Signs of attention deficit as a pathological syndrome of mental development in children. Attention deficit hyperactivity disorder (hyperkinetic disorder)

Over the past decade, the number of diseases commonly called hyperactivity, or scientifically called attention deficit disorder in children, has increased. How to understand: the baby is sick or pedagogically neglected?

Attention deficit hyperactivity disorder (ADHD) is a medical diagnosis defined as a neurological-behavioral developmental disorder. Characterized by difficulty concentrating, excessive motor activity, disregard for accepted social norms, aggressiveness, and inability to control emotions.

The first signs appear in preschool childhood, but according to the American Psychiatric Association, diagnosis is allowed only from the age of twelve. According to a 2006 study, 3–5% of the American population, including adults, have the disease.

A treatment for the neurological cause of the disorder has not been found. In 30% of children, symptoms disappear with age, or children adapt to them. In case of maladjustment, a decrease in intellectual abilities and perception of information is observed. There are methods for correcting behavioral deviations.

Since the 70s of the last century, there have been debates regarding the reality of this disease. Many public figures, politicians, doctors and parents consider it a fiction. The UN Committee on the Rights of the Child has confirmed an increase in misdiagnosis and has recommended more research into methods for recognizing ADHD.

The disorder is divided into 3 types:

1. Attention deficit itself (ADHD - AD). Difficulty concentrating and remembering.
2. Hyperactivity and impulsivity (ADHD - HI, ADHD - G). Motor disinhibition, restlessness, and thoughtlessness of actions are observed.
3. Mixed type (ADHD - C). A combination of three signs.

Symptoms of the disease

Children who do not have this disease are often called hyperactive. The reason lies in the fact that signs of the disorder in small manifestations are characteristic of childhood: restlessness, difficulty concentrating with poor motivation, haste. And with a lack of education, they tend to worsen. This may be due to medical or parental error.

According to the 2007 guidelines for diagnosing ADHD:

• Diagnostics of behavior must take place in at least two environments (school – home – circle) of the older child school age;
• Long-term observation is necessary to determine the persistence of symptoms (at least six months);
• If the child’s development lags behind his peers;
• Behavioral disorders are accompanied by learning and communication difficulties.

Main signs of the disease

Absent-mindedness:

• It is difficult for a child to maintain attention on a task, to engage in activities that require long-term concentration, and is easily distracted.
• Often tries to avoid completing assignments that involve lengthy mental work (helping with housework, school homework).
• It is difficult to independently organize the implementation of some activity.
• Often loses necessary things, absent-minded.
• Cannot concentrate on details.

Impulsivity is insufficient control of actions when following instructions. An important symptom accompanying attention deficit in children:

• Quick reaction to the implementation of a task while ignoring or underestimating accompanying instructions.
• Inability to foresee the bad consequences of one's actions or circumstances.
• The desire to impress others (especially peers) with actions that are dangerous to their health and life (frequent poisoning, injuries).

Hyperactivity:

• Motor disinhibition. Constantly jumps around, fidgets in his chair, spins around.
• It is difficult for the child to sit in one place when necessary. During lessons he runs around the classroom.
• He plays loudly and is talkative.

ADHD symptoms appear in older adults preschool age. The child is restless, makes many aimless movements, and unceremoniously interrupts adults. It’s difficult to get your little one to prepare for school. Having sat down to study under my mother’s pressure, he is constantly distracted.

School-age children have problems mastering material due to their low ability to concentrate. Academic performance is below average, difficulties in relationships with peers. Conducting a lesson in a classroom with a child with attention deficit disorder is difficult. He constantly distracts others, spins around, interrupts the teacher, and is in a hurry to complete the task. Books and notebooks are forgotten in class. Despite the disinhibited behavior, junior schoolchildren do not show aggression.

Adolescence changes symptoms. External impulsiveness turns into internal anxiety and fussiness. The inability to independently plan time and organize activities leads to irresponsibility. Poor academic performance and problems communicating with classmates affect self-esteem, which leads to depression and short temper. The desire to occupy a significant position among peers can push one to take thoughtless risks, often resulting in injuries and bruises.

If the teenager does not outgrow the disease, it progresses into adulthood. Emotional instability and irritability persist. Chronic lack of punctuality, forgetfulness, inability to complete initiatives, and high sensitivity to criticism make him a bad employee. Low self-esteem prevents you from realizing your potential. People suffering from this disease often find an outlet in various addictions: alcohol, drugs. If you don’t engage in self-development, you risk finding yourself at the bottom of your life.

Causes of pathology

Experts have not yet clearly established the triggering factors for ADHD. Presumable ones are:

• Genetic background. It is assumed that the disorder is congenital and is associated with disruption of the central nervous system. nervous system. This is where scientists see the neurological root of the disease.
• Deteriorating ecology. Air poisoning from exhaust gases, water pollution from harmful household chemicals.
• Features of the course of pregnancy. Infectious and chronic diseases of the mother, alcohol consumption, smoking.
• Complications during childbirth: long, rapid, stimulation of labor, intoxication by anesthesia, entanglement of the fetus with the umbilical cord.
• Illnesses in the first year of life, accompanied by high fever, and taking potent medications.

Diagnostic methods

The medical community has been debating for half a century about effective ways to recognize ADHD. Scientists at Canada's McMaster University have confirmed that there are currently no specific tests or medical equipment that directly diagnose ADHD. In addition, the criteria for diagnosing the disease have changed during the existence of the diagnosis and differ in different countries.

American psychiatrists use two scales: Connors and Yale-Brown, which ask parents or teachers to evaluate the child’s behavior according to parameters characteristic of the disorder: inattention, hyperactivity and impulsivity. However, experts who criticize the diagnostic methods argue that the assessment of behavior on these scales is too biased, and the diagnostic criteria are so vague that it is possible to diagnose ADHD in any healthy child with “uncomfortable” behavior.

To avoid medical errors, consultation with several specialists is necessary, including a pediatrician, psychologist and pediatric neurologist. Additional medical examinations will be required: MRI of the brain, Doppler sonography, EEG, which will be the basis for a psychiatrist’s diagnosis of ADHD.

