Activity and attention disorders in children

Activity and attention disorders are a group of disorders united according to the phenomenological principle based on weakly modulated behavior with age-inappropriate hyperactivity, attention deficit, impulsivity, and lack of stable motivation for activities requiring volitional efforts.

This group of disorders is characterized by the absence of clear clinical boundaries and reliable diagnostic markers.

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Epidemiology

Epidemiological studies conducted in different countries demonstrate a wide range of indicators (from 1-3 to 24-28%) in the population. This may indicate real local causes leading to the growth of this mental pathology in specific regions. A significant part of the studies is poorly comparable due to differences in methodology and technical methods of implementation, diagnostic criteria, and heterogeneity of the studied groups of children. Most psychoneurologists indicate 3-7% of school-age children. Hyperkinetic disorders are found in boys 4-9 times more often than in girls.

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Causes Activity and attention disorders in children

The etiology has not been fully established. There are three groups of factors that can cause the development of the syndrome - medical and biological or cerebro-organic factors, genetic and psychosocial. The independent significance of psychosocial factors is questionable; most often they enhance the manifestations of the syndrome of genetic, cerebro-organic or mixed genesis.

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Pathogenesis

The results of biochemical studies have shown that the main neurotransmitter systems of the brain (dopaminergic, serotonergic and noradrenalinergic) play an important role in pathogenesis. At the same time, the presence of fundamental differences in the exchange of monoamines in this pathology was established. The ambiguity of biochemical indicators is explained by the pathogenetic heterogeneity of the syndrome.

Pathological changes are recorded in various areas of the brain - the prefrontal zones of the cerebral cortex, the posterior association center, the thalamus region, and the conduction pathways.

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Symptoms Activity and attention disorders in children

Clinical manifestations vary in different age groups (preschool children, schoolchildren, adolescents, adults). There is evidence that 25-30% of children retain the main manifestations of the syndrome as adults.

Preschool children differ from their peers by their high motor activity already in the first years of life. They are in constant motion, run, jump, try to climb where they can, grab everything that appears in front of their eyes with their hands, without thinking, break and throw objects. They are driven by tireless curiosity and "fearlessness", because of which they often find themselves in dangerous situations - they can fall into holes, get an electric shock, fall from a tree, get burns, etc. They cannot wait. The desire must be fulfilled here and now. When held back, refused, reprimanded, children throw tantrums or experience fits of anger, often accompanied by verbal and physical aggression.

Symptoms of impaired activity and attention

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Forms

The classification of hyperkinetic disorders is based on the ICD-10 criteria. The main division is carried out depending on the presence or absence of concomitant syndromes of activity and attention disorders, signs of aggressiveness, delinquency or dissocial behavior.

The diagnosis of "activity and attention disorder" (attention deficit hyperactivity disorder or syndrome; attention deficit hyperactive disorder) is used when the general criteria for hyperkinetic disorder (F90.0) are met, but there are no criteria for conduct disorder.

The diagnosis of hyperkinetic behavior disorder is made when the full criteria for both hyperkinetic disorders and behavior disorders (F90.1) are met.

According to the American classification DSM-IV, three forms are distinguished:

• with a predominance of hyperactivity/impulsivity;
• with predominantly attention deficit disorder;
• mixed, in which hyperactivity is combined with attention deficit.

A number of domestic researchers differentiate based on the clinical and pathogenetic principle. They distinguish encephalopathic forms, in the genesis of which early organic lesions of the central nervous system play a significant role, dysontogenetic forms with developmental asynchrony (as an age equivalent of developing psychopathies and character accentuations) and mixed variants.

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Diagnostics Activity and attention disorders in children

Currently, standardized diagnostic criteria have been developed, which are lists of the most characteristic and clearly traceable signs of this disorder.

• Behavior problems must have an early onset (before age 6) and be of long duration.
• The disorders require abnormal levels of inattention, hyperactivity, and impulsivity.
• Symptoms must be present in more than one setting (home, school, clinic).
• Symptoms are detected through direct observation and are not caused by other disorders such as autism, affective disorder, etc.

Diagnostics of activity and attention disorders

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Prevention

The earliest possible implementation of pathogenetically justified therapy, minimizing the influence of psychosocial factors that determine the further development of the psychopathological condition. The pediatrician's task is to recommend that the child's parents consult a psychiatrist or neurologist if the patient has signs of hyperactivity.

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