in the hyperactive impulsive type, there must be 4 symptoms of hyperactive impulsivity for 6 months. In order to diagnose the combined type, 6 or more symptoms of inattentive and 6 or more symptoms of hyperactivity impulsivity must be persisted for 6 months or more. According to faranone 1998, they are likely to develop conduct problems, attend special education classes and have poor social skills. According to barkley 1989, they are 3-6 time more in males than in females.
The prevalence rate varies between 2-7% in USA, Germany and New Zealand but the rate is higher in india and china.
According to Barkley 1996, the DSM-IV criteria have no age and gender adjustments. It also doesn’t not include a guideline about appropriate behaviour.
According to barkley 40% of parent with children with adhd have similar symptoms. 35% of siblings are also affected as well. Twin studies by martin 2002 found a 70-80% concordance risk in MZ twins. This clearly highlights a large genetics components of ADHD. Feingold 1973, suggested flavour, colouring and additives are contributing factors however the US govt confirmed no dietary links.
Before treatment commence, professionals establish the type of adhd and the severity of the symptoms. Bradley 1938 suggested there are improvements with amphetamines but medication is not always effective. Psychotherapy/counselling is used to teach the child new skills, it also helps to decrease impulsivity and aggressive behaviour. Play therapy is sometimes used in young infants to measure impulsivity and also help improve the child’s social skills. Behaviour modification is by far the most effective treatment of adhd especially for the combined type as it targets desired behaviour to change. Parents are also advised in how to keep the home safe, and taught ways to respond to child’s behaviour, parenting classes. In schools, educational interventional programmes are designed to help child concentrate, teacher training, individual/group classes.
With age the hyperactivity but the attention problems persists into adolescence and adulthood. By adulthood 1/3 to ½ are normal. According to Gadow 2001, add in adults are recognised and may develop other psychiatric disorders.
Attachment
According to the attachment cycle, the baby has needs both physical and psychological (fear or sense of separation). The baby signals needs through attachment behaviour. The adult responds by eye contact. The baby needs are met and child is relieved, relaxed. Through their first attachment, the child learns things about themselves; I am loveable and can influence things. About others, others love and are concerned about me therefore are available to me. They learn about how the world will be like whether it is a safe or scary place.
As we grow older, we use this idea to make sense of every situation and relationship. For us all our early influence ill influence our view of the world and our expectations later in life. These views can change as we have new experiences but this takes time as many people find it difficult to let go of early views.
Children gain many things from forming attachments such as knowing right and wrong, learning social skills, cope better with stress and frustration, gradually capable of taking care of themselves.
We are social beings therefore our brain develop through social relationships. An individual’s brain develop capabilities suited for the environment he/she is raised. These capabilities do not change to match new environment. at birth the limbic system is quite developed and can process intense emotional arousal. The cortex and its pathways at birth is relatively undeveloped and cannot process emotion at the stage. Babies can automatically regulate temperature at 2-3 months through sweating and 6-12 months through shivering. They learn this regulation of emotion from the primary care giver through attunement during the first 2 to 3 years.
Emotional regulation begins during attunement via a pricess called affect mirroring. Briefly before other responses, the attuned adult reflects the emotions of the child with facial expressions and tone of voice, then responds appropriately. This process continue from co-regulation through verbal labelling and overt soothing strategies. A frightened baby will be hugged, verbal explanations.
During socialisation, the carer have to educate or manage boundaries. I.e. if the child wants something he cant have, when the adult says no, this experienced as a scary breakdown in the relationship and the child is shamed. A competent adult will quickly sooth the child and fix the relationship reinforcing lesson learnt. During high arousal, the limbic system dominates the consciousness and the cortex shuts down. The cortex must be functioning before lesson can be learnt therefore by the child been soothed, emotional arousal is contained therefore regulation process can be learned.
Sensitive attunement creates a pathway between cortex and the limbic system which us responsible for self regulation of effect. This pathway appears to less well developed in people who were severely abused or neglected before the age of 2-3.