Treatment of the disease

To correct attention deficit in children, an integrated approach is required, including the eradication of neuropsychological and behavioral problems. Taking into account the characteristics and type of ADHD of the child, a personal rehabilitation program is selected. With timely consultation with a specialist and treatment, it is possible to reduce the symptoms of ADHD until recovery.

Drug therapy

It should be noted that the prescription of pharmacological correction is acceptable in cases where restoration of cognitive functions cannot be achieved with non-drug treatment.

Taking medications to improve brain function in children with attention deficit disorder is a fairly common practice in the United States. Medicines are divided into several groups:

1. Psychostimulants (Ritalin (methylphenidate), Amphetamine, Dexamphetamine). They have a powerful stimulating effect on the central nervous system: improve concentration, reduce manifestations of impulsivity. In the United States, Ritalin is commonly used to treat ADHD, although there is no evidence of effectiveness. Many experts consider it controversial, since long-term use of Ritalin leads to the development of psychosis, paranoid and schizophrenic tendencies (visual and auditory hallucinations, aggressiveness), and is addictive. An Australian study involving 2868 families and lasting 20 years showed the ineffectiveness of psychostimulant treatment for ADHD. In a number of countries, including Russia, methylphenidate (Ritalin) is prohibited.
2. Antidepressants: Imipramine, Thioridazine, Desipramine. Significantly improve attention, reduce hyperactivity, but have side effects on physical health with long-term use.
3. Nootropic drugs (Nootropil, Cerebrolysin, Piracetam). Neurometabolic stimulants that affect the cerebral cortex and enhance cognitive processes. They are considered low-risk psychopharmacological drugs, but can cause complications. Widely used in post-Soviet countries.

A significant disadvantage of drug therapy for ADHD is the short-term results of treatment: the child’s condition improves only while taking the drug and has no effect on recovery at all. The use of psychostimulants by adolescents with attention deficit disorder develops a tendency to take drugs.

Non-pharmacological therapy

ADHD can be treated without the use of medications. There are two non-drug methods for correcting the neurological side of the disorder:

1. Neuropsychological approach. Claims that certain physical exercises affect the functioning of the cortical structures of the brain, activate and fill mental processes with energy. Based on the teachings of A.R. Luria on the “neuropsychological developmental loop”. This support for children with attention deficit helps to develop self-control, arbitrariness, and increase learning efficiency.
2. Syndromic method. Restoration of the cervical spine damaged due to birth injuries, which normalizes blood supply to the brain.

In addition to the treatment methods described above, experts recommend:

• Yoga classes, meditation. Helps you relax, reduces impulsivity, improves blood supply to the whole body, including the brain.
• Special diet. Elimination of sugar, allergens, caffeine.

Behavior correction for ADHD consists of the following methods:

Cognitive psychotherapy is the most effective treatment used in the correction of mental disorders (neuroses, phobias, depression). Helps children with attention deficit problems who have problems communicating with peers successfully socialize. Impulsivity coupled with a lack of interaction skills leads to rejection, which exacerbates isolation.

Therapy includes personal and group sessions. Communication skills training helps develop the following communication abilities: the ability to build relationships, resolve conflicts, understand others, and control negative emotions. To successfully master the skills, you must attend at least 20 classes in a group consisting of 6–8 people. Personal cognitive behavioral therapy breaks up ineffective patterns of action and thinking. Helps children with attention deficit to reinforce the desired behavior.

• Family psychotherapy. Must be present in the treatment of ADHD in children. Spent with the whole family. Parents face their feelings of guilt for a “not that kind” child and learn to react correctly in life’s circumstances.

For attention deficit disorder in children, treatment must involve doctors, parents and teachers. The greatest burden falls on the family, whose members must have a good knowledge of the characteristics and methods of treating ADHD, and create conditions at home that are conducive to the child’s recovery:

• Love. Show tenderness and care. The baby needs to feel the support of loved ones.

Important! The feeling of pity is a bad ally. Do not free the student from various household chores, fueling his “special” status. He will begin to feel sorry for himself, which will negatively affect the dynamics of treatment.

Together, we can correct the child’s behavior and help him recover.

Attention deficit hyperactivity disorder is a disorder of neurological and behavioral development in children; the course of this disease is chronic. As a rule, the first symptoms of this disease appear in late preschool and school age. Many symptoms of ADHD are not “specific” to this disease, and can manifest themselves to one degree or another in absolutely all children. Children with ADHD primarily have difficulty concentrating, increased motor activity (hyperactivity), and exhibit impulsive behavior (almost uncontrollable).

Reasons for development

ADHD is a persistent and chronic syndrome for which there is no cure in modern medicine. It is believed that children can outgrow this syndrome, or adapt to its manifestations in adulthood.

In the 1970s, there was much controversy about ADHD among medical professionals, educators, parents, and politicians. Some said that this disease does not exist at all, others argued that ADHD is transmitted genetically, and there are physiological bases for the manifestation of this condition. A number of scientists prove the influence of climate conditions on the development of ADHD.

There is reason to believe that acute or chronic intoxication (drinking alcohol, smoking, drugs) during pregnancy and breastfeeding may subsequently have an impact on the manifestation of ADHD in children. Preeclampsia, toxicosis, eclampsia during childbirth, premature birth, intrauterine growth retardation, cesarean section, prolonged labor, late breastfeeding, artificial feeding from birth and prematurity are also risk factors for the development of this syndrome.

Traumatic brain injuries and past infectious diseases can influence the development of hyperactivity in children. With hyperactivity, the neurophysiology of the brain is disrupted; in such children, a deficiency of dopamine and norepinephrine is found.

Signs

It is customary to distinguish three types of ADHD: the case with attention deficit, the case with child hyperactivity and impulsivity, and the mixed type.

According to statistics from American scientists, this disorder is observed on average in 3-5% of American children; most often, signs of this disease appear in boys. Many signs of ADHD in children are not always detected. The first symptoms of hyperactivity manifest themselves in kindergarten and primary school. Psychologists should observe children in lessons at school, and how they behave at home and on the street.

