Attention Deficit Disorder - How to deal with a hyperactive child?

Capricious, restless children are a real punishment for parents and teachers. It is difficult for them not only to be quiet in class, but also to just sit quietly in one place. They are talkative, unrestrained, change their mood and type of activity almost every minute. It is almost impossible to capture the attention of a fidget, as well as to direct his stormy energy into right direction. Whether this is ordinary bad manners or a mental disorder, only a specialist can establish. What is the attention deficit in children and how to treat this pathology? How can parents and educators deal with this problem? Let's talk about everything related to ADHD.

Signs of the disease

Attention Deficit Disorder is a behavioral disorder first described by a neuropsychiatrist from Germany in the nineteenth century. However, the fact that this is a pathology associated with minor impairments of brain activity was discussed only in the mid-60s of the last century. Only in the mid-nineties, the disease took its place in the medical classification, and was called "Attention Deficit Disorder in Children."

Pathology is considered by neurologists as chronic condition, effective method for which no cure has yet been found. Accurate diagnosis is made only in school age or when teaching in elementary grades. To confirm it, it is necessary that the child prove himself not only in everyday life, but also in the learning process. Medical statistics show that hyperactivity occurs in 5-15% of schoolchildren.

The characteristic symptoms of a child's behavior with ADHD can be conditionally divided into 3 categories.

• inattention

the child is easily distracted from classes, forgetful, unable to concentrate. He does not seem to hear what parents or teachers are saying. Such children constantly have problems with completing tasks, following instructions, organizing free time and the educational process. They make too many mistakes, but not because they think badly, but because of inattention or because of haste. They give the impression of being too distracted, because they lose something all the time: personal items, toys, clothing.

• Hyperactivity

children with a similar diagnosis are never calm. They constantly take off, run somewhere, climb poles and trees. In a sitting position, the limbs of such a child do not stop moving. He necessarily dangles his legs, moves objects on the table or makes other unnecessary movements. Even at night, the baby or teenager rolls too often in bed, knocking down bedding. In a team, they give the impression of being too sociable, talkative and fussy.

• Impulsiveness

they say about such children that their tongue is ahead of their head. The child at the lesson shouts out from the place, without even listening to the question, prevents others from answering, interrupting and crawling forward. He does not know how to wait or delay getting what he wants even for a minute. Often such manifestations are considered by parents and teachers as character traits, although these bright signs syndrome.

Psychologists and neurologists note that the manifestations of pathology in representatives of different age categories differ.

1. Kids are naughty, overly capricious, poorly managed.
2. Schoolchildren are forgetful, scattered, talkative and active.
3. Adolescents tend to dramatize even minor events, constantly show anxiety, easily fall into depression, and often behave defiantly.

A child with such a diagnosis may show reluctance to communicate with peers, show rudeness towards peers and elders.

When does Attention Deficit Disorder begin to appear in children?

Signs of pathology are indicated at an early age

Already in a baby of 1-2 years old, distinct symptoms of the disease are observed. But most parents accept such behavior as the norm or ordinary childhood whims. No one goes to the doctor with such problems, missing important time. Children have speech delay, excessive mobility with impaired coordination.

3 year old is worried age crisis associated with personal awareness. Capriciousness and stubbornness are the usual companions of such changes. But in a child with disabilities, such signs are more pronounced. He does not respond to comments, and demonstrates hyperactivity, simply does not sit still for a second. It is very difficult to put such a “liver” to sleep. The formation of attention and memory in children with the syndrome noticeably lags behind their peers.

In preschool children, the signs of ADHD are the inability to concentrate on classes, listen to the teacher, or simply sit in one place. At the age of five or six, children are already beginning to prepare for school, the load, physical and psychological, increases. But since kids with hyperactivity are a little behind their peers in mastering new knowledge, they develop low self-esteem. Psychological stress leads to the development of phobias, manifested physiological responses such as tics or bedwetting (enuresis).

Students diagnosed with ADHD have poor academic performance, despite the fact that they are not stupid at all. Adolescents do not develop relationships with the team and teachers. Teachers often write down such children as disadvantaged, because they are harsh, rude, often conflict with classmates, do not respond to comments or criticism. Among peers, adolescents with ADHD also often remain outcasts, because they are overly impulsive, prone to aggression and antisocial behavior.

Advice: Challenging Behavior means that your child wants to attract attention to himself, but does not yet know how to do it differently.

About attention deficit disorder, as a neurological disease, they started talking in Russia not too long ago and doctors still do not have enough experience in making a diagnosis. Pathology is sometimes confused with mental retardation, psychopathy, and even schizophrenic disorders. Diagnosis is further complicated by the fact that some of these signs are characteristic of ordinary children. Without careful analysis and long-term observation, it is difficult to determine why the child is inattentive during the lesson or too active.

Causes of the disease

European and American doctors have been researching the syndrome for decades. Meanwhile, its causes have not yet been reliably established. Among the main factors for the occurrence of pathology, it is customary to name:

• genetic predisposition,
• birth trauma,
• nicotine and alcohol consumed by the expectant mother,
• unfavorable course of pregnancy,
• rapid or premature birth,
• stimulation of labor activity,
• head trauma at an early age
• meningitis and other infections affecting the central nervous system.

The occurrence of the syndrome is facilitated by psychological problems in the family or neurological diseases. Pedagogical mistakes of parents, excessive strictness in education can also impose some imprint. But the main cause of the disease is still called the lack of hormones of norepinephrine and dopamine. The latter is considered a relative of serotonin. The level of dopamine rises during the moments of activities that a person considers pleasant for himself.

Fun Fact: Because dopamine and norepinephrine human body able to receive from some food products, there are theories that the cause of ADHD in children is malnutrition, for example, strict vegetarian diets.

It is customary to distinguish three types of the disease.

1. The syndrome may present with hyperactive behavior but no signs of attention deficit.
2. Attention deficit, not associated with hyperactivity.
3. Hyperactivity combined with attention deficit .

Correction of hyperactive behavior is carried out comprehensively and includes various methods, among which there are both medical and psychological. Europeans and Americans, upon detection of attention deficit in children, use psychostimulants for treatment. Such drugs are effective, but unpredictable in the consequences. Russian experts recommend mainly methods that do not include pharmacological agents. Treat the syndrome with the help of pills begin if all other methods have failed. In this case, nootropic drugs are used that stimulate cerebral circulation or natural sedatives.

What should parents do if their child has Attention Deficit Disorder?

• Physical activity. But sport games that include competitive elements are not suitable for them. They only contribute to excessive overexcitation.
• Static loads: wrestling or weightlifting are also contraindicated. Aerobic exercise has a good effect on the nervous system, but moderate. Skiing, swimming, cycling will use up excess energy. But parents need to ensure that the child does not overwork. This will lead to a decrease in self-control.
• Working with a psychologist

Psychological correction in the treatment of the syndrome is aimed at reducing anxiety and increasing the sociability of a baby or teenager. For this, techniques are used to modulate various situations of success, thanks to which the specialist has the opportunity to observe the child and select the most suitable areas of activity for him. The psychologist uses exercises that promote the development of attention, memory, speech. It is not easy for parents to communicate with such children. Often, mothers who have a child with a syndrome grow up themselves have signs of a depressive disorder. Therefore, families are recommended joint classes with a specialist.

• Behavioral correction of attention deficit hyperactivity disorder in children involves positive changes in their environment. As the child achieves success in classes with a psychologist, it is better to change the environment of peers.
• With a new team, children find it easier to find a common language, forgetting old problems and grievances. Parents also need to change their behavior. If before that excessive strictness was practiced in education, control should be loosened. Permissiveness and freedom should be replaced by a clear timetable. Parents need to compensate for the lack of positive emotions, more often to praise the child for their efforts.
• When raising such children, it is better to minimize prohibitions and refusals. Of course, you shouldn’t cross the line of reason, but impose a “taboo” only on what is really dangerous or harmful. A positive parenting model involves frequent use of verbal praise and other rewards. You need to praise a baby or teenager even for small achievements.
• It is necessary to normalize relations between family members. You should not quarrel in front of the child.
  Parents need to strive to win the trust of their son or daughter, maintain mutual understanding, calm communication without shouting and commanding tone.
• Joint leisure for families where hyperactive kids are brought up is also very important. It's good if the games are educational in nature.
• Children with similar problems need a clear daily routine, an organized place for classes.
• Daily chores that children perform on their own are very disciplined. Therefore, be sure to find a few such cases and monitor their implementation.
• Make sure your child has the right requirements for their abilities. No need to underestimate its capabilities or, on the contrary, overestimate them. Speak in a calm voice, address him with a request, and not with an order. Do not try to create greenhouse conditions. He must be able to cope with loads appropriate to his age.
• Such children need to devote more time than usual. Parents will also have to adapt to the lifestyle of the younger family member, adhering to the daily routine. You should not forbid a child anything if it does not apply to everyone else. Toddlers and middle-aged children should not visit crowded places, it promotes overexcitation.
• Hyperactive children are able to disrupt the learning process, but at the same time it is impossible to influence them in proven ways. Such children are indifferent to shouts, remarks and bad marks. But you still need to find a common language with an excessively active student. How should a teacher behave if there is a child with ADHD in the class?

A few tips to help keep things under control:

• During the lesson, arrange small physical education breaks. This will benefit not only hyperactive, but also healthy children.
• Classrooms should be equipped functionally, but without distracting decor, in the form of crafts, stands or paintings.
• In order to better control such a child, it is better to put him on the first or second desk.
• Keep active kids busy with errands. Ask them to wipe the board, distribute or collect notebooks.
• To better assimilate the material, present it in a playful way.
• A creative approach is effective in teaching all children without exception.
• Break tasks into small blocks, so it will be easier for children with ADHD to navigate.
• Let children with behavioral problems prove themselves in something necessary, show their best side.
• Help such a student to establish contact with classmates, take a place in the team.
• Charging during the lesson can be done not only standing, but also sitting. For this purpose, finger games are well suited.
• Constant individual contact is required. It must be remembered that they respond better to praise, it is with the help of positive emotions that the necessary positive behavior patterns are fixed.

Conclusion

Parents who have a hyperactive child in their family should not dismiss the advice of doctors and psychologists. Even if the problem becomes less acute over time, the diagnosis of ADHD will have an impact in the future. In adulthood, it will cause poor memory, inability to control one's own life. In addition, patients with a similar diagnosis are prone to various kinds of addictions and depression. Parents should become an example for their child, help him find a place in life, gain faith in his own strength.

