ATTENTION - DEFICIT / HYPERACTIVITY DISORDER (ADHD)

Attention-deficit/hyperactivity disorder is a common disorder in children, characterized by hyperactivity, inattention, and impulsivity, leading to impairment in personal, social, academic, and work functioning.

What is Attention-Deficit/Hyperactivity Disorder (ADHD)?

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder - a group of disorders that begin during development (usually before school age). ADHD is a syndrome characterized by hyperactivity, reduced attention, and impulsivity, leading to impairments in personal, social, academic, and work functioning.

ADHD is considered a characteristic disorder in children, however, symptoms of this disorder can persist into adulthood. ADHD is strongly associated with emotional problems and impaired social functioning, such as poor ability to cope with stress; poor ability to communicate and empathize with others; bullying others, dropping out of school, becoming unemployed, often related to accidents (especially traffic accidents), being easy to substance abuse, and so on. These symptoms can affect the quality of life of people with ADHD, and in fact, they have a high suicide rate compared to people without the disorder. In addition to negative consequences, some studies also show that adults with ADHD may have more entrepreneurial traits, be more risk-taking, be open to new experiences, and be more creative.

Subgroups

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), there are three main types of ADHD, including:

- Attention deficit hyperactivity disorder - predominantly inattentive type

- Attention deficit hyperactivity disorder - predominantly hyperactive/impulsive type

- Attention deficit hyperactivity disorder - combined form 

Signs and Symptoms of ADHD

A typical sign of ADHD is the persistent appearance of inattention and/or hyperactivity and impulsivity, affecting the body's function or development, causing hindrances in living, studying, and working.

- Inattention is manifested through easy distraction when performing tasks, lack of perseverance, and difficulty organizing work.

- Hyperactivity is expressed through behaviors such as excessive activity/movement in inappropriate situations, playing loudly, or talking too much.

- Impulsive behavior can be demonstrated by interrupting/bothering others (social intrusiveness) and/or making important decisions without considering the consequences. It should be noted that the above actions do not stem from personal opposition or lack of understanding.

As mentioned above, although ADHD is considered a disorder specific to children, there are many documented cases where the signs of ADHD persist into adulthood. With each different age characteristic, the specific symptoms of ADHD have certain differences (See Table 1).

Table 1: Some ADHD symptoms by stage/age

 

Pre-school years

Primary school years

Adolescence

Adulthood

Inattention

- Short play sequences (<3 min) 

- Leaving activities incomplete 

- Not listening

- Brief activities (<10 min) 

- Premature changes in activity 

- Forgetful; disorganized; being easily distracted

- Less persistence than peers (<30 min) 

- Lack of focus on the details of a task 

- Poor planning ahead

- Details not completed 

- Appointments forgotten 

- Lack of foresight

Overactivity

- Excessive vandalism

- Restless when calm expected

- Fidgety

- Restless (subjective feelings)

Impulsivity

- Does not listen 

- No sense of danger (hard to distinguish from oppositionality)

- Acting out of turn; interrupting other children and blurting out answers 

- Thoughtless rule-breaking 

- Intrusions on peers; accidents

- Poor self-control 

- Reckless risk-taking

- Premature and unwise decision making

- Impatience

- Easy to have accidents

 

While hyperactivity is expressed through behavior in young children, hyperactivity in adults is often characterized by feelings of restlessness and anxiety. Therefore, ADHD in adults is often more difficult to diagnose.

WARNING: The symptoms listed are for reference only. If you suspect that you or your child has attention deficit hyperactivity disorder, see a psychologist at a reputable psychological/psychiatric assessment and treatment facility for an accurate diagnosis.

Assessment and Diagnosis of ADHD

Meta-analysis data suggest that the worldwide prevalence of ADHD in children and adolescents is approximately 5 - 7%. Although ADHD symptoms improve during late adolescence, about 30% of children previously diagnosed with ADHD continue to show symptoms of inattention, disorganization, or impulsive behavior in adulthood.