Children with ADHD are not only inattentive, they are also very impulsive. They lack behavioral control in response to any demands. Such children quickly and independently react to any situation that arises, without waiting for instructions and recommendations from parents and other adults. Such children do not correctly evaluate teachers’ requirements and assignments. Children with hyperactivity cannot correctly assess the results of their actions, and what destructive or bad influence they can provide. Such children are very capricious, they lack a sense of fear, and expose themselves to unnecessary risks in order to show themselves off in front of their peers. Children with hyperactivity very often get injured, poisoned, and damage other people's property.

Diagnostics

According to international criteria, a diagnosis of ADHD can be given to children if they have the corresponding symptoms no earlier than 12 years of age (according to foreign publications, this diagnosis is also valid at the age of six). Signs of ADHD must appear in different settings and situations. To make a diagnosis of ADHD, six main symptoms (from the list below) must be present, and if signs of the disease persist beyond the age of 17, 5 symptoms are sufficient. Signs of the disease must appear consistently for six months or more. There is a certain gradation of symptoms. Inattention syndrome and hyperactivity disorder have their own symptoms, and they are considered separately.

Inattention

Increased activity in children with ADHD

Hyperactivity in children with ADHD manifests itself always and everywhere.

ADHD behavior can be “unbearable” for parents, teachers, and other family members. Most often, it is the parents who are blamed for the poor upbringing of their child. It is very difficult for parents themselves to deal with such children, and they constantly feel a sense of shame for the behavior of their son or daughter. Constant comments at school about the hyperactivity of a daughter or son, on the street - from neighbors and friends.

Having a child diagnosed with ADHD does not mean that the parents did not raise him well and did not teach him how to behave correctly. Parents of such children must understand that ADHD is a disease that requires proper treatment. Parents and the internal environment in the family will help a boy or girl get rid of increased hyperactivity, become more attentive, do better at school, and subsequently adapt to adult life. Every small man must discover your inner potential.

Children are in great need of parental attention and care. In the world of modern technology and if they have money, parents can buy their child any toy, the most modern phone, tablet and computer. But no modern “toys” will give your baby warmth. Parents must not only feed and clothe their children, they must devote all their free time to them.

Very often, parents get tired of their children with hyperactivity and try to shift all the worries about raising them to their grandparents, but this is not a way out of the current difficult situation. Parents of such “special” children should consult a psychologist and solve this problem together with teachers and medical workers. The sooner parents realize the seriousness of ADHD, and the sooner they turn to specialists, the better the prognosis for curing this disease.

Parents should arm themselves with knowledge about this disease. There is a lot of literature on this topic. Only in close cooperation with a doctor and teacher can one achieve good results in the treatment of this disease. ADHD is not a “label” and you shouldn’t be afraid of the word. You need to talk to the teachers at school about the behavior of your beloved child, discuss all the problems with them, and make sure that the teachers understand what is happening to their boy or girl.

The most common cause of learning problems and behavioral disorders in children is attention deficit hyperactivity disorder (ADHD). The disorder is observed mainly in schoolchildren and preschool children. Young patients with this diagnosis correctly perceive their surroundings, but are restless, show increased activity, do not complete what they start, and do not foresee the consequences of their actions. This behavior is always associated with the risk of getting lost or injured, so doctors regard it as a neurological disease.

What is attention deficit disorder in children

ADHD is a neurological-behavioral disorder that develops in childhood. The main manifestations of attention deficit disorder in children are difficulty concentrating, hyperactivity, and impulsivity. Neurologists and psychiatrists regard ADHD as a spontaneous and chronic disease for which an effective treatment has not yet been found.

Attention deficit disorder is observed mainly in children, but sometimes the disease manifests itself in adults. The problems of the disease are characterized by different degrees of severity, so it should not be underestimated. ADHD affects relationships with other people and overall quality of life. The disease is complex, so sick children have problems performing any work, learning and mastering theoretical material.

Attention deficit disorder in a child is difficulties not only with mental, but also with physical development. According to biology, ADHD is a dysfunction of the central nervous system (CNS), which is characterized by the formation of the brain. Such pathologies in medicine are considered the most dangerous and unpredictable. ADHD is diagnosed 3-5 times more often in boys than in girls. In male children, the disease often manifests itself as aggression and disobedience, in female children – inattention.

Causes

Attention deficit disorder in children develops for two reasons: genetic predisposition and pathological influence. The first factor does not exclude the presence of illness in the child’s closest relatives. Both distant and short-range heredity play a role. As a rule, in 50% of cases, a child develops attention deficit disorder due to a genetic factor.

Pathological influence occurs for the following reasons:

• maternal smoking;
• taking medications during pregnancy;
• premature or rapid labor;
• malnutrition of the child;
• viral or bacterial infections;
• neurotoxic effect on the body.

Symptoms of ADHD in children

It is most difficult to track the symptoms of the disease in preschool children from 3 to 7 years old. Parents notice the manifestation of hyperactivity in the form of constant movement of their baby. The child cannot find something exciting to do, rushes from corner to corner, and constantly talks. Symptoms are caused by irritability, resentment, and intemperance in any situation.

Once the child reaches 7 years of age, when it is time to go to school, the problems increase. Children with hyperactivity disorder do not keep up with their peers in terms of learning, because they do not listen to the material presented and behave uncontrollably in class. Even if they take on a task, they do not complete it. After some time, children with ADHD switch to another activity.

Reaching adolescence, the hyperactive patient changes. The signs of the disease are replaced - impulsiveness turns into fussiness and internal restlessness. In adolescents, the disease manifests itself as irresponsibility and lack of independence. Even at an older age, there is no planning of the day, time management, or organization. Relationships with peers, teachers, and parents deteriorate, which gives rise to negative or suicidal thoughts.

Common ADHD symptoms for all ages:

• impaired concentration and attention;
• hyperactivity;
• impulsiveness;
• increased nervousness and irritability;
• constant movements;
• learning difficulties;
• delayed emotional development.

Kinds

Doctors divide attention deficit disorder in children into three types:

1. Predominance of hyperactivity. More often observed in boys. The problem does not only occur at school. Wherever it is necessary to remain in one place, the boys show extreme impatience. They are irritable, restless, and do not think about their behavior.
2. Prevalence of impaired concentration. More common in girls. They cannot concentrate on one task and have difficulty following commands and listening to other people. Their attention is distracted by external factors.
3. Mixed appearance, when attention deficit and hyperactivity are equally expressed. In this case, the sick child cannot be unambiguously classified into any category. The problem is considered individually.