Someone thinks that this is just a character, someone considers it a wrong upbringing, but many doctors call it Attention Deficit Hyperactivity Disorder. Attention deficit hyperactivity disorder (ADHD) is a dysfunction of the central nervous system(mainly the reticular formation of the brain), manifested by difficulties in concentrating and maintaining attention, learning and memory disorders, as well as difficulties in processing exogenous and endogenous information and stimuli. This is one of the most common neuropsychiatric disorders in childhood, its prevalence ranges from 2 to 12% (average 3-7%), and is more common in boys than girls. ADHD can occur both in isolation and in combination with other emotional and behavioral disorders, having a negative impact on the child's learning and social adaptation.

The first manifestations of ADHD are usually observed from 3-4 years of age. But when a child gets older and enters school, he has additional difficulties, since the beginning of schooling makes new, higher demands on the child's personality and his intellectual capabilities. Exactly at school years attention disorders become apparent, as well as difficulties in mastering the school curriculum and poor academic performance, self-doubt and low self-esteem.

Children with Attention Deficit Disorder have normal or high intelligence, but tend to do poorly in school. In addition to learning difficulties, attention deficit disorder is manifested by motor hyperactivity, attention defects, distractibility, impulsive behavior, and problems in relationships with others. In addition to the fact that children with ADHD misbehave and study poorly at school, as they grow older, they may be at risk for the formation of deviant and antisocial forms of behavior, alcoholism, and drug addiction. Therefore, it is important to recognize the early manifestations of ADHD and be aware of the possibilities for their treatment. It should be noted that attention deficit disorder is observed in both children and adults.

Causes of ADHD

A reliable and unique cause of the syndrome has not yet been found. It is believed that the formation of ADHD is based on neurobiological factors: genetic mechanisms and early organic damage to the central nervous system, which can be combined with each other. They determine the changes in the central nervous system, violations of higher mental functions and behavior, corresponding to the picture of ADHD. The results of modern research indicate the involvement of the “associative cortex-basal ganglia-thalamus-cerebellum-prefrontal cortex” system in the pathogenetic mechanisms of ADHD, in which the coordinated functioning of all structures ensures control of attention and organization of behavior.

In many cases, an additional impact on children with ADHD is exerted by negative socio-psychological factors (primarily family factors), which in themselves do not cause the development of ADHD, but always contribute to an increase in the child's symptoms and adaptation difficulties.

genetic mechanisms. Among the genes that determine the predisposition to the development of ADHD (the role of some of them in the pathogenesis of ADHD is confirmed, while others are considered as candidates) are genes that regulate the metabolism of neurotransmitters in the brain, in particular dopamine and norepinephrine. Dysfunction of neurotransmitter systems of the brain plays an important role in the pathogenesis of ADHD. At the same time, disturbances in the processes of synaptic transmission are of primary importance, which entail disconnection, a break in connections between the frontal lobes and subcortical formations, and as a result of this, the development of ADHD symptoms. In favor of violations of neurotransmitter transmission systems as the primary link in the development of ADHD is evidenced by the fact that the mechanisms of action of drugs that are most effective in the treatment of ADHD are to activate the release and inhibition of the reuptake of dopamine and norepinephrine in presynaptic nerve endings, which increases the bioavailability of neurotransmitters at the level of synapses. .

AT modern concepts Attention deficit in children with ADHD is considered as a result of disturbances in the work of the noradrenaline-regulated posterior cerebral attention system, while behavioral inhibition and self-control disorders characteristic of ADHD are considered as a lack of dopaminergic control over the flow of impulses to the forebrain attention system. The posterior cerebral system includes the superior parietal cortex, the superior colliculus, the thalamic cushion (the dominant role belongs to the right hemisphere); this system receives dense noradrenergic innervation from the locus coeruleus (blue spot). Norepinephrine suppresses spontaneous discharges of neurons, thereby the hindbrain attention system, which is responsible for orienting to new stimuli, prepares to work with them. This is followed by a switch in the mechanisms of attention to the anterior cerebral control system, which includes the prefrontal cortex and the anterior cingulate gyrus. The susceptibility of these structures to incoming signals is modulated by dopaminergic innervation from the ventral tegmental nucleus of the midbrain. Dopamine selectively regulates and limits excitatory impulses to the prefrontal cortex and cingulate gyrus, providing a reduction in excessive neuronal activity.

Attention deficit hyperactivity disorder (ADHD) is considered a polygenic disorder in which multiple disorders of dopamine and/or noradrenaline metabolism that exist simultaneously are due to the influence of several genes that override the protective effect of compensatory mechanisms. The effects of the genes that cause ADHD are complementary. Thus, ADHD is considered as a polygenic pathology with a complex and variable inheritance, and at the same time as a genetically heterogeneous condition.

Pre- and perinatal factors play an important role in the pathogenesis of ADHD. The formation of ADHD may be preceded by disturbances in the course of pregnancy and childbirth, in particular gestosis, eclampsia, the first pregnancy, the age of the mother is younger than 20 years or older than 40 years, prolonged labor, post-term pregnancy and prematurity, low birth weight, morphofunctional immaturity, hypoxic ischemic encephalopathy, a disease of a child in the first year of life. Other risk factors are the use by the mother during pregnancy of certain medicines, alcohol and smoking.

Apparently, a slight decrease in the size of the prefrontal areas of the brain (mainly in the right hemisphere), subcortical structures, corpus callosum, and cerebellum found in children with ADHD compared with healthy peers using magnetic resonance imaging (MRI) is apparently associated with early CNS damage. These data support the concept that the occurrence of ADHD symptoms is due to impaired connections between the prefrontal regions and subcortical ganglia, primarily the caudate nucleus. Subsequently, additional confirmation was obtained through the use of functional neuroimaging methods. Thus, when determining cerebral blood flow using single photon emission computed tomography in children with ADHD, compared with healthy peers, a decrease in blood flow (and, consequently, metabolism) in the frontal lobes, subcortical nuclei and midbrain was demonstrated, and in the most more changes were expressed at the level of the caudate nucleus. According to the researchers, changes in the caudate nucleus in children with ADHD were the result of its hypoxic-ischemic damage during the neonatal period. Having close connections with the thalamus opticus, the caudate nucleus performs an important function of modulation (mainly of an inhibitory nature) of polysensory impulses, and the lack of inhibition of polysensory impulses may be one of the pathogenetic mechanisms of ADHD.

With the help of positron emission tomography (PET), it was found that cerebral ischemia transferred at birth leads to persistent changes in dopamine receptors of the 2nd and 3rd types in the structures of the striatum. As a result, the ability of receptors to bind dopamine decreases and a functional insufficiency of the dopaminergic system is formed.

A recent comparative MRI study of children with ADHD, the purpose of which was to assess regional differences in the thickness of the cerebral cortex and compare their age dynamics with clinical outcomes, showed that children with ADHD showed a global decrease in cortical thickness, most pronounced in the prefrontal (medial and upper) and precentral regions. At the same time, in patients with worse clinical outcomes during the initial examination, the smallest thickness of the cortex was found in the left medial prefrontal region. Normalization of the thickness of the right parietal cortex was associated with the best outcomes in patients with ADHD and may reflect a compensatory mechanism associated with changes in the thickness of the cerebral cortex.

The neuropsychological mechanisms of ADHD are considered from the standpoint of disorders (immaturity) of the functions of the frontal lobes of the brain, primarily the prefrontal area. Manifestations of ADHD are analyzed from the standpoint of a deficit in the functions of the frontal and prefrontal parts of the brain and insufficient formation of executive functions (EF). Patients with ADHD present with "executive dysfunction". The development of UV and the maturation of the prefrontal region of the brain are long-term processes that continue not only in childhood but also in adolescence. EF is a rather broad concept referring to the range of abilities that serve the task of maintaining the necessary sequence of efforts to solve a problem, aimed at achieving a future goal. Significant components of the EF that are affected in ADHD are: impulse control, behavioral inhibition (restraint); organization, planning, management of mental processes; maintaining attention, keeping from distractions; inner speech; working (operative) memory; foresight, forecasting, a look into the future; hindsight past events, mistakes made; change, flexibility, ability to switch and revise plans; choice of priorities, the ability to allocate time; separating emotions from real facts. Some UV researchers emphasize "hot" social aspect self-regulation and the child's ability to control his behavior in society, while others emphasize the role of the regulation of mental processes - the "cold" cognitive aspect of self-regulation.

Influence of adverse environmental factors. Anthropogenic pollution human environment environment, largely associated with microelements from the group of heavy metals, can have negative consequences for children's health. It is known that in the immediate vicinity of many industrial enterprises, zones with a high content of lead, arsenic, mercury, cadmium, nickel and other microelements are formed. The most common heavy metal neurotoxicant is lead, and its sources of environmental pollution are industrial emissions and vehicle exhaust gases. Lead exposure to children can cause cognitive and behavioral problems in children.

The role of nutritional factors and unbalanced nutrition. Nutritional imbalances (eg, lack of protein with an increase in easily digestible carbohydrates, especially in the morning), as well as micronutrient deficiencies, including vitamins, folates, omega-3 polyunsaturated fatty acids (PUFAs) can contribute to the onset or exacerbation of ADHD symptoms. , macro- and microelements. Micronutrients such as magnesium, pyridoxine and some others directly affect the synthesis and degradation of monoamine neurotransmitters. Therefore, micronutrient deficiencies can affect the neurotransmitter balance and hence the manifestation of ADHD symptoms.
Of particular interest among micronutrients is magnesium, which is a natural lead antagonist and promotes the rapid elimination of this toxic element. Therefore, magnesium deficiency, among other effects, can contribute to the accumulation of lead in the body.

Magnesium deficiency in ADHD can be associated not only with its insufficient intake with food, but also with an increased need for it during critical periods of growth and development, with severe physical and neuropsychic stress, and stress. Under conditions of environmental stress, nickel and cadmium, along with lead, act as magnesium displacing metals. In addition to a lack of magnesium in the body, the manifestation of ADHD symptoms can be influenced by zinc, iodine, and iron deficiencies.

Thus, ADHD is a complex neuropsychiatric disorder accompanied by structural, metabolic, neurochemical, neurophysiological changes in the central nervous system, as well as neuropsychological disorders in the processes of information processing and UV.

Symptoms of ADHD in children

Symptoms of ADHD in a child may be the reason for the primary appeal to pediatricians, speech therapists, defectologists, psychologists. Often it is teachers of preschool and school educational institutions who first pay attention to the symptoms of ADHD, and not parents. The detection of such symptoms is a reason to show the child to a neurologist and neuropsychologist.

Main manifestations of ADHD

1. Attention disorders
Does not pay attention to details, makes many mistakes.
It is difficult to maintain attention when performing school and other tasks.
He does not listen to what is said to him.
Cannot follow instructions and follow through.
Unable to independently plan, organize the execution of tasks.
Avoids things that require prolonged mental stress.
Often loses his things.
Easily distracted.
Shows forgetfulness.
2a. Hyperactivity
Often makes restless movements with arms and legs, fidgets in place.
Cannot sit still when necessary.
Often runs or climbs somewhere when it is inappropriate.
Can't play quietly.
Excessive aimless physical activity is persistent, it is not affected by the rules and conditions of the situation.
2b. Impulsiveness
Answers questions without listening to the end and without thinking.
Can't wait for their turn.
Interferes with other people, interrupts them.
Chatty, unrestrained in speech.