DSM-5 provides the following diagnostic criteria for ADHD:

INATTENTION: Have at least 6 of the 9 symptoms below, lasting at least 6 months

1. Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or during other activities (e.g., overlooks or misses details, work is inaccurate); 

2. Often has difficulty sustaining attention in tasks or play activities (e.g., has difficulty remaining focused during lectures, conversations, or lengthy reading);

3. Often does not seem to listen when spoken to directly (e.g., the mind seems elsewhere, even in the absence of any obvious distraction);

4. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., starts tasks but quickly loses focus and is easily sidetracked); 

5. Often has difficulty organizing tasks and activities (e.g., difficulty managing sequential tasks; difficulty keeping materials and belongings in order; messy, disorganized work; poor time management; failure to meet deadlines);

6. Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (e.g., schoolwork or homework; for older adolescents and adults, preparing reports, completing forms, reviewing lengthy papers);

7. Often loses things necessary for tasks or activities (e.g., school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones);

8. Is often easily distracted by extraneous stimuli (for older adolescents and adults, may include unrelated thoughts);

9. Is often forgetful in daily activities (e.g., doing chores, running errands; for older adolescents and adults, returning calls, paying bills, keeping appointments).

HYPERACTIVITY/IMPULSATION: At least 6 of the 9 symptoms below, lasting at least 6 months

1. Often fidgets with or taps hands or feet or squirms in seat; 

2. Often leaves seat in situations when remaining seated is expected (e.g., leaves his or her place in the classroom, in the office or other workplace, or in other situations that require remaining in place);

3. Often runs about or climbs in situations where it is inappropriate (In adolescents or adults, may be limited to feeling restless);

4. Often unable to play or engage in leisure activities quietly;

5. Is often “on the go,” acting as if “driven by a motor” (e.g., is unable to be or uncomfortable being still for an extended time, as in restaurants, meetings; may be experienced by others as being restless or difficult to keep up with);

6. Often talks excessively;

7. Often shouts out a reply sometime recently an address has been completed (e.g., completes people’s sentences; cannot hold up for a turn in discussion); 

8. Often has trouble holding up his or her turn (e.g., when holding up in line);

9. Often hinders or interferes with others (e.g., butts into discussions, games, or activities; may begin using other people’s things without inquiring or accepting authorization; for adolescents and adults, may intrude into or take over what others are doing).

Among them, some symptoms of attention deficit or hyperactivity appear before age 12; and appear simultaneously in two or more environments (For example: At home, school or work; with friends and relatives, etc). There must be clear proof that the over indications meddled with or decreased the quality of the individual's social, educational, or word-related work.

One thing to note here is that the symptoms that appear do not originate from other mental disorders (For example: Mood disorders, anxiety disorders, dissociative disorders, personality disorders, intoxication, or substance withdrawal).

WARNING: The symptoms listed are for reference only. If you suspect that you or your child has attention deficit hyperactivity disorder, see a psychologist at a reputable psychological/psychiatric assessment and treatment facility for an accurate diagnosis.

Causes and Risk Factors of ADHD

Biological factors

ADHD has quite clear genetic origins. Twin studies have demonstrated a heritability of this disorder at 70-80% in both children and adults. Some problems with cortical function, brain structure, or neurotransmitters are also related to the formation of ADHD.

Besides, external environmental factors can also be a risk factor for ADHD, such as low birth weight, premature birth; exposure to maternal stress in utero; mother being obese, having high blood pressure, smoking or using drugs or stimulants during pregnancy; lead or pesticide poisoning; nutritional deficiencies/excesses.

Psychological and social factors

Many psychological and social factors are also related to ADHD, such as family stress, marital discord, poverty, domestic violence, parents being criminals, etc. In particular, parental parenting style (too harsh parenting or little encouragement) can also be a potential factor leading to this disorder. Furthermore, children with ADHD who show signs of inattention, hyperactivity, and impulsivity often encounter negative reactions from their parents and those around them. Conflicts in these relationships can lead to psychological reactions such as depression, low self-esteem, rebellion, and lack of social skills with peers; causing ADHD symptoms to become more severe.