Diagnostics

Treatment for attention deficit disorder in children begins after diagnosis. First, a psychiatrist or neurologist collects information: a conversation with parents, an interview with the child, diagnostic questionnaires. A doctor has the right to make a diagnosis of ADHD if, for 6 months or more, the child has had at least 6 symptoms of hyperactivity/impulsivity and 6 signs of inattention, according to special tests. Other specialist actions:

• Neuropsychological examination. The EEG (electroencephalogram) brain function is studied at rest and while performing tasks. The procedure is harmless and painless.
• Pediatrician consultation. Symptoms similar to ADHD are sometimes caused by diseases such as hyperthyroidism, anemia and other medical conditions. Their presence can be excluded or confirmed by a pediatrician after a blood test for hemoglobin and hormones.
• Instrumental research. The patient is sent for ultrasound dopplerography (ultrasound Dopplerography of the vessels of the head and neck), EEG (electroencephalography of the brain).

Treatment

The basis of ADHD therapy is behavior correction. Drug treatment of attention deficit disorder is prescribed on an outpatient basis and in extreme cases, when the child’s condition cannot be improved without it. First, the doctor explains to parents and teachers the essence of the disorder. Conversations with the child himself, to whom the reasons for his behavior are explained in an accessible form, help improve the quality of life.

When parents understand that their baby is not spoiled or spoiled, but suffers from a neurological pathology, their attitude towards their child changes greatly, which improves family relationships and increases the little patient’s self-esteem. An integrated approach is often used to treat schoolchildren and adolescents, including drug and non-drug therapy. When diagnosing ADHD, the following methods are used:

1. Classes with a psychologist. The doctor uses techniques to improve communication skills and reduce the patient’s anxiety. A child with speech impairments is advised to work with a speech therapist.
2. Physical activity. Should be chosen for the student sports section, which does not provide for competitive activities, static loads, or demonstration performances. Best choice with attention deficit there will be skiing, swimming, cycling and other aerobic exercise.
3. Folk remedies. For ADHD, medications are prescribed for a long period, so from time to time synthetic drugs should be replaced with natural sedatives. Tea with mint, lemon balm, valerian and other herbs that have a positive effect on the nervous system have an excellent calming effect.

Treatment of ADHD in children with drugs

Currently, there are no medications that completely eliminate attention deficit disorder. The doctor prescribes a small patient one medication (monotherapy) or several medications (complex treatment), based on the individual characteristics and course of the disease. The following groups of drugs are used for therapy:

• Psychostimulants (Levamphetamine, Dexamphetamine). Medicines increase the production of neurotransmitters, which leads to normal brain activity. As a result of their use, impulsivity, depression, and aggressiveness decrease.
• Antidepressants (Atomoxetine, Desipramine). The accumulation of active substances in synapses reduces impulsivity and increases attention due to improved signal transmission between brain cells.
• Norepinephrine reuptake inhibitors (Reboxetine, Atomoxetine). Reduce the reuptake of serotonin and dopamine. As a result of taking them, the patient becomes calmer and more assiduous.
• Nootropic (Cerebrolysin, Piracetam). They improve brain nutrition, provide it with oxygen, and help absorb glucose. The use of this type of drug increases the tone of the cerebral cortex, which helps relieve general tension.

The most popular medications for the drug treatment of ADHD in children are:

• Citral. It is recommended for use in the treatment of pathology in preschool children. This is an analgesic, anti-inflammatory, antiseptic agent, which is prepared in the form of a suspension. It is prescribed to children from birth as a sedative and a medicine that reduces intracranial pressure. It is strictly forbidden to use the drug if you are hypersensitive to the components.
• Pantogam. Nootropic agent with neurotrophic, neuroprotective, neurometabolic properties. Increases the resistance of brain cells to toxic substances. Moderate sedative. During the treatment of ADHD, the patient's physical performance and mental activity are activated. The dosage is determined by the doctor in accordance with individual characteristics. It is strictly forbidden to take the drug if you have an individual intolerance to the substances included in its composition.
• Semax. A nootropic drug with a mechanism of neurospecific effects on the central nervous system. Improves cognitive (cognitive) processes of the brain, increases mental performance, memory, attention, learning ability. Use in individual dosage prescribed by the doctor. The drug is not prescribed for seizures or exacerbation of mental disorders.

Physiotherapy and massage

A variety of physical therapy treatments are used in comprehensive ADHD rehabilitation. Among them:

• Medicinal electrophoresis. Actively used in children's practice. Vascular drugs (Eufillin, Cavinton, Magnesium) and absorbable agents (Lidaza) are often used.
• Magnetotherapy. A technique that is based on the effect of magnetic fields on the human body. Under their influence, metabolism is activated, blood supply to the brain improves, and vascular tone decreases.
• Photochromotherapy. A treatment method in which individual biologically active points or specific areas are exposed to light. As a result, vascular tone is normalized, central nervous system excitations are balanced, concentration and muscle condition are improved.

During complex therapy, acupressure is recommended. As a rule, it is done in courses 2-3 times a year of 10 procedures. A specialist massages the collar area and ears. A relaxing massage is very effective, which doctors advise parents to master. Slow massaging movements can bring even the most restless fidget into a balanced state.

Psychological and psychotherapeutic methods

As already mentioned, the most effective therapy is psychological, but lasting progress may require several years of sessions with a psychologist. Specialists use:

• Cognitive-behavioral methods. Consists of forming with the patient different models behavior, subsequently choosing the most correct ones. The baby learns to understand his emotions and desires. Cognitive-behavioral methods help facilitate adaptation to society.
• Play therapy. There is a formation of attentiveness and perseverance in the form of a game. The patient learns to control increased emotionality and hyperactivity. The set of games is selected individually, taking into account the symptoms.
• Art therapy. Practicing various types of art reduces anxiety, fatigue, and frees you from excessive emotionality and negative thoughts. The realization of talents helps the little patient increase self-esteem.
• Family therapy. A psychologist works with parents, helping to develop the correct line of education. This allows you to reduce the number of conflicts in the family and make communication easier for all its members.

