Alkhadra Hospital, Tripoli, Libya
JMJ Vol.3 No.1 (March) 2004: 5-8
This is the first in a series of reviews that aim for early recognition of ADHD, initiation of active multimodal treatment, raising the awareness and facilitates the understanding of the disorder. Most of us would never consider bad behaviour as a medical problem and many people would say that it is impossible to give a precise label to child’s behaviour because it is so complex, diffuse and unpredictable. Much of it is related to the setting and circumstances in which the child may find him/her self. Also every child is born with a unique personality and will react differently to any given set of conditions.
Historically, professionals have focused on different components of the pattern. Hyperactivity (hyperkinesis) was considered the dominant feature until the 1970s when a shift in research interest to inattention led to the adoption in 1980 of the term attention deficit disorder. This could exist with or without hyperactivity (ADD + H) in the American Psychiatric Association’s Diagnostic and statistical manual (DSM-111). When revised in DSM-III-R, this became attention deficit hyperactivity disorder (ADHD), a term which persists in the current DSM-IV. The WHO International Classification of Diseases (ICD) retained the emphasis on hyperactivity in both its 9th and 10th revision. The term hyperkinetic disorder (HD) is current in ICD-10. For both ADHD and HD the clinical elements required for the definition are essentially behavioural, in spite of the attention deficit concept. (5) ADHD is a condition that leads to behaviour problems because the brain doesn’t receive all the messages it should. It causes difficulties at home, in the school and in play. But with medicine and the right approach, children with ADHD can lead full lives. (7)Many parents and professionals do not like the idea of placing a label on a child. If a child is labelled “hyperactive” or is told that he has “ADHD”, they feel that there is a distinct possibility that he may live up to the definition by assuming the very image that they would prefer him to avoid. They fear
also that the child might use the label as an excuse for his behaviour, and be encouraged to deny responsibility for his own action; difficult children have a strong tendency to do this anyway. (1)When a child has ADHD it affects the whole family, it’s confusing for the child, stressful for the parents and difficult for brothers and sisters. (7)The hyperactive child presents a significant challenge for parents and teachers. Researchers have suggested that hyperactivity may be the most common, persistent problem of childhood. It is persistent or chronic because there is no cure and the many problems facing hyperactive children must be managed day in and day out throughout childhood and adolescence. It is important to understand that the hyperactive child is exhibiting the most common childhood difficulties in a greatly exaggerated form.
Dr. Keith Comers well-known researcher in the field of childhood hyperactivity has noted that evaluation for hyperactivity is complicated. There is no absolute diagnostic test for hyperactivity. It requires the careful collection of information from a variety of sources (i.e. parents and teachers), in a variety of ways. In addition, there are no positive markers in a child’s developmental history that will absolutely diagnose hyperactivity. Though certain early childhood developmental factors (i.e. difficult-to-comfort infant or the infant with sleep difficulty) may place children at risk.
Keywords: Attention Deficit Hyperactivity, children’s behaviour, hyperkinesis