Since the last twenty years centrality of Attention Disorders are often referred to as ADHD (attention deficit hyperactive disorders. This disorder is characterized by the inability of children to concentrate on something that is encountered, so that his attention span is very short time compared to other children that age, usually accompanied by symptoms hyperactive and impulsive behavior. These disorders can interfere with the child's development in terms of cognitive, behavioral, socialization and communication.
Hyperactivity disorder is a disorder that is often encountered in behavioral disorders in children. In recent years hyperactivity disorder is a problem that was highlighted and a major concern in the medical community nor the general public .. The incidence of this disorder is around 30-10%, in the United States around 3-7% while in Germany, Canada and New Zealand about 5-10%. Diagnosis and Statistics Manual (DSM IV) mentions the prevalence of the incidence of ADHD in school age children ranging from 3 to 5 percent. Incidence rate in Indonesia is still not a definite figure, meskipujh this disorder seems to appear quite a lot happening.
Sometimes a child is only considered 'naughty' or 'stubborn' and 'stupid', so often handled incorrectly, such as the violence perpetrated by parents and teachers because of lack of insight and understanding of ADHD. There is a tendency more frequently in boys than girls.
In epidemiological incidence ratio with a ratio of 4: 1. But it seems the longer it seems incidence is increasing. Often found in pre-school age children and school age, there is a tendency of this complaint will be reduced after primary school age. Although not rare few clinical manifestations are found in adolescents or adults. ADHD is a developmental disorder that has onset of symptoms before age 7 years. After age children, will remain as a teenager or adult. It is estimated that people with ADHD will settle around 15-20% in adulthood.
About 65% will experience residual symptoms during adulthood or sometimes slowly disappearing. The incidence of adult ADHD at the age of about 2-7%. Predisposition of this disorder is 25 percent in families with parents who membakat.
Early detection of these disorders is very important to minimize the symptoms and consequences thereof in the future.
This should involve multiple levels of society. Among both medical and nonmedical. General practitioners, pediatricians and other clinicians associated with kesehatn child should be able to detect early risk factors and symptoms that occur. Clinical manifestations that occur can arise at an early age but the symptoms will be evident at the start of school to do a diagnose to parents and teachers, to evaluate progress and directing the pattern of education and parenting a child with hyperactive when it can be done early detection and treatment at an early stage.
DEFINITIONS
In normal children often show signs of: lack of attention, easily distracted, emotional explosiveness even excessive activity. It's just that in children with ADHD disorder, these symptoms are more frequent and heavier quality than a normal child his age.
The pattern of children's attention to a case is divided into several classifications. The most severe group is exclusive over which a child is only focused on something that caught his attention without regard to other things to extremes (such as in infants who are considering ignoring her buttons and other stimuli), this pattern is called autism. The group with the degree of focus of attention is going easily distracted child. Attention can only survive a few moments just by other stimuli that may not be adequate.
This is called the difficulty of attention (attention deficit hyperactivity disorder). Normal conditions is the best pattern because children are able to notice something and divert it to the other at the right time without losing the power of concentration, this pattern is a normal pattern of mental development of children are mature.
The definition of hyperactivity is an increase in motor activity up to a certain extent the cause behavioral disturbances that occurred, at least at two places and a different atmosphere.
Child activities that are not common and tend to be characterized by excessive anxiety disorders, always waving fingers, feet, pencil, can not sit still and always left his seat even though at the time where he should sit quietly degan.
Other terminology used includes several behavioral disorders include: bubbling feelings, excessive activity, likes to make trouble, defying persistent and destructive.
Temperament of a child is a living and dynamic characteristics, though sometimes in a child is more dynamic than other children. If there is an excessive increase in motor activity on a child than other children her age, then often times 'the kids' complaints as hyperactive by their parents.
Such assessment is very subjective and depends on the standards used by parents in assessing a child's normal activity levels. The notion that the kids 'hyperactivity' may not be appropriate if only because the children showed signs of 'naughty' and 'making noise' at certain times but overall showed normal activity.
In the case of 'children are' precisely the parents who should be given the understanding and knowledge of how to properly guide and direct a child with a pattern of behavior that 'according to parents' excessive.
CAUSE
The exact cause and pathology of ADHD still have not been revealed clearly. As with autism disorder, ADHD is a statu multi-factorial disorder.
Many factors are considered as peneyebab this disorder, including genetic factors, brain development during pregnancy, during perinatal brain development, level of intelligence (IQ), the occurrence of metabolic dysfunction, lack of hormonal disorder, physical environment, social and patterns of child care by parents, teachers and influential people around him.
Many studies show the effectiveness of treatment with psychostimulants, which facilitate expulsion of dopamine and noradrenergic tricyclics. This condition mengungatkan sepukalsi disruption of brain areas associated with kekuirangan neurotransmitters. Thus, neurotransmitters dopamine and norepinephrine often diokaitkan with ADHD ..
Genetic factors appear to hold the biggest role of behavioral disturbances of ADHD. Several studies conducted found that the hyperactivity that occurs in a child is always accompanied by a history of similar disorders in families in which at least one close family.
