Key Words: Attention
deficit hyperactivity disorder, children, behaviour therapy,
parent training.
Introduction
Attention deficit hyperactivity disorder (ADHD) is a common
behavioural disorder of childhood. It is a major public health
problem. Children with ADHD have significant impairment in
sustaining attention and this in turn will have negative
impact on the academic performance and social-emotional
development of the child [1]. Most of the children present to
child guidance clinic between the ages of 5-10 years. But ADHD
can be problematic in pre-school age group and can continue
into the adolescence. ADHD in childhood is a developmental
precursor of later antisocial disorder [2]. Hence early
behavioural interventions are necessary in the management of
children with attention deficit hyperactivity disorder. Parent
training programmes are interventions aimed at training
parents in techniques which enable them to manage children's
challenging behaviour [3].
Clinical Features
Attention deficit hyperactivity disorder can be of 3 types:
Predominantly hyperactive type, predominantly inattentive type
or combined type. To diagnose ADHD, the symptoms of
inattention and hyperactivity should persist for at least 6
months and it should be maladaptive and inconsistent with
developmental level.
The attentional difficulties in children include elements of
distraction, forgetfulness, disorganization, proneness to lose
things, avoidance of tasks requiring concentration such as
school work.
The symptoms of hyperactivity / impulsiveness include
fidgetiness, restlessness, excessive talk, running about
excessively, difficulty in playing quietly and difficulty in
awaiting turn. They may also have associated cognitive,
emotional and social problems like impaired sense of time,
problems with planning and memory, temper outbursts as well as
problems with peer group, teachers and family members.
More than 50% of children with attention deficit hyperactivity
disorder have comorbid behavioural or emotional disorders.
About 35% of ADHD patients have oppositional defiant disorder.
About 40% of adolescents with ADHD have comorbid conduct
disorder. Anxiety disorders co-occur with attention deficit
hyperactivity disorder in about 25% of children. About 60% of
ADHD children have comorbid learning problems.
Non medication treatment of ADHD
Many controlled trials have shown that behaviour therapy is
effective in the management of children with ADHD. Cognitive
behaviour therapy attempts to modify the dysfunctional
assumptions and maladaptive behaviour. Parent training is
found to be effective in improving the home functioning and
modifying the target behaviours. Family conflict is usually
seen in families of children with ADHD, for which family
therapy is needed. Poor parenting skills and the stress of
parenting a difficult child can be managed through family
treatment interventions. Poor academic achievement is common
among children with attention deficit hyperactivity disorder,
for which remedial education programs are necessary. Social
skills training is also found to be effective in the
management of children with ADHD.
Behaviour therapy and Parent Training in ADHD
Children with ADHD have significant problems with behavioural
disinhibition that affect their peer relationships. Behaviour
therapies for ADHD aim to help parents and teachers better
manage the behavioural problems of these children [4].
Evidence-based treatments for attention-deficit hyperactivity
disorder in children include parent training and behavioural
interventions. Behaviour therapy alone may be useful for
treating less pronounced ADHD symptoms [5].
Frolich et al [6] pointed out that cognitive behaviour therapy
(CBT) is an important component in the treatment of ADHD.
Parent management training is a useful adjunct to CBT and it
is effective in situations where children have problems of
self guidance. CBT with special focus on self-instructional
and self-management skills help in reducing academic problems
and aggressive behaviour in children with ADHD. After
cognitive behaviour therapy, the core symptoms of ADHD at home
and in school as well as the conduct problems get reduced [6].
Furlong M et al [7] in the systematic review including 10
randomized controlled trials and three quasi-randomised
trials, concluded that behavioural therapy and group-based
parenting interventions are effective for improving child
conduct problems and parenting skills. Behavioural therapies
evoke particular interest in the management of ADHD, as they
are often viewed more favourably by parents [8]. Randomized
controlled trial by Herbert SD et al provided support for the
effectiveness of the parenting program for reducing ADHD
symptoms and associated problems in preschool-aged children
[9]. Study by Curtis DF et al [10] examined classroom
behavioural outcomes for children with ADHD following their
participation in behavioural parent training and child-focused
behavioural activation therapy. Participants included students
aged 7-10 years diagnosed with ADHD-Combined Type. Results
indicated statistically significant improvements for
externalizing behaviours and inattention.
Conclusion
Attention deficit Hyperactivity disorder (ADHD) is
characterised by high levels of inattention, hyperactivity and
impulsivity that are present before the age of seven years and
seen in a range of situations which are inconsistent with the
child's developmental level. Children with ADHD have
significant impairments in behaviour and can experience
long-term adverse effects on academic performance, vocational
success, and social development. This in turn will have a
profound negative impact on the individuals, families and
society [1]. Evidence-based treatments for attention-deficit
hyperactivity disorder in children include psychosocial
interventions like parent training and behavioural therapies.
Behaviour therapy alone may be useful for treating mild ADHD
symptoms [5].
References
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32(5):565-73.
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