Methods to Treat and Control ADHD

Drug treatment

Psychostimulants are considered effective and are often used to treat ADHD. The drug helps intervene and normalize the function of neurotransmitters, and increase nerve activity in the frontal cortex, thereby helping people with ADHD increase attention and reduce impulsivity. However, psychostimulants can cause some side effects such as insomnia, headache, irritability, agitation, nervousness, tremors, loss of appetite, nausea, and weight loss; It can even cause developmental delays in children. Therefore, it is necessary to be extremely cautious when using drugs and only use them with the advice and prescription of a clinician.

Psychosocial and behavioral therapy

Behavioral interventions, especially behavioral skills training for parents and classroom behavioral interventions are highly effective in reducing symptoms of ADHD in both the short and long term.

- Skills training for parents involves professionals supporting and teaching parents about effective reinforcement and discipline strategies to deal with ADHD-related behaviors in children;

- Behavioral intervention in the classroom includes behavior management techniques for teachers, such as seating children with ADHD near the teacher's desk, breaking up assignments, writing task reminders, etc.

This helps children feel motivated, and increases their sense of self-efficacy, thereby minimizing the symptoms of this disorder. However, it is necessary to consider the child's personal characteristics, social situation, and family to be able to combine and coordinate different measures for the most effective treatment.

For adolescents, some other recommended psychological approaches include social and organizational skills training, meditation-based therapy, and cognitive therapy (CT).

In order to have an effective ADHD treatment and intervention program for children, parents, and caregivers need to have a certain understanding of common developmental disorders in children, as well as have the results of an accurate psychological assessment. from a psychologist, doctor, or other professional. Diagnosis results that are inaccurate or come from inexperienced or unreliable specialists can have major consequences on the child's future education and development.

Refer to the Child Psychological Assessment Service at the Vietnam - France Psychology Institute

Vietnam - France Psychology Institute is one of the leading units specializing in providing assessment and diagnosis services for developmental disorders, consultation, and psychological therapy for children and adolescents in Vietnam. We work with a team of experts from Vietnam and the French Republic, with many years of experience in diagnosis, consultation, and therapy for children under 18 years old. Along with that, we also cooperate with many educational institutions and schools in assessing and consulting on school psychology for students and training professional skills for many child psychology experts across the country.

A psychological evaluation at the Vietnam - France Psychology Institute usually lasts 3.5 to 5 hours and is performed by experienced experts in the evaluation room equipped with appropriate tools.

Working hours: From Monday to Saturday morning

- Morning: 8:00 - 12:00

- Afternoon: 13:00 - 17:00

Vietnam - France Psychology Institute is looking forward to accompanying families, and supporting parents and children to identify and overcome psychological difficulties with the good, dedicated, ethical experts at the Institute.

If you feel you are having symptoms of ADHD, go to a medical facility for timely examination and diagnosis, or contact the Vietnam - France Psychology Institute via Hotline: 0977.729.396 for specific advice. Early intervention is key to improving health and quality of life.

Reference:

[1] Rối loạn tăng động giảm chú ý. https://iacapap.org/_Resources/Persistent/c2568d324b4e4ab601f87bb35d4404bb21b893d4/D.1-ADHD-2020-vi-Final.pdf

[2] Tâm bệnh học. Đặng Hoàng Minh (chủ biên)

[3] Diagnostic and statistical manual of mental disorders _ DSM-5. https://repository.poltekkes-kaltim.ac.id/657/1/Diagnostic%20and%20statistical%20manual%20of%20mental%20disorders%20_%20DSM-5%20(%20PDFDrive.com%20).pdf

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VIETNAM - FRANCE PSYCHOLOGY INSTITUTE

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