The essential characteristics of ADHD are:

Duration: symptoms persist for at least 6 months;
- constancy, distribution to all spheres of life: adaptation disorders are observed in two or more types of environment;
- severity of violations: significant violations in training, social contacts, professional activities;
- other mental disorders are excluded: the symptoms cannot be associated exclusively with the course of another disease.

Depending on the predominant symptoms, there are 3 forms of ADHD:
- combined (combined) form - there are all three groups of symptoms (50-75%);
- ADHD with predominant attention disorders (20-30%);
- ADHD with a predominance of hyperactivity and impulsivity (about 15%).

Symptoms of ADHD have their own characteristics in preschool, primary school and adolescence.

Preschool age. Between the ages of 3 and 7, hyperactivity and impulsivity usually begin to appear. Hyperactivity is characterized by the fact that the child is in constant motion, cannot sit still during classes for even a short time, is too talkative and asks an endless number of questions. Impulsivity is expressed in the fact that he acts without thinking, cannot wait for his turn, does not feel restrictions in interpersonal communication, intervening in conversations and often interrupting others. Such children are often characterized as misbehaving or too temperamental. They are extremely impatient, arguing, making noise, shouting, which often leads them to outbursts of strong irritation. Impulsivity can be accompanied by recklessness, as a result of which the child endangers himself (increased risk of injury) or others. During games, energy is overflowing, and therefore the games themselves become destructive. Children are sloppy, often throw, break things or toys, are naughty, poorly obey the demands of adults, and can be aggressive. Many hyperactive children lag behind their peers in language development.

School age. After entering school, the problems of children with ADHD increase significantly. The learning requirements are such that a child with ADHD is not able to fulfill them fully. Since his behavior does not correspond to the age norm, he fails to achieve results in school that correspond to his abilities (while the general level of intellectual development in children with ADHD corresponds to the age range). During the lessons, they do not hear the teacher, it is difficult for them to cope with the proposed tasks, as they experience difficulties in organizing work and bringing it to the end, they forget in the course of fulfilling the conditions of the task, they do not master the teaching materials well and cannot apply them correctly. They quite soon turn off the process of doing the work, even if they have everything necessary for this, do not pay attention to details, show forgetfulness, do not follow the instructions of the teacher, switch poorly when the conditions of the task change or a new one is given. They are unable to do their homework on their own. Compared with peers, difficulties in the formation of writing, reading, counting, and logical thinking skills are much more common.

Relationship problems with others, including peers, teachers, parents, and siblings, are common among children with ADHD. Since all manifestations of ADHD are characterized by significant mood swings at various times and in different situations The child's behavior is unpredictable. Hot temper, cockiness, oppositional and aggressive behavior are often observed. As a result, he cannot play for a long time, successfully communicate and establish friendly relations with peers. In the team, he serves as a source of constant anxiety: he makes noise without hesitation, takes other people's things, interferes with others. All this leads to conflicts, and the child becomes unwanted and rejected in the team.

Faced with this attitude, children with ADHD often consciously choose to play the role of class jester, hoping to build relationships with their peers. A child with ADHD not only does not study well on his own, but often "breaks" the lessons, interferes with the work of the class, and therefore is often called to the director's office. In general, his behavior creates the impression of "immaturity", inconsistency with his age. Only younger children or peers with similar behavior problems are usually ready to communicate with him. Gradually, children with ADHD develop low self-esteem.

At home, children with ADHD usually suffer constant comparisons to siblings who are well-behaved and learn better. Parents are annoyed by the fact that they are restless, obsessive, emotionally labile, undisciplined, disobedient. At home, the child is unable to take responsibility for the implementation of daily tasks, does not help parents, is sloppy. At the same time, comments and punishments do not give the desired results. According to the parents, “Something always happens to him”, that is, there is an increased risk of injuries and accidents.

Adolescence. In adolescence, pronounced symptoms of impaired attention and impulsivity continue to be observed in at least 50-80% of children with ADHD. At the same time, hyperactivity in adolescents with ADHD is significantly reduced, replaced by fussiness, a sense of inner restlessness. They are characterized by lack of independence, irresponsibility, difficulties in organizing and completing the execution of assignments and especially long-term work, which they are often unable to cope without outside help. School performance often worsens, as they cannot effectively plan their work and distribute it over time, they postpone the execution of necessary tasks from day to day.

Difficulties in relationships in the family and school, behavioral disorders are growing. Many adolescents with ADHD are distinguished by reckless behavior associated with unjustified risk, difficulties in following the rules of conduct, disobedience to social norms and laws, failure to comply with the requirements of adults - not only parents and teachers, but also officials, such as school administration representatives or police officers. At the same time, they are characterized by weak psycho-emotional stability in case of failures, self-doubt, low self-esteem. They are too sensitive to teasing and ridicule from peers who think they are stupid. Adolescents with ADHD continue to be characterized by peers as immature and inappropriate for their age. In everyday life they neglect necessary measures safety, which increases the risk of injury and accidents.

Adolescents with ADHD are prone to being involved in teen gangs that commit various offenses, they may develop cravings for alcohol and drugs. But in these cases, they, as a rule, turn out to be led, obeying the will of peers who are stronger in character or older than themselves and without thinking about the possible consequences of their actions.

Disorders associated with ADHD (comorbid disorders). Additional difficulties in intra-family, school and social adaptation in children with ADHD may be associated with the formation of concomitant disorders that develop against the background of ADHD as the underlying disease in at least 70% of patients. The presence of comorbid disorders can lead to clinical manifestations ADHD, poorer long-term prognosis, and less effective treatment for ADHD. Behavioral and emotional disturbances associated with ADHD are considered as unfavorable prognostic factors for the long-term, up to chronic, course of ADHD.

Comorbid disorders in ADHD are represented by the following groups: externalized (oppositional defiant disorder, conduct disorder), internalized (anxiety disorders, mood disorders), cognitive (speech development disorders, specific learning difficulties - dyslexia, dysgraphia, dyscalculia), motor (static-locomotor failure, developmental dyspraxia, tics). Other comorbid ADHD disorders can be sleep disturbances (parasomnias), enuresis, encopresis.

Thus, learning, behavioral and emotional problems can be associated with both the direct influence of ADHD and comorbid disorders, which should be diagnosed in a timely manner and considered as indications for additional appropriate treatment.

Diagnosis of ADHD

In Russia, the diagnosis of "hyperkinetic disorder" is approximately equivalent to the combined form of ADHD. To make a diagnosis, all three groups of symptoms (table above) must be confirmed, including at least 6 manifestations of inattention, at least 3 - hyperactivity, at least 1 - impulsiveness.

To confirm ADHD, there are no special criteria or tests based on the use of modern psychological, neurophysiological, biochemical, molecular genetic, neuroradiological and other methods. The diagnosis of ADHD is made by a doctor, but educators and psychologists should also be familiar with the diagnostic criteria for ADHD, especially since it is important to obtain reliable information about the child's behavior not only at home, but also at school or a preschool institution in order to confirm this diagnosis.

In childhood, ADHD “imitators” are quite common: in 15-20% of children, forms of behavior outwardly similar to ADHD are periodically observed. In this regard, ADHD must be distinguished from a wide range of conditions that are similar to it only in external manifestations, but differ significantly both in causes and methods of correction. These include:

Individual characteristics of personality and temperament: the characteristics of the behavior of active children do not go beyond the age norm, the level of development of higher mental functions is good;
- Anxiety disorders: the characteristics of the child's behavior are associated with the action of psychotraumatic factors;
- consequences of traumatic brain injury, neuroinfection, intoxication;
- asthenic syndrome in somatic diseases;
- specific disorders of the development of school skills: dyslexia, dysgraphia, dyscalculia;
- endocrine diseases (pathology of the thyroid gland, diabetes mellitus);
- sensorineural hearing loss;
- epilepsy (absence forms; symptomatic, locally conditioned forms; side effects of anti-epileptic therapy);
- hereditary syndromes: Tourette, Williams, Smith-Mazhenis, Beckwith-Wiedemann, fragile X-chromosome;
- mental disorders: autism, affective disorders (mood), mental retardation, schizophrenia.

In addition, the diagnosis of ADHD should be built taking into account the peculiar age dynamics of this condition.

Treatment for ADHD

On the present stage it becomes obvious that the treatment of ADHD should be directed not only to the control and reduction of the main manifestations of the disorder, but also to the solution of other important tasks: improving the functioning of the patient in various areas and his most complete realization as a person, the emergence of his own achievements, improving self-esteem, normalizing the situation around him, including within the family, developing and strengthening communication skills and contacts with people around him, recognition by others and increasing satisfaction with his own life.

The study confirmed the significant negative impact of the difficulties experienced by children with ADHD on their emotional state, family life, friendships, schooling, and leisure activities. In this regard, the concept of an expanded therapeutic approach has been formulated, which implies the extension of the influence of treatment beyond the reduction of the main symptoms and taking into account functional outcomes and quality of life indicators. Thus, the concept of an expanded therapeutic approach involves addressing the social and emotional needs of the child with ADHD, which should be addressed. Special attention both at the stage of diagnosis and treatment planning, and in the process of dynamic observation of the child and evaluation of the results of therapy.

Most effective for ADHD is comprehensive care, which combines the efforts of doctors, psychologists, teachers working with the child, and his family. It would be ideal if a good neuropsychologist takes care of the child. Treatment for ADHD should be timely and must include:

Helping the family of a child with ADHD - family and behavioral therapy techniques that provide better interaction in families of children with ADHD;
- development of parenting skills for children with ADHD, including parent training programs;
- educational work with teachers, correction of the school curriculum - through a special - presentation of educational material and the creation of such an atmosphere in the classroom that maximizes opportunities successful learning children;
- psychotherapy of children and adolescents with ADHD, overcoming difficulties, developing effective communication skills in children with ADHD during special remedial classes;
- drug therapy and diet, which should be long enough, since improvement extends not only to the main symptoms of ADHD, but also to the socio-psychological side of the patients' lives, including their self-esteem, relationships with family members and peers, usually starting from the third month of treatment . Therefore, it is advisable to plan drug therapy for several months up to the duration of the entire academic year.

