"Attention Deficit Hyperactivity Disorder is characterized by persistent Inattention and/or Hyperactivity - impulsivity which interferes with normal development and functioning" (Diagnostic and Statistical Module of Mental Disorders-5). Inattention may manifest as wandering off task, inability to sustain focus, and disorganized behavior which is not due to defiance on the part of the child. Hyperactivity refers to excessive movements such as fidgeting, tapping or even excessive running. Impulsivity refers to actions which are carried out by the child without any forethought or consideration. ADHD has been classified under Intellectual Disabilities in DSM-V (Diagnostic and Statistical Module of Mental Disorders).
First and foremost is an environment that is encouraging for the child. Support from parents, therapists, and teachers is a must. Apart from the environment, the manner in which one must deal with ADHD children is crucial. It can be tough as it might require a lot of energy and effort which can drain a person. Instead of yelling or speaking out of frustration to prevent the children from doing something, we can tell them what to do instead, For example instead of saying “don’t do that”, tell them “do this instead”.
Image 1.7 is a representation of behavioral therapy being applied on a child. The role of a therapist is essential along with the pharmacological approach in managing ADHD.
Image source - How to Become a Child Counselor with an Online Degree [online image]. (2021). Grace College Online. https://online.grace.edu/news/how-to-become-a-child-counselor/
Treatment of ADHD through medications-
Dopamine and norepinephrine travel through neurons and stay at the synaptic cleft which is the junction between two neurons, the longer the dopamine and norepinephrine stay at the synaptic cleft, the longer their effects remain. Dopamine deals with alertness, motor functions, compulsions, pleasure, etc and norepinephrine deals with fight or flight, increasing heart rate, blood pressure etc. Both together help children with ADHD by increasing their alertness, concentration hence improving focus, increased blood pressure calms the hyperactive symptoms etc.
In normal conditions dopamine stays in the synaptic cleft long enough to allow the person to concentrate, which is not the case with individuals with ADHD, where the dopamine does not stay long enough hence they have difficulties in concentrating. Methylphenidate and amphetamine block the receptors so that dopamine and norepinephrine stay in the synaptic cleft for longer duration.
Treatment of ADHD through Psychotherapy-
Psychotherapy includes various types of methods Example-
Cognitive behavioral therapy focuses on organization and planning, reframing the child's perception of himself, cognitive restructuring, distractibility etc.
In Behavioral therapy positive behavior is reinforced with rewards, negative behavior is ignored, and privileges are taken away if the negative behavior is severe.
Many effective therapeutic methods include Play therapy, music therapy, Equine therapy, etc. special games are being developed that understand the brain of ADHDs, many brain training and ADHD coaching focus on designing effective ways to cope up with ADHD depending upon the level of it which is different for every individual (Lambez et al, 2019).
Image 1.8 depicts the instructor using play therapy on the child which is a new technique and can be applied to neurodevelopmental disorders such as ADHD.
Image source - How to Become a Child Counselor with an Online Degree [online image]. (2021). Grace College Online. https://online.grace.edu/news/how-to-become-a-child-counselor/
Other Therapeutic Methods:
Other approaches such as classroom interventions, academic interventions, and peer-related interventions can be used as psychosocial treatment methods. Additionally, new techniques such as
computerized cognitive–based training for various aspects of cognition including working-memory and attention aim to reduce ADHD core symptoms and improve neuropsychological functioning. Research in this field is still in the early stages. Another alternative treatment method for ADHD which has been studied in the past is neurofeedback.
Neurofeedback:
Image 1.9 represents the neurofeedback technique which measures the brain activity of the subject, processes it using software and provides feedback to the participant which can then be used to alter the brain activity consciously.
Image source - Chandra, S. (2021). What is Neurofeedback? A Psychiatrist’s Perspective [online image]. Suruchi Chandra M.D. https://chandramd.com/what-is-neurofeedback/
Even though neurofeedback has been studied in recent works, its true depth is yet to be unveiled. It is based on a brain-computer interface (BCI) and works using software that measures the participant's brain activity, processes it and provides feedback to the participant on specific parameters of his/her brain activity. With the help of this feedback, the participant is able to understand his own brain activity and alter it to change certain aspects of cognition and behavior (Enriquez-Geppert et al, 2019).
This can be understood by a simple analogy. Suppose, a three child is unable to draw a triangle correctly. So, his parents first ask the child to try and draw a triangle as accurately as he can. They then show him exactly where he is making mistakes. This acts as the feedback. With the help of this feedback, the child would be able to correct his mistakes and improve the outcome.
It is quite important to note that neurofeedback works on the principles of operant conditioning and procedural learning skills. Operant conditioning is a method of behavior modification where the behavior of the subject is altered using reinforcements or punishments which can be both positive and negative. Neurofeedback allows the brain to undergo plasticity (changes in connections) which, in turn, helps to correct any dysfunctional brain activity (Enriquez-Geppert et al, 2019).
Neurofeedback can be used for diagnostic, therapeutic, and efficiency purposes and can prove to be an important technique to modify brain activity in children having ADHD.
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