Video

Some people think it’s just a character, others think it’s a bad 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 concentrating and maintaining attention, learning and memory disorders, as well as difficulties processing exogenous and endogenous information and stimuli. This is one of the most common psychoneurological disorders in childhood, its prevalence ranges from 2 to 12% (on average 3-7%), more common in boys than in girls. ADHD can occur either alone or 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 noted from 3-4 years of age. But when a child gets older and enters school, he faces additional difficulties, since the beginning of schooling places new, higher demands on the child’s personality and intellectual capabilities. It is during the school years that attention disorders become obvious, 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 typically do poorly in school. In addition to learning difficulties, attention deficit disorder is manifested by motor hyperactivity, defects in concentration, distractibility, impulsive behavior, and problems in relationships with others. In addition to the fact that children with ADHD behave poorly and do poorly at school, as they get older, they may be at risk for developing deviant and antisocial behavior, alcoholism, and drug addiction. Therefore it is important to recognize early manifestations ADHD and know about treatment options. It should be noted that attention deficit disorder occurs in both children and adults.

Causes of ADHD

Reliable and the only reason 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 are the ones who determine changes in the central nervous system, disorders of higher mental functions and behavior that correspond to the picture of ADHD. results 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 the control of attention and the organization of behavior.

In many cases, additional influence on children with ADHD is exerted by negative socio-psychological factors (primarily intra-family), 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. The genes that determine predisposition to the development of ADHD (the role of some of them in the pathogenesis of ADHD has been confirmed, while others are considered candidates) include genes that regulate the exchange of neurotransmitters in the brain, in particular dopamine and norepinephrine. Dysfunction of the brain's neurotransmitter systems plays an important role in the pathogenesis of ADHD. In this case, the main significance is the disruption of synaptic transmission processes, which entail disconnection, interruption of connections between the frontal lobes and subcortical formations and, as a consequence, the development of ADHD symptoms. In favor of disorders of neurotransmitter transmission systems as a 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 the activation of the release and inhibition of the reuptake of dopamine and norepinephrine in presynaptic nerve endings, which increases the bioavailability of neurotransmitters at the synapse level .

In modern concepts, attention deficit in children with ADHD is considered as a result of disturbances in the functioning of the posterior cerebral attention system, regulated by norepinephrine, while the disorders of behavioral inhibition and self-control characteristic of ADHD are considered as a failure 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 in this case belongs to the right hemisphere); this system receives dense noradrenergic innervation from the locus coeruleus (locus coeruleus). Norepinephrine suppresses spontaneous neuronal discharges, thereby preparing the posterior cerebral attention system, which is responsible for orienting to new stimuli, to work with them. Following this, attention mechanisms switch to the forebrain control system, which includes the prefrontal cortex and the anterior cingulate cortex. 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 cortex, ensuring a reduction in excessive neuronal activity.

Attention deficit hyperactivity disorder is considered a polygenic disorder, in which multiple simultaneous disturbances in the metabolic processes of dopamine and/or norepinephrine are caused by the influence of several genes, overriding 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 complex and variable inheritance, and at the same time as a genetically heterogeneous condition.

Pre- and perinatal factors plays an important role in the pathogenesis of ADHD. The formation of ADHD may be preceded by disturbances during pregnancy and childbirth, in particular gestosis, eclampsia, first pregnancy, maternal age 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 include maternal use of certain medications during pregnancy, alcohol, and smoking.

Apparently, early damage to the central nervous system is associated with 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). These data support the concept that the onset of ADHD symptoms is caused by disruptions in connections between the prefrontal regions and subcortical nodes, 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) was demonstrated in the frontal lobes, subcortical nuclei and midbrain, and the changes were most pronounced at the level 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 newborn period. Having close connections with the thalamus optica, 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.

Using positron emission tomography (PET), it was found that cerebral ischemia suffered at birth entails persistent changes in dopamine receptors of types 2 and 3 in the structures of the striatum. As a result, the ability of receptors to bind dopamine decreases and a functional deficiency 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-related dynamics with clinical outcomes, showed: children with ADHD showed a global decrease in cortical thickness, most pronounced in the prefrontal (medial and superior) and precentral departments. Moreover, in patients with the worst clinical outcomes during the initial examination, the smallest cortical thickness was found in the left medial prefrontal region. Normalization of right parietal cortical thickness was associated with better outcomes in patients with ADHD and may reflect a compensatory mechanism associated with changes in cortical thickness.

The neuropsychological mechanisms of ADHD are considered from the perspective of impairments (immaturity) of the functions of the frontal lobes of the brain, primarily the prefrontal region. Manifestations of ADHD are analyzed from the perspective of deficits in the functions of the frontal and prefrontal parts of the brain and insufficient development of executive functions (EF). ADHD patients exhibit “executive dysfunction.” The development of EF 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 fairly broad concept that refers to a 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 EF that are affected in ADHD are: impulse control, behavioral inhibition (containment); organization, planning, management of mental processes; maintaining attention, keeping away from distractions; inner speech; working (RAM) memory; foresight, forecasting, looking into the future; retrospective assessment of past events, mistakes made; change, flexibility, ability to switch and revise plans; choice of priorities, ability to manage time; separation of emotions from real facts. Some EF researchers emphasize the “hot” social aspect of self-regulation and the child’s ability to control their behavior in society, while others emphasize the role of regulation of mental processes—the “cold” cognitive aspect of self-regulation.

The influence of unfavorable environmental factors. Anthropogenic pollution of the natural 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 high levels of lead, arsenic, mercury, cadmium, nickel and other trace elements are formed. The most common neurotoxicant from the group of heavy metals is lead, and its sources of environmental pollution are industrial emissions and vehicle exhaust gases. Lead exposure to children can cause cognitive and behavioral disorders in children.