Medications to treat ADHD

An effective drug specifically designed for the treatment of ADHD is atomoxetine hydrochloride. The main mechanism of its action is associated with the blockade of norepinephrine reuptake, which is accompanied by an increase in synaptic transmission involving norepinephrine in various brain structures. In addition, experimental studies have found an increase in the content of not only norepinephrine, but also dopamine under the influence of atomoxetine selectively in the prefrontal cortex, since in this area dopamine binds to the same transport protein as norepinephrine. Since the prefrontal cortex plays a leading role in the control functions of the brain, as well as attention and memory, an increase in the concentration of norepinephrine and dopamine in this area under the influence of atomoxetine leads to a decrease in the manifestations of ADHD. Atomoxetine has a beneficial effect on the behavioral characteristics of children and adolescents with ADHD, its positive effect is usually manifested already at the beginning of treatment, but the effect continues to increase during the month of continuous use of the drug. In most patients with ADHD, clinical efficacy is achieved by prescribing the drug in the dose range of 1.0-1.5 mg/kg of body weight per day with a single dose in the morning. The advantage of atomoxetine is its effectiveness in cases of ADHD combined with destructive behavior, anxiety disorders, tics, enuresis. The drug has many side effects, so the reception is strictly under the supervision of a doctor.

Russian specialists in the treatment of ADHD traditionally use nootropic drugs. Their use in ADHD is justified, since nootropic drugs have a stimulating effect on insufficiently formed cognitive functions in children of this group (attention, memory, organization, programming and control of mental activity, speech, praxis). Given this circumstance, the positive effect of drugs with a stimulating effect should not be taken as paradoxical (given the hyperactivity in children). Vice versa, high efficiency nootropics seems to be natural, especially since hyperactivity is only one of the manifestations of ADHD and is itself caused by violations of higher mental functions. In addition, these drugs have a positive effect on metabolic processes in the central nervous system and contribute to the maturation of the inhibitory and regulatory systems of the brain.

A recent study confirms the good potential hopantenic acid preparation in the long-term treatment of ADHD. Positive influence on the main symptoms of ADHD is achieved after 2 months of treatment, but continues to increase after 4 and 6 months of its use. Along with this, the beneficial effect of long-term use of hopantenic acid on adaptation and functioning disorders characteristic of children with ADHD in various areas, including behavioral difficulties in the family and in society, schooling, reduced self-esteem, and lack of basic life skills, was confirmed. However, in contrast to the regression of the main symptoms of ADHD, longer periods of treatment were needed to overcome disorders of adaptation and socio-psychological functioning: a significant improvement in self-esteem, communication with others and social activity was observed based on the results of a parental survey after 4 months, and a significant improvement in indicators of behavior and schooling, basic life skills, along with a significant regression of behavior associated with risk, after 6 months of using the hopantenic acid preparation.

Another area of ​​treatment for ADHD is to control negative factors nutrition and the environment, leading to the intake of neurotoxic xenobiotics (lead, pesticides, polyhaloalkyls, food colorings, preservatives) into the child's body. This should be accompanied by the inclusion in the diet of the necessary micronutrients that help reduce the symptoms of ADHD: vitamins and vitamin-like substances (omega-3 PUFAs, folates, carnitine) and essential macro- and microelements (magnesium, zinc, iron).
Among the micronutrients with a proven clinical effect in ADHD, magnesium preparations should be noted. Magnesium deficiency is determined in 70% of children with ADHD.

Magnesium is an important element involved in maintaining the balance of excitatory and inhibitory processes in the central nervous system. There are several molecular mechanisms through which magnesium deficiency affects neuronal activity and neurotransmitter metabolism: magnesium is required to stabilize excitatory (glutamate) receptors; magnesium is an essential cofactor of adenylate cyclases involved in signal transmission from neurotransmitter receptors to controlling intracellular cascades; magnesium is a cofactor for catechol-O-methyltransferase, which inactivates excess monoamine neurotransmitters. Therefore, magnesium deficiency contributes to the imbalance of the "excitation-inhibition" processes in the CNS towards excitation and can affect the manifestation of ADHD.

In the treatment of ADHD, only organic magnesium salts (lactate, pidolate, citrate) are used, which is associated with a high bioavailability of organic salts and the absence of side effects when they are used in children. The use of magnesium pidolate with pyridoxine in solution (ampoule form of Magne B6 (Sanofi-Aventis, France)) is allowed from the age of 1 year, lactate (Magne B6 in tablets) and magnesium citrate (Magne B6 forte in tablets) - from 6 years . The magnesium content in one ampoule is equivalent to 100 mg of ionized magnesium (Mg2+), in one tablet of Magne B6 - 48 mg of Mg2+, in one tablet of Magne B6 forte (618.43 mg of magnesium citrate) - 100 mg of Mg2+. The high concentration of Mg2+ in Magne B6 forte allows you to take 2 times fewer tablets than when taking Magne B6. The advantage of Magne B6 in ampoules is also the possibility of more accurate dosing, the use of the Magne B6 ampoule provides a rapid increase in the level of magnesium in the blood plasma (within 2-3 hours), which is important for the rapid elimination of magnesium deficiency. At the same time, taking Magne B6 tablets contributes to a longer (within 6-8 hours) retention of an increased concentration of magnesium in erythrocytes, that is, its deposition.

The advent of combined preparations containing magnesium and vitamin B6 (pyridoxine) has significantly improved pharmacological properties magnesium salts. Pyridoxine is involved in the metabolism of proteins, carbohydrates, fatty acids, the synthesis of neurotransmitters and many enzymes, has a neuro-, cardio-, hepatotropic, and hematopoietic effect, contributes to the replenishment of energy resources. The high activity of the combined preparation is due to the synergistic action of the components: pyridoxine increases the concentration of magnesium in plasma and erythrocytes and reduces the amount of magnesium excreted from the body, improves the absorption of magnesium into gastrointestinal tract, its penetration into cells, as well as fixation. Magnesium, in turn, activates the process of transformation of pyridoxine into its active metabolite pyridoxal-5-phosphate in the liver. Thus, magnesium and pyridoxine potentiate each other's action, which allows their combination to be successfully used to normalize magnesium balance and prevent magnesium deficiency.

The combined intake of magnesium and pyridoxine for 1-6 months reduces the symptoms of ADHD and restores normal values magnesium in erythrocytes. After a month of treatment, anxiety, attention disturbances and hyperactivity decrease, concentration of attention, accuracy and speed of task performance improve, and the number of errors decreases. There is an improvement in gross and fine motor skills, a positive dynamics of EEG characteristics in the form of the disappearance of signs of paroxysmal activity against the background of hyperventilation, as well as bilateral-synchronous and focal pathological activity in most patients. At the same time, taking Magne B6 is accompanied by the normalization of magnesium concentration in erythrocytes and blood plasma of patients.

Replenishment of magnesium deficiency should last at least two months. Considering that alimentary deficiency of magnesium occurs most often, when drawing up nutritional recommendations, one should take into account not only the quantitative content of magnesium in foods, but also its bioavailability. So, fresh vegetables, fruits, herbs (parsley, dill, green onions) and nuts have the maximum concentration and activity of magnesium. When preparing products for storage (drying, canning), the concentration of magnesium decreases slightly, but its bioavailability drops sharply. This is important for children with ADHD who have a deepening of magnesium deficiency that coincides with the period of school from September to May. Therefore, the use of combined preparations containing magnesium and pyridoxine is advisable during the school year. But, alas, the problem cannot be solved by drugs alone.

Home psychotherapy

Any classes are desirable to be carried out in a playful way. Any games where you need to hold and switch attention will do. For example, the game "find the pairs", where cards with images are opened and turned over in turn, and you need to remember and open them in pairs.

Or even take the game of hide and seek - there is a sequence, certain roles, you need to sit in the shelter for a certain time, and you also need to figure out where to hide and change these places. All this is a good training of the functions of programming and control, and moreover, it occurs when the child is emotionally involved in the game, which helps to maintain the optimal tone of wakefulness at this moment. And it is needed for the emergence and consolidation of all cognitive neoplasms, for the development of cognitive processes.

Remember all the games that you played in the yard, they are all selected by human history and are very useful for the harmonious development of mental processes. Here, for example, is a game where you need to "do not say yes and no, do not buy black and white" - after all, this is a wonderful exercise for slowing down a direct answer, that is, for training programming and control.

Teaching Children with Attention Deficit Hyperactivity Disorder

With such kids, you need special approach to study. Often children with ADHD have problems maintaining optimal tone, which causes all other problems. Due to the weakness of the inhibitory control, the child is overexcited, restless, cannot concentrate on anything for a long time, or, conversely, the child is lethargic, he wants to lean against something, he quickly gets tired, and his attention can no longer be collected by any means until some upswing and then downswing again. The child cannot set tasks for himself, determine how and in what order he will solve them, do this work without being distracted and test himself. These children have difficulties in writing - omissions of letters, syllables, merging two words into one. They do not hear the teacher or are accepted for the task without listening to the end, hence, the problems in all school subjects.

We need to develop in the child the ability to program and control their own activities. While he himself does not know how to do this, these functions are taken over by the parents.

Training

Choose a day and address the child with these words: "You know, they taught me how to do homework quickly. Let's try to do them very quickly. It should work out!"

Ask the child to bring a portfolio, lay out everything you need to complete the lessons. Say: well, let's try to set a record - do all the lessons in an hour (let's say). Important: the time while you are preparing, clearing the table, laying out textbooks, figuring out the task, is not included in this hour. It is also very important that the child has all the tasks recorded. As a rule, children with ADHD do not have half of the tasks, and endless calls to classmates begin. Therefore, we can warn you in the morning: today we will try to set a record for completing tasks in the shortest possible time, only one thing is required of you: carefully write down all the tasks.

First item

Let's get started. Open the diary, see what is given. What will you do first? Russian or math? (It does not matter what he chooses - it is important that the child chooses himself).

Take a textbook, find an exercise, and I time it. Read the assignment aloud. So, I did not understand something: what needs to be done? Please explain.

You need to reformulate the task in your own words. Both - both the parent and the child - must understand what exactly needs to be done.

Read the first sentence and do what needs to be done.

Better do it first trial action verbally: what do you need to write? Speak aloud, then write.

Sometimes a child says something correctly, but immediately forgets what was said - and when it is necessary to write it down, he no longer remembers. Here the mother should work as a voice recorder: to remind the child what he said. The most important thing is to be successful from the very beginning.

It is necessary to work slowly, not to make mistakes: pronounce it as you write, Moscow - "a" or "o" next? Speak in letters, in syllables.

Check this out! Three and a half minutes - and we have already made the first offer! Now you can easily finish everything!

That is, the effort should be followed by encouragement, emotional reinforcement, it will allow maintaining the optimal energy tone of the child.

The second sentence takes a little less time than the first.

If you see that the child began to fidget, yawn, make mistakes - stop the clock. "Oh, I forgot, I have something left unfinished in my kitchen, wait for me." The child should be given a short break. In any case, you need to ensure that the first exercise is done as compactly as possible, in fifteen minutes, no more.

