Attention deficit and hyperactivity disorder
This is not a disease you need to know a massive amount about but you will need to be aware of it. Basically, if somebody says "ADHD" and you stare blankly back at them like some sort of a moron (or medical student), it won't look good.
Definition
Developmentally inappropriate level of attention and/or hyperactivity present before the age of 7 years. This is pretty much a textbook definition.
Epidemiology
Estimates vary as to its prevalence given a wide variety of diagnostic criteria but it is somewhere around 10-50/1000 children. The ratio is boys:girls 4:1 (which probably isn't surprising if you ever went to school or have met boys under the age of 7)
Clinical Features
There are a huge number of clinical but basically it comes down to three things: inattention, hyperactivity and impulsivity.
Yes, it is difficult to differentiate between an unruly child and one who suffers from ADHD but the disorder is where this becomes far worse that what could be considered unruly. In terms of inattention this would be things like:
- lots of careless mistake in schoolwork
- low attention span when playing
- not seeming to listen
- difficulty following task and with organisation
- easily distracted
Under the "hyperactivity" banner the following should be considered:
- fidgets in seat
- leaves class when should be seated
- runs and climbs things in inappropriate situations
- difficulty in keeping quiet
And finally the "impulsivity" symptoms would be:
- blurts out answer before question are finished
- difficulty waiting turn
- interrupts
Obviously, these things are subjective but there are scoring questionnaires which are given to parents in order that the level of attention deficit and hyperactivity can be measured in a more objective (though not completely objective) manner.
Management
Ideally, the management would consist of both drugs and psychotherapy. However, drugs alone are more effective than psychotherapy alone if the choice has to be made.
First-line management is to get teachers and parents to use what are effectively self-help techniques on concentration skills, quiet self-occupation... things in that sort of general area. This includes increasing self-esteem as often these kids aren't happy as they're constantly doing things wrong.
Drugs
If this fails, the next option is tablets and this will be either methylphenidate (better know as Ritalin), dexamphetamine and clonidine (although the latter is a relatively new treatment). The first two are stimulants but quite how they work is in already-hyperactive children to increase concentration is not well understood. They just do! Get over it!
Psychotherapy
Psychologist are hard to come by in the NHS with waiting list of up to 18 months not being uncommon. The form of therapy that will be of use depends very much on the child although family therapy is often useful.