The role of nutritional factors and unbalanced nutrition. The emergence or intensification of ADHD symptoms can be facilitated by an imbalanced diet (for example, insufficient protein with an increase in the amount of easily digestible carbohydrates, especially in the morning), as well as a lack of micronutrients in food, including vitamins, folates, omega-3 polyunsaturated fatty acids (PUFAs) , macro- and microelements. Micronutrients such as magnesium, pyridoxine and some others directly affect the synthesis and degradation of monoamine neurotransmitters. Therefore, micronutrient deficiencies may influence neurotransmitter balance and, consequently, 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 may be associated not only with its insufficient intake from food, but also with an increased need for it during critical periods of growth and development, during severe physical and neuropsychic stress, and exposure to stress. Under conditions of environmental stress, nickel and cadmium act as magnesium-displacing metals along with lead. In addition to a lack of magnesium in the body, the manifestation of ADHD symptoms can be influenced by deficiencies of zinc, iodine, and iron.

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 information processing and EF.

ADHD symptoms in children

Symptoms of ADHD in a child may be the reason for an initial visit to pediatricians, speech therapists, speech pathologists, and psychologists. Often, preschool and school teachers first pay attention to the symptoms of ADHD. educational institutions, 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 and makes many mistakes.
Has difficulty maintaining attention when completing school and other tasks.
Does not listen to speech addressed to him.
Cannot follow instructions and complete a task.
Unable to independently plan and organize tasks.
Avoids activities that require prolonged mental stress.
Often loses his things.
Easily distracted.
Shows forgetfulness.
2a. Hyperactivity
Often makes restless movements with his arms and legs, fidgets in place.
Cannot sit still when needed.
Often runs around or climbs somewhere when it is inappropriate.
Can't play quietly and calmly.
Excessive aimless motor activity is persistent and 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 his turn.
Disturbs other people, interrupts them.
Talkative, unrestrained in speech.

Mandatory 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 impairments: significant impairments in learning, social contacts, professional activity;
- other mental disorders are excluded: symptoms cannot be associated exclusively with the course of another disease.

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

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

Preschool age. Between the ages of 3 and 7 years, 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. Impulsiveness is expressed in the fact that he acts without thinking, cannot wait for his turn, does not feel restrictions in interpersonal communication, interfering in conversations and often interrupting others. Such children are often characterized as having little behavior or being too temperamental. They are extremely impatient, argue, make noise, shout, which often leads them to outbursts of severe irritation. Impulsivity may be accompanied by recklessness, resulting in the child endangering himself (increased risk of injury) or others. During games, energy overflows, and therefore the games themselves become destructive. Children are sloppy, often throw and break things or toys, are disobedient, do not obey the demands of adults, and can be aggressive. Many hyperactive children lag behind their peers in speech development.

School age. After entering school, the problems of children with ADHD increase significantly. The learning demands are such that a child with ADHD is unable to fully meet them. Because his behavior does not correspond to the age norm, he fails to achieve results in school that correspond to his abilities (at the same time, the general level of intellectual development in children with ADHD corresponds to the age range). During lessons, teachers are not heard, it is difficult for them to cope with the proposed tasks, since they experience difficulties in organizing the work and completing it, forget the terms of the task as they complete it, do not assimilate educational materials well and cannot apply them correctly. They quickly turn off from the process of doing work, even if they have everything necessary for this, do not pay attention to details, show forgetfulness, do not follow the teacher’s instructions, and do not switch well when the conditions of the task change or a new one is given. They cannot cope with homework on their own. Compared with peers, difficulties in developing writing, reading, counting, and logical thinking skills are much more common.

Problems in relationships with others, including peers, teachers, parents, and siblings, are constantly encountered in children with ADHD. Since all manifestations of ADHD are characterized by significant mood swings over different periods of time 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, communicate successfully and establish friendly relations with peers. In a group, he serves as a source of constant anxiety: he makes noise without thinking, takes other people’s things, and disturbs others. All this leads to conflicts, and the child becomes unwanted and rejected in the team.

When faced with such attitudes, children with ADHD often consciously choose to play the role of class jester, hoping to improve relationships with their peers. A child with ADHD not only studies poorly on his own, but often “disrupts” lessons, interferes with the work of the class, and therefore is often called to the principal’s office. In general, his behavior creates the impression of “immaturity”, inappropriate for his age. Usually only younger children or peers with similar behavior problems are ready to communicate with him. Gradually, children with ADHD develop low self-esteem.

At home, children with ADHD typically suffer from constant comparisons with siblings who behave well and do better academically. Parents are annoyed by the fact that they are restless, intrusive, emotionally labile, undisciplined, and disobedient. At home, the child is unable to responsibly carry out daily tasks, does not help parents, and is sloppy. At the same time, comments and punishments do not give the desired results. According to the parents, “Something always happens to him,” meaning there is an increased risk of injuries and accidents.

Adolescence. In adolescence, severe symptoms of 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 decreases significantly and is replaced by fussiness and a feeling of internal restlessness. They are characterized by lack of independence, irresponsibility, difficulties in organizing and completing assignments and especially long-term work, which they are often unable to cope with without outside help. Academic performance at school often deteriorates, since they cannot effectively plan their work and distribute it over time, and they put off doing necessary things from day to day.

Difficulties in relationships in the family and school, and behavioral disorders are increasing. Many adolescents with ADHD are characterized by reckless behavior involving unjustified risks, difficulties in following rules of behavior, disobedience to social norms and laws, and failure to comply with the demands of adults - not only parents and teachers, but also officials, such as school administrators or police officers. At the same time, they are characterized by weak psycho-emotional stability in the event of failures, self-doubt, and low self-esteem. They are overly sensitive to teasing and ridicule from peers who think they are stupid. Others continue to characterize the behavior of adolescents with ADHD as immature and inappropriate for their age. In their daily lives, they neglect the necessary safety measures, which increases the risk of injuries and accidents.

Teenagers with ADHD are prone to becoming involved in teenage gangs that commit various offenses, and they may develop a craving for alcohol and drug use. But in these cases, they, as a rule, turn out to be followers, submitting to the will of peers or people older than themselves who are stronger in character and without thinking about possible consequences of your actions.