Turn

After that, you can already relax (the timer turns off). You are hero! You did the exercise in fifteen minutes! So, in half an hour we will do the whole Russian! Well, you already deserve compote. Instead of compote, of course, you can choose any other reward.

When you give a break, it is very important not to lose your mood, not to let the child be distracted during the rest. Well, are you ready? Let's do two more exercises the same way! And again - we read the condition aloud, we pronounce it, we write it.

When the Russian is finished, you need to rest more. Stop the timer, take a break of 10-15 minutes - like a school break. Agree: at this time you can’t turn on the computer and TV, you can’t start reading a book. You can do physical exercises: leave the ball, hang on the horizontal bar.

Second subject

We do the same math. What is given? Open textbook. Let's start time again. Separately, we retell the conditions. We pose a separate question that needs to be answered.

What is asked in this problem? What is needed?

It often happens that the mathematical part is perceived and reproduced easily, but the question is forgotten, formulated with difficulty. The question should be given special attention.

Can we answer this question right away? What needs to be done for this? What do you need to know first?

Let the child most in simple words tell you what needs to be done in what order. At first it is external speech, then it will be replaced by internal. Mom should insure the child: in time to hint to him that he went the wrong way, that it is necessary to change the course of reasoning, not to let him get confused.

The most annoying part math task are the rules for solving problems. We ask the child: did you solve a similar problem in class? Let's see how to write so as not to make a mistake. Let's take a look?

You need to pay special attention to the recording form - after that it costs nothing to write down the solution to the problem.

Then check. Did you say you need to do this and that? Did it? And this? It? Checked, now you can write the answer? Well, how long did the task take us?

How did you do it in such a short amount of time? You deserve something delicious!

The task is done - we take up the examples. The child dictates and writes to himself, the mother checks the correctness. After each column we say: amazing! Are we taking on the next column or compote?

If you see that the child is tired - ask: well, will we work some more or will we go to drink compote?

Mom should be in good shape on this day herself. If she is tired, wants to get rid of it as soon as possible, if her head hurts, if she cooks something in the kitchen at the same time and runs there every minute - this will not work.

So you need to sit with the child once or twice. Then the mother should begin to systematically eliminate herself from this process. Let the child tell his mother everything semantic part in your own words: what to do, how to do it. And the mother can go away - go to another room, to the kitchen: but the door is open, and the mother imperceptibly controls whether the child is busy with work, whether he is distracted by extraneous matters.

It is not necessary to focus on mistakes: it is necessary to achieve the effect of effectiveness, it is necessary that the child has the feeling that he is succeeding.

Thus, early detection of ADHD in children will prevent future learning and behavioral problems. The development and application of complex correction should be carried out in a timely manner, be of an individual nature. Treatment for ADHD, including drug therapy, should be long enough.

Prognosis for ADHD

The prognosis is relatively favorable, and in a significant proportion of children, even without treatment, symptoms disappear during adolescence. Gradually, as the child grows, disturbances in the neurotransmitter system of the brain are compensated, and some of the symptoms regress. However, clinical manifestations of attention deficit hyperactivity disorder (excessive impulsivity, irascibility, absent-mindedness, forgetfulness, restlessness, impatience, unpredictable, rapid and frequent mood changes) can also be observed in adults.

The factors of the unfavorable prognosis of the syndrome are its combination with mental illness, the presence of mental pathology in the mother, as well as the symptoms of impulsivity in the patient himself. Social adaptation of children with attention deficit hyperactivity disorder can be achieved only if the family and school are interested and cooperate.

What's this?

Experts call the term “ADHD” a neurological behavioral disorder that begins in early childhood and manifests itself in the form of problems concentrating, increased activity and impulsiveness. The hyperactivity syndrome is where excitation always prevails over inhibition.

The reasons

Scientists, educators and doctors suggest that the appearance of ADHD symptoms depends on the influence of various factors. So, biological factors are divided into prenatal and postnatal period.

The causes of organic lesions can be:

• the use of large quantities of alcohol and smoking during pregnancy;
• toxicosis and immune incompatibility;
• premature, protracted birth, the threat of miscarriage and an attempt to terminate the pregnancy;
• a consequence of anesthesia and caesarean section;
• entanglement with the umbilical cord or incorrect presentation of the fetus;
• stress and psychological trauma mothers during pregnancy, unwillingness to have a child;
• any diseases of the child during infancy, accompanied by high fever, can also affect the formation and development of the brain;
• unfavorable psychosocial environment and hereditary predisposition;
• emotional disorders, increased anxiety, trauma.

There are also social reasons - these are the peculiarities of upbringing in the family or pedagogical neglect - upbringing according to the "family idol" type.

The appearance of ADHD is influenced by many social factors, both the child himself and the mother of the unborn baby.

signs

How can parents determine if their child has hyperactivity. I think at the initial stage of the definition it is very easy to do. It is enough to note the symptoms that your child has for a certain time.

Signs of inattention:

• dislikes noisy rooms;
• it is difficult for him to concentrate;
• he is distracted from the task, reacts to external stimuli;
• with great pleasure grabs the job, but often moves from one unfinished action to another;
• does not hear well and does not perceive instructions;
• has difficulty in self-organization, often loses his things in the garden or at home.

Hyperactive children are especially inattentive

Signs of hyperactivity:

• climbs on the table, cabinets, cabinets, on the street on trees, fences;
• more often runs, spins and spins in place;
• during classes, walks around the room;
• there are restless movements of the arms and legs, as if twitching;
• if he does something, then with noise and shouting;
• he constantly needs to do something (play, craft and draw) he does not know how to relax.

ADHD is also manifested by excessive activity in children

Hyperactivity affects the inability to restrain emotions

You can only talk about ADHD syndrome when your child has almost all of the above symptoms for a very long time.

The mental activity of children with ADHD syndrome is cyclical. The child can work well actively for 5-10 minutes, then there comes a period when the brain rests, accumulates energy for the next cycle. At this moment, the child is distracted, does not hear anyone. Then mental activity is restored, and the child is ready to work again within 5-15 minutes. Children with ADHD have "flickering attention", a lack of concentration without additional motor stimulation. They need to move, spin, and constantly turn their heads to stay 'conscious'.

In order to maintain concentration of attention, children activate the centers of balance with the help of physical activity. For example, they lean back on the chair so that the rear legs do not touch the floor. If their head is still, they will be less active.

How to distinguish ADHD from being spoiled?

First of all, let's remember that all children are born with a temperament already laid down by mother nature. And how it will manifest itself depends on the development of the baby, and on the upbringing of the parents.

Temperament directly depends on nervous processes, such as excitation and inhibition. At the moment, there are four types of temperament - these are sanguine, choleric, phlegmatic and melancholic. The main thing that parents should know is that there are no pure temperaments, just one of them prevails to a greater extent than others.

If your child is mobile when you are talking with friends on the street, or he throws tantrums in the store, and at that time you are busy choosing products, then this is a normal, healthy, active child.

But we can talk about hyperactivity only when the child is constantly running around, it is impossible to distract him, in the kindergarten and at home the behavior is the same. That is, sometimes the symptoms of temperament can indeed overlap with the symptoms of attention deficit hyperactivity disorder.

ADHD in children is recognized as high motor activity, quick excitability and excessive emotionality.

Parents share their experience of raising children with ADHD in the following video.

Classification of ADHD

The International Psychiatric Classification (DSM) identifies the following variants of ADHD:

1. mixed - a combination of hyperactivity with impaired attention - occurs most often, especially in boys;
2. inattentive - attention deficit prevails, more common in girls with violent imagination;
3. hyperactive - hyperactivity dominates. It can be a consequence of both the individual characteristics of the temperament of children, and some disorders of the central nervous system.

Symptoms in children of different ages

Symptoms of hyperactivity can appear even before the baby is born. Such babies can be very active in the womb. An overly mobile child is a very dangerous phenomenon, because its activity can provoke entanglement of the umbilical cord, and this is fraught with hypoxia.

For babies under 1 year old

1. Very active motor reaction to various actions.
2. Excessive loudness and hyperexcitability.
3. Speech development may be delayed.
4. Sleep disturbance (rarely in a state of relaxation).
5. High sensitivity to bright light or noise.
6. It should be remembered that the capriciousness of a baby at this age can be caused by malnutrition, growing teeth, and colic.

For babies 2-3 years old

• Restlessness.
• Fine motor disorders.
• Chaotic movements of the baby, as well as their redundancy.
• At this age, the signs of ADHD are activated.

Preschoolers

1. They are unable to concentrate on their business (listen to a fairy tale, finish playing a game).
2. In the classroom, he confuses assignments, quickly forgets the question asked.
3. It's hard to get to sleep.
4. Disobedience and whims.
5. Babies at the age of 3 are very stubborn, wayward, as this age is accompanied by a crisis. But with ADHD character traits intensify.

Schoolchildren

• Lack of focus in class.
• He answers quickly, without hesitation, interrupting adults.
• Experiencing self-doubt, low self-esteem.
• Fears and anxiety.
• Unbalance and unpredictability, changes in mood;
• Enuresis, complaints of pain in the head.
• Tics appear.
• Not able to long time calmly wait a long time.

Which experts should be contacted for help?

To confirm such a diagnosis, parents should first of all contact a neurologist. It is he who, having collected the entire history, after examinations and tests, can confirm the presence of ADHD.

A child psychologist conducts psychological diagnostics using various questionnaires and methods for examining mental functions (memory, attention, thinking), as well as the emotional state of the child. Children of this type are often overexcited and tense.

If you look at their drawings, you can see superficial images, lack of color solutions or the presence of sharp strokes and pressure. When raising such a baby, one should adhere to a single parenting style.

To clarify the diagnosis hyperactive child additional tests are prescribed, since various diseases can be hidden behind such a syndrome.

To establish or refute the diagnosis of ADHD, you should contact a specialist

Correction and treatment

Rehabilitation of a child with ADHD includes both individual support and psychological, pedagogical and medication correction.

At the first stage, a child psychologist and a neurologist conduct consultations, individual examinations, biofeedback technologies are used, where the child is taught to breathe correctly.

In the correction of ADHD, the entire social and related environment of a hyperactive child should interact: parents, educators and teachers.

Used to treat ADHD in children psychological tricks

Drug treatment is an additional, and sometimes the main method of correcting ADHD. In medicine, children are prescribed nootropic drugs (cortexin, encephabol), they have a beneficial effect on brain activity and are effective in cases of inattention. If, on the contrary, hyperactive symptoms predominate, then drugs that contain gamma-aminobutyric acid, pantogam, phenibut are used, they are responsible for inhibiting processes in the brain. It must be remembered that all of the above medicines can only be taken as directed by a neurologist.

Any medications are given to the child only as prescribed by the doctor.

It is important for parents to monitor the nutrition of the child.