Also found a third of people with hyperactive father also suffered from the same disorder in their childhood. Parents and relatives with ADHD at risk of 2-8 times more prone to occur with ADHD, monozygotic twins is more apt to occur with ADHD compared with dizygotic twins also showed the involvement of genetic fator in the ADHD disorder.
The involvement of genetic and chromosome is still not clearly known. Several genes associated with the code of dopamine receptors and serotonin production, including DRD4, DRD5, DAT, DBH, 5-HTT, and 5-HTR1B, many associated with ADHD.
Neuropsychological research indicating cortical circuits connecting the frontal and executive function hall ganglia. Catecholamines are the main neurotransmitter function associated with frontal lobe brain function.
Thus, dopaminergic and noradrenergic neurotransmission appears to be a major target in the treatment of ADHD.
Another theory mentions the possibility of a dysfunction of neuronal circuits in the brain that is affected by the neurotransmitter dopamine as the originator of the movement and as self-control activities. Due to minimal brain disorder, which causes the occurrence of resistance at the control system of the child's behavior.
In a study conducted by using MRI examinations obtained picture of brain dysfunction in the right mesial prefrontal region and striae Subcortical which implies the occurrence of barriers to responses that do not relefan and certain functions. In people with ADHD there is weakness of the brain activity of the lower right prefrontal cortex and left kaudatus related to the influence of delay time of motor responses to sensory stimuli.
Several other researchers reveal maturation theory of lack or a slowness in the process of development of children with ADHD. According to this theory, people can finally pursue his delay and this situation postulated would occur around the age of puberty. So these symptoms do not settle but only temporarily before the delay that occurred can be pursued.
Many researchers have ADHD patients with gastrointestinal disorders are often associated with the acceptance of certain food reactions. Theories about food allergies, Feingold theory which assumed that the salicylates have unfavorable effects on the child's behavior, as well as the theory that sugar is a substance that stimulates hyperactivity in children. Mentioned among others about the theory and ortomolecular megavitamin as therapy
Damage to brain tissue or a brain damage caused by trauma to primary and recurrent trauma in the same place. Both theories are worth considering as the cause of the hyperactivity syndrome which the author divided into three groups.
In this disorder structural deviation from the normal form due to a variety of reasons other than because of trauma. Another disturbance in the form of damage to the central nervous system (CNS) is anatomically as well as that caused by infection, bleeding and hypoxia.
Other changes occurred without any disruption of brain function and anatomical changes in the structure clear. This deviation caused the stimulus barrier or even the emergence of excessive stimulus that causes a significant deviation in the development of child relationships with parents and the surrounding environment.
The study by comparing the MRI images between children with ADHD and normal children, it produces a different picture, where in children with ADHD have a picture of the brain that is more symmetrical than the normal children who are generally more right brain than left brain.
With the radiologic examination of the brain PET (positron emission tomography) got the idea that in children with ADHD with hyperactivity disorder is more prevalent obtained excessive brain activity compared to normal children by measuring sugar levels (as a primary energy source of brain activity) that found a significant difference between patients with hyperactive and normal children.
RISK FACTORS
In the early detection of this behavior disorder it is necessary to know the risk factors that could lead to disruption of ADHD. Much research evidence shows the role of composition of the central nervous dysfunction (CNS). Thus, some abnormalities and disorders that occur after pregnancy, childbirth and childhood should be considered a risk factor.
During the period of gestation, the CNS dysfunction caused by metabolic disorders, genetic, infection, intoxication, drugs, smoking, alcohol and psychogenic factors. Diabetes and preeclampsia disease should also be observed.
At the time of delivery, caused by prematurity, post date, constraints, labor, labor induction, abnormal position (presentation babies), the side effects of therapy, immune system depression and trauma during vaginal birth. While the childhood period har5uis observed chronic gastrointestinal disorders, infections, trauma, medication therapy, poisoning, metabolic disorders, vascular disorders, psychological factors, malignancy and the occurrence of seizures. Accident history to be admitted to hospital, physical violence, verbal, emotional or feeling abandoned. Serious trauma, receive harsh treatment or miss something during childhood, not self-conscious or unconscious.
EARLY DETECTION OF SYMPTOMS hyperactive
To be able to have a disorder called ADHD, there should be three main symptoms that appear in the behavior of a child, namely inatensi, hyperactivity, and impulsivity. Inatensi or less concentration of attention can be seen from the failure of a child in giving full attention to something. Children are not able to maintain concentration on something, so easy to switch attention from one thing to another.
Symptoms can be seen from the behavior of hyperactive children who can not be silent. Sitting quietly is something that is difficult. He would get up and running, running to and fro, and even climb climb. In addition, he tends to talk a lot and cause noise.
Impulsive symptoms characterized by difficulty the child to delay the response. There is a kind of encouragement to say / do things that are not controlled. The drive is urged to be expressed immediately and without consideration. A concrete example of impulsive symptoms are impatient behavior.
Children will not be impatient to wait for the complete discussion. Children will interrupt the conversation or to rush to answer before the question submitted is complete. Children are also not able to wait their turn, like a queue for example. Another aspect of impulsivity is the son of a high potential for conducting activities that endanger, either for himself or others.