Disorders associated with ADHD (comorbid disorders). Additional difficulties in 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 aggravation of the clinical manifestations of ADHD, worsening long-term prognosis and reduced effectiveness of treatment for ADHD. Concomitant behavioral disorders and emotional disorders associated with ADHD are considered unfavorable prognostic factors for long-term, even chronic, course of ADHD.

Comorbid disorders in ADHD are presented 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 accompanying ADHD disorders may include sleep disorders (parasomnias), enuresis, and encopresis.

Thus, problems in learning, behavior and emotional health may be associated both with the direct influence of ADHD and with comorbid disorders, which should be promptly diagnosed 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 must be confirmed (table above), including at least 6 manifestations of inattention, at least 3 of hyperactivity, and at least 1 of impulsivity.

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 teachers and psychologists should also be well acquainted with the diagnostic criteria for ADHD, especially since to confirm this diagnosis it is important to obtain reliable information about the child’s behavior not only at home, but also at school or preschool.

In childhood, conditions that mimic ADHD are quite common: 15-20% of children periodically exhibit forms of behavior that are externally similar to ADHD. 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 reasons and methods of correction. These include:

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

In addition, the diagnosis of ADHD should be based on the unique age-related dynamics of this condition.

ADHD Treatment

On modern stage It becomes obvious that treatment of ADHD should be aimed not only at controlling and reducing the main manifestations of the disorder, but also at solving other important problems: improving the patient’s functioning in various areas and his fullest realization as an individual, the appearance of his own achievements, improving self-esteem, normalizing the situation around him, including within the family, the formation and strengthening of communication skills and contacts with people around him, recognition by others and increasing satisfaction with his life.

The study confirmed the significant negative impact of the difficulties experienced by children with ADHD on their emotional state, family life, friendships, school work, and leisure activities. In this regard, the concept of an expanded therapeutic approach has been formulated, implying the expansion of the influence of treatment beyond the reduction of 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 a child with ADHD, which should be paid special attention both at the stage of diagnosis and treatment planning, and in the process of dynamic monitoring of the child and assessing the results of the therapy.

The most effective treatment 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 must 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 suffering from ADHD;
- developing parents’ skills in raising children with ADHD, including parent training programs;
- educational work with teachers, correction of the school education plan - through a special presentation of educational material and the creation of an atmosphere in the classroom that maximizes the opportunities for successful learning of children;
- psychotherapy for children and adolescents with ADHD, overcoming difficulties, developing effective communication skills in children with ADHD during special correctional classes;
- drug therapy and diet, which should be quite long-term, since the 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 school year.

Medications to treat ADHD

An effective drug specifically designed to treat ADHD is atomoxetine hydrochloride. The main mechanism of its action is associated with the blockade of norepinephrine reuptake, which is accompanied by increased synaptic transmission with the participation of norepinephrine in various brain structures. In addition, experimental studies revealed an increase under the influence of atomoxetine in the content of not only norepinephrine, but also dopamine 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 providing executive 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 weakening of the manifestations of ADHD. Atomoxetine has a beneficial effect on the behavioral characteristics of children and adolescents with ADHD; its positive effect usually appears at the beginning of treatment, but the effect continues to increase over a month of continuous use of the drug. In most patients with ADHD, clinical effectiveness is achieved when the drug is prescribed in the dose range of 1.0-1.5 mg/kg body weight per day with a single dose in the morning. The advantage of atomoxetine is its effectiveness in cases of combination of ADHD with destructive behavior, anxiety disorders, tics, and enuresis. The drug has many side effects, so use is strictly under the supervision of a doctor.

Russian specialists traditionally use nootropic drugs. Their use in ADHD is justified, since nootropic drugs have a stimulating effect on insufficiently developed cognitive functions in children of this group (attention, memory, organization, programming and control of mental activity, speech, praxis). Taking into account this circumstance, the positive effect of drugs with a stimulating effect should not be perceived as paradoxical (given the hyperactivity present in children). On the contrary, the high effectiveness of nootropics seems natural, especially since hyperactivity is only one of the manifestations of ADHD and is itself caused by disturbances in higher mental functions. In addition, these drugs have a positive effect on metabolic processes in the central nervous system and promote the maturation of the inhibitory and regulatory systems of the brain.

Recent study confirms good potential hopantenic acid drug in the long-term treatment of ADHD. A positive effect 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 the drug hopantenic acid on adaptation and functioning disorders characteristic of children with ADHD in various areas, including behavioral difficulties in the family and in society, school studies, decreased self-esteem, and lack of development of basic life skills, has been confirmed. However, in contrast to the regression of the main symptoms of ADHD, longer periods of treatment were necessary to overcome adaptation disorders and socio-psychological functioning: a significant improvement in self-esteem, communication with others and social activity was observed according to the results of a parent survey after 4 months, and a significant improvement in behavioral indicators and school performance, basic life skills, along with a significant regression of risk behavior - after 6 months of use of the drug hopantenic acid.

Another direction of treatment for ADHD is to control negative nutritional and environmental factors that lead to the entry of neurotoxic xenobiotics into the child’s body (lead, pesticides, polyhaloalkyls, food coloring, preservatives). This should be accompanied by the inclusion in the diet of necessary micronutrients that help reduce ADHD symptoms: 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 detected in 70% of children with ADHD.

Magnesium is an important element involved in maintaining the balance of excitation and inhibition 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 control intracellular cascades; magnesium is a cofactor for catechol-O-methyltransferase, which inactivates excess monoamine neurotransmitters. Therefore, magnesium deficiency contributes to an imbalance of “excitation-inhibition” processes in the central nervous system 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 the high bioavailability of organic salts and the absence of side effects when used in children. The use of magnesium pidolate with pyridoxine in solution (ampule form of Magne B6 (Sanofi-Aventis, France)) is permitted from the age of 1 year, lactate (Magne B6 tablets) and magnesium citrate (Magne B6 forte tablets) - from 6 years . The magnesium content in one ampoule is equivalent to 100 mg of ionized magnesium (Mg2+), in one Magne B6 tablet - 48 mg Mg2+, in one Magne B6 forte tablet (618.43 mg magnesium citrate) - 100 mg 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 ampoule form of Magne B6 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 promotes longer (for 6-8 hours) retention of increased concentrations of magnesium in red blood cells, that is, its deposition.

