are often seen in conjunction with a diagnosis of ADHD. The individual experiences disappointment, shame, and feelings of inadequacy and low self-esteem. There is an increased risk of poor academic performance, rejection by peers, lack of social acceptance, financial loss, and traffic accidents.
To assess ADHD, a comprehensive and multifaceted evaluation should be conducted by gathering information from the child, family, teachers, close environment, and neuropsychological tests, and a multi-stage clinical evaluation should be performed to establish a diagnosis.
In addition to the clinical interview, measurement tools and the latest versions of intelligence scales, such as the Weschler Intelligence Scale for Children and Conners' rating scales, performance tests, parent-teacher-clinician rating scales, and structured interviews should be used.
The step-by-step diagnostic approach is as follows: (1) Collect data from multiple sources, such as home and school. (2) Investigate whether there is another explanation for the behavioral problems. (3) Carefully monitor and follow up on the waiting period. (4) If the problems persist despite assistance exercises and functional impairment, treatment procedures are applied.
DEAHB Treatment
Before starting the treatment program, the subtypes of ADHD and the presence of comorbid conditions should also be considered. For example, compared to the combined type, the subtype in which the inattentive pattern is predominant has been found to have differences such as slower cognitive processing, less interest and curiosity, less enjoyment of learning, and determining success more through external criteria.
Psychoeducation, medication, psychotherapy, and developing self-management skills are all part of the comprehensive treatment that should be provided. While starting medication after receiving an ADHD diagnosis is the generally accepted treatment approach, it is not the only solution; psychosocial interventions, behavioral therapies, and cognitive behavioral therapy should also be continued.
Family, School, and Social-Based Education
Family-based and school-based interventions should be implemented and carried out in parallel. Teachers should be involved in the treatment process, extra time should be given for tests and exams, homework should be reduced, and more frequent and specific reports about the child should be requested from the school. Ensuring cooperation between school and family will eliminate conflicts, and providing positive reinforcement will increase motivation. In addition, it is recommended that children who experience social problems in their relationships with their peers be given positive social skills training. The goal is to teach skills such as waiting during conversation, initiating and maintaining conversation, and regulating emotions.