The third addition to the above symptoms, diagnosis can be given to hyperactive there are still some other conditions. Interference on already settled at least 6 months, and occurred before the children aged 7 years. These symptoms appeared at least in 2 situations, for example at home and at school.
Clinical manifestations that occur are very broad, ranging from mild to severe, or can occur with a minimal number of symptoms until more symptoms. The clinical presentation of ADHD can tampaknuya Sejas detected early infant age.
Symptoms that should be further examined at the age of the baby is a baby who is very sensitive to sound and light, crying, screaming, it's hard to be quiet, sleep time is very less and often woke up, colic, difficulty eating or drinking milk either breast milk or bottle., Can not appeased or held, refused to be loved, excessive salivation, sometimes as thirst is often asked for a drink, head banging (banging head, hitting the head, knocking his head backward) and often angry excessive.
Other complaints on big boy is the son looks Clumsy (awkward), impulsive, often have an accident or fall, odd behavior / change that annoying, constant movement or monotonous, more noisy than other children. Aggressive, Intellectual (IQ) but normal or high achievement in poor schools, lack of concentration when in school, excessive activity and not be silent, irritability and explosive temper, poor appetite. Bad hand / eye coordination., Hard working, rebellious and disobedient, like hurting yourself (pulling hair, skin hurt, hit the head etc) and sleep disorders.
Signs and symptoms in older children is an act which only focused on one thing only and are likely to act recklessly, easily confused, forget the lessons of school and work at home, difficulty doing tasks at school and at home, difficulties in listening, difficulty in performing some command, often let slip talk, impatient, noisy and convoluted speech, anxiety and overreacted, in a hurry, talkative and likes to make trouble, and like to cut the conversation and intervened speech of others
The above symptoms usually occur before age 7 years, experienced in 2 or more different atmosphere (at school, at home or in clinics, etc.), accompanied by a significant obstacle in the social, academic achievement and often wrong in putting something and can also arise in conjunction with the development disorder, schizophrenia or psychotic disorders lainnya20).
Other views on children with hyperactivity occurs affective disorganization, decreased self-control and excessive activity significantly. They usually act in 'reckless' and impulsive, irreverent, and likes to interrupt and interfere in other people's business. Often less noticed, is not able to concentrate and often do not complete the work on something and try to avoid jobs that require high power concentration, ignoring his toys or something, irritable, hard to get along and often unpopular with their peers.
Not infrequently those with this disorder accompanied by stunted growth and development, but we did not find a specific brain abnormality. In general, their academic achievement is low and insecure. They often show an act of anti-social with a variety of reasons that parents, teachers and treat their environment by not precise and does not solve the problem.
Approximately 50-60% of ADHD patients get sedkitnya one other comorbid behavioral disorders. Behavioral disorders are learning disorders, restless-legs syndrome, ophthalmic convergence insufficiency, depression, anxiety disorders, personality antisosia, substance abuse, conduction disorders and obsessive-compulsive behavior.
ADHD occurs affective disorganization, decreased self-control and excessive activity significantly. They usually act in 'reckless' and impulsive, irreverent, and likes to interrupt and interfere in other people's business. Often less noticed, is not able to concentrate and often do not complete the work on something and try to avoid jobs that require high power concentration, ignoring his toys or something, irritable, hard to get along and often unpopular with their peers.
Not infrequently those with this disorder accompanied by stunted growth and development, but we did not find a specific brain abnormality.
In general, their academic achievement is low and insecure. They often show an act of anti-social with a variety of reasons that parents, teachers and treat their environment by not precise and does not solve the problem.
Risk of ADHD that more increases if one brother or parents have ADHD or other psychological disorders. Posikologis and behavioral disorders include bipolar disorders, conduction disorders, depression, dissociative disorders, anxiety disorders, learning disorders, mood disorders, panic disorder, obsessive-compulsive disorder, panic disorder accompanied goraphobia.
Also lainnnya behavioral disorders such as developmental disorders perfasif including Asperger's disorder, Posttraumatic stress disorder (PTSD), Psychotic, Social phobia, ganggguan sleep, Tourette syndrome and ticks.
ADHD DIAGNOSIS
Diagnosis of hyperactivity can not be made solely based on biased information from the parents but at least people with information of schools, and the patient must do the examination even when checking the patient did not show signs of hyperactivity, considering the circumstances when the examination and possible other things that might form the trigger of hyperactivity.
In some cases even require psychometric examination and evaluation of education. Until now there is no one standard of physical and psychological examination for hyperactivity.
This means that clinical examination should be done very carefully, although not yet found a clear relationship between the type of examination conducted by the occurrence of hyperactivity. A variety of questionnaires can be arranged to help diagnose, but most importantly is a major concern and continuous examination, because it is not possible diagnosis is established only in a single examination.
When you get a child to age 6 to 12 years who show signs of hyperactivity with low academic achievement and behavioral disorders, the possibility should be evaluated early
To diagnose ADHD use the DSM IV criteria are also used, must have 3 symptoms: Hyperactivity, attention problems and conduction problems.
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