The advent of combination preparations containing magnesium and vitamin B6 (pyridoxine) has significantly improved the pharmacological properties of magnesium salts. Pyridoxine is involved in the metabolism of proteins, carbohydrates, fatty acids, the synthesis of neurotransmitters and many enzymes, has neuro-, cardio-, hepatotropic, as well as hematopoietic effects, and helps replenish energy resources. The high activity of the combined drug is due to the synergistic action of the components: pyridoxine increases the concentration of magnesium in plasma and red blood cells and reduces the amount of magnesium excreted from the body, improves the absorption of magnesium in the gastrointestinal tract, its penetration into cells, and 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 makes it possible to successfully use their combination to normalize magnesium balance and prevent magnesium deficiency.

Combined intake of magnesium and pyridoxine for 1-6 months reduces symptoms of ADHD and restores normal magnesium levels in red blood cells. After just a month of treatment, anxiety, attention problems and hyperactivity decrease, concentration, accuracy and speed of completing tasks improve, and the number of errors decreases. There is an improvement in gross and fine motor skills, positive dynamics of EEG characteristics in the form of 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 the drug Magne B6 is accompanied by normalization of the concentration of magnesium in the red blood cells and blood plasma of patients.

Replenishment of magnesium deficiency should last at least two months. Considering that nutritional magnesium deficiency is the most common, when drawing up nutritional recommendations, one should take into account not only the quantitative content of magnesium in foods, but also its bioavailability. Thus, 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 worsening magnesium deficiency coinciding with the school period from September to May. Therefore, the use of combination drugs containing magnesium and pyridoxine is advisable during the school year. But, alas, you cannot solve the problem with medications alone.

Home psychotherapy

It is advisable to conduct any classes in a playful way. Any games where you need to hold and switch attention are suitable. For example, the game “find pairs”, where cards with images are opened and turned over one by one, 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 a shelter for a certain time, and you also need to figure out where to hide and change these places. All this is good training for programming and control functions, and it also occurs when the child is emotionally involved in the game, which helps maintain optimal wakefulness at this moment. And it is needed for the emergence and consolidation of all cognitive new formations, for the development of cognitive processes.

Remember all the games you played in the yard, all of them were 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 “don’t say yes and no, don’t buy black and white” - after all, this is a wonderful exercise for inhibiting a direct response, that is, for training programming and control.

Teaching children with attention deficit hyperactivity disorder

Children like these require a special approach to learning. Often children with ADHD have problems maintaining optimal tone, which causes all other problems. Due to the weakness of inhibitory control, the child is overexcited, restless, cannot concentrate on anything for a long time, or, on the contrary, 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 a rise in productivity, and then a decline again. The child cannot set tasks for himself, determine how and in what order he will solve them, complete this work without distraction and test himself. These children have difficulties when writing - missing letters, syllables, merging two words into one. They don’t hear the teacher or start 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 his own activities. While he does not know how to do this himself, these functions are taken on by his parents.

Preparation

Choose a day and address your child with these words: “You know, they taught me how to do my homework quickly. Let’s try to do them very quickly. Everything should work out!”

Ask your child to bring a briefcase and lay out everything they need to complete their homework. Say: well, let's try to set a record - do all the homework in an hour (let's say). Important: the time while you are preparing, clearing the table, laying out textbooks, figuring out the assignment is not included in this hour. It is also very important that the child has all the tasks written down. As a rule, children with ADHD do not have half of their assignments, and endless calls to classmates begin. Therefore, you can warn us 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 your diary and see what is assigned. What will you do first? Russian or mathematics? (It doesn’t matter what he chooses - it’s important that the child chooses himself).

Take a textbook, find an exercise, and I'll time it. Read the assignment out loud. So, I didn’t understand something: what needs to be done? Explain please.

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

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

It’s better to first do the first test action verbally: what do you need to write? Say it out loud, then write it.

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

You need to work slowly, not make mistakes: pronounce it as you write, is Moscow “a” or “o” next? Pronounce by letter, by syllable.

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 help maintain the child’s optimal energy tone.

You need to spend a little less time on the second sentence than on the first.

If you see that the child has begun to fidget, yawn, or make mistakes, stop the clock. “Oh, I forgot, I have something unfinished in the 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 about fifteen minutes, no more.

Turn

After this, you can rest (the timer turns off). You are hero! You did the exercise in fifteen minutes! So, in half an hour we will do all the Russian! Well, you've already earned compote. Instead of compote, of course, you can choose any other reward.

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

When 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 cannot turn on the computer and TV, you cannot start reading a book. You can do physical exercises: throwing a ball, hanging on a horizontal bar.

Second item

We do math the same way. What is asked? Open your textbook. We start time again. We retell the conditions separately. 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 and formulated with difficulty. You need to pay special attention to this question.

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

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

The most unpleasant part of a mathematical task is the rules for formatting solutions to problems. We ask the child: have you solved a similar problem in class? Let's see how to write so as not to make mistakes. Shall we 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. You said you need to do this and that? Did you do this? And this? This? Have you checked, can you write an answer now? Well, how long did the task take us?

How did you manage to do so much in such a time? You deserve something delicious!

The task is done - let's take on the examples. The child dictates to himself and writes it down, the mother checks for accuracy. After each column we say: amazing! Shall we take on the next column or compote?

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

Mom should be in good shape on this day. If she is tired, wants to get rid of it quickly, if she has a headache, if she is simultaneously cooking something in the kitchen and constantly running around - this will not work.

So you need to sit with the child once or twice. Then the mother must begin to systematically remove herself from this process. Let the child tell his mother the whole semantic part in his own words: what needs to be done, how to do it. And the mother can leave - go to another room, to the kitchen: but the door is open, and the mother quietly controls whether the child is busy with something, whether he is distracted by extraneous matters.

There is no need to dwell on mistakes: you need to achieve the effect of effectiveness, you need to give the child the feeling that he is succeeding.

Thus, early identification of ADHD in children will prevent learning and behavior problems in the future. The development and application of complex correction must be carried out in a timely manner and be individual in nature. Treatment for ADHD, including medication, must be long-term.

Prognosis for ADHD

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

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