• It is mandatory to take 1000 mg of calcium, necessary for the development of a growing organism.
• The need for magnesium ranges from 180 mg to 400 mg per day. It is found in buckwheat, wheat, peanuts, potatoes and spinach.
• Omega 3 is a special type of fatty acid which provides the passage of impulses to the cells of the heart, brain, so it is also important in the treatment of ADHD.

The main thing is that vitamins such as "choline" and "lecithin" are still present in the baby's nutrition - these are the protectors and builders of the nervous system. Products that contain these substances are very useful (eggs, liver, milk, fish).

A very good effect is observed after the use of kinesiotherapy- this is breathing exercises, stretching, oculomotor exercises. Timely massage courses (SHOP) of the cervical spine will also be useful, starting from an early age.

It will also be useful sand therapy, work with clay, groats and water, but these games must be played under the strict supervision of adults. Especially if the child is small. Now on the shelves of children's stores you can find ready-made kits for such games, for example, Kinesthetic Sand, a table for playing with water and sand. The best result can be achieved if parents begin treatment and correction in a timely manner at an early age, when symptoms are just beginning to appear.

Useful acquisitions very good effect on the psyche of the child

• Learn to follow the daily routine, for a child with ADHD this is very important, do all the routine moments at the same time.
• Create a comfortable environment for your child, where he can be active for his own good. Write down in sports sections, mugs and swimming. Protect from overwork, try to get enough sleep.
• When you forbid one thing, always offer an alternative in return. For example, at home you can’t play with the ball, but on the street you can, offer to play together.
• If possible, parents can attend behavioral programs that are held at the centers. There they will be taught how to properly interact with children, they will share the secrets of raising and developing such children. Also, such classes are held with children, both individually and in group form.
• To reinforce verbal instructions, use visual stimulation, pictures of actions.
• Children are very fond of stroking, massage each other, draw on the back with your hands.
• Listen to music. It has long been proven that classical music helps children focus and concentrate.
• W. Beethoven "Piano Concerto No. 5-6" controls all parts of your child's brain at the same time, stimulates speech skills, motor skills.
• A. Mozart: "Symphony No. 40 in G minor" trains the muscles in the ear, the sound activates motor and auditory functions.
• Parents in the home environment can correct children themselves with the help of games aimed at training one function.

Learn how to create a comfortable environment for a child with ADHD

Useful games

Attention Games

"Catch - do not catch." This is an analogue to everyone's favorite game "Edible - inedible". That is, one leading player throws the ball and says a word, for example, related to animals, and the second participant catches or discards it.

You can also play "Find the Difference"; "Forbidden Movement"; "Listen to the command."

Games to relieve emotional stress

• "Touch." With the help of the game, you teach your child to relax, relieve anxiety and develop his tactile sensitivity. Use for this miscellaneous items and materials shreds of fabric, fur, bottles made of glass and wood, cotton wool, paper. Spread it on the table in front of the child or put it in a bag. When he carefully examines them, invite him with his eyes closed to try to guess what object he took or touches. The games "Tender paws" are also interesting; "Talk with hands"
• "Cake". Invite your child to bake their favorite cake, play with his imagination. Let the child be the dough, depict the preparation of the dough using the elements of massage, stroking, tapping. Ask what to cook, what to add. This fun game relaxes and relieves stress.

Khaletskaya O.V.

What is Attention Deficit Hyperactivity Disorder?

Currently, this disease is referred to as "Attention Deficit Disorder" (ADD) and "Attention Deficit-Hyperactivity Disorder" (ADHD).

Attention deficit hyperactivity disorder (ADHD) is a condition that often occurs in childhood, characterized by the versatility of clinical manifestations and their significant impact on the entire subsequent neuropsychic development of the child.

For the first time in 1902, a lecture by Dr. George Frederic Still was published in the English journal LANCET. In this article, he described 20 young patients who were very aggressive, had behavioral disturbances, emotional disturbances. Dr. Still found that these children had a "moral control defect" which he believed was inherited in some cases, and in others the result of brain damage during pregnancy and childbirth and other pathologies. From that moment began the study of minimal brain dysfunction, which has been going on for more than 100 years.

Beginning in the 1950s, physicians and educators began to use the term "minimal brain dysfunction" to describe children with increased distractibility and hyperactivity. Hyperactivity, increased distractibility and impulsivity gave the name to these disorders as hyperkinetic syndrome in children.

It is known that the term "minimal brain dysfunction" was officially introduced in 1962 at a special international conference in Oxford. The term has since taken official status in the medical literature.

In the pedagogical literature, children with such disorders are often defined as children with specific learning difficulties - "Neurolologically Based Learning Disabilities" or "Specific Learning Disabilities" - SLD, or as children with specific developmental and learning disabilities - "Developmental and Learning Disabilities" - DLD.

At the same time, many authors note that the term MMD does not quite accurately and fully reflect the clinical manifestations that are observed in this condition, as well as the dynamism and diversity of the pathological process. In the 1980s, the term "minimal brain dysfunction" was replaced by the term "Attention Deficit Disoder" (ADD). In 1987, the name was changed again to reflect all the significant problems: Attention Deficit-Hyperactivity Disoder (ADHD). Given that minimal brain dysfunction is under study, different authors may describe this pathological condition using different terms (Silver, 1990).

The relevance of the problem of ADHD is determined by the significant frequency of these disorders - 5 - 15% among children of school age and 12 - 21% among children of preschool and primary school age. Conservative estimates of the prevalence of Attention Deficit Disorder among adults place the figure at 7%. Among American schoolchildren, attention deficit hyperactivity disorder occurs in 3-5%. At the same time, it was found that ADHD can serve as a favorable basis for the emergence of a number of mental illnesses and social maladaptation.

ADHD is a pathological condition that largely determines the contingent of children who are not ready for schooling or who find school maladjustment in the primary grades.

Children with ADHD have not only typical learning difficulties, but also behavioral deviations. Their behavior does not correspond to the age norm, therefore, in a regular school, they, as a rule, do not achieve results that correspond to their abilities. With increasing demands modern look life at a very early age, these children become constant objects of observation of pediatricians, neurologists and parents. Increased activity of the child, impaired attention, perception, fine motor skills, pronounced lability in communication and activity most often leads parents to a neurologist. A child with ADHD, who has normal abilities, is unable to acquire the necessary knowledge, lags behind in development, which is especially pronounced at primary school age.

All this emphasizes the relevance of this problem, dictating the need for further research. this disease from the standpoint of pediatrics and child neurology

What are the causes of Attention Deficit Hyperactivity Disorder?

The etiology of this pathological condition remains poorly understood. Currently, there are 3 main groups of causative factors:

• Biological factors:
• Organic brain damage in the early stages of its development
• genetic predisposition
• Socio-psychological factors
• A combination of a number of unfavorable factors.

In particular, it is believed that this disease is associated with organic damage to the brain in the early stages of its development. It is believed that ADHD develops as a result of moderate brain damage during pregnancy and childbirth. Indeed, these disorders can explain most cases of ADHD.

Unfavorable perinatal factors include prolonged intrauterine discomfort of the child due to the action of various factors, hypoxia, trauma during pregnancy and childbirth, the mother's use of drugs, toxins, physical and emotional trauma to the mother during pregnancy, lack of prenatal ties with the mother (when the child is psychologically is not desired).

Thus, the most common consequence of perinatal damage to the nervous system is ADHD.

In the etiology of ADHD, a large role is played by mild CNS damage in the prenatal period of a child's development, often unrecognized. It is noted that the degree of damage to the nervous system can be diffuse or highly selective, limited to damage to certain layers and zones of the central nervous system.

Attention is currently focused on the role genetic factors in the development of the disease. J.U.Crichton identifies the so-called constitutional type of minimal brain dysfunction. The author considers the presence of a family incapacity for certain forms of education to be an important proof of hereditary burden. The works of J.M. Finucci et al. several variants of hereditary burdening have been identified.

J.U.Crichton believes that the study of writing is the most reliable and extremely simple way to detect an almost compensated defect in older children with this pathology. In such patients, damage to other specific cognitive processes can also be detected, such as the evaluation of schematic images, the evaluation of the rhythm and musical structure of speech, face recognition, and recognition of social concepts. With age, such patients largely compensate for their defects. J.M. Finucci described cases where similar disorders were found in adults. This fact retrospectively testified that they had learning difficulties in childhood.

G.Weiss found that even under favorable conditions, children with the constitutional type of ADHD, becoming adults, continue to have serious language problems. The prognosis for children with school maladaptation is described in the work of S.Shouhaut and P.Satz, where the authors point to the persistence of various cognitive impairments at an older age. However, it should be remembered that the genetic predisposition is not the only acting factor, and the influence of the genetic predisposition of the parents manifests itself in a rather complicated way.

Attempts are being made to identify the gene responsible for ADHD.

In most cases, children have a combination of a number of unfavorable factors, when a hereditary predisposition is combined with organic brain damage, as well as with unfavorable environmental factors. . These combinations were most frequently observed in children with speech and behavioral disorders and specific learning difficulties.

So in the light modern knowledge the theory of a single factor that caused ADHD should be abandoned. Even if the history reveals probable cause damage, as a rule, one should never assume the presence of one factor, but one should always provide for the possibility of the influence of several factors affecting each other. Damage is most likely to occur in the brain at different stages of its development, under the influence of factors that differ in nature and intensity and affect different parts of the brain.

As a result, a very variegated picture of pathological manifestations is formed, reflecting the inadequate development of the functions of the central nervous system.

How does Attention Deficit Hyperactivity Disorder manifest itself?

The clinical picture of ADHD is extremely variable and diverse. The manifestations of the disease vary from case to case in proportion to the degree of impairment and depend on the age of the child.

The main clinical manifestations of this pathological condition include violations of behavior, attention and developmental disorders of the child.

Conduct violations appear in children as attention deficit hyperactivity disorder. Will the child have ADHD if there is no hyperactivity? Despite the fact that hyperactivity syndrome is the leading variant of behavioral disorders in patients, its absence does not contradict the diagnosis of ADHD. This pathological condition can occur without hyperactivity, the child may be hypoactive, but at the same time he has pronounced attention disorders, impulsivity, absent-mindedness and other manifestations.

In this regard, there are three subtypes of ADHD - hyperactive-impulsive, with predominantly attention disorders, and mixed (combined) type.

The American Psychiatric Association in 1994 formulated diagnostic criteria for this syndrome (Table 1). Clinical manifestations should be observed at least six months, cause a significant deterioration in the patient's quality of life, be present in at least two areas of life (eg, at home and at school), and are developmentally appropriate. The diagnosis must be differentiated from other problems of attention, behavior and learning.

Many psychological signs ADHD can be observed already in the early stages of a child's development, these manifestations can change with age.

In infancy, such children, as a rule, are very restless, are characterized by increased irritability, often scream, they have sleep and eating disorders.

Neuropsychic development at an early age often comes with a delay, and therefore the child in many respects depends on the environment and does not form adequate reactions to incoming influences.

The specific manifestations characteristic of a child with ADHD make it very difficult for the mother to form an even emotional attitude towards him. Even minor deviations in the behavior of an infant violate the mother's attitude towards him; so the child himself, by his behavior, creates a certain atmosphere for himself.

It is during this period that a young mother needs the help of a psychologist so that she understands the reasons for the child's behavior and correctly relates to the problems that have arisen.

As a rule, such assistance is not provided. Features of the child's behavior are explained by age factors and it is believed that they will disappear with time.

In the 1st year of life, such children have impaired motor development. Violations in the motor development of the child, his mobility, impulsivity, combined with awkwardness is the source of nervous tension mother trying to comfort him.

The awkwardness also manifests itself in the area of ​​fine movements, which is especially pronounced when writing at school.

Often there is a violation of speech development, children begin to speak later. At school age, there may be problems with learning to read - dyslexia.

At preschool age, typical manifestations of ADHD are revealed, while the development of the child occurs unevenly, with a lag in the formation of individual functions.

Our data indicate that the age stages of maturation of certain higher brain functions in healthy and sick children with ADHD are different, and in patients their development is somewhat delayed. The most important period for children with ADHD in terms of identifying and correcting disorders is the period of 5-6 years, when the development of higher brain functions is most intensive.

In patients with ADHD, by the age of 7, there is no complete maturation of higher brain functions. As a result, the child is not ready for school. Systematic loads at school, as a rule, lead in this group of children to the disruption of the compensatory mechanisms of the central nervous system and the development of a maladaptive school syndrome. Therefore, the decision on the readiness of a child with ADHD for school should be carried out strictly individually, taking into account the quantitative and qualitative assessment existing violations.

Patients with ADHD may experience impaired cognitive processes. These disorders are associated with disorders of auditory and visual perception, difficulties in the formation of concepts, infantilism and vagueness of thinking, which are constantly influenced by momentary impulses; not the last place is occupied by immaturity of speech, a limited vocabulary, agrammatisms, slowness of speech and other disorders of a social nature. Attention disorders and hyperactivity are also an obstacle to the successful completion of school requirements. Children, being in captivity of numerous external influences, cannot concentrate on the learning process. They often pay attention to minor phenomena and cannot get rid of it. The child is in constant motion, cannot sit. If hyperactivity extends to the area of ​​speech motor skills, the child shouts something out during the lesson or begins to speak impulsively when this should not be done.

The formation of emotional and social maturity is also impaired. A child with ADHD is not independent, is not capable of full self-service. He masters the role of a schoolboy with great difficulty.

Children with ADHD are characterized by reduced performance. They are not capable of continuous and purposeful work.

General lability, changes in the child's moods over short periods of time, low emotional stability leading to affect-type reactions, as well as the predominance of impulsive, uncontrollable reactions, lack of control over their own actions characterize children with ADHD as unprepared for school, who will have certain difficulties in adapting to school conditions and requirements.

All the aforementioned deviations are observed in individual children to an unequal degree, but the manifestation of at least some of them is enough to cause difficulties that will subsequently affect his further stay at school.

Children with ADHD are prone to accidents, indiscipline in all situations - at home, in games, at school. The natural consequence of this is the difficulties of schooling.

In addition to attention deficit hyperactivity disorder, patients tend to dyspraxia- violation purposeful action, motor awkwardness. Children with such disorders have a number of characteristic manifestations:

• They have difficulty mastering self-care skills (tying shoelaces, fastening buttons, etc.).
• Poor drawing and sketching.
• There is a disorganization of activities when dressing.
• A clumsy gait is characteristic.
• There are violations of the smoothness and sequence of movements, the transition from one movement to another is difficult.
• Complicated movements of the tongue and lips are disturbed.
• Impaired coordination of the right and left hand.

Widely considered in the literature issues of learning difficulties. Learning difficulties is a broad term that includes a heterogeneous group of impairments that manifest significant difficulties in understanding and using speech, reading, writing, and numeracy. Learning difficulties are disorders in which children with normal level intelligence cannot be adequately trained.

There are several subtypes of learning difficulties:

1. Reading difficulties (dyslexia)
2. Difficulties in writing
3. Difficulties in mastering mathematics.

The most common (more than 80%) are reading difficulties, the effectiveness of which depends on the speed of decoding and recognition of phonemes in single words.

Dyslexia has characteristic clinical manifestations, when a child reads:

• skips or confuses letters, syllables, endings,
• does not read the words to the end,
• skipping lines
• misplaces accents
• cannot retell what he has read, because reading is guessing,
• the phenomenon of "mirror reading" is possible.

The clinical manifestations of dysgraphia are as follows:

• the phenomenon of "mirror writing",
• illegible handwriting,
• skipping letters, syllables, underwriting endings when writing,
• violations of the agreement of words in sentences,
• confuses letters similar in spelling and spatial arrangement (i-sh, l-m, t-p, etc.)

Difficulties in mastering mathematics appear, as a rule, later, when the child moves on to subject education. Dyscalculia can be isolated, or it can occur as a result of a violation of the understanding of the logical structures of the tasks.

Children have the following symptoms:

• poorly differentiated numbers,
• automated account broken,
• poorly master mathematical operations - addition, subtraction, multiplication, division.

In addition to the learning problems listed above, children with ADHD may also have speech disorders. Typical clinical manifestations are as follows:

• Speech tempo disorders: takhilalia, bradilalia, etc.
• Violations of sound pronunciation with a preserved vocabulary (dysartharia or motor dyslalia).
• Speech disorders (stuttering).
• Speech perception disorders (sensory dyslalia).
• Difficulties in constructing phrases, distortion of the syllabic structure of the word, incorrect use of prepositions, verb forms, endings.

Early recognition of specific learning difficulties is important, and if not addressed, children may develop secondary emotional and behavioral problems.

Before entering school, a comprehensive examination of children with ADHD should become mandatory so that parents and teachers are informed in time about the possibility of difficult situations and can work with the child from the very beginning in a way that is consistent with his abilities and shortcomings. In some cases, it is possible to recommend a later admission to school, systematic, individual training that affects the development of the child in the right direction.

Persistent poor performance, knowledge own shortcomings lead to the creation of a negative self-image in the child. In this regard, several types of child reactions are possible.

Some children have aggressive reactions during school activities, games. This reaction is characteristic of a lower stage of development, in the form of primitive reactions, since the child is not able to find a way out of difficult situations.

The second possibility is escape. The child runs away from a situation with which he cannot successfully cope. The most specific form of flight is "going into sickness".

Regression or return to lowest level development is also a fairly common response of a child with ADHD. The child does not want to be big and independent, because this brings him nothing but trouble.

A common defensive response in children with ADHD is denial of difficulties and inadequate appreciation. real situation. The child represses too traumatizing reality from his consciousness. Where he always fails and cannot escape.

Currently, a new theory has emerged to explain the pathological manifestations of ADHD. According to Dr. Barclay (USA), the problem of ADHD is not that patients do what other children do not, but that other children have the ability to suppress such behaviors, i.e. something that children with ADHD cannot do. In his works, he described 4 main psychological characteristics that need to be paid attention to when diagnosing and treating ADHD.

• The first is the ability to hold an event in the brain for a long time, which allows a person to study and remember past experience. This makes it possible to anticipate the situation in the future. Children with ADHD cannot keep an event in the brain for a long time, compare it with past experience and anticipate the future unfolding of events, they live in the moment.
• The second feature is the inability to suppress the immediate emotional response and impulse.
• The third ability is the use of language as a means of communication. People exchange information, give instructions, plans before doing something. Children with ADHD do not have internal communication ability.
• The fourth is the ability to analyze and synthesize information that is impaired in patients.

According to this theory, ADHD is not a disorder of attention, it is a disorder of repression, which prevents the use of other abilities of children with ADHD. This is a much broader view of this pathological condition than just hyperactivity, impulsivity, impaired attention.

Also described are symptoms of ADHD such as stuttering, enuresis, hyperkinesis, syncope, cephalalgia, vegetative-vascular dystonia, maladjustment school syndrome, etc.

According to a number of researchers, by the age of 13-14, in some patients, with proper rehabilitation, compensation of clinical manifestations is achieved. However, other researchers argue that ADHD can progress during adolescence and adulthood and lead to antisocial behavior and delinquency, alcoholism and drug addiction.

Evidence has emerged that ADHD symptoms persist into adulthood in 11% to 50% of cases, thus a significant number of adults may have this disorder. Subsequent studies have found that adults with ADHD tend to have lower academic performance, job performance difficulties, and lower socioeconomic status. They are prone to antisocial personality disorders and drug addiction disorders. As in children, the diagnosis of ADHD in adults can be made based on DSM-IV criteria, while we must remember that some signs could be in childhood. These data indicate the need for early diagnosis and timely correction of the identified disorders in children with MMD in order to socially adapt and improve the quality of their subsequent life.

What research should be done on children with ADHD?

The diagnosis of ADHD is based on clinical and psychological-pedagogical examination. Unfortunately, there are no laboratory and instrumental criteria confirming the presence of the syndrome. An important role here is played by diaries and questionnaires filled out by parents and teachers, as well as computer tests to assess attention and the degree of impulsivity. In general, the diagnosis is usually made on the basis of a comprehensive examination, including:

• pediatric,
• neurological,
• pedagogical,
• speech therapy.

During a clinical examination, attention is drawn to the identification of dysembryogenesis stigmas in children, “small” developmental anomalies, which, according to a number of authors, are often associated with ADHD.

In addition to assessing the history data, the general condition of the child, it is necessary to conduct a special neurological examination. Conventional research is usually not enough, since patients do not have typical focal disorders. To detect changes that are difficult to detect and cannot be attributed to ordinary neurological syndromes, tests have been developed for a group of so-called subtle neurological signs and reflexes typical of this disease.

General somatic examination also implies a systematic observation of the curves of growth and body weight.

Neurophysiological diagnostics is not leading in the diagnosis of ADHD and is carried out according to indications. Electroencephalographic (EEG) studies are an adjunct to a neurological examination. It has been established that the frequency of EEG deviations in children with ADHD in different age groups ranges from 30 to 90%. Despite the inconsistency of literature data regarding electroencephalographic parameters in patients, most researchers note the presence of pathological changes in the bioelectric curve, which may indicate the role of an organic factor in the pathogenesis of this pathological condition.

The leading methods for diagnosing this pathological condition are a number of test methods, including neuropsychological examination.

At present, the following test methods are most often used abroad: for assessing intelligence - children's intellectual scale Wechsler Intelligence Scal for Children-Wise; for examination and evaluation of visual-motor integration - Bender's test; to assess visual-auditory integration - the auditory-visual test (The test of auditory-visual integration); to assess attention - vigilance test; a test to assess speech and learning difficulties; to assess behavior - a scale of hyperactivity (Werry-Weiss-Peters Activity Scal, Brazelton Scal Data).

Domestic research uses neuropsychological techniques developed by A.R. Luria, which were specially adapted to childhood to study the state of higher brain functions. Neuropsychological examination makes it possible to clarify the topography of violations of higher brain functions, reveal deviations in the functioning of various parts of the brain, and also determine the degree of compensation for the identified violations, which is necessary in terms of pre-school preparation of the child. A neuropsychological study can be carried out by a neurologist, to whom the patient turned (for this purpose, research methods for neurologists have been specially developed). For a more detailed assessment, it is advisable to refer the child to a neuropsychologist, who will give recommendations for further development.

The leading place is given to clinical and psychological research aimed at identifying the qualitative structure of the defect and determining not only the actual, but also the potential development - the “zone of proximal development”. For these purposes, domestic authors use the method of "teaching experiment", i.e. providing the child with dosed assistance, the researcher seeks to determine his potential, which can make it possible to predict the further development of the subject.

How to treat patients with ADHD?

The main areas of treatment for ADHD include:

• Medical monitoring of the general condition of the child, identification and treatment of somatic disorders.
• In-depth examination by a neurologist using neuropsychological techniques (to identify the degree of development of higher brain functions) at 3, 5 and 7 years.
• Individual neuropsychological rehabilitation.
• Psychotherapeutic impact on the child, his family and the people in whose environment he lives.
• Appropriate school approach and organization of special education.
• Medical therapy.

It must be admitted that so far it has not been found effective method treatment of disorders inherent in minimal brain dysfunction. The search is by trial and error. In general, the prognosis for this disorder is good.

Treatment should include medical, psychological and pedagogical correction, as well as behavioral correction. Moreover, parents play a very important role in the implementation of therapy.

Emphasis should be placed on methods pedagogical impact- drawing up individual training programs together with parents and teachers, talking with parents. They must clearly understand:

1. Hyperactive behavior is not a fault. It is caused by a violation of attention and self-control, often congenital.
2. The prognosis is more favorable if parents are able to calmly and warmly treat the child.
3. Children with this condition need extra help at home and at school.
4. In some hyperactive children, psychological difficulties persist into adulthood.

When counseling parents, it is important to encourage them to focus on positive feedback, on providing support to the child in cases where he is able to be attentive. Punishment must be avoided.

Parents should discuss the problem with school teachers in order to minimize the influence of external distractions (for example, it is advisable to put the child in the first desk). Teachers should keep in mind that such children learn material in small parts, and immediate encouragement helps to increase their attention. The teacher's individual appeals to the child in the classroom can be of great benefit.

Pedagogical measures set as their main task both the correction of behavior and the correction of violations that determine the specific difficulties in teaching children with ADHD. Corrective education should be combined with medical and recreational activities and an individual approach to learning, taking into account the difficulties that are characteristic of each child.

If a lag in the development of higher brain functions is detected based on the results of a neuropsychological examination, it is necessary to carry out rehabilitation measures that contribute to the development of lagging mental functions and prepare the child for schooling. For this purpose, developing games are selected.

Thus, neuropsychological research allows to reflect a complete picture of the child's strengths and weaknesses, which is communicated to parents and other interested parties. Parents are also informed of detailed recommendations for correcting the identified violations. The recommendations indicate realistic proposals for a training program, rehabilitation programs, as well as a strategy for managing his behavior. In addition, the issue of the possibility of studying at school for 6-7-year-old children is being resolved.

Observing and examining the child in dynamics, the doctor must control all changes and make corrections in restorative education.

If during the examination violations in the development of speech are detected - general underdevelopment of speech, stuttering, dyslalia, dysarthria - the child is sent to a speech therapist for corrective work.

Psychological and psychotherapeutic influences include behavior correction, correction of emotional and volitional disorders, family and individual psychotherapy.

According to Barkley R.A. (1990), the correction of violations in a child will be effective if rehabilitation programs are carried out in the place, at the time and in the environment where these violations are recorded. Taking children out of the classroom and placing them in specialized centers for treatment for several weeks may not help the child, as the center is far from where the problem occurs.

Behavior correction in children with ADHD includes a properly organized daily routine, as well as a number of special activities. It is known that hyperactivity syndrome is most often detected in this disease. Children are restless, overly mobile, their attention is disturbed, they are emotionally labile, irritable. For children with this type of behavioral disorder, games aimed at developing and strengthening active inhibition are recommended. It is recommended to hold the following collective and individual games: “Freeze”, “Morning, afternoon, evening, night”, “The sea is worried ...”. The decrease in motor disinhibition is facilitated by the fact that children are given the opportunity to realize the need for movement during the day. But after a mobile game, a short-term game must necessarily be carried out, which contributes to the transition from a state of excitement to rest. It could be a game of "Train". The composition of the children-"wagons" gradually slows down, approaches the big station and goes to rest ... Then you can invite the child to play board game or educational games.

With another type of behavioral disorder - hypoactivity - there is lethargy, a decrease in interest in the environment, passivity. In this case, it is necessary to reduce the child's stiffness, self-doubt, fear of a possible mistake. In this case, games for the development of communication of the child are recommended. If possible, it is recommended to attend clubs and sports sections with the child, in which significant head injuries are excluded.

Currently, a promising method of rehabilitation is music therapy, which has a psychosensory-emotional impact. This technique involves listening to a music program in a tape recording, as well as singing songs. Music therapy relieves emotional tension, anxiety, develops auditory perception and improves overall well-being. Music therapy programs are selected individually, taking into account the age of the child, clinical manifestations. The duration of the session and the duration of the course are also individual.

Withdrawal physical tension, impulsiveness compensation is well promoted by sports and other types of physical activity. Physical education for children with ADHD has proven itself well. In their very various forms it is one of the most important methods of therapeutic influence. Not only individual lessons are recommended, but also joint lessons of parents with children. Physical education is aimed at developing motor skills and sensorimotor skills, balance, and the ability to change position correctly. The course also includes exercises for muscle relaxation and general sedation, which allows the patient to achieve relaxation. Exercises to music have a beneficial effect, where the therapeutic effect is achieved through a combination of movements with the perception of music. It is advisable to combine physical education with general strengthening massage, which also has a sedative effect.

Medical treatment is appointed only in case of pronounced social maladaptation of the child. The goal of drug treatment is to level out behavioral disorders, correct learning difficulties and manifestations of neurosis-like disorders.

When prescribing drugs, remember the following:

• Drug therapy should not be considered a panacea.
• Before prescribing treatment, a comprehensive examination of the child is necessary.
• The effectiveness of treatment will be higher when the therapy is combined with other rehabilitation effects.
• Long-term dynamic monitoring of the child is necessary.
• Drug therapy should not be given unless there is evidence of a negative impact of behavioral and attentional disturbances on the child's learning and communication difficulties.

The drug component of treatment includes, first of all, the appointment of stimulating drugs and nootropic drugs. However, parents should understand that drug treatment is not a panacea for all problems. To correct the violations existing in the child, great efforts will be required on the part of parents and teachers.

The use of vitamins in the complex treatment of ADHD is currently being studied. In recent years, domestic researchers have obtained data on the effectiveness of the use of vitamin-mineral complexes and multivitamin preparations in the treatment of children with ADHD. In particular, the effectiveness of neuromultivit in the treatment of children with ADHD of school age has been shown. This indicates the expediency of including multivitamin complexes in the protocols for the treatment of patients.

According to all clinicians, ADHD requires long-term treatment, and this stimulates the search for new non-traditional methods treatment of this pathological condition.

Patients with ADHD should be registered with a neurologist and pediatrician for at least 8 years, and if clinical manifestations persist, even longer. Examinations of patients should be carried out at least 2 times a year, if necessary - once every 3 months and more often.

In addition to specific neurological measures, it is important to dynamically monitor the child by a pediatrician to identify and treat somatic disorders.

It should be emphasized that the rehabilitation of patients with ADHD should be early, when the compensatory capabilities of the child's brain are still great and a persistent pathological stereotype has not yet formed. The dependence of the effectiveness of treatment on the age of the child is confirmed by our studies.

In addition, an important aspect of rehabilitation is the regularity of therapy. The dependence of the dynamics of the pathological process on the regularity of the therapy has been proven by our studies. Moreover, the frequency of therapy depends on the severity of the clinical manifestations of the disease and may be different for each patient.

Clinical manifestations of ADHD can be corrected if rehabilitation interventions are started from the early preschool age, when the compensatory capabilities of the brain are great and a persistent pathological stereotype has not yet formed. In the absence of rehabilitation measures, with the growth of the child, defects in the development of higher brain functions and behavioral problems worsen, which subsequently leads to difficulties in schooling. Therefore, it is very important to conduct dynamic monitoring of the condition and development of children, starting from an early age, and timely prescribe corrective therapy.

Table 1.

Diagnostic criteria for attention deficit hyperactivity disorder according to the DSM-IV classification

(Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Copyright 1994 American Psychiatric Association)

A. Diagnosis requires the presence of the following symptoms listed in sections 1 and 2:

1. Six or more of the listed symptoms of inattention that persist for at least 6 months and are severe enough to indicate a lack of adjustment and non-adaptation to normal age characteristics.

attention deficit

1. Frequent mistakes due to inattention.
2. Frequent difficulties due to the need to maintain attention for a long time.
3. Often it seems that the child does not listen to the speech addressed to him.
4. Failure to follow instructions and fail to complete homework.
5. Difficulties in scheduling work time and homework.
6. Frequent avoidance of tasks that require prolonged mental stress.
7. Frequent loss of things.
8. Easily distracted.
9. Often shows forgetfulness in everyday situations.

2. Six or more of the listed symptoms of hyperactivity and impulsivity that persist in the child for at least 6 months and are so pronounced that they indicate a lack of adaptation and inconsistency with normal age characteristics.

Hyperactivity

1. Fussiness and frequent restlessness.
2. Often gets up from his seat during class or in other situations where he needs to stay still.
3. Often shows aimless motor activity.
4. Can't usually be quiet.
5. Frequent behavior "like clockwork".
6. Frequent instances of rapid and excited conversation.

Impulsiveness

1. Often answers questions without thinking, without listening to them to the end.
2. Inability to wait long and patiently.
3. Frequent attempts to offend or interrupt peers in conversation.

B. The onset of clinical manifestations in the child under 7 years of age.

C. Problems associated with the above symptoms occur in two or more settings (eg, school and home).

D. There is strong evidence of clinically significant impairments in social contact or schooling.

E. The existing disorders are not associated with previous developmental disorders, schizophrenia and other mental illnesses and conditions (mood disorders, anxiety